Increasing costs from bladder cancer in the Brazilian Health System: the role of establishing public health policies

Korkes, Fernando; Maluf, Fernando C.

doi:10.1590/s1677-5538.ibju.2020.0658

Cited by 8 publications

(12 citation statements)

References 8 publications

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“…Bladder cancer is the sixth most common cancer in the US and represents 4.6% of all new cancer diagnoses, equivalent to 80.470 new cases and 17.670 deaths in the US during 2019 (1). It also has significantly elevated ex-penses and perhaps the highest lifetime treatment costs per patient (2).…”

Section: Introductionmentioning

confidence: 99%

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

et al. 2022

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Purpose: To describe the current scientifi c knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. Materials and Methods: Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021. Results: A total of 841 studies were identifi ed, and abstracts were analyzed. Twentyone relevant studies were then identifi ed and reviewed. After all, information was gathered from 16 studies, the authors discussed the specifi c topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm. Conclusion: For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.

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Section: Introductionmentioning

confidence: 99%

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

et al. 2022

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“…Therefore, these initial costs might become much higher during a longer follow-up. And for stage IV disease, they might become even higher in the years to come with the possible incorporation of new agents as immunotherapeutics [13,14].…”

Section: Discussionmentioning

confidence: 99%

Stage-Related Cost of Treatment of Bladder Cancer in Brazil

Korkes

Timóteo

Soledade

et al. 2022

PharmacoEconomics Open

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Purpose Bladder cancer is the ninth most frequent cancer worldwide with the twelfth highest incidence. However, its treatment has financial impacts that directly affect health burden. There is a scarcity of data about the costs related to healthcare in Brazil, especially in the public setting. As previously demonstrated, despite not being one of the most frequent cancers, bladder cancer appears to be one of the most expensive. The present study aimed to assess the costs related to the treatment of bladder cancer in the public setting in Brazil. Patients and Methods Retrospective data of patients treated for urothelial bladder carcinoma from 2019 to 2020 were retrieved at a single center. All charts were reviewed, with the assessment of clinical data, exams, surgical data, and postprocedure outcomes. The hospital finance department calculated the costs for outpatient evaluation, inpatient procedures, complementary exams, materials, drugs, and professionals' fees throughout all operations. Results A total of 107 patients with bladder cancer were analyzed, representing a total expenditure of BRL 5,671,042.70 and a mean cost of BRL 53,000.04 per patient (US$1.00 = BRL 5.60). Median costs were progressively higher for patients with stages I, II, III, and IV. Patients who underwent radical cystectomy (n = 14) had a median treatment cost of BRL 136,606.25 ± 96,059.08, during a mean follow-up of 9.2 months. Hospitalization costs represented 25% (range 20-43% according to the stage) of all expenditure. Medications and medical supplies represented 18% (16-23% according to the stage) of expenditure. Medical fees represented 31% of costs for stage I disease, but only 4% in stage II, III, and IV. Costs associated with emergency room visits were only observed in stage III and IV disease, representing 1% of all expenditure. Conclusions The management of bladder cancer resulted in a significant economic burden on our public health system. The costs associated with stage I bladder cancer were 4-12 times higher than those related to the treatment of other common malignancies at initial stages. Treatment was also expensive during the first months with more advanced stages.

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“…Urinary tract infection is another possible morbidity in this target group during invasive cystoscopic surveillance [ 7 ]. Furthermore, cost-effectiveness is a concern, especially for older adults [ 8 , 9 ]. Finally, the necessity of non-invasive surveillance was raised during this COVID-19 pandemic to avoid a delay that might affect the oncological outcome [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Microscopic hematuria and pelvic ultrasonography could rule out flexible cystoscopy during surveillance for T1-low grade non-muscle invasive bladder cancer

Awad

Harraz

Farg

et al. 2023

Arab Journal of Urology

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Purpose Cystoscopy (rigid/flexible [FC]) is the standard surveillance tool for non-muscle invasive bladder cancer (NMIBC). Nevertheless, it has its drawbacks. The objective of this study is to evaluate the performance of microscopic hematuria (MH), abdominal ultrasonography (US), and urine cytology (UC) as potential substitutes for FC in patients with T1-low-grade (T1-LG) NMIBC. Methods Over a 12-month period, patients attending our tertiary referral center for T1-LG NMIBC follow-up underwent urine analysis for MH and UC, and then US and FC were performed as outpatient surveillance procedures. Those with positive findings underwent inpatient rigid cystoscopy under anesthesia and biopsy. The negative predictive values (NPV) and sensitivity of different combinations of MH, UC, US, and FC were compared with the standard histopathology. Results In 218 evaluated patients, FC had the highest NPV (97.9%). However, this figure showed no statistically significant difference if compared with the combination of negative MH and US (93.8%) (difference = 0.04, p = 0.1) or the combination of MH, US, and UC (94.9%) (difference = 0.03, p = 0.2). The reported sensitivity results were similarly comparable between FC (94.2%) and the aforementioned combinations (90.4% and 92.3%; differences: 0.038 and 0.019; p = 0.4 and 0.7, respectively). Conclusions During the surveillance of NMIBC for patients diagnosed with T1-LG disease, the combination of MH/US has comparable sensitivity and NPV with FC. This non-invasive combination could be considered the first station that might preclude the need for FC in a considerable percentage of this group of patients.

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Increasing costs from bladder cancer in the Brazilian Health System: the role of establishing public health policies

Cited by 8 publications

References 8 publications

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

Stage-Related Cost of Treatment of Bladder Cancer in Brazil

Microscopic hematuria and pelvic ultrasonography could rule out flexible cystoscopy during surveillance for T1-low grade non-muscle invasive bladder cancer

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