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1.
Background
Hospitalisation of acutely ill nursing home residents is associated with health risks such as infections, complications, or falls, and results in high costs for the health care system. Taking the case of pneumonia, nursing homes generally can ensure care according to guidelines.Aim
Extrapolation of overall expenditures for the German statutory health insurance system from the hospitalisation of nursing home residents with respiratory infection/pneumonia; developing alternative cost scenarios to compare nursing home care with hospital care in consideration of patients’ condition.Methods
Data provided by health insurance funds were extrapolated to the German statutory health insurance system and weighted via German-DRG case values. Care processes (hospital vs. nursing home) were modelled, and treatment steps were divided into cost categories. The patient’s condition was standardised via the Barthel Index.Results
Total expenditures of € 163.3 million were incurred for inpatient care of nursing home residents transferred to hospitals for respiratory infection/pneumonia in 2013 in Germany. Process modelling reveals lower direct costs for nursing home care as well as better development of patients’ condition. Looking at operators of nursing homes, both care scenarios necessitate additional services without reimbursement.Conclusion
Expenditure projections for the hospital care of nursing home residents with pneumonia reveal high saving potential. Avoidance of hospital admission serves to considerably reduce the insurers’ expenditures but also the duration and severity of illness. The study illustrates economic incentive structures for health care providers and indicates courses of action for health policy and nursing homes operators.2.
Christian Jacob Benno Bechtel Susanne Engel Peter Kardos Roland Linder Sebastian Braun Wolfgang Greiner 《The European journal of health economics》2016,17(2):195-201
Introduction
Asthma is associated with a substantial economic burden on the German Statutory Health Insurance.Aims and objectives
To determine costs and resource utilization associated with asthma and to analyze the impact of disease severity on subgroups based on age and gender.Methods
A claims database analysis from the statutory health insurance perspective was conducted. Patients with an ICD-10-GM code of asthma were extracted from a 10 % sample of a large German sickness fund. Five controls for each asthma patient matched by age and gender were randomly selected from the same database. Costs and resource utilization were calculated for each individual in the asthma and control group. Incremental asthma-related costs were calculated as the mean cost difference. Based on prescribed asthma medication, patients were classified as intermittent or persistent. In addition, age groups of ≤5, 6–18, and >18 years were analyzed separately and gender differences were investigated.Results
Overall, 49,668 individuals were included in the asthma group. On average, total annual costs per patient were €753 higher (p = 0.000) compared to the control group (€2,168 vs. €1,415). Asthma patients had significantly higher (p = 0.000) outpatient (€217), inpatient (€176), and pharmacy costs (€259). Incremental asthma-related total costs were higher for patients with persistent asthma compared to patients with intermittent asthma (€1,091 vs. €408). Women aged >18 years with persistent asthma had the highest difference in costs compared to their controls (€1,207; p < 0.0001). Corresponding healthcare resource utilization was significantly higher in the asthma group (p = 0.000).Conclusions
The treatment of asthma is associated with an increased level of healthcare resource utilization and significantly higher healthcare costs. Asthma imposes a substantial economic burden on sickness funds.3.
Florian Hofer Dmitrij Achelrod Tom Stargardt 《Applied health economics and health policy》2016,14(6):691-701
Background
Chronic obstructive pulmonary disease (COPD) poses major challenges for health care systems. Previous studies suggest that telemonitoring could be effective in preventing hospitalisations and hence reduce costs.Objective
The aim was to evaluate whether telemonitoring interventions for COPD are cost-effective from the perspective of German statutory sickness funds.Methods
A cost-utility analysis was conducted using a combination of a Markov model and a decision tree. Telemonitoring as add-on to standard treatment was compared with standard treatment alone. The model consisted of four transition stages to account for COPD severity, and a terminal stage for death. Within each cycle, the frequency of exacerbations as well as outcomes for 2015 costs and quality adjusted life years (QALYs) for each stage were calculated. Values for input parameters were taken from the literature. Deterministic and probabilistic sensitivity analyses were conducted.Results
In the base case, telemonitoring led to an increase in incremental costs (€866 per patient) but also in incremental QALYs (0.05 per patient). The incremental cost-effectiveness ratio (ICER) was thus €17,410 per QALY gained. A deterministic sensitivity analysis showed that hospitalisation rate and costs for telemonitoring equipment greatly affected results. The probabilistic ICER averaged €34,432 per QALY (95 % confidence interval 12,161–56,703).Conclusion
We provide evidence that telemonitoring may be cost-effective in Germany from a payer’s point of view. This holds even after deterministic and probabilistic sensitivity analyses.4.
Nils Kossack Christian Schindler Ines Weinhold Lennart Hickstein Moritz Lehne Jochen Walker Aljoscha S. Neubauer Dennis Häckl 《Zeitschrift fur Gesundheitswissenschaften》2018,26(1):81-90
Aim
Cataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment.Subject and methods
In this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany.Results
PCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001).Conclusion
Considering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results.5.
B. Svendsen N. Grytten L. Bø H. Aarseth T. Smedal K-M. Myhr 《The European journal of health economics》2018,19(9):1243-1257
Background
Multiple sclerosis (MS) imposes high economic costs on society, but the patients and their families have to bear some of these costs.Objective
We aimed to estimate the magnitude of these economic costs in Norway.Method
We collected data through a postal questionnaire survey targeting 922 MS patients in Hordaland County, western Norway, in 2013–2014; 546 agreed to participate and were included. The questionnaire included clinical and demographic characteristics, volume and cost of MS-related resource use, work participation, income, government financial support, and disability status.Results
The mean annual total economic costs for the patients and their families were €11,603. Indirect costs accounted for 66% and were lower for women than for men. The direct costs were nearly identical for men and women. The costs increased up to Expanded Disability Status Scale score 6 except for steps between 3 and 4 where it remained nearly constant. The costs reduced from EDSS 6 to 8, and increased from 8 to 9. Lifetime costs ranged from €24,897 to €70,021 for patients with late disease onset and slow progression, and between €441,934 and €574,860 for patients with early onset and rapid progression.Conclusion
The economic costs of MS impose a heavy burden on the patients and their families. Supplementing the information on the cost of MS to society, our finding should be included as background information in decisions on reimbursing and allocating public resources for the well-being of MS patients and their families.6.
Jens-Oliver Bock Dirk Heider Herbert Matschinger Hermann Brenner Kai-Uwe Saum Walter E. Haefeli Hans-Helmut König 《The European journal of health economics》2016,17(2):149-158
Introduction
All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans.Methods
Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57–84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals’ WTP was elicited based on a contingent valuation method with a payment card.Results
Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20 % of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly.Discussion
The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.7.
Objective
In recent years, the co-existence in Germany of two parallel comprehensive insurance systems—statutory health insurance (SHI) and private health insurance (PHI)—has been posited as a possible cause of a persistent unequal regional distribution of physicians. The present study investigates the effect of the proportion of privately insured patients on the density of SHI-licensed physicians, while controlling for regional variations in the average income from SHI patients.Methods
The proportion of residents in a district with private health insurance is estimated using complete administrative data from the SHI system and the German population census. Missing values are estimated using multiple imputation techniques. All models control for the estimated average income ambulatory physicians generate from treating SHI insured patients and a well-defined set of covariates on the level of districts in Germany in 2010.Results
Our results show that every percentage change in the proportion of residents with private health insurance is associated with increases of 2.1 and 1.3 % in the density of specialists and GPs respectively. Higher SHI income in rural areas does not compensate for this effect.Conclusion
From a financial perspective, it is rational for a physician to locate a new practice in a district with a high proportion of privately insured patients. From the perspective of patients in the SHI system, the incentive effects of PHI presumably contribute to a concentration of health care services in wealthy and urban areas. To date, the needs-based planning mechanism has been unable to address this imbalance.8.
Anne-Line Couillerot-Peyrondet Cléa Sambuc Yoël Sainsaulieu Cécile Couchoud Isabelle Bongiovanni-Delarozière 《The European journal of health economics》2017,18(4):459-469
Objectives
In the current pressured economic context, and to continue to treat the growing number of patients with high-quality standards, the first step is to have a better understanding of the costs related to end-stage renal disease (ESRD) treatment according to various renal replacement therapy, age, diabetes status, and clinical events.Methods
In order to estimate the direct costs of all adult ESRD patients, according to (RRT) modality, patient condition, and clinical events, data from the French national health insurance funds were used.Results
The mean monthly costs for the 47,862 stable prevalent patients (73 % of the population) varied substantially according to treatment modality (from 7300€ for in-center hemodialysis to 1100€ for a functioning renal graft) and to clinical event (8300€ for the first month of dialysis, 11,000€ for the last month before death, 22,800€ for the first month after renal transplantation). Mean monthly costs varied according to diabetic status and to age to a lesser extent.Conclusions
These results demonstrate, for the first time in France and in Europe, the importance of a dynamic view of renal care and the bias likely when comparing treatments in cross-sectional studies.9.
I. García-Nogueras I. Aranda-Reneo L. M. Peña-Longobardo J. Oliva-Moreno Pedro Abizanda 《The journal of nutrition, health & aging》2017,21(2):207-214
Background
Frailty is associated with adverse health outcomes, but its association with hospital healthcare costs has not been analyzed. The main objective was to estimate the adjusted annual costs and use of hospital healthcare resources in frail older adults compared to non frail ones.Design
FRADEA Study. Mean follow-up 1044 days (SD 314).Setting
Albacete city, Spain.Participants
830 adults ≥70 years.Measurements
Age, sex, comorbidity measured with the Charlson index and Fried´s Frailty phenotype as independent variables, and use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs as outcome variables. Outcome data were collected from Minimum Data Set of the Complejo Hospitalario Universitario Albacete. The cost base year was 2013. Logistic regression and two-part models were used to analyze the association between frailty and the use of healthcare resources. Generalized Linear Models were applied to estimate the impact of frailty and comorbidity on the healthcare costs.Results
The average cost associated with the use of health resources was 1,922€/year. Frail participants had an average total cost of health resources of 2,476€/year, pre-frail 2,056€/year, and non-frail 1,217€/year. 67% of the total health cost was associated with hospital admission cost, 29% with specialist visits cost and 4% with emergency visits cost. Frailty and comorbidity were the most important factors associated with the use of hospital healthcare resources. Adjusted healthcare costs were 592€/year and 458€/year greater in frail and pre-frail participants respectively, compared to non-frail ones, and having a Charlson index ≥ 3, was associated with an increased costs of 2,289€/year.Conclusion
Frailty and comorbidity are meaningful and complementary associated with increased hospital healthcare resources use, and related costs.10.
11.
Objectives
To examine the association between early retirement and presence of chronic morbidity in an Italian working population approaching the statutory pension age.Methods
The study population consisted of men and women aged 45–59 years, employed at some time in the past (n = 18,547), who participated in a national cross-sectional survey, conducted in 2005. By means of a standardized questionnaire, information was collected on employment status, chronic diseases, and sociodemographics. The outcome was being retired as of the survey date. The association with number of diseases reported and specific long-term illnesses was assessed through multivariate Poisson regression models with robust standard errors, adjusted for potential confounders (p < 0.05).Results
In the final multivariable models, people with poorer health were more likely to retire earlier. Diseases of the nervous system, malignant tumors, myocardial infarction, other cardiac diseases, and arthrosis/arthritis were the illnesses most strongly associated with early retirement; furthermore, the risk of retirement increased linearly as the number of diseases reported increased. Among other covariates, age, area of residence, educational level, and occupational social class were also significantly associated with the outcome. Occupational social class significantly modified the association between morbidity and retirement in men, among whom a higher risk of retirement associated with morbidity was observed in the highest, compared with lower social classes.Conclusions
A statistically significant and independent association between chronic morbidity and early retirement was observed among subjects approaching the statutory pension age, suggesting the need to develop interventions to improve prevention and treatment of chronic conditions.12.
Objectives
To analyze the association between physical inactivity in different domains and direct public healthcare expenditures in adults and to identify whether the clustering of physical inactivity in different domains would contribute to increased public healthcare.Methods
The sample composed of 963 adults randomly selected in a middle-size Brazilian city. Annual healthcare expenditure was estimated including all items registered in the medical records in the last 12 months prior to the interview. Habitual physical activity was estimated using Baecke questionnaire, which considers three components of physical activity (work, sports and leisure-time activities).Results
Higher healthcare expenditures of medicines were associated with lower physical activity at work (OR 1.58 [1.06–2.35]), sport (OR 1.57 [1.12–2.18]) and physical inactivity in three domains (OR 2.12 [1.18–3.78]). Expenditures related to medicine (r = 0.109 [95 % CI 0.046–0.171]) and overall expenditures (r = 0.092 [95 % CI 0.029–0.155]) were related to physical inactivity, independently of age, sex, smoking, blood pressure and obesity.Conclusions
Physically inactive subjects in different domains of physical activity have increased likelihood to be inserted at groups of higher healthcare expenditure.13.
Juliane Tetzlaff Ulrike Junius-Walker Denise Muschik Jelena Epping Sveja Eberhard Siegfried Geyer 《Zeitschrift fur Gesundheitswissenschaften》2017,25(2):215-222
Aim
Time trends in multimorbidity have rarely been examined and no criteria have been developed to measure the development of multimorbidity over time. Against the backdrop of increasing numbers of diagnoses a robust measure is needed that is sensitive to changes over time and allows to differentiate between multimorbid and non-multimorbid individuals. We examine how prevalence estimates change as criteria for defining multimorbidity are varied systematically and how this influences the observed time trend.Subject and methods
Our analyses are based on the data of a German statutory health insurance from 2005 to 2013. Measures are compared using different minimal numbers of chronic conditions required to define multimorbidity: three and six. As a stricter criterion both variants are then combined with polypharmacy.Results
All definitions of multimorbidity are leading to increasing prevalence rates over time. Defining multimorbidity as the presence of three or more chronic conditions leads to very high prevalence rates and is lacking discriminative power in the oldest old. Lower prevalence rates with a sharp increase over time can be observed in the proportion of insured with at least six chronic conditions. Adding polypharmacy reduces the growth over time remarkably.Conclusion
The analyses suggest that the increase of multimorbidity is mainly driven by chronic conditions that are not in need of complex medication. Simple disease counts are inappropriate for defining multimorbidity.14.
F. R. Rolli M. Ruggeri F. Kheiraoui C. Drago M. Basile C. Favaretti A. Cicchetti 《The European journal of health economics》2018,19(9):1365-1374
Background
Hepatitis C virus (HCV) is a major health issue worldwide. New generation of direct-active antiviral medications is an epoch-making turning point in the management of HCV infections.Objective
Conducing a cost-effectiveness analysis comparing the combination of elbasvir/grazoprevir and sofosbuvir?+?pegylated interferon/ribavirin for the management of all HCV patients (even those in the initial stages of fibrosis).Methods
A Markov model was built on the natural history of the disease to assess the efficacy of the alternatives. The outcomes are expressed in terms of quality adjusted life-years (QALYs) and result in terms of incremental cost-effectiveness ratio).Results
Elbasvir/grazoprevir implies an expenditure of €21,104,253.74 with a gain of 19,287.90 QALYs and sofosbuvir?+?pegylated interferon/ribavirin implies an expenditure of €31,904,410.11 with a gain of 18,855.96 QALYs. Elbasvir/grazoprevir is thus a dominant strategy.Conclusion
Consideration should be given to the opportunity cost of not treating patients with a lower degree of fibrosis (F0–F2).15.
Felix Kapp Julia Rapp Julia Rose Linda Kruse Annekatrin Wetzstein 《Pr?vention und Gesundheitsf?rderung》2018,13(4):298-304
Background
Within serious games, in particular simulation games, have potential when it comes to teaching complex topics. Simulation games allow learners to explore the complex interplay of various variables. The current campaign of the German statutory accident insurance (DGUV; Deutsche Gesetzliche Unfallversicherung) addresses such a complex topic in the field of prevention at work: one’s own prevention culture.Aims
Based on the goals of the current campaign (e.?g., promoting a holistic approach with regard to safety and health in organizations), the aim of the present contribution is to describe how a serious game can help raise awareness for one’s own prevention culture.Results
The article presents the concept of the simulation game “culture of prevention” (short working title “simkult”). In this multiplayer game, the player has the role of a restaurant manager who is responsible for the health and productivity of his employees. In this article, the core elements of the game, the implementation within teams, and preliminary results of the concept evaluation are presented and discussed.16.
Background
Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households.Aims and methods
This paper reports on an ‘extended’ cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles.Results
Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income.Conclusions
Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.17.
T. Lehnert O. H. Günther A. Hajek S. G. Riedel-Heller H. H. König 《The European journal of health economics》2018,19(9):1213-1223
Background
Most people prefer to “age in place” and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care.Objective
To investigate preferences for home- and community-based long-term care services packages.Design
Discrete choice experiment conducted in mailed survey.Setting and participants
Randomly selected sample of the general population aged 45–64 years in Germany (n?=?1.209).Main variables studied
Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2–4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment.Results
Quality of care was the most important attribute to respondents and small teams of regular caregivers (1–2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98.Conclusions
Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.18.
Tomáš Mlčoch Jiří Klimeš Libor Fila Věra Vávrová Veronika Skalická Marek Turnovec Veronika Krulišová Jitka Jirčíková Dana Zemková Klára Vilimovská Dědečková Alena Bílková Vladimíra Frühaufová Lukáš Homola Zuzana Friedmannová Radovan Drnek Pavel Dřevínek Tomáš Doležal Milan MacekJr. 《The European journal of health economics》2017,18(1):73-82
Background
Economic data pertaining to cystic fibrosis (CF), is limited in Europe generally, and completely lacking in Central and Eastern Europe. We performed an analysis of all direct costs associated with CF relative to key disease features and laboratory examinations.Methods
A retrospective prevalence-based cost-of-illness (COI) study was performed in a representative cohort of 242 CF patients in the Czech Republic, which represents about 65 % of all Czech CF patients. Medical records and invoices to health insurance companies for reference year 2010 were analyzed.Results
The mean total health care costs were €14,486 per patient, with the majority of the costs going towards medicinal products and devices (€10,321). Medical procedures (€2676) and inpatient care (€1829) represented a much smaller percentage of costs. A generalized linear model showed that the strongest cost drivers, for all cost categories, were associated with patient age and lung disease severity (assessed using the FEV1 spirometric parameter), when compounded by chronic Pseudomonas aeruginosa airway infections. Specifically, maximum total costs are around the age 16 years; a FEV1 increase of 1 % point represented a cost decrease of: 0.9 % (medicinal products), 1.7 % (total costs), 2.8 % (procedures) and 7.0 % (inpatient care).Conclusions
COI analysis and regression modeling using the most recent data available can provide a better understanding of the overall economic CF burden. A comparison of our results with other methodologically similar studies demonstrates that although overall costs may differ, FEV1 can nonetheless be utilized as a generally transferrable indicator of the relative economic impact of CF.19.
Xue Yang Mingsheng Chen Jinglin Du Zhonghua Wang 《International journal for equity in health》2018,17(1):173
Background
China has recently made efforts to integrate urban and rural basic medical insurance systems in order to ensure both urban and rural enrollees obtain unified benefits. However, whether the distribution of government healthcare subsides has become more equitable remains unknown. The purpose of this study was to analyze determinants of and inequality in net inpatient care benefits under the integration of urban-rural medical insurance systems in China.Methods
Data were obtained from a nationally representative household survey, the Fifth National Health Services Survey (2013), conducted in Anhui province. A multiple regression model and concentration index (CI) was used to estimate related factors and inequality of inpatient care net benefits.Results
Findings indicated that individuals received more inpatient care benefits when urban and rural social healthcare systems were integrated. Factors associated with net benefits included gender, age, marital status, retirement, educational level, history of chronic diseases, health status, willingness to seek inpatient care and per capita income. The rich were found to disproportionately benefit from inpatient care, and the CI of net benefits for integrated insurance enrollees was the lowest among all three available health insurance schemes. These findings indicate that the recent unification of urban-rural social health insurances reduces inequality in net benefits from government subsidies. Some socioeconomic factors, such as per capita income, 60?years of age and over, history of chronic disease and high educational level positively influence inequality.Conclusion
In China, accelerating the integration of urban and rural medical insurance systems is an effective way to increase equity of benefit in urban and rural areas. Strategies aimed at reducing inpatient benefit inequality must address socioeconomic factors influencing healthcare outcomes.20.
Paola Mantellini Giuseppe Lippi Lapo Sali Grazia Grazzini Silvia Delsanto Beatrice Mallardi Massimo Falchini Guido Castiglione Francesca Maria Carozzi Mario Mascalchi Stefano Milani Leonardo Ventura Marco Zappa 《The European journal of health economics》2018,19(5):735-746