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List of potential topics for master thesis projects

The Division is currently offering master students, who are interested in conducting a research project in the discipline of Health Economics, a variety of opportunities to be supervised by a health economist on its team. The following corresponds to the list of potential topics. The successful student candidates will be deemed as a member of the dynamic, productive and highly efficient team.

Applicants should have a background in economics, health policy, or the analysis of cancer programs; intermediate knowledge of mathematics and statistics; basic knowledge of one statistical analysis software (such as R, STATA, SAS).
For additional information, please send inquiries to Katrin Eike-Verfürth.

Exploring Financial Burden of Cancer among Patients and Their Families in Germany – A Qualitative Approach
Financial burden on cancer patients is well established in the literature. It is not only composed of direct (medical, non-medical) and indirect (productivity loss) costs (i.e., objective measures), but also by intangible costs related to psychological distress (i.e., subjective factors). These burdens may negatively affect healthcare outcomes and decrease the quality of life for the patients and their families. In Germany, very few studies evaluate cancer's financial burden through the patient's perspective (Apostolidis et al., 2018, Winkler et al., 2018), and none address the effects through the perspective of the family.
The socioeconomic impact of cancer, where financial burden plays an important role, is a focus area of the Division of Health Economics at DKFZ. We are currently establishing a Consensus European Task Force with the goal of developing a comprehensive framework addressing the socioeconomic impact of cancer. Accordingly, this framework will reflect the appropriate constructs related to the socioeconomic impact of cancer reviewed by the experts of the Task Force and also by patients and their families through focus group interviews.
Using a qualitative approach, a potential master thesis would examine the socioeconomic impact of cancer on patients and their families through their own stories. Patients and their family members will be recruited from existing connections with German cancer patients. Semi-structured interviews will be conducted with patients and their family members. These interviews will be accompanied by additional questions designed to capture how respondents interpreted the questions, if they had difficulties answering questions, and would provide opportunities for respondents to elaborate on their experiences (Boateng et al., 2018). With this in-depth information, the psychological aspect of financial burden of cancer and related themes will be evaluated in detail.

APOSTOLIDIS, L., MEHLIS, K., WITTE, J., SURMANN, B., KUDLICH, M., WALTHER, J., GREINER, W. & WINKLER, E. C. 2018. Financial toxicity in patients with colorectal cancer and neuroendocrine tumors. Journal of Clinical Oncology, 36, 6533-6533.
WINKLER, E. C., MEHLIS, K., SURMANN, B., WITTE, J., LINGNAU, R., APOSTOLIDIS, L., WALTHER, J. & GREINER, W. 2018. Financial toxicity in German cancer patients: How does a chronic disease impact the economic situation? Annals of Oncology, 29, viii752.
BOATENG, G. O., NEILANDS, T. B., FRONGILLO, E. A., MELGAR-QUIÑONEZ, H. R. & YOUNG, S. L. 2018. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Frontiers in Public Health, 6.

Epidemiological and Economic Burden of Cancer in Europe
This project consists of producing state-of-the-art burden of disease reviews for each of the major cancer types in Europe that include: (1) up-to-date epidemiology information and (2) current figures on treatment costs. The epidemiology section will be based mostly on authoritative statistics. The costs section would comprise a collection of cost estimations for Germany to be obtained from public access databases as well as a full systematic literature reviews of relevant articles. The goal is to obtain a reliable range of annual treatment cost estimations per patient and, ideally, to distinguish and explore differences by cost types (direct medical, direct non-medical and indirect costs).

Exploring Healthcare Utilization Patterns of Lung Cancer Patients in Certified and Non-Certified Hospitals in Germany
The main objective is to explore and compare health care utilization patterns related to lung cancer patients in certified and non-certified hospitals in Germany and to observe their changes over time. Hospital accreditation or certification has been used as the main strategy to provide cancer patients better care and to improve their prognosis. Since 2003, the German Cancer Society (Deutsche Krebsgesellschaft, DKG) has introduced a certification process for hospitals providing high-quality cancer care (either Organkrebszentren – C or Cancer Center – CC), while the German Cancer Aid (Deutsche Krebshilfe, DKH) also awards a status if hospitals meet additional criteria (Onkologische Spitzenzentren – CCC). A bottom-up approach will be conducted based on administrative data provided by a large health insurance company in Germany consisting of eight million insured members registered between 2007 and 2018. The study will describe the use of healthcare services and treatments from the perspective of the health insurance company of patients with a de novo lung cancer diagnosis in certified and non-certified hospitals. All evaluations will be compared to a control group of individuals without a cancer diagnosis and consider subgroup analysis by patient (e.g. age groups, gender) and comorbidities (e.g. chronic obstructive pulmonary disease, cardiovascular diseases).

Same Limitation, Same Question, but Different Answers: Exploring Variations in the Interpretation of ICECAP-A Questionnaire
In health economics the potential benefits of new health technologies are assessed in order to inform decision making. Conventional questionnaires (i.e., instruments) that are used to evaluate the effects of medical technologies tend to use the quality of life (QoL) of patients to assess value. Specifically, when evaluating new medical technologies, most current instruments mainly measure benefits by focusing on health and health-related QoL. However, it can be argued that advancements in medical technologies can have an effect that goes beyond health or health related QoL. For example, due to a successful new treatment, a patient is able to visit friends and family again, which, in turn, may have a positive effect on his or her QoL. In order to capture the value of psychosocial functions—that is, to capture a broader understanding of QoL—the ICECAP-A (ICEpop CAPability measure for Adults) questionnaire was developed.
The aim of this project is to identify whether the items of the ICECAP-A questionnaire function differently in different countries. Owing to cultural differences, it's possible some ICECAP-A questions are interpreted in different ways by participants. To assess this, data from the Multi-Instrument Comparison study (MIC-study) will be used to conduct a differential item functioning analysis. The MIC study, conducted in six different countries, is designed to explore, amongst other things, the differences between various questionnaires that are used in health economics to assess value.

Factors Affecting the Uptake of New Approved Lung Cancer Drugs in Germany
The successful dissemination of a new cancer treatment is crucial for patients, the pharmaceutical sector and the health care system in general. There is an extended belief that in Germany, patients´ access to new approved drugs is faster than in other EU countries. This because of the covering of all EMA´s approved medicinal products sold in the outpatient sector which have not been explicitly excluded by the G-BA (Gemeinsame Bundesausschuss). However, the German healthcare system is complex and different incentives play juxtaposed roles. For instance, in a survey of 150 German physicians, the majority (67%) stated that, when making therapeutic decisions, they consider the possibility of market withdrawal of newly approved medicines for which no reimbursed price had been agreed (Greine & Witte, 2016). This suggests a possible delay in drug uptake to avoid the effects of a potential withdrawal from the market.
The aim of this study is to investigate the uptake time of new lung cancer drugs in Germany. New lung cancer drugs, approved by the EMA between 2005 and 2019 and used in Germany inpatient or in outpatient settings, will be eligible for inclusion in the analysis. Monetary uptake of oncology drugs will be assessed in terms of expenditures for specific drugs. The analysis will be based on administrative data from one of the largest insurance companies in Germany. Differences between German states, physician patterns (oncologists vs non oncologists), hospitals (certified vs not-certified), type of drugs (biologics vs small molecules), method of administration, and patient indication (one vs multiple indicators) will be examined. In addition, factors related to the reimbursement procedure will be studied, such as the additional benefit assigned by G-BA´s and IQWIG´s, stated reasons for these recommendations/decisions and price agreement procedure (arbitration vs non-arbitration). Moreover, relevant guidelines will be studied to evaluate if the direct mention of a particular drug has a relevant impact on its uptake.

Is cancer patient movement to remote treatments going to be permanent?: Effects on clinical guidelines and clinicians patterns of prescriptions
Recent empirical research suggests that the COVID-19 crisis has affected physicians' practice patterns. For instance, in a recent survey of oncologists in 28 countries, the majority of participants stated that during the pandemic they recommended less chemotherapy, immune checkpoint inhibitors, and steroids (Ürün, 2020). Even more important, participants mentioned that they were more hesitant to recommend second- or third-line therapies in metastatic disease. In addition to individual changes in behaviour, patterns have also changed as a consequence of the publication of new clinical guidelines that advise how to proceed with cancer patients during the COVID-19 crisis (ESMO, 2020). Additionally, recent data by IQVIA (Rickwood & Harb, 2020) showed, during the first six months of 2020, a sharp decrease in inpatient and a parallel increase in outpatient drug sales in the five biggest European countries (excluding and including over-the-counter and consumer health products, and also when oncologic drugs were analysed in isolation). This is explained not only by the suspension and delay of inpatient treatment and the stock-pile of outpatient, but also by the propensity of the physicians to substitute, as much as possible, inpatient with outpatient treatment. The data suggests that this effect is particularly relevant for Germany, where patients can have easier access to specialists in the outpatient setting and receive prescriptions of specialised drugs through this channel. The objective of the present study is to conduct a systematic review of the evidence published between 2020 and 2021 regarding the variation in physicians' practice patterns and treatments, particular those that are relevant for cancer patients. Special emphasis will be given to results from the five largest European countries (Germany, France, Italy, Spain and the UK). In addition, and depending on data processing time by the statutory insurance company, administrative data from 2019 and 2020 will be explored to assess if a significant substitution of drugs from ambulatory to the hospital sectors existed in Germany for lung cancer patients during the COVID-19 pandemic.

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