Cost of bladder cancer in Lebanon before and after the economic collapse: A probabilistic modeling study

Abstract

Abstract Background: Lebanon has one of the highest incidence rates of bladder cancer (BC) in the world. In 2019, Lebanon’s economy collapsed which majorly impacted healthcare costs and coverage. This study assesses the overall direct costs of urothelial BC in Lebanon, from the perspective of public and private third-party payers (TPP) and households, and evaluates the impact of the economic collapse on these costs. Methods: This was a quantitative, incidence-based cost-of-illness study, conducted using a macro-costing approach. Costs of medical procedures were obtained from the records of various TPPs and the Ministry of Public Health. We modeled the clinical management processes for each stage of BC, and conducted probabilistic sensitivity analyses to estimate and compare the cost of each stage, pre-and post-collapse, and for each payer category. The model’s probability parameters were obtained from existing literature and local experts’ opinions, using the conventional Delphi method. Results: Before the collapse, the total annual cost of BC in Lebanon was estimated at LBP 19,676,494,000 (USD 13,117,662). Post-collapse, the use of optimal treatment and management decreased, paralleled with an increase in the proportion of BC patients not undergoing any follow-up. The total annual cost of BC in Lebanon increased by 767.67% and was estimated at LBP 170,727,187,000 (USD 7,422,921). TPP payments increased by 61.42% whereas out-of-pocket (OOP) payments increased by 2,745.33% resulting in a decrease in TPP coverage to only 16.5% of total costs. The cost contribution of low, intermediate and high risk BC slightly decreased whereas the cost contribution of muscle-invasive and metastatic BC slightly increased. Conclusions: Our study shows that BC in Lebanon constitutes a significant economic burden costing 0.32% of total health expenditures. The economic collapse induced an increase of 767.67% in the total annual cost, and a catastrophic increase in OOP payments.