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

Abstract

Breast cancer centres - certified in accordance with the criteria of the German Cancer Association and the German Mastology Association - are established throughout Germany. Although the setting up of centres and the subsequent need for certification are associated with a marked increase in costs, initial data show positive effects on quality. Certified centres are cost-effective from the point of view of health economics - they lead to improved quality in processes and results without creating any increase in costs for the funding bodies. However, the organization of the necessary structures, with interdisciplinary treatment, documentation and quality-assurance measures, requires considerable resources. Increasing consolidation of inpatient services is also involved, while shortening of the patients' hospitalization periods is leading to reduced remuneration from the funding bodies. The current cost deficits, which have resulted from the increased resources required, need to be recouped through additional charges. It will only be possible to maintain the high quality achieved if additional charges become available to cover the centres' added costs. Good data are increasingly becoming available as a basis for negotiations on charges - e.g., with regard to the quality of results and the National Cancer Plan - as well as clear support from patients.

Should Breast Cancer Surgery Be Done in an Outpatient Setting?

“…In Germany oncological care is largely provided by certified centers which are supported by service providers, the funding agencies and German healthcare policy in the context of the National Cancer Plan. As regards senology, there are enough DKG-and DGS-certified breast cancer centers to provide nationwide coverage [13]. Several publication have already shown that the care of patients with breast cancer provided by certified breast cancer centers is currently not adequately remunerated, and that surcharges are urgently required to cover the costs of the care provided by certified facilities [14][15][16][17].…”

“…BCT 5-870.a2 + 5-401. 13 The establishment of a center followed by its certification is associated with significantly higher additional costs, but the data shows that centers have a positive impact on the quality of results. From the perspective of the health services, certified centers are therefore cost-effective: they improve the quality of processes and results without the funding agencies having to bear significantly higher costs.…”

“…Although § 5 para. 2 of the Law on Hospital Fees (KHEntgG) does provide a legal basis for funding the additional costs incurred by certified facilities, surcharges are seldom allowed [13,16,19]. Nevertheless, the certified centers still provide a range of services, usually without surcharge, to ensure that patients receive adequate care.…”

Health economics of breast cancer management: An oversight

“…However, these new therapeutics pose an extra burden on the already compromised economies all over the world. Moreover, the implementation of properly qualified breast cancer centers, comprehensive multidisciplinary teams and the institution of quality assurance measures to help foster a standard of care for breast cancer management require considerable costs [2] . The proper assessment of aspects relevant to breast cancer health economics should be conducted after joint discussion between breast cancer physicians and experts in health economics and quality of medical care [3] .…”

Health Economics in Breast Cancer

“…In addition to basic healthcare economics [1], the viewpoint of the certified breast centers is considered [2], as well as those of the outpatient networks [3], diagnostic facilities in the context of mammography screening [4], and business management [5] (which still appears to be foreign to some medical specialists). In particular, the point of view of the patients, whose care must not be allowed to become the plaything of debates over costs, is presented [2]. All of these different points of view need to be integrated, so that the funding bodies and MDK can gain a picture of evidence-based health care [6].…”