Are Certified Breast Centers Cost-Effective?

Abstract

The German health care system has entered an era of specialist centers and certification. Hospitals are required to introduce quality management with external monitoring, refining and improving their quality of treatment. These statutory requirements can only be met through specialization, centralization, and establishing centers and networks with internal and external interdisciplinary collaboration. The breast centers certified according to the criteria of the German Cancer Society (DKG) and German Society for Mastology (DGS) are pioneers here. Simultaneously, there are increasing demands for more cost-effective medical services despite limited resources – making economic analysis of health care provision necessary. Few economic studies of the centers and certification system have been conducted, however. General long-term quality data, particularly for results, are not yet available from certified breast centers. At present, a certified breast center is not itself a proven independent prognostic parameter for treatment results. However, the individual criteria required for breast center certification show a significant positive influence on clinical efficacy. Certified breast centers involve substantial extra costs that are not reimbursed by funding bodies, so the slightest potential benefit for patients from certified centers already appears cost-effective. When the actual costs, currently usually subsidized by other departments, are considered, it is unclear whether certified breast centers remain cost-effective.

Relevance of Health Economics in Breast Cancer Treatment - the View of Certified Breast Centres and Their Patients

“…There is a legal basis for the financing of the additional costs involved in certified centre structures (German Hospital Remuneration Law - Section 5, Paragraph 2) [11,26]. This specifies that a claim to an additional charge arises if a centre or a focus of expertise is present.…”

Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level

“…As a consequence hospitals and breast centers have to analyze costs and reimbursements and adjust them accordingly to avoid potential losses which are not covered. Losses can occur from providing high-quality care in certified breast centers as calculated [43,44], from the use of expensive devices like breast implants which are not covered at 90.3% for immediate breast reconstruction after mastectomy [33], or from insufficient processes of chemotherapy reimbursement if not controlled [30]. At the present time the question is unsolved of how quality of care can be paid for [45,46].…”

Economic Constraints - the Growing Challenge for Western Breast Cancer Centers

“…For instance, the 7-year survival of breast cancer patients improves depending on the volume of treated patients and on whether or not a patient is treated in a certified Breast Cancer Center. Conversely, being treated in smaller departments impacts negatively on patient survival [14,15]. In Germany, certified Breast Cancer Centers offer high-quality medical care, and a recent publication suggest an overall positive impact on survival when being treated in a Breast Cancer Center [7].…”