Virtually no other topic has attracted more attention in oncology in recent years than chimeric antigen receptor (CAR) T‑cell therapy (CART). On the one hand it opens up completely new treatment options for cancer patients, while on the other it generates treatment costs exceeding € 300,000 per treatment. The aim of this work is to analyze the economic, procedural and organizational challenges of CAR T‑cell therapy from the perspective of the service provider, the cost-bearer and the pharmaceutical manufacturer. The current German diagnosis-related-group (G-DRG) catalog, the G‑DRG tariff, of the German Federal Joint Committee (G-BA) guidelines and G‑DRG coding principles were used to evaluate the reimbursement and remuneration system in Germany. Practical experiences of medical sites were integrated in the analysis. The findings demonstrate great economic challenges especially from the perspective of aCART site. Increasing certification and qualification efforts lead to financial pressure. Insufficient reimbursement and inadequate cost-covering for CART treatment result in budget restrictions for hospitals. High drug costs as well as enormous personnel and infrastructural requirements demand transparent and sufficient reimbursement for hospitals. Interaction between hospital and pharmaceutical manufacturer in the CART process might enable new means of cooperation.

Osteoporosis is nowadays understood as an increased risk of fractures, with bone density measurement by dual-energy X‑ray absorptiometry (DXA) being auseful diagnostic criterion and apotent fracture predictor; however, especially in geriatric patients the result is often falsely negative, so that the diagnosis, indications for treatment and treatment selection should be based on an overall clinical evaluation of the individual situation. Sarcopenia is defined as ageriatric syndrome characterized by ageneralized loss of skeletal mass and muscle function. Sarcopenia is associated with an increased likelihood of adverse outcomes including falls, fractures, disability and mortality. Since 2018 it is possible in Germany to encode sarcopenia in the International Statistical Classification of Diseases and Related Health Problems, 10th revision, German modification (ICD-10-GM, M62.50). In the case of ahigh fracture risk and indications for the presence of sarcopenia, the whole body composition should be assessed by DXA within the framework of the measurement of bone mineral density. In the treatment of osteosarcopenia non-pharmacological measures must be initiated in addition to pharmacological measures. It is particularly important to clarify and if necessary to resolve the cause of falls resulting in fractures as well as to regularly reevaluate the treatment goals.