Hans-Helmut König

The impact of ageing on hospital care and long-term care—the example of Germany

BACKGROUNDnIn the next few decades the population in all EU-countries will age rapidly. This could have a major impact on the health care sector. This study analyses the effect of population ageing on utilisation in two key sectors of the health care system, namely hospital care and long-term care in Germany, up to 2020 with an outlook to 2050.nnnMETHODSnTwo population scenarios, one with constant, one with increasing life expectancy, were combined with constant age and gender specific utilisation rates of hospital and long-term care. In the case of hospital care two projection methods were used: Method A differentiates between age-groups, gender and main diagnosis. Method B differentiates between age-groups, survivors and decedents.nnnRESULTSnPopulation ageing was found to cause a moderate increase in hospital days, but was associated with substantial changes in the disease and age structure. In the case of increasing life expectancy, method B lead to a lower growth in hospital days than method A. The number of persons receiving long-term care will increase strongly, associated with a shift to more severe disability and institutional care. Changes in the composition of private households and the increasing labour participation of women will lead to additional demand for professional caregivers at home and in institutions.nnnCONCLUSIONSnChanges in the number and disease structure of hospital days due to population ageing will require reorganisation and restructuring of hospital departments. In the case of long-term care a high increase in professional home care and institutional care will be required. Health policy has to take into account these developments in order to adequately deal with future demand for these services.

Cost Effectiveness of Adding Folinic Acid to Fluorouracil Plus Levamisole as Adjuvant Chemotherapy in Patients with Colon Cancer in Germany

AbstractObjective: To assess the cost effectiveness of the addition of folinic acid to fluorouracil plus levamisole in patients with colon cancer from the perspective of the German Social Health Insurance.n Study Design and Methods: Patients with International Union Against Cancer (Union International Contre Cancer; UICC) II/T4 or UICC III colon cancer enrolled in an open-label randomised clinical trial in Germany (Forschungsgruppe Onkologie Gastrointestinaler Tumoren-1 [FOGT-1]) received either fluorouracil plus levamisole (A, standard) or fluorouracil plus levamisole and folinic acid (B) for 12 months as adjuvant chemotherapy after curative intended surgery. Outcome measures for economic evaluation were disease-free life-years gained (df-LYG) and overall life-years gained (LYG) derived from the respective Kaplan-Meer survival curves. Direct medical costs from the perspective of the German Social Health Insurance were estimated retrospectively (2000 values) and incremental cost-effectiveness ratios (ICERs) were calculated. A Markov model was used to project the trial results beyond 5 years for the patients’ remaining life expectancy.n Results: Adding folinic acid to the fluorouracil/levamisole regimen results in an increase in time to progression and survival in patients with locally advanced colon cancer. Within the trial period of 5 years ICERs (B versus A) were €33 008 per df-LYG and €51 225 per LYG (costs and effects discounted at 5%). The Markov model yielded ICERs of €11 176 per df-LYG and €11 020 per LYG (costs and effects discounted at 5%). The model was robust for variations of key variables in the sensitivity analysis.n Conclusions: Results of this cost-effectiveness analysis suggest that the addition of folinic acid offers clinical benefits at additional costs which are likely to be acceptable for decision makers in the long term. Cost-effectiveness ratios calculated within the clinical trial period were just above €50 000/LYG. Because treatment benefits, i.e. prolonged survival, are sustained beyond 5 years whereas incremental costs are mainly incurred in the first year, results of the Markov model yielded cost-effectiveness ratios that compare more favourably with other published ICERs.

Prognostic significance of soluble interleukin-2 receptor-α in adenocarcinoma of the pancreas

Soluble interleukin-2-receptor-alpha (sIL-2Ralpha) serum concentrations were examined in chronic pancreatitis patients, patients with cystadenocarcinoma of the pancreas, patients with adenocarcinoma of the pancreas and healthy blood donors. sIL-2Ralpha serum concentrations in pancreatic cancer patients were significantly higher than those of normal control subjects or chronic pancreatitis patients. In patients with adenocarcinoma of the pancreas no significant differences were found between sIL-2Ralpha and tumor size, grading, resectability and lymph node involvement. In Kaplan-Meier regression analysis patients with adenocarcinoma of the pancreas with low sIL-2Ralpha levels (<500 U/ml) lived significantly shorter than patients with sIL-2Ralpha concentrations above 500 U/ml (P < 0.01), suggesting that determination of sIL-2Ralpha serum concentrations could provide additional important information about prognosis.

Cost-effectiveness of orthoptic screening in kindergarten: a decision-analytic model.

purpose The purpose of this study was to analyze the cost-effectiveness of orthoptic screening for amblyopia in kindergarten. METHODS. A decision-analytic model was used. In this model all kindergarten children in Germany aged 3 years were examined by an orthoptist. Children with positive screening results were referred to an ophthalmologist for diagnosis. The number of newly diagnosed cases of amblyopia, amblyogenic non-obvious strabismus and amblyogenic refractive errors was used as the measure of effectiveness. Direct costs were measured form a third-party payer perspective. Data for model parameters were obtained from the literature and from own measurements in kindergartens. A base analysis was performed using median parameter values. The influence of uncertain parameters was tested in sensitivity analyses. RESULTS. According to the base analysis, the cost of one orthoptic screening test was 7.87 euro. One ophthalmologic examination cost 36.40 euro. The total cost of the screening program in all kindergartens was 3.1 million euro. A total of 4,261 new cases would be detected. The cost-effectiveness ratio was 727 euro per case detected. Sensitivity analysis showed considerable influence of the prevalence rate of target conditions and of the specificity of the orthopic examination on the cost-effectiveness ratio. CONCLUSIONS. This analysis provides information which is useful for discussion about the implementation of orthoptic screening and for planning a field study.

Do physicians accept quality of life and utility measurement

This study investigates to what extent physicians accept quality of life (QoL) and economic utility measures as endpoints in clinical studies. It also explores who physicians think should value health states. As part of a European study three different physician groups were surveyed using a standardized mail questionnaire. These surveys were carried out by national random sample in Finland (rendering n=367) and by nonrandom samples in Austria (n=33), and Germany (n=41). Acceptance of utility measurement was classified by a four-level hierarchy. Knowledge of the QoL concept ranged between 30% and 54% in the three samples. QoL was accepted by 72–90% of physicians, a summary index of QoL by 62–80%, its combination with duration by 51–68%, and quality-adjusted life years by 44–61%. Most physicians felt that health care professionals should value health states, and 92–94% considered common effect measures in clinical and economic studies to be desirable or necessary. Most physicians surveyed accepted QoL as a study endpoint, a significant share accepted utility measurement. Evaluating health effects by common measures is considered an important challenge.