Health Economics

Exploring the Economics of Lung Cancer

Real-world data on healthcare utilization and costs related to lung cancer in Germany remain limited. To address this gap, we analyzed administrative claims data from one of the country’s largest health insurers.

The initial study established methods for identifying lung cancer cases, estimated national incidence, and examined survival rates relative to comorbidities. Two follow-up studies focused on (1) medication costs and prescription patterns, and (2) inpatient costs and treatment patterns across Germany.

Preliminary findings showed inpatient costs averaged €25,000 per patient—or approximately €18,000 per year of survival—with notable variation by age and region, but minimal differences by sex or comorbidities. The average hospital stay declined significantly over a 12-year period.

Outpatient prescription costs averaged €12,000 per patient, with lower costs during initial treatment and peaks in the terminal phase. These costs rose substantially over the study period.

 

Cost of Cancer Drug Development

The high cost of developing new cancer drugs is often cited as a key driver of rising prices and raises concerns about the long-term sustainability of the R&D-based biopharmaceutical industry.

We conducted a comprehensive review of peer-reviewed literature on the costs of bringing a new molecular entity (NME) to market, highlighting factors behind the wide variation in published estimates. Reported capitalized pre-launch R&D costs ranged from $161 million to $4.54 billion (2019 USD), with anticancer drugs among the most expensive—ranging from $944 million to $5.4 billion.

Our analysis confirmed a consistent upward trend in R&D costs per NME. To improve the quality and comparability of future research, we developed a suitability scoring system for evaluating study validity in this field.

 

Cost of CAR-T Cell Treatments

CAR T-cell therapies offer promising options for certain blood cancers, with the potential for long-term remission or cure. The European Commission approved two such gene therapies in 2018, marking a milestone in cancer treatment.

We evaluated the full cost spectrum of CAR-T cell therapy—including production, patient involvement, admission, and toxicity management—using both micro- and gross-costing approaches.

Our findings showed, for the first time, that production in not-for-profit settings can be a more cost-effective and efficient alternative to centralized models. Further cost reductions are expected as decentralized production benefits from standardization, economies of scale, and process improvements—consistent with the early life cycle stage of this innovative technology.

 

Selected Publications

D. Hernandez, C.-Y. Cheng, K. Hernandez-Villafuerte, M. Schlander:
Survival and comorbidities in lung cancer patients: evidence from administrative claims data in Germany.
Oncology Research, 2022: 30(4), 173-185.
DOI: 10.32604/or.2022.027262.

T. Ran, S. B. Eichmüller, P. Schmidt, M. Schlander:
Cost of decentralized CAR T cell production in an academic non-profit setting.
International Journal of Cancer, 2020: 147(12), 3438-3445.
DOI: 10.1002/ijc.33156

T. Ran, S. B. Eichmüller, P. Schmidt, M. Schlander:
Reply to: Comments on "Cost of decentralized CAR T cell production in an academic non-profit setting".
International Journal of Cancer, 2021: 148(2), 516-517.
DOI: 10.1002/ijc.33253

M. Schlander, K. Hernandez-Villafuerte, C. -Y. Cheng, J. Mestre-Ferrandiz, M. Baumann:
How much does it cost to research and develop a new drug? A systematic review and assessment.
Pharmacoeconomics, 2021: 39(11), 1243-1269.
DOI: 10.1007/s40273-021-01065-y

M. Schlander, T. Ran, P. Schmict, S.B. Eichmüller:
Can we reduce the acquisition cost of CAR T cell therapies?
Annals of Oncology, 2020: 31(Supplement 4) S966.
DOI: 10.1016/j.annonc.2020.08.1912

The Socioeconomic Impact of Cancer on Patients and Families

While health economists often analyze costs from societal or payer perspectives, the patient viewpoint remains under explored in applied research. In the U.S., the concept of financial toxicity has drawn attention to the economic burden of cancer treatment. In contrast, it's often assumed that universal healthcare systems in Europe protect patients from financial hardship.

However, many European cancer patients still face substantial economic strain. Their financial burden includes direct medical and non-medical costs (e.g., co-payments), as well as indirect costs like lost income—often only partially offset by social welfare systems. In addition to these tangible costs, patients and families frequently bear intangible burdens, such as psychological distress, diminished quality of life, and even worse clinical outcomes.

To better reflect this broader experience, we propose using the term socioeconomic impact, which encompasses the full spectrum of financial, psychological, and social consequences for patients, survivors, and their families. Recognizing these impacts is essential to fully understanding the burden of cancer and designing supportive policies and interventions.

 

Organisation of European Cancer Institutes (OECI) Consensus Task Force

Research on the socioeconomic impact of cancer from the patient and family perspective in Europe is still emerging, characterized by fragmented methods, terminology, and a lack of unified theory. To address these gaps, an international Task Force was launched in March 2021 within the OECI Health Economics Working Group, led by Michael Schlander (chair) and Wim van Harten (co-chair).

The Task Force aimed to develop a European consensus on a comprehensive conceptual framework, consistent taxonomy, and standardized definitions. Its goal is to reduce redundant and non-comparable research and promote more coordinated, rigorous, and policy-relevant efforts.

Since its inception, the Task Force has conducted extensive consensus-building activities, including focus groups, Delphi exercises, and consultations with patient representatives and external experts. This process culminated in 25 consensus recommendations, published in The Lancet Oncology (April 2024), which include a definition of socioeconomic impact, a detailed framework of causes and outcomes, and guidance for developing and validating patient-reported outcome instruments.

 

Empirical Research

In parallel with the conceptual work, additional empirical studies have explored the socioeconomic impact of cancer. One study analyzed data from the Socio-Economic Panel (SOEP), one of Germany’s largest household surveys, revealing that average job incomes declined by 26% to 28% within the first year following a cancer diagnosis.

In another project, conducted with the DKFZ Unit of Cancer Survivorship (led by Volker Arndt), we analyzed CAESAR study data to assess out-of-pocket expenses and income losses among breast cancer survivors in Germany, identifying key factors contributing to their financial burden.

 

Selected Publications

P.D. Pham, J. Ubels, R. Eckford, M. Schlander:
Measuring the Socioeconomic Impact of Cancer: A Systematic Review and Standardized Assessment of Patient-Reported Outcomes (PRO) Instruments.
PharmacoEconomics Open, 2025. Published 04 April 2025
DOI: 10.1007/s41669-025-00568-0

M. Schlander, W. van Harten, V.P. Retèl, P.D. Pham, J. M. Vancoppenolle, J. Ubels, O.S. López, C. Quirland, F. Maza, E. Aas, B. Crusius, A. Escobedo, N. Franzen, J. Fuentes-Cid, D. Hernandez, K. Hernandez-Villafuerte, I. Kirac, A. Paty, T. Philip, S. Smeland, R. Sullivan, E. Vanni, S. Varga, T. Vermeulin, R.D. Eckford:
The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions.
The Lancet. Oncology, 2024: 25 (4), e152–e163.
DOI: 10.1016/S1470-2045(23)00636-8

P.D. Pham, M. Schlander, R. Eckford, K. Hernandez-Villafuerte, J. Ubels:
Developing a conceptual framework for socioeconomic impact research in European cancer patients: A 'best-fit' framework synthesis.
The Patient, 2023: 16(5) 515-536.
DOI:10.1007/s40271-023-00632-z

V. Arndt, D. Hernandez, M. Schlander:
Einkommenseinbußen nach Krebs – Ergebnisse aus Deutschland [Income loss after cancer—Results from Germany].
Onkologie, 2022: 28, 951-956.
DOI: 10.1007/s00761-022-01243-3

D. Hernandez, M. Schlander:
Income loss after a cancer diagnosis in Germany: An analysis based upon the socio-economic panel survey.
Cancer Medicine, 2021: 10 (11), 3726-3740.
DOI: 10.1002/cam4.3913

R. Eckford, K. Hernandez-Villafuerte, A. Spier, L. Hirschberg, M. Schlander:
A systematic review of the socioeconomic impact of cancer on patients and families: Are differences among countries being effectively captured and addressed?
Value in Health, 2020: 23(Supplement 2), S478.
DOI: 10.1016/j.jval.2020.08.453

K. Hernandez-Villafuerte, R. Eckford, A. Spier, M. Schlander:
How to Describe the Socioeconomic Impact of Cancer on Patients and their Families: An Evaluation of Terminology by Global Regions and Healthcare Systems.
Presentation at iHEA 14^th World Congress on Health Economics.
Virtual. July 12-15, 2021

M. Schlander: 
PRO (“patient-reported outcomes”) und Lebensqualität in der Onkologie [Patient-reported outcomes (PRO) and quality of life in oncology].
Forum 2020: 35, 382-390.
DOI: 10.1007/s12312-020-00841-9

J. Schneider, D. Hernandez, CAESAR study group, M. Schlander, V. Arndt:
Out-of-pocket payments and loss of income among long-term breast cancer survivors in Germany: A multi-regional population-based study.
Journal of Cancer Survivorship, 2023: 17(6), 1639-1659.
DOI: 10.1007/s11764-022-01293-x

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 [ER1]Updated to reflect where we are now.