Division of Health Economics

The Division of Health Economics at the German Cancer Research Center (DKFZ) was established in January 2017. It became operational in October 2017, with an off-site meeting of the newly formed foundation team at the Eberbach Monastery near Eltville in the Rheingau region. At the retreat, a strategy for the Division was agreed on, along with a charter defining standards of conduct for the Division.

Since its inauguration the aim of the Division has been to contribute to our understanding of the costs and cost effectiveness of cancer and cancer care—spanning the continuum from prevention and early detection/screening to diagnosis and treatment. To this end, the Division has established collaborations both within the DKFZ and its networks, as well as with other German and international scientific institutions.

The original aims of the DKFZ Division of Health Economics were, according to an agreement with the Management Board of 2015, during a time horizon of ten years:

• To establish the DKFZ, on a worldwide scale, among the top-10 centers of excellence for the economics of cancer care;
• to become the leading center of excellence for the economics of cancer care in Germany,
  and as such, the primary national point of reference for information on the cost of cancer and the cost effectiveness of interventions aimed at improving cancer-related morbidity and mortality, including prevention, diagnostics, and treatment;
• To constitute the DKFZ and its new Division as a respected member of the international health economics community,
  and as such, an important contributor to the further development of health economic evaluation methods (better) reflecting social objectives of collectively financed health schemes.

To this end, a research program was initiated that rested on three pillars:

• Cancer-related burden of disease and cost of illness studies related to malignant disorders, in particular from the perspectives of society as a whole, as well as payers and patients,
  with increasing attention to the socioeconomic impact of a cancer diagnosis on patients and their relatives;
• Comparative cost value (primarily, cost benefit and cost effectiveness) analyses of intervention strategies in cancer prevention, screening, diagnosis, and treatment;
• Further development of health economic evaluation methods, including scientific exploration of advanced concepts such as “social cost value analysis,” driven by the rationale that the current methods do not capture relevant social norm preferences adequately,
  which may contribute to a systematic undervaluation to a systematic undervaluation of many cancer treatment options.

For more information on What We Do, please see here.

To better understand the Division of Health Economics’ scientific rationale, Professor Michael Schlander, head of the division, provided insight when interviewed by the BBC Scotland at the 20th Annual European Congress of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR; Glasgow, Scotland; November 2017). Here are his answers to four topics he was asked about, i.e.,

• his vision for the new Division of Health Economics at the German Cancer Research Center;
• the need for an improved (or even alternative) health economic evaluation model that better captures social value, and the promise and implications of "social cost value analysis" in the context of Health Technology Assessments (HTAs);
• some of the challenges surrounding defensible pharmaceutical pricing and reimbursement policies, considering the cost structure of the research-based biopharmaceutical industry;
• the analytical gap between concerns about affordability and budget impact analyses on the one hand, and conventional health economic evaluations on the other hand.

In an interview for the periodical DKFZ Intern (February 2017), Professor Schlander provided further clarity.

• M. Schlander: Interview: Für mehr Klarheit [For more clarity] DKFZ Intern, (2017) 2 14-17.

With the COVID-19 pandemic reaching Europe in the beginning of 2020, the Division extended its activities, actively participating in a globally active Task Force on “COVID-19 and Cancer” of the Union for International Cancer Control (UICC) under the leadership of Professor Richard Sullivan (King’s College London). Research was initiated into the impact of the pandemic on priority-setting in health care, on cancer care, and on cancer patients.

Furthermore, in keeping with the priority field “cost of cancer”, a Task Force was inaugurated under the umbrella of the Organisation of European Cancer Institutes (OECI) with the objective to develop conceptual and methodological standards for Socioeconomic Impact research, and studies were initiated in cooperation with researchers at the Netherlands Cancer Institute (NKI).

When the decision was made to establish the DKFZ Division of Health Economics, it was expected that the approach adopted by Division would provide for a platform for further growth, generating relevant economic information to stakeholders, including health care policy makers and agencies concerned with Health Technology Assessments (HTAs), as well as contribute overall to the science of economic evaluation of cancer care and medical interventions. However, more recent developments, including an unexpected institution-wide revision of budget revision allocations during the first half of 2021, required a re-assessment of the original objectives and strategy, resulting in a consolidation of the scope of projects pursued by the Division.

In a recent presentation to scholars at the DKFZ and the University of Heidelberg, delivered as part of a lecture series “Science@DKFZ”, Professor Schlander emphasized the potential contribution of health economics to the success of a major biomedical research center:

• M. Schlander: The Role and Potential Contribution of Health Economics to the Success of a Major Biomedical Research Center. Keynote Lecture “Science@DKFZ”, Heidelberg, September 26, 2022.

There can be little if any doubt that the translation of research findings “from bench to bedside” will increasingly depend on the demonstration of value for money; clinical development strategies will need to generate clinical and economic evidence required by Health Technology Assessment (HTA) agencies reviewing value propositions on grounds of comparative effectiveness as well as cost effectiveness.

We believe that future cancer research and its public funding should be informed by its expected utility, i.e., supported by early strategic economic value assessments. At the same time, there should be a strong interest in the future development of evaluation methods that capture dimensions of value beyond individual gains in length and health-related quality of life, and their aggregation.