Healthcare costs associated with breast cancer in Germany: a claims data analysis



This study estimates the healthcare costs associated with breast cancer (BC) for different treatment phases (initial, intermediate, terminal) in Germany from the payer’s perspective.


The analysis uses claims data from the AOK Bayern covering 2011–2014 for continuously insured BC patients identified through inpatient and outpatient diagnoses. We calculate the healthcare costs attributable to BC using a control group design comparing the target population to a 1:2 matched control group adjusted for age, gender, and comorbidities. For incident and prevalent BC cases, we calculate age-standardized phase-specific incremental costs stratified by cost domain.


The initial, intermediate, and terminal phases comprise 3841, 28,315, and 1767 BC cases, respectively. BC-related incremental costs follow a u-shaped curve, with costs highest near diagnosis and death, and lower in between. With average costs of €33,237 per incident and €28,211 per prevalent case in the remaining 11 months before death, the highest BC-related incremental healthcare costs can be found in the terminal phase. In the initial phase, there were mean incremental costs of €21,455 the first 11 months after diagnosis. In the intermediate phase, incremental costs totaled €2851 per incident and €2387 per prevalent case per year. Healthcare costs decreased with age in most phases. The cost drivers depend on the treatment phase, with cytostatic drugs and inpatient treatment showing the highest economic impact in most phases.


The study concludes that BC care costs impose a relevant economic burden on statutory health insurance and vary substantially depending on the treatment phase.

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Correspondence to Kristine Kreis.

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Appendix 1

See Table 5

Table 5 Claims defining treatment types in BC patients

Appendix 2

See Fig. 2

Fig. 2

Age-standardized incremental healthcare costs of BC cases in the initial phase by treatment type (in €, mean). As cases were few we aggregated BC cases with radiotherapy (n = 68) or chemotherapy (n = 33) or radiotherapy + chemotherapy (n = 17) or no active therapy (n = 1110) to “other forms of therapy”. The group “no active therapy” includes all BC cases without any claim for surgery, radiotherapy and chemotherapy

Appendix 3

See Fig. 3

Fig. 3

Age-standardized incremental healthcare costs of BC cases in the terminal phase by treatment type (in €, mean). The group “no active therapy” includes all BC cases without any claim for surgery, radiotherapy and chemotherapy

Appendix 4

See Table 6

Table 6 Unstandardized healthcare costs of incident BC cases (n) in Germany by age group (in €, mean [standard deviation])

Appendix 5

See Table 7

Table 7 Unstandardized healthcare costs of prevalent BC cases (n) in Germany by age group (in €, mean [standard deviation])

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Kreis, K., Plöthner, M., Schmidt, T. et al. Healthcare costs associated with breast cancer in Germany: a claims data analysis. Eur J Health Econ (2020) doi:10.1007/s10198-019-01148-w

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  • Breast cancer
  • Disease cost
  • Claims data
  • Joinpoint
  • Germany

JEL Classification

  • I10
  • I13
  • I14