Journal of medical economics · 2025
Hexaminolevulinate-enhanced photodynamic diagnosis in the management of non-muscle-invasive bladder cancer (NMIBC): the influence of differing European health care payment systems on the potential financial impact of adoption.
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Belsey Jonathan, Lapon Jane
Аннотация
INTRODUCTION: The management of NMIBC is based on primary resection, followed by a surveillance programme stratified according to the risk status of the tumour. The completeness of the primary resection will determine the likelihood of early recurrence and requirement for re-resection. The use of photodynamic diagnosis (PDD) has been shown to extend the median time to first recurrence compared to white-light cystoscopy alone (WLC). However, PDD requires the use of a fluorescent imaging agent, which incurs an additional cost. This analysis explores the impact of the health care payment system on the budgetary impact of PDD adoption by a hospital.
METHODS: A previously published budget impact model was adapted to allow for the exploration of costs across four different payment environments: Denmark, France, Italy and Finland. Using the same set of clinical assumptions around disease risk profiles, recurrence rates and usage of PDD, coupled with country-specific costs, the net budget impact per patient with NMIBC was estimated for each country over a 3-year time horizon. The analysis was carried out from the perspective of a hospital with a protocol-driven strategy for PDD adoption.
RESULTS: In Denmark, with a differential tariff system between PDD and WLC, the additional cost of the technology was fully offset by the tariff, with a net surplus of €170 per patient. In France and Italy, with a flat-rate tariff, there was a net cost of €108 and €120 per patient respectively. In Finland, with a block contract system, the net cost per patient was €206.
CONCLUSIONS: Despite a consistent clinical benefit associated with PDD, differences in healthcare payment systems across Europe impact on its net financial impact. The use of flexible budgetary impact models may allow tailored implementation plans to be developed, allowing local needs to be balanced with cost consequences., thereby allowing for targeted adoption.
METHODS: A previously published budget impact model was adapted to allow for the exploration of costs across four different payment environments: Denmark, France, Italy and Finland. Using the same set of clinical assumptions around disease risk profiles, recurrence rates and usage of PDD, coupled with country-specific costs, the net budget impact per patient with NMIBC was estimated for each country over a 3-year time horizon. The analysis was carried out from the perspective of a hospital with a protocol-driven strategy for PDD adoption.
RESULTS: In Denmark, with a differential tariff system between PDD and WLC, the additional cost of the technology was fully offset by the tariff, with a net surplus of €170 per patient. In France and Italy, with a flat-rate tariff, there was a net cost of €108 and €120 per patient respectively. In Finland, with a block contract system, the net cost per patient was €206.
CONCLUSIONS: Despite a consistent clinical benefit associated with PDD, differences in healthcare payment systems across Europe impact on its net financial impact. The use of flexible budgetary impact models may allow tailored implementation plans to be developed, allowing local needs to be balanced with cost consequences., thereby allowing for targeted adoption.