{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:34:08Z","timestamp":1787762048692,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In Germany, the German Cancer Society (Deutsche Krebsgesellschaft [DKG]) accredits hospitals to ensure high\u2010quality cancer treatment through adherence to clinical guidelines and a multidisciplinary approach. Evidence suggests certified hospitals (CHs) achieve better clinical outcomes and prognoses than non\u2010certified hospitals (NCHs). However, additional services required for certification incur substantial, unreimbursed costs, necessitating a focused cost\u2010effectiveness 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\u2010effectiveness analysis. Direct medical costs (inpatient, outpatient, medication, and certification) were compared between CHs and NCHs. Life\u2010years gained (LYG) were calculated from 5\u2010year restricted mean survival time. The incremental cost\u2010effectiveness 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\u2013216). Accounting for \u20ac1.5\u2009M in certification\u2010related costs and marginal direct medical costs, the total incremental cost was \u20ac1.81\u2009M per 1000 patients. This resulted in an ICER of \u20ac9036 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.<\/jats:p>","DOI":"10.1002\/ijc.70388","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T02:57:41Z","timestamp":1773111461000},"page":"159-172","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A cost\u2010effectiveness analysis of breast cancer treatment in certified versus non\u2010certified hospitals in Germany"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6888-0951","authenticated-orcid":false,"given":"Min\u2010Wai","family":"Lwin","sequence":"first","affiliation":[{"name":"Division of Health Economics German Cancer Research Center (DKFZ)  Heidelberg Germany"},{"name":"Medical Faculty Mannheim University of Heidelberg  Mannheim Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Schoffer","sequence":"additional","affiliation":[{"name":"Center for Evidence\u2010Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Streissnig","sequence":"additional","affiliation":[{"name":"Center for Evidence\u2010Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Wimberger","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Frauenheilkunde und Geburtshilfe Universit\u00e4tsklinikum Carl Gustav Carus an der Technischen Universit\u00e4t Dresden  Dresden Germany"},{"name":"National Center for Tumor Diseases (NCT), NCT\/UCC Dresden, a partnership between DKFZ, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology, and Helmholtz\u2010Zentrum Dresden\u2010Rossendorf (HZDR)  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gerken","sequence":"additional","affiliation":[{"name":"Tumorzentrum Regensburg Zentrum f\u00fcr Qualit\u00e4tssicherung und Versorgungsforschung der Universit\u00e4t Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Bierbaum","sequence":"additional","affiliation":[{"name":"Center for Evidence\u2010Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Bobeth","sequence":"additional","affiliation":[{"name":"Center for Evidence\u2010Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"R\u00f6\u00dfler","sequence":"additional","affiliation":[{"name":"Center for Evidence\u2010Based Healthcare, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Dr\u00f6ge","sequence":"additional","affiliation":[{"name":"Quality and healthcare research team Wissenschaftliches Institut der AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Ruhnke","sequence":"additional","affiliation":[{"name":"Quality and healthcare research team Wissenschaftliches Institut der AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"G\u00fcnster","sequence":"additional","affiliation":[{"name":"Quality and healthcare research team Wissenschaftliches Institut der AOK (WIdO)  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kees Kleihues\u2010van","family":"Tol","sequence":"additional","affiliation":[{"name":"Arbeitsgemeinschaft Deutscher Tumorzentren e. V  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Link","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Frauenheilkunde und Geburtshilfe Universit\u00e4tsklinikum Carl Gustav Carus an der Technischen Universit\u00e4t Dresden  Dresden Germany"},{"name":"National Center for Tumor Diseases (NCT), NCT\/UCC Dresden, a partnership between DKFZ, Faculty of Medicine and University Hospital Carl Gustav Carus TUD Dresden University of Technology, and Helmholtz\u2010Zentrum Dresden\u2010Rossendorf (HZDR)  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Scharl","sequence":"additional","affiliation":[{"name":"Onkologische Fachklinik Bad Trissl  Oberaudorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth C.","family":"Sturm\u2010Inwald","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics University Medical Center Regensburg  Regensburg Germany"},{"name":"Comprehensive Cancer Center Alliance WERA (CCC WERA)  Regensburg Germany"},{"name":"National Center for Tumor Diseases (NCT)  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Kast","sequence":"additional","affiliation":[{"name":"Zentrum Famili\u00e4rer Brust\u2010 und Eierstockkrebs und Centrum f\u00fcr Integrierte Onkologie Universit\u00e4t zu K\u00f6ln  K\u00f6ln Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Papathemelis","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Frauenheilkunde und Geburtshilfe Klinikum St. Marien Amberg  Amberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Ortmann","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics University Medical Center Regensburg  Regensburg Germany"},{"name":"Comprehensive Cancer Center Alliance WERA (CCC WERA)  Regensburg Germany"},{"name":"National Center for Tumor Diseases (NCT)  Dresden Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Klinkhammer\u2010Schalke","sequence":"additional","affiliation":[{"name":"Tumorzentrum Regensburg Zentrum f\u00fcr Qualit\u00e4tssicherung und Versorgungsforschung der Universit\u00e4t Regensburg  Regensburg Germany"},{"name":"Arbeitsgemeinschaft Deutscher Tumorzentren e. 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Robert Koch Institute.2022. Accessed April 3 2025.https:\/\/www.krebsdaten.de\/Krebs\/EN\/Content\/Cancer_sites\/Breast_cancer\/breast_cancer_node.html"},{"key":"e_1_2_13_4_1","unstructured":"Federal Statistical Office.Genesis\u2010online cost of illness [Internet]. Statistisches Bundesamt.2025. Accessed April 3 2025.\u00a0https:\/\/www.destatis.de\/EN\/Themes\/Society\u2010Environment\/Health\/Cost\u2010Illness\/_node.html"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-024-02893-y"},{"issue":"18","key":"e_1_2_13_6_1","first-page":"316","article-title":"The screening, diagnosis, treatment, and follow\u2010up of breast cancer","volume":"115","author":"W\u00f6ckel A","year":"2018","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_13_7_1","volume-title":"S3 Evidence\u2010based Guideline for the Early Detection, Diagnosis, Treatment and Follow\u2010up of Breast Cancer (Version 4.4)","author":"German Guideline Program in Oncology (GGPO)","year":"2021"},{"key":"e_1_2_13_8_1","unstructured":"DKG (Deutsche Krebsgesellschaft).Annual report of the Certified Oncology Centers (Jahresbericht der zertifizierten Onkologischen Zentren).2017. 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