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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.  This pillar is divided into three sub-categories:

1. Burden of cancer

Burden and cost of cancer - Germany

A series of short studies, currently being conducted, 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 were 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 were retrieved from the Global Burden of Disease (GBD) report from the Institute for Health Metrics and Evaluation (IHME). Economic cost information was 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.

Regional variation in cancer incidence



In Germany regional differences in cancer incidence on a state level have been indicated in previous studies (e.g. GEKID Atlas). Internationally, a correlation between socioeconomic status and cancer incidence on a district level has been observed in many cancer types, such as colorectal (CRC) and breast cancer (BC). This generated questions regarding possible variations among German districts in the effect of specific health policies (i.e., policy beneficial in one state may not be optimal in another). With the exception of Hoebel et al. (2018), previous analyses on a district level focused only on particular states in Germany. This study, currently under submission, analyzed differences, on a 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 to the correlation of socioeconomic status and BC as well as CRC incidence. Furthermore, results highlight the heterogeneity of the SES effect on cancer incidence by considering cancer type, age, and sex.

2. Costing studies

Exploring the economics of lung cancer

There is only limited information available on the real-life patterns of health care utilization and associated costs attributable to a diagnosis of lung cancer in Germany. Therefore, we are conducting a bottom-up approach based on administrative data that will provide a better understanding of the cost of lung cancer and its determinants. Moreover, the use of administrative data allows economic analyses to be conducted from the perspective of SHI. The main objective is to explore the patterns of health care utilization and the costs attributable to a diagnosis of lung cancer in Germany, and observe their changes over time. All evaluations include subgroup analyses by patient (e.g., age group, gender) and provider characteristics (e.g., healthcare specialist, non-certified versus certified hospitals), comorbidities (e.g., chronic obstructive pulmonary disease, cardiovascular diseases), and explore trends over time. 

Cost of cancer drug development

There are compelling reasons to believe that the average cost of developing a new cancer treatment has been continuously increasing. This has far-reaching implications for the business model of the biopharmaceutical industry. In spite of its relevance, there have been only a few attempts to approximate 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 evaluate the quality of the reporting, models used, assumptions, and type of information considered. Additionally, the study investigates 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 genetic gene therapies for oncology 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 aid in the assessment of the financial 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 entry agreements.

3. Socioeconomic impact analysis (Patient perspective)

The socioeconomic impact of cancer on patients and families

Not only does insufficient health care coverage compromise the financial sustainability of cancer patients and their families, but also indirect non-medical costs (e.g., productivity losses due to mortality and morbidity) do as well. Cancer patients are often unable to work or to maintain the same level of productivity relative to the healthy population. The decrease in productivity could lead to job loss 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 potential impoverishment of cancer patients is sometimes referred to as 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 to shed light on the factors that lead to financial toxicity in cancer patients and their families, and the variations among countries and regions.

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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