The projects included in this pillar are closely related to analyses of the epidemiological and treatment cost burden of different cancer types, the cost of cancer drug development, and the socioeconomic impact of cancer on patients and families. Currently, five projects are conducted in this pillar:

Burden and cost of cancer

A series of short studies will provide a summary of the available data on the economic burden of disease for major cancer types in Germany. This project responds to the need for a centralized source of information on cancer cost in Germany, and it is expected to become a reference point for researchers in the area of economics of cancer. Epidemiology figures are constructed from the records of the German Centre for Cancer Registry Data (ZfKD) at the Robert Koch Institute (RKI). Impact on quality of life measures are retrieved from the Global Burden of Disease (GBD) report from the Institute for Health Metrics and Evaluation (IHME). Economic cost information is collected from published cancer cost studies in Germany, as well as from the relevant grey literature, such as publications from sickness funds, the Federal Statistical Office (Destatis), and Health Technology Assessment (HTA) agencies.

Cost of cancer drug development

There are compelling reasons to believe that the average cost to develop a new cancer treatment have been continuously increasing. This has far-reaching implications for the business model of the biopharmaceutical industry. In spite of its relevance, there is only a limited number of attempts to approach the R&D costs of biopharmaceutical products. Researchers from the Tufts Center for the Study of Drug Development in the USA have dominated the discussion with a series of estimations (DiMasi et al. 1991, 1995, 2003, 2004, 2016). Their latest approximation suggests, after considering failures and cost of capital, an R&D cost of around 2.6 billion Euros per new molecule entity (NME) that reaches the market (DiMasi et al., 2016). Nevertheless, the estimations made by the Tufts Center have been heavily criticized for the lack of transparency in the information used as well as for some of the assumptions considered in the model. Consequently, a number of new models have emerged with a wide range of results and assumptions. The DKFZ Division of Health Economics is currently conducting an in-depth analysis of the previous studies. During the first stage of the project, we are evaluating the quality of the reporting, models used, assumptions and type of information considered. Additionally, the study is investigating the factors that explain the variability of the estimations and the apparent increase in R&D costs.

Cost of CAR-T cell treatments

Immunotherapy such as chimeric antigen receptor (CAR) T cell therapy is a promising treatment option for some blood cancers, with the possibility of cure. In August 2018, the European Commission approved the use of two immunotherapies with specific indications. An ongoing project aims to evaluate the costs associated with CAR-T cell therapy, including production costs and costs related to preparation, treatments, and toxicity management, using micro-costing and gross-costing methods. Identifying the costs and cost drivers of CAR-T therapy will assist in assessing the financial burden/budget impact of this therapy in Germany and other European countries. It will also provide useful information for stakeholders to make informed decisions regarding policy, regulation, and possible payment mechanisms.

The socioeconomic impact of cancer on patients and families

Not only an insufficient health care coverage compromises the financial sustainability of cancer patients and their families, but also indirect non-medical costs, such as productivity losses due to mortality and morbidity. Cancer patients are often not able to work or to be at the same level of productivity than the healthy population. The decrease in productivity could lead to the loss of their jobs or earlier retirement. As a consequence, they and their families will experience a decrease in income, and thus, a possible decrease in their socioeconomic status and quality of life.

This possible impoverishment of cancer patients is sometimes called financial toxicity or financial hardship. Efforts have been made to analyze and measure the effects of financial toxicity on patients and their families. However, although financial hardship is common among cancer survivors, the literature indicates that there is considerable heterogeneity in its prevalence. An obvious factor that explains this heterogeneity is the variation of the organization and funding structure of the health systems. Therefore, the transferability of studies across health systems is questionable.

This project aims at shedding light on the factors that lead to financial toxicity in cancer patient and their families, and its variations among countries and regions.

Regional variation in cancer incidence



In Germany regional differences in cancer incidence on state level have been suggested in previous studies (e.g. GEKID Atlas). Internationally, a correlation between socioeconomic status and cancer incidence at district level has been observed in many cancer types, such as colorectal (CRC) and breast cancer (BC). This generates questions regarding possible variations among German districts in the effect of specific health policies. With the exception of Hoebel et al. (2018), previous analyses at district level have focused on particular states covering parts of Germany only. This study analyzes differences at district level of cancer incidence and whether these differences can be explained by variations in colonoscopy and mammography screening rates and/or socioeconomic status. This study adds further support for the correlation of socioeconomic status and BC as well as CRC incidence. Moreover, the analysis sheds light on the heterogeneity of the SES effect on cancer incidence by considering cancer type, age and sex.

Selected Publications

M. Schlander, K. Hernandez-Villafuerte, C. Thielscher:
Cost of cancer in Germany [Kosten der onkologie in Deutschland].
Forum, (2018) 33(5) 330-337.

J. Espin, M. Schlander, B. Godman, P. Anderson, J. Mestre-Ferrandiz, I. Borget, A. Hutchings, S. Flostrand, A. Paranby, C. Jommi:
Projecting pharmaceutical expenditure in EU5 to 2021: Adjusting for the impact of discounts and rebates.
Applied Health Economics and Health Policy, (2018) 16(6) 803-817.
DOI: 10.1007/s40258-018-0419-1.

M. Schlander, C.-M. Dintsios, A. Gandjour:
Budgetary impact and cost drivers of drugs for rare and ultrarare diseases.
Value in Health, (2017) 21(5) 525-531.
DOI: 10.1016/j.jval.2017.10.015.

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