Economic Analysis of Molecular Diagnostics in Non-Small Cell Lung Cancer - A Review of the Care and Reimbursement Situation in the German Inpatient Sector

Background Since 2009, targeted therapies against certain molecular tumour mutations of non-small cell lung cancer have led to significant improvements in overall survival. Molecular pathological diagnostics are a precondition for the provision of targeted therapies. The rate of performed tests is low, as current surveys identified. While there is a billing option for molecular diagnostics in the outpatient sector, the inpatient flat rate reimbursement system lacks an option to bill the diagnostics - which is discussed as a hurdle for testing.Method The aim of the analysis was to determine the supply and reimbursement structures in molecular diagnostics in Germany. For this purpose, the supply path and the billing options for molecular diagnostics were systematically and qualitatively processed. All hospitals that treat patients with the ICD-10 diagnosis "lung cancer" were quantitatively surveyed in the German Hospital Directory and applicable outpatient billing options were assigned to each hospital.Results A billing option for molecular diagnostics was defined for the following cases: physicians and care units authorized by the Statuary Health Insurance, outpatient treatment at the hospital, outpatient (specialist) medical care, a university outpatient clinic at the hospital or participation in an integrated care contract. Lung cancer patients were treated at 1,001 hospital locations (889 hospitals) in 2020. 52% of the hospitals have no outpatient billing option (n=462), of which 89% have = 500 beds (n=413). Of 171,824 hospital cases, 32% (n=55,826) were treated in hospitals with no outpatient billing facility. 81% of these cases were in hospitals with= 500 beds (n=45,260).Conclusion Hospitals that lack the option of outpatient billing for molecular diagnostics could be subject to an economic disincentive due to insufficient inpatient remuneration. Innovative care concepts demonstrate the possibilities of quality-assured, sector-independent remuneration. A transfer into standard care could eliminate disincentives.