Increasing Costs and Limited Mortality Improvement in Incident Metastatic Lung Cancer in German Statutory Health Insurance Claims, 2011–2024

Objective: To describe trends in age- and sex-standardized 12-month overall survival (OS) and inflation-adjusted costs among patients with incident metastatic lung cancer (mLC) in anonymized German statutory health insurance claims data from 2011 to 2024.

Methods: Patients with mLC were identified using ICD-10-GM diagnosis codes: C34 (LC) and C77–C79 for metastatic disease. Metastatic disease was required to occur within ±3 months of the qualifying LC diagnosis, with no evidence of mLC during a 1-year baseline period. Age- and sex-standardized 12-month OS, standardized to the overall German statutory health insurance population, was assessed from the date of incident mLC (index date). Fourteen annual cohorts were defined according to index date year of each patient (2011–2024). Inflation-adjusted all-cause healthcare costs were measured over the 12-month post-index period for each patient and reported by index-year cohort. Trends in OS and costs were evaluated over time, using 2011 as the reference year.

Results: The cohort included 658 patients in 2011, peaked at 1,991 in 2021, and included 591 patients in 2024; mean age increased from 65.7 to 68.5 years over the years. Standardized 12-month OS ranged from 55.4% to 71.3%, showing only limited improvement over the observed index years: 61.6%/69.5% in 2011/2012 (peak: 71.3% for index year 2018) versus 63.9%/68.4% in 2023/2024. In contrast, costs increased substantially over the years from €31,591 to €59,236 per patient (+87.5%). Costs excluding the final 4 weeks before death increased from €27,836 to €53,299. The cost structure shifted markedly: inpatient cost share declined from 65% to 50%, while outpatient drug cost share increased from 26% to 43%.