Prostate cancer follow-up costs in Germany from 2000 to 2015

Abstract

Purpose: The main objective of this study is to estimate and evaluate 10-year follow-up costs after prostate cancer treatment with curative (surgery, radiotherapy) and non-curative intent (hormone, androgen deprivation) per patient in Germany in 2000, 2008, and 2015.

Methods: Prostate cancer follow-up recommendations were extracted from the European Association of Urology guidelines from 2000 to 2015. Per patient costs were calculated with a detailed micro-costing approach considering direct and indirect medical expenses. Input parameters were derived from expert interviews, literature research, and official scales of tariffs. Costs for insurers, providers, and payers were included to estimate societal costs.

Results: Mean 10-year follow-up costs per patient after treatment with curative intent amounted to EUR 4415 in 2000, EUR 4224 in 2008 (p < 0.001), and EUR 5159 in 2015 (p < 0.001). Costs after hormone therapy with metastasis cumulated to EUR 10,846 in 2000, EUR 9818 in 2008 (p < 0.001), and EUR 11,978 in 2015 (p < 0.001). While insurers covered 37% of costs in 2000 (EUR 1664), only 23% of costs were reimbursed in 2015 (EUR 1195; p < 0.001). Cost sources mainly included consultations (55%), transportation (18%), and imaging (27%).

Conclusion: Early detection and advances in prostate cancer treatment increased 10-year survival rates beyond 80% in Germany, ultimately expanding the number of survivors requiring follow-up. Statutory insurers reacted by decreasing the reimbursement rates to reduce per patient cost by up to 46%. Consequently, the economic burden was mainly shifted to payers and providers.

Implications for cancer survivors: Equitable and effective follow-up schedules covered by insurance funds are necessary to care for prostate cancer patients.

Keywords: Budget impact; Cost; Follow-up; Health insurance; Prostate cancer.

Fig. 1

Cumulative 10-year prostate cancer follow-up costs (EUR) per patient by initial treatment type from the (I) payer, (II) provider, (III) insurance, and (IV) societal perspective. All costs were inflation adjusted with the hospital & community health services index [–24]. p values compared to year 2000: p < 0.05 (*), p < 0.01 (**), p < 0.001 (***). Bars show standard deviations. Insurance bills do not possess standard deviations because fixed reimbursement rates were extracted from the official scales of tariffs

Fig. 2

Cumulative 10-year prostate cancer follow-up cost distribution by initial treatment type for (I) perspective and (II) resource use

Fig. 3

10-year budget impact analysis for prostate cancer follow-up costs (EUR million) in 2000, 2008, and 2015. Brackets represent the 95% confidence interval used to univariately vary each point estimator. Follow-up costs per patients were varied by estimations displayed in Fig. 1