The cost of treatment and follow-up of bladder cancer in Italy

Objectives: To evaluate the costs of bladder bladder cancer treatment and follow-up. Materials and Methods: A purely economic analysis was carried out evaluating in our Institution a) the cost of an hospital stay of patients submitted to transurethral resection of superficial bladder cancer and to radical cystectomy for invasive bladder cancer, b) the cost of endovesical immuno-chemotherapy performed as day hospital regimen, c) the cost of the first year of follow-up according to European Association of Urology's Guidelines as outpatient regimen. Results: The total cost related to a superficial tumour of the bladder treated with an endoscopic resection amounts to € 2,242.20, while in case of invasive bladder cancer treated with a radical cystectomy it comes to € 6,860. For chemo-immunotherapy the costs in a day hospital regimen related to a 8-weekly session of mitomicin, 6-weekly session of epirubicin and BCG are € 1,420, € 1,037 and € 975, respectively. The first year of follow-up for a patient with low risk of superficial bladder cancer without recurrence costs € 265.15. In case of high risk superficial bladder cancer the cost reaches € 321.75. In case of a patient with invasive bladder cancer in the first year, when follow-up is more strict, expenses amount to € 548.90. Conclusions: Cancer bladder is a high-cost illness due, in particular, to its heterogeneity in presentation and high rate of recurrences which makes any evaluation underestimated. The possibility of containing costs is essentially related to optimization of the follow-up and to the development of optimal therapeutic procedures which could lead to a reduction in the number of recurrences.