ArticleJournal of cancer research and clinical oncology2026
Comparative Cost and Utilization Analysis of CAR-T Therapy and Autologous Stem Cell Transplantation for Diffuse Large B-Cell Lymphoma in Germany: Insights from Statutory Health Insurance Billing and Nationwide Inpatient Data.
Article in Journal of cancer research and clinical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeChimeric Antigen Receptor (CAR) T-cell therapy has transformed the treatment of diffuse large B-cell lymphoma (DLBCL) but carries higher drug acquisition costs than autologous stem cell transplantation (autoSCT), while administration and follow-up costs remain underrepresented in economic evaluations and reimbursement decision-making. This study compares administration-related and subsequent treatment costs of CAR-T and autoSCT for DLBCL from the German statutory health insurance (SHI) perspective.
methodsA two-step analysis based on two German databases was performed. In step 1, SHI billing data (representing 5 million insured individuals, ≙ 8% of SHI) from 2020-2022 were analyzed longitudinally. Costs were divided into initial regime (IR) (all services except CAR-T drug acquisition) and a following regime (FR). In step 2, a cross-sectional analysis of all German inpatient cases from 2020-2023 (17 million cases/year) assessed inpatient costs.
resultsStep 1 included 12 CAR-T and 59 autoSCT patients. Median IR costs per patient were €61,703 (CAR-T) versus €55,802 (autoSCT), while FR costs were lower for CAR-T (€44,832 versus €69,453). Most frequently reported adverse events (any grade) for CAR-T versus autoSCT were: B-cell aplasia/neutropenia (77% versus 64%), thrombocytopenia (38% versus 64%). Step 2 included 1,229 CAR-T and 2,239 autoSCT inpatient cases (2020-2023). Average LOS was comparable (27.3 versus 27.8 days), and average inpatient costs were lower for CAR-T (€13,991 versus €29,432).
conclusionAlthough associated with higher IR costs, CAR-T therapy in DLBCL demonstrated lower inpatient and FR costs compared to autoSCT. This analysis focused on administration and follow-up costs, excluding drug acquisition costs, characterizing the economic burden beyond drug pricing.
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