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@ARTICLE{Lwin:310348,
      author       = {M. W. Lwin$^*$ and O. Schoffer and C. Streissnig and P.
                      Wimberger and M. Gerken and V. Bierbaum and C. Bobeth and M.
                      Rößler and P. Dröge and T. Ruhnke and C. Günster and K.
                      K. Tol and T. Link and A. Scharl and E. C. Sturm-Inwald and
                      K. Kast and T. Papathemelis and O. Ortmann and M.
                      Klinkhammer-Schalke and J. Schmitt and M. Schlander$^*$},
      title        = {{A} cost-effectiveness analysis of breast cancer treatment
                      in certified versus non-certified hospitals in {G}ermany.},
      journal      = {International journal of cancer},
      volume       = {nn},
      issn         = {0020-7136},
      address      = {Bognor Regis},
      publisher    = {Wiley-Liss},
      reportid     = {DKFZ-2026-00548},
      pages        = {nn},
      year         = {2026},
      note         = {#EA:C100#LA:C100# / epub},
      abstract     = {In Germany, the German Cancer Society (Deutsche
                      Krebsgesellschaft [DKG]) accredits hospitals to ensure
                      high-quality cancer treatment through adherence to clinical
                      guidelines and a multidisciplinary approach. Evidence
                      suggests certified hospitals (CHs) achieve better clinical
                      outcomes and prognoses than non-certified hospitals (NCHs).
                      However, additional services required for certification
                      incur substantial, unreimbursed costs, necessitating a
                      focused cost-effectiveness evaluation. This retrospective
                      cohort study utilized anonymized administrative routine
                      healthcare data from Allgemeine Ortskrankenkasse, Germany's
                      largest statutory health insurance. The study sample
                      comprised 143,720 incident breast cancer (BC) patients
                      treated between 2009 and 2017 across both CHs and NCHs. A
                      health system perspective was used in this
                      cost-effectiveness analysis. Direct medical costs
                      (inpatient, outpatient, medication, and certification) were
                      compared between CHs and NCHs. Life-years gained (LYG) were
                      calculated from 5-year restricted mean survival time. The
                      incremental cost-effectiveness ratio (ICER), quantified as
                      cost per LYG, served as the primary outcome measure,
                      reported in 2024 euro. Treatment in CHs significantly
                      improved breast cancer survival, yielding 201 LYG per 1000
                      patients $(95\%$ confidence interval: 185-216). Accounting
                      for €1.5 M in certification-related costs and marginal
                      direct medical costs, the total incremental cost was €1.81
                      M per 1000 patients. This resulted in an ICER of €9036 per
                      LYG. Despite the financial investment required for DKG
                      certification, BC treatment in CHs provided significant
                      survival benefits at a reasonable incremental cost,
                      reinforcing the clinical and economic value. These findings
                      offer critical insights for hospital authorities and
                      healthcare policymakers, supporting the continued investment
                      in certification.},
      keywords     = {breast cancer (Other) / breast cancer treatment cost
                      (Other) / cancer center certification (Other) / certified
                      hospitals (Other) / cost‐effectiveness analysis (Other)},
      cin          = {C100},
      ddc          = {610},
      cid          = {I:(DE-He78)C100-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41802986},
      doi          = {10.1002/ijc.70388},
      url          = {https://inrepo02.dkfz.de/record/310348},
}