DOES DKG-CERTIFICATION IMPROVE VALUE? A COST-EFFECTIVENESS ANALYSIS OF BREAST CANCER CARE USING CLAIMS DATA IN GERMANY
Author(s)
Min Wai Lwin, MPH1, Olaf Schoffer, PhD2, Christoph Streissnig, PhD2, Jochen Schmitt, Prof. Dr. med. , MPH2, Michael Schlander, Prof. Dr. med., MBA, PhD1.
1German Cancer Research Center (DKFZ), Heidelberg, Germany, 2Center for Evidence-Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany, Dresden, Germany.
1German Cancer Research Center (DKFZ), Heidelberg, Germany, 2Center for Evidence-Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany, Dresden, Germany.
OBJECTIVES: The German Cancer Society (DKG) certifies hospitals to promote high-quality cancer care through adherence to evidence-based guidelines, multidisciplinary treatment pathways, and continuous quality assurance. Previous studies have demonstrated superior survival rates for patients treated in certified hospitals (CHs) compared with non-certified hospitals (NCHs). However, certification requires additional services and infrastructure that generate substantial costs not fully reimbursed by the healthcare system. This study evaluated the cost-effectiveness of breast cancer (BC) treatment in CHs compared with NCHs.
METHODS: A retrospective cohort study was conducted using anonymized administrative claims data from AOK, the largest statutory health insurance provider in Germany. The study included 143,720 incident BC patients treated between 2009 and 2017 in CHs and NCHs. A health system perspective was used. Direct medical costs, including inpatient, outpatient, pharmaceutical, and certification-related costs, were estimated per 1,000 BC patients. Effectiveness was measured as life-years gained (LYG), calculated from the difference in 5-year restricted mean survival time (RMST) based on overall survival. Incremental costs, incremental effectiveness, and the incremental cost-effectiveness ratio (ICER) were calculated and reported in 2024 Euros.
RESULTS: Treatment in CHs was associated with significantly improved survival compared with treatment in NCHs. The 5-year RMST analysis demonstrated an incremental gain of 201 life-years per 1,000 patients (95% CI: 185-216). Certification-related costs amounted to approximately €1.5 million per 1,000 patients, while additional direct medical costs were comparatively modest. The total incremental cost associated with treatment in CHs was €1.81 million per 1,000 patients. The resulting ICER was €9,036 per LYG.
CONCLUSIONS: Breast cancer treatment in DKG-certified hospitals provides substantial survival benefits at a relatively low incremental cost. These findings indicate that hospital certification represents a cost-effective strategy for improving cancer outcomes. This study provides economic evidence supporting the continued implementation and funding of the certification program, offering valuable insights for healthcare decision-making in oncology care.
METHODS: A retrospective cohort study was conducted using anonymized administrative claims data from AOK, the largest statutory health insurance provider in Germany. The study included 143,720 incident BC patients treated between 2009 and 2017 in CHs and NCHs. A health system perspective was used. Direct medical costs, including inpatient, outpatient, pharmaceutical, and certification-related costs, were estimated per 1,000 BC patients. Effectiveness was measured as life-years gained (LYG), calculated from the difference in 5-year restricted mean survival time (RMST) based on overall survival. Incremental costs, incremental effectiveness, and the incremental cost-effectiveness ratio (ICER) were calculated and reported in 2024 Euros.
RESULTS: Treatment in CHs was associated with significantly improved survival compared with treatment in NCHs. The 5-year RMST analysis demonstrated an incremental gain of 201 life-years per 1,000 patients (95% CI: 185-216). Certification-related costs amounted to approximately €1.5 million per 1,000 patients, while additional direct medical costs were comparatively modest. The total incremental cost associated with treatment in CHs was €1.81 million per 1,000 patients. The resulting ICER was €9,036 per LYG.
CONCLUSIONS: Breast cancer treatment in DKG-certified hospitals provides substantial survival benefits at a relatively low incremental cost. These findings indicate that hospital certification represents a cost-effective strategy for improving cancer outcomes. This study provides economic evidence supporting the continued implementation and funding of the certification program, offering valuable insights for healthcare decision-making in oncology care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE392
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Reproductive & Sexual Health