1. How to reduce costs of IC treatment?
Some practical considerations
Sandor Lovasz MD. PhD.
Rózsakert Medical Center,
Budapest, Hungary

2. regular, long lasting, expensive treatment.
What does IC/BPS cause?
Interstitial cystitis (IC/BPS) is a lifelong lasting (incurable) progressive disease,
causing very serious symptoms.
IC/BPS adversly influence:
Ability to work
Rest and recreation
Social life
Sexuality
This results in a continuously intolerable quality of life, which needs
regular, long lasting, expensive treatment.

3. What are the consequences of long-lasting seeking for diagnosis?
The slope to hell:
Chronic fatique
Literally suffering
Uncountable visits at different specialists
Involuntary unemployment (loosing the job)
Lost of friends and family
Devorse
Finencial bankruptcy
Depression
70% higher rate of suicide

4. Expenses of IC/BPS therapy
There is just sporadic information on costs of IC treatment, which significantly can vary between different countries depending on used medications and different treatment protocols.
Long lasting local instillations and the maintenance therapy are a great expense to the patients preventing a significant number of them from getting be treated.
In countries where social insurance does not cover treatment costs of IC/BPS at all, even higher proportion of patients cannot afford long lasting and costly treatment.
In Germany for example, 40% of the patients must stop treatment due to finantial difficulties.

5. What are the options of the cost reduction in favour of the patients?
Early diagnosis of the disease
By reducing time to proper diagnosis significant amount of expenses can be spared for the patients.
What are the prerequsites for this?
To let spread reputation of IC/BPS in the population by organized, regular media presence (press, radio, television, and social media).
To organize education courses for urologists, GPs, and gynecologists
To set up a net of specialists (specialised centers) covering all regions of the country with appropriate number of nurses.

6. What are the options of the cost reduction in favour of the patients?
Treatment form
The long list of recommended non-invasive therapies prolongs the introduction of efficacious treatment. The wasted time (sometime1- 2 years) costs much money (to the patient).
Choose the least invasive, but the most effective treatment, possibly a casual treatment (GAG replenishment) with the highest chance of having long-lasting positive result – as initial treatment.
All other forms of recommended noninvasive treatment attempts are non-casual, therefore limited in time and efficacy. Therefore they are just as additional, adjuvant therapy indicated, if needed at all.

7. What are the options of the cost reduction in favour of the patients?
Drugs used for the cocktais
Monotherapy with any of the GAG-layer compounds has a much lower likehood of efficacy than the use of
Mixture of drugs (cocktails) containing possibly all GAG-compounds (heparin, hyaluronic acid, chondroitine sulfate).
Due to the high drug prices, we tried to use reduced amount (20-50%) of the cocktail compounds with no remarkable reduction of efficacy.
Due to the low evidence grade of this observation a prospective, multicenter clinical trial could give the appropriate evidence.

8. What are the options of the cost reduction in favour of the patients?
Costs of travelling
Regular instillations (even if maintenance therapy) result in considerable travelling expenses for the patients.
In case of well trained regional centers, the expenses can significantly be reduced due to the shorter distances.
Optimal solution: treatment at patients home: no travelling expenses at all.

9. What are the options of the cost reduction in favour of the patients?
Time consuming travelling + treatment
Time is money.
Most of the patients are still active workers.
Patients need to have a day off (salary reduction).
Solution:
- More effective treatment
- Better condition
- Reduced instillation frequency

10. What are the options of the cost reduction in favour of the patients?
Handling fee (depends on doctors and institutions) are still considerable
Patients should not choose the most reputed and highest qualified doctor for routine instillations.
Trained nurses may perform the treatment for lower handling fee.
Patients can educate themselves (Internet), thus less unanswered questions remain. Therefore medical examination and treatment get shorter – lower handling fee.

11. Optimized maintenance therapy – reduced expenses
How to go on when an acceptable, stable condition has been reached?
Decision should be taken together with the patient.
The options are:
Stop treatment and just restart in case of worsening symptoms
Keep on with the instillation therapy by regular 6-8 weeks frequency (depending on previous course of improvement)
Individual frequency calibration – stepwise elongation of instillation intervalls till symptoms return – testing individual limits
Optimization of treatment intervals – dynamic, individually tailored frequency
Self instillation by self cathetrization !
Optimal treatment frequency has not yet been defined.
Prospective, multicenter clinical study is needed by the ESSIC!

12. The optimal solution of expenses related dilemmas in the future
The optimal timing of instillations (optimal treatment protocol)
is not yet defined. Therefore, the recommended instillation frequency results in a high rate of overtreatment. An individually tailored instillation protocol based on the continuously monitored condition of the patient can prevent overtreatment and minimize treatment costs.
Finally, the most expressed cost reduction can be reached by introducing and spreading the method of self-catheterization and self-treatment. This method, beside the henceforth listed optimization of the treatment expenses, is the only solution for the exponentially growing patient number and the limited capacity of the healthcare system.

13. Self-catheterization and self-treatment
Patients can spare: - Costs of medication - Travelling expenses - Time and costs of free time - Costs of medical care - Cost of overtreatment - Costs of undertreatment
Personally optimized cocktails given in individually tailored frequency and dosage.
This is the best solution regarding both efficacy and costs.

14. Future of cost-reduced IC/BPS therapy
Education package for patients: theoretical teaching of catheterization, basic knowledge of sterility, written documentation, skill training
Develop medical aid and tools for self-treatment
Patients’ education for appropriate using of medical aid of self-catheterization (regular feedback from patients)
Registering patient for long-term follow-up
Moving pharmaceutical industry to prepare special cocktails optimized for self- catheterization
The future is approaching, let’s prepare for it!
Self-catheterization, self-treatment!