To the Editor:
We were impressed by the findings of the recent study by Berger et al., which provides a significant population-based overview of the epidemiology and economic burden of follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) in Germany [1]. The authors clearly demonstrate the growing pressure these lymphomas exert on the healthcare system. However, we believe three key considerations are essential for a complete interpretation of the findings and their policy implications.
The study’s temporal scope (2015–2020) needs careful interpretation, as it largely precedes the widespread introduction of high-cost innovations like CAR-T-cell therapies and bispecific antibodies in Germany [2]. Thus, the reported cost structure may not reflect the current economic landscape. The lymphoma cost burden is evolving from an inpatient-centric model to one dominated by outpatient drug costs, underscoring the necessity for continual real-world studies.
The limited clinical granularity, particularly the absence of disease stage, International Prognostic Index (IPI) score, and treatment line information, represents a second constraint. It hinders a root-cause analysis of the cost differences between FL and DLBCL [3]. Although DLBCL is associated with greater inpatient resource use [1], the failure to distinguish the purpose of hospitalization obscures the key levers for improving the efficiency of care delivery and resource allocation. We strongly agree that linking claims data with detailed clinical datasets is important for elucidating cost drivers [4].
Although the study’s exclusive payer perspective is sound methodologically, it inherently narrows the scope of the economic evaluation. Consequently, the analysis overlooks significant societal costs such as productivity loss, out-of-pocket expenses, and informal care required to understand the multifaceted impact of DLBCL [5].
The data in the research indirectly reveal a profound psychosocial burden, yet this reality finds no reflection in current payment structures. This disconnect underscores the urgent need for policy action: psychosocial support must be recognized as essential medical care and funded accordingly. Such a policy is both an ethical obligation and a strategically sound investment, promising long-term benefits through better quality of life and treatment compliance.
In conclusion, the authors’ important contribution is praised. A key imperative for future research is the linkage of claims data with comprehensive clinical and patient-reported outcomes. This integration is essential not only to identify cost drivers but also to make the invisible psychosocial burden visible and actionable. This dual focus is the cornerstone of delivering holistic, high-value care that truly serves all lymphoma patients.
Author contributions
**J.R.W.:** Conceptualization, Project Administration, Software, Data Curation, Visualization, Methodology, Writing – Original Draft. **J.X.H.:** Writing – Original Draft, Writing – Review & Editing, Visualization. **G.H.Z.:** Supervision, Funding Acquisition, Data Curation, Conceptualization.
Funding
This study was supported by the National Natural Science Foundation of China (No.82260911), Innovation and Entrepreneurship Training Program for College Students (Grant No. S202410412112). Key projects of Jiangxi Province’s “Science and Technology + Traditional Chinese Medicine” Joint Plan (2023KZI01002). Ganpo Talent Support Program - Training Program for Academic and Technical Leaders in Major Disciplines (20243BCE51028), Graduate Research Project of Jiangxi Science Education Society (2025KXJYS810).
Data availability
No datasets were generated or analyzed during the current study.
Declarations
Ethical approval
Not applicable.
Consent to publish
All authors have read and approved the final manuscript and consent to its publication.
Competing interests
The authors declare no competing interests.
Footnotes
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References
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Associated Data
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Data Availability Statement
No datasets were generated or analyzed during the current study.