gms | German Medical Science

Objectives: To analyze the socio-economic burden of soft tissue sarcoma survivorship for the 10 years after initial treatment in Germany during 2000, 2010 and 2020.

Methods: Soft tissue sarcoma guidelines were extracted from the National Comprehensive Cancer Network (NCCN). Per patient costs were estimated with a micro-costing approach considering direct and indirect medical expenses derived from literature and official scales of tariffs. Three perspectives covering costs for patients, providers, and insurers were included to estimate societal costs. Cost progression was compared across cancer localization and risk-stratification, stakeholders, resource use, and follow-up years.

Results: Mean 10-year follow-up costs per patient amounted to 5,038 Euro for low-risk and 7,292 Euro for high-risk sarcoma of the extremities (SOC) and 8,183Euro for low-risk and 9,585 Euro for high-risk sarcomas of the intra-/retroperitoneum (SOP). While overall expenditure rose by +8% from 2000 to 2020 for low-risk (p<0.001), high-risk SOC expenditure did not change significantly (+2%). In contrast, expenditure for both low-risk and high-risk SOP decreased by -8% and -5%, respectively (p<0.001). While health insurances covered 50% of costs in 2000, they lowered reimbursement rates to 29% in 2020; effectively shifting costs to providers and patients. 50% of follow-up resources were consumed by medical imaging (x-ray, CT, MRI), 32% by physician consultations, and 18% by travel expenditure. Yearly spending was unevenly distributed across follow-up years (years 1-2: 1,184 Euro, years 3-4: 910 Euro, years 6-10: 455 Euro).

Conclusions: This study highlights the socio-economic burden of STS cancer survivorship. Personalized, evidence-based, and insurance-covered follow-ups for cancer survivors are needed to ensure the early detection of local recurrences, metastases, and treatment-related side-effects.