title: Cost-components of lung cancer care within the first three years after initial diagnosis in context of different treatment regimens.
abstract: OBJECTIVE
  Although lung cancer is of high epidemiological relevance in Germany, evidence on its economic implications is scarce. Sound understanding of current care structures and associated expenditures is required to comprehensively judge the additional benefit of novel interventions in lung cancer care. Adopting a payer perspective, our study aims to analyze expenditures for individuals with incident lung cancer.
  
  
  METHODS
  Patients with an initial diagnosis of lung cancer (ICD-10 code C34) in 2009 were searched in a large, nationwide base of health insurance claims data and grouped according to initial treatment (Surgery, Chemotherapy/Radiotherapy, No specific treatment). All-cause SHI and lung cancer-related spending was assessed for a patient-individual three-year time frame after initial diagnosis. Expenditures per case and expenditures per year survived were calculated via Generalized Linear Gamma Models adjusted for age, gender, living region, baseline metastases, multiple tumors and initial treatment regimen using time under observation as a weighting factor.
  
  
  RESULTS
  17,478 individuals were identified. Lung cancer-related expenditures peaked within the first six months after initial diagnosis. Following, they declined subsequently and so did their share in all-cause SHI spending. Lung cancer-related expenditures per case were estimated at €20,400 (53% of all-cause expenditures) with a huge variance according to initial treatment regimen [
  
  
  METHODS
  €20,400, Chemotherapy/Radiotherapy: €26,300, No specific treatment: €4200]. Cost per year survived amounted to €15,500 (55% of all cause expenditures) [
  
  
  METHODS
  €11,600, Chemotherapy/Radiotherapy: €20,200, No specific treatment: €7600].
  
  
  CONCLUSIONS
  Analyses of lung cancer-related expenditures need to take into account treatment strategies and survival. Our study is representative for a large share of the population and provides detailed, patient-level information on costs of care and their compilation. Results render estimates available for the cost of lung cancer e.g. for budget impact analyses, cost-effectiveness analyses of screening and prevention schemes, or prognostic models of life-time expenditures per lung cancer case.
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. Electronic address: l.schwarzkopf@helmholtz-muenchen.de.
authors.forename: Larissa
authors.initials: L
authors.lastname: Schwarzkopf
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. Electronic address: margarethe.wacker@helmholtz-muenchen.de.
authors.forename: Margarethe
authors.initials: M
authors.lastname: Wacker
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. Electronic address: holle@helmholtz-muenchen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. Electronic address: leidl@helmholtz-muenchen.de.
authors.forename: Reiner
authors.initials: R
authors.lastname: Leidl
authors.affiliation: Wissenschaftliches Institut der AOK (WIdO), Forschungsbereich Integrierte Analysen, Rosenthaler Straße 31, 10178 Berlin, Germany. Electronic address: Christian.Guenster@wido.bv.aok.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Günster
authors.affiliation: Wissenschaftliches Institut der AOK (WIdO), Forschungsbereich Integrierte Analysen, Rosenthaler Straße 31, 10178 Berlin, Germany. Electronic address: Juergen-Bernhard.Adler@wido.bv.aok.de.
authors.forename: Jürgen-Bernhard
authors.initials: JB
authors.lastname: Adler
authors.affiliation: Ludwig-Maximilians-Universität München, University Hosital, Division of Respiratory Medicine and Thoracic Oncology, Thoracic Oncology Centre Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ziemssenstr. 1, 80336 München, Germany. Electronic address: Huber@med.uni-muenchen.de.
authors.forename: Rudolf Maria
authors.initials: RM
authors.lastname: Huber
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D005858:Germany; D005102:Health Expenditures; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000191:economics*; D008297:Male
chemical_list: D000970:Antineoplastic Agents
keywords: Cost of illness; Germany; Health insurance claims data; Lung cancer incidence; Spending; Therapeutic strategy