Janine Biermann

Heart Failure: the Commonest Reason for Hospital Admission in Germany: Medical and Economic Perspectives

BACKGROUND Heart failure is now the commonest reason for hospitalization in Germany (German Federal Statistical Office, 2008). Heart failure will continue to be a central public health issue in the future as the population ages. This article focuses on regional differences, the costs of the disease, and the expected rate of increase in cases in the near future. METHODS This analysis is based on diagnosis statistics, cause-of-death statistics, and cost of illness data, as reported by the German Federal Statistical Office. Age- and sex-specific differences are taken into account. RESULTS 2006 was the first year in which heart failure led to more hospital admissions in Germany (317 000) than any other diagnosis. At present, about 141 000 persons in Germany aged 80 and over have heart failure; by the year 2050, it is predicted that more than 350 000 persons in this age group will be affected. The rate of diagnosis of heart failure, its frequency as a cause of death, and the costs associated with it all vary across the individual states of the Federal Republic of Germany. The nationwide cost of heart failure in 2006 was estimated at 2.9 billion euros. CONCLUSIONS These findings reveal that heart failure has become more common as an admission diagnosis of hospitalized patients in Germany. Because the population is aging, new concepts for prevention and treatment will be needed in the near future so that the affected patients can continue to receive adequate care.

Treatment costs and indirect costs of cluster headache: A health economics analysis:

Background: Cluster headache (CH) is the most frequent trigemino-autonomic cephalgia. CH can manifest as episodic (eCH) or chronic cluster headache (cCH) causing significant burden of disease and requiring attack therapy and prophylactic treatment. Methods: Treatment costs (direct costs) due to healthcare utilisation, as well as costs caused by disability and reduction in earning capacity (indirect costs), were obtained using a questionnaire in CH patients treated in a tertiary headache centre based at the University Duisburg-Essen over a 6-month period. Results: A total 179 patients (72 cCH, 107 eCH) were included. Mean attack frequency was 3.5 ± 2.5 per day. Mean direct and indirect costs for one person were €5963 in the 6-month period. Direct costs were positively correlated with attack frequency (r = 0.467, p < 0.001). Burden of disease measured with HIT-6 showed a significant correlation with attack frequency (r = 0.467, p < 0.001). Twenty-four (13.4%) of the participants were disabled and not able to work. Conclusion: CH leads to major socioeconomic impact on patients as well as society due to direct healthcare costs and indirect costs caused by loss of working capacity.

Allergic disorders of the respiratory tract — findings from a large patient sample in the German statutory health insurance system

SummaryBackground: Worldwide, the number of patients with allergic diseases is global increasing, especially in the industrialized nations. Experts estimate that only about 10 % of allergic patients are treated according to the latest guidelines. The aim of this study is to map the medical care situation of patients with allergic respiratory diseases under the German statutory health insurance system and to investigate the impact on patient care since January 1, 2009, when ceilings for service volumes in allergology were implemented.Therefore, we analyzed the diagnostic and therapeutic behaviour of physicians between 2007 and 2010 by using claims data from the National Association of Statutory Health Insurance Physicians. Methods: The claims data was from the national four-birthday sample, including more than 9 million patients (13 % of the population). From this, the study cohort was extracted, including 725,000 patients with allergic rhinitis and 260,000 patients with allergic asthma. Analyzes refer to diagnostic codes and fee schedule items, e. g., as for specific immunotherapy. Results: The average number of total coded diagnoses per patient and per physician’s office has generally increased, while the number of physician’s offices encoding allergological diagnoses is decreasing. In contrast, the number of claimed allergological fee schedule items (especially specific immunotherapy) diminished. 7 % of patients with rhinitis and 5 % of patients with allergic asthma receive specific immunotherapy, mostly performed by specialists. Conclusion: The analysis shows an increase in the total number of allergic patients in the studied cohort. In contrast, the ratio of patients receiving specific immunotherapy seems disproportionately low. One consequence could be additional health care costs arising from the progression of these diseases, e. g., by an increase of allergic asthma.ZusammenfassungHintergrund: Die Zahl der Patienten mit allergischen Erkrankungen nimmt weltweit, vor allem in den Industrienationen, zu. Experten schätzen, dass nur etwa 10 % der allergischen Patienten entsprechend den aktuellen Leitlinien behandelt werden. Das Ziel der vorliegenden Studie ist es, die Versorgungssituation von gesetzlich versicherten Patienten mit allergischen Atemwegserkrankungen abzubilden und diese im Hinblick auf potenzielle Einflüsse zu untersuchen, die durch die zum 1. Januar 2009 eingeführten Regelleistungsvolumina entstanden sind. Hierzu wurde das Diagnose- und Therapieverhalten allergologisch tätiger Ärzte anhand der Abrechnungsdaten der Kassenärztlichen Bundesvereinigung von 2007 bis 2010 analysiert. Methoden: Die Datengrundlage stellt die nationale Vier-Geburtstagsstichprobe dar, die mehr als 9 Millionen Patienten (13 % der Bevölkerung) einschließt. Aus dieser wurde die Studienkohorte extrahiert, welche 725.000 Patienten mit allergischer Rhinitis und 260.000 Patienten mit allergischem Asthma umfasst. Die Analysen beziehen sich auf Diagnose- und Abrechnungskodes, z. B. für die spezifische Immuntherapie. Ergebnisse: Die durchschnittliche Gesamtzahl der kodierten Diagnosen pro Patient und pro Arztpraxis hat insgesamt zugenommen, während die Zahl der Arztpraxen abnimmt, die allergologische Diagnosen kodieren. Im Gegensatz dazu sinkt die Zahl der abgerechneten allergologischen Gebührenordnungsziffern (insbesondere die spezifische Immuntherapie). 7 % der Patienten mit Rhinitis und 5 % der Patienten mit allergischem Asthma erhalten eine spezifische Immuntherapie, welche meist von Fachärzten durchgeführt wird. Schlussfolgerung: Die Analyse zeigt einen Anstieg der Gesamtzahl von allergischen Patienten in der untersuchten Kohorte. Im Gegensatz dazu scheint der Anteil der Patienten, die eine spezifische Immuntherapie erhalten, unterproportional. Infolge dessen könnten zusätzliche Kosten im Gesundheitswesen durch die Progredienz der Erkrankungen entstehen, z. B. durch eine Zunahme des allergischen Asthmas.

Economic burden of patients with various etiologies of chronic systolic heart failure analyzed by resource use and costs

analyzed by resource use and costs Janine Biermann , Till Neumann ⁎, Christiane E. Angermann , Raimund Erbel , Bernhard Maisch , David Pittrow , Vera Regitz-Zagrosek , Thomas Scheffold , Rolf Wachter , Gotz Gelbrich , Jurgen Wasem , Anja Neumann b and on behalf of the German Competence Network Heart Failure a Clinic of Cardiology, University Hospital Essen, Germany b Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany c Department of Internal Medicine I and Comprehensive Heart Failure Center, University Hospital Wurzburg, Germany d Department of Internal Medicine, Cardiology, University Hospital Giessen and Marburg, Marburg, Germany e Department for Clinical Pharmacology, Medical Faculty, Carl Gustav Carus, Technical University of Dresden, Germany f Department of Cardiovascular Diseases in Women, Charite University Medicine, Berlin, Germany g Institute for Heart and Circulation Research, University of Witten/Herdecke, Dortmund, Germany h Department of Cardiology and Pneumology, Georg-August University Gottingen, Germany i Clinical Trial Centre Leipzig, University of Leipzig, Germany

Evaluation of the short- and long-term safety and therapy outcomes of the everolimus-eluting bioresorbable vascular scaffold system in patients with coronary artery stenosis: Rationale and design of the German-Austrian ABSORB RegIstRy (GABI-R).

BACKGROUND Third-generation drug-eluting metal stents are the gold standard for treatment of coronary artery disease. The permanent metallic caging of the vessel, however, can result in limited vasomotion, chronic inflammation, and late expansive remodeling, conditions that can lead to late and very late stent thrombosis. The development of bioresorbable scaffolds (BRSs) promises advantages over metal stents due to complete biodegradation within 2-4years. Theoretically, since vessel scaffolding is temporary and no permanent implant remains in the vessel, BRSs, as opposed to metal stents, once degraded would no longer be potential triggers for stent-related adverse events or side effects. METHODS/DESIGN The short- and long-term outcome after implantation of an everolimus-eluting, poly-L-lactic acid-based bioresorbable scaffold system (ABSORB, Abbott Vascular, Santa Clara, CA, USA) in the world-wide greatest all-comers cohort will be evaluated in the prospective, non-interventional, multicenter German-Austrian ABSORB RegIstRy (GABI-R). GABI-R will include over 5000 patients from about 100 study sites in Austria and Germany. Safety endpoints such as cardiac death, myocardial infarction, and clinically driven percutaneous or surgical target lesion and vessel revascularization will be evaluated during hospitalization and in the follow-up period (minimum of 5years). CONCLUSION Although two randomized controlled trials and several registries have documented safety and efficacy as well as non-inferiority of this everolimus-eluting ABSORB device compared with drug-eluting metal stents, the current knowledge regarding clinical application, treatment success, and long-term safety of using this BRS in daily routine is limited. Thus, the goal of GABI-R is to address this lack of information.

Einfluss der demographischen Entwicklung auf die stationären Fallzahlen und Kosten deutscher Krankenhäuser

ZusammenfassungHintergrund:Für die kommenden 30 Jahre wird eine progrediente Alterung der Bevölkerung in den westlichen Industrienationen prognostiziert. Neben sozioökonomischen und gesellschaftlichen Effekten sind hierdurch Auswirkungen auf das Gesundheitssystem zu erwarten. Die vorliegende Arbeit betrachtet die Auswirkungen des demographischen Wandels auf stationäre Fallzahlen und resultierende Kosten in deutschen Krankenhäusern.Methodik:Analysegrundlage bilden die 12. koordinierte Bevölkerungsvorausberechnung, die Daten von Hauptdiagnosegruppen der Diagnosestatistik sowie der Krankheitskostenrechnung des Statistischen Bundesamtes. Die Projektion erfolgt unter Berücksichtigung alters- und geschlechtsspezifische Unterschiede.Ergebnisse:Die Zahl der stationären Krankenhausaufenthalte wird zwischen 2010 und 2040 insgesamt um 12% steigen. Der größte Anstieg wird mit einer Zunahme der Fallzahlen um 34% bis 2040 bei Erkrankungen des Herzkreislaufsystems erwartet. Aufenthalte wegen psychischen und Verhaltensstörungen zeigen hingegen eine gegenläufige Entwicklung mit einer Reduktion der Fallzahlen um 9%. Als Folge der zu erwartenden ansteigenden stationären Krankenhausaufnahmen muss von einer weiteren Steigerung der Ausgaben in diesem Gesundheitssektor ausgegangen werden.Diskussion:Die Alterung der Bevölkerung wird die Nachfrage nach stationären Krankenhausleistungen in den kommenden Jahren weiter ansteigen lassen. Dabei sind Unterschiede zwischen den einzelnen Krankheitsgruppen zu erwarten. Die Entwicklung neuer Versorgungsstrategien sollte diese Aspekte berücksichtigen.AbstractBackground:In the next years the population of most western countries will age rapidly. Beside socioeconomic and social problems sustainable consequences on the health care system are expected. Ageing of the population will place a corresponding growth in demand of health care services and relating expenditures. The following analysis assesses the impact of demographic factors on hospital admissions and related costs over the next 30 years.Method:German Federal Statistical Office 12th coordinated population projection, diagnosis statistics and cost of illness data were used to develop a projection of future hospital admissions and associated economic burden. The model considers age- and sex-specific differences.Results:Ageing will increase all-cause hospital admissions by 12% between 2010 and 2040. Diseases of the circulatory system will have one of the most tremendous increases with an expected rise of 34% until 2040. In contrast, hospital stays because of mental and behavioural disorders will decrease by 9%. As hospital admissions rise we expect a further increase in overall expenditures for hospitalisations.Discussion:Ageing of the population will further increase the demand for inpatient hospital services during the coming years. Nevertheless, the increase of hospital admissions will differ concerning single illness groups. The development of new care strategies should take these aspects into consideration.BACKGROUND In the next years the population of most western countries will age rapidly. Beside socioeconomic and social problems sustainable consequences on the health care system are expected. Ageing of the population will place a corresponding growth in demand of health care services and relating expenditures. The following analysis assesses the impact of demographic factors on hospital admissions and related costs over the next 30 years. METHOD German Federal Statistical Office 12th coordinated population projection, diagnosis statistics and cost of illness data were used to develop a projection of future hospital admissions and associated economic burden. The model considers age- and sex-specific differences. RESULTS Ageing will increase all-cause hospital admissions by 12% between 2010 and 2040. Diseases of the circulatory system will have one of the most tremendous increases with an expected rise of 34% until 2040. In contrast, hospital stays because of mental and behavioural disorders will decrease by 9%. As hospital admissions rise we expect a further increase in overall expenditures for hospitalisations. DISCUSSION Ageing of the population will further increase the demand for inpatient hospital services during the coming years. Nevertheless, the increase of hospital admissions will differ concerning single illness groups. The development of new care strategies should take these aspects into consideration.

Influence of the demographic change on hospital admissions and costs in Germany

ZusammenfassungHintergrund:Für die kommenden 30 Jahre wird eine progrediente Alterung der Bevölkerung in den westlichen Industrienationen prognostiziert. Neben sozioökonomischen und gesellschaftlichen Effekten sind hierdurch Auswirkungen auf das Gesundheitssystem zu erwarten. Die vorliegende Arbeit betrachtet die Auswirkungen des demographischen Wandels auf stationäre Fallzahlen und resultierende Kosten in deutschen Krankenhäusern.Methodik:Analysegrundlage bilden die 12. koordinierte Bevölkerungsvorausberechnung, die Daten von Hauptdiagnosegruppen der Diagnosestatistik sowie der Krankheitskostenrechnung des Statistischen Bundesamtes. Die Projektion erfolgt unter Berücksichtigung alters- und geschlechtsspezifische Unterschiede.Ergebnisse:Die Zahl der stationären Krankenhausaufenthalte wird zwischen 2010 und 2040 insgesamt um 12% steigen. Der größte Anstieg wird mit einer Zunahme der Fallzahlen um 34% bis 2040 bei Erkrankungen des Herzkreislaufsystems erwartet. Aufenthalte wegen psychischen und Verhaltensstörungen zeigen hingegen eine gegenläufige Entwicklung mit einer Reduktion der Fallzahlen um 9%. Als Folge der zu erwartenden ansteigenden stationären Krankenhausaufnahmen muss von einer weiteren Steigerung der Ausgaben in diesem Gesundheitssektor ausgegangen werden.Diskussion:Die Alterung der Bevölkerung wird die Nachfrage nach stationären Krankenhausleistungen in den kommenden Jahren weiter ansteigen lassen. Dabei sind Unterschiede zwischen den einzelnen Krankheitsgruppen zu erwarten. Die Entwicklung neuer Versorgungsstrategien sollte diese Aspekte berücksichtigen.AbstractBackground:In the next years the population of most western countries will age rapidly. Beside socioeconomic and social problems sustainable consequences on the health care system are expected. Ageing of the population will place a corresponding growth in demand of health care services and relating expenditures. The following analysis assesses the impact of demographic factors on hospital admissions and related costs over the next 30 years.Method:German Federal Statistical Office 12th coordinated population projection, diagnosis statistics and cost of illness data were used to develop a projection of future hospital admissions and associated economic burden. The model considers age- and sex-specific differences.Results:Ageing will increase all-cause hospital admissions by 12% between 2010 and 2040. Diseases of the circulatory system will have one of the most tremendous increases with an expected rise of 34% until 2040. In contrast, hospital stays because of mental and behavioural disorders will decrease by 9%. As hospital admissions rise we expect a further increase in overall expenditures for hospitalisations.Discussion:Ageing of the population will further increase the demand for inpatient hospital services during the coming years. Nevertheless, the increase of hospital admissions will differ concerning single illness groups. The development of new care strategies should take these aspects into consideration.BACKGROUND In the next years the population of most western countries will age rapidly. Beside socioeconomic and social problems sustainable consequences on the health care system are expected. Ageing of the population will place a corresponding growth in demand of health care services and relating expenditures. The following analysis assesses the impact of demographic factors on hospital admissions and related costs over the next 30 years. METHOD German Federal Statistical Office 12th coordinated population projection, diagnosis statistics and cost of illness data were used to develop a projection of future hospital admissions and associated economic burden. The model considers age- and sex-specific differences. RESULTS Ageing will increase all-cause hospital admissions by 12% between 2010 and 2040. Diseases of the circulatory system will have one of the most tremendous increases with an expected rise of 34% until 2040. In contrast, hospital stays because of mental and behavioural disorders will decrease by 9%. As hospital admissions rise we expect a further increase in overall expenditures for hospitalisations. DISCUSSION Ageing of the population will further increase the demand for inpatient hospital services during the coming years. Nevertheless, the increase of hospital admissions will differ concerning single illness groups. The development of new care strategies should take these aspects into consideration.

Budget impact analysis on the introduction of a guideline based hepatitis B and C screening into a routine check-up in the German primary care setting

Abstract Objectives: Systematic screening for chronic hepatitis B and C does not yet exist in Germany. Therefore, the implementation of a screening approach within a preventive medical examination performed by primary care physicians (‘Check-Up 35+’) was evaluated in a recent prospective multicenter study. The present analysis estimates the financial consequences for the statutory health insurance by budget impact analysis. Materials and methods: A Markov cohort model was developed consisting of 21 health states. Four different screening scenarios derived from the previous multicenter study were compared to usual care, a strategy without screening for hepatitis. Actual cost data for Germany were calculated and systematic literature searches for all input parameters were performed. Results: The base case results in incremental costs for the screening strategies compared to no hepatitis screening of 165–227 € per patient in a 20-year horizon. Two main parameters influence the financial consequences: (A) detection and treatment increase the costs in the beginning. (B) Screening avoids hepatitis induced end-stage liver disease. The initial higher costs exceed the later savings. Sensitivity analyses demonstrate a strong impact of medication costs for the treatment of additionally detected hepatitis infections on the outcome. This finding is robust to sensitivity analysis. Conclusions: The screening strategy proposed here implies additional costs for the statutory health insurance, however, a decision regarding its usefulness must consider criteria other than cost. For example, the high burden of disease due to liver cirrhosis and liver carcinoma should be considered. Therefore, an additional cost-effectiveness-analysis should be conducted.

Economic burden of multiple sclerosis to the social insurance system in Germany

AimThis study aims to calculate the cost of illness concerning multiple sclerosis (MS) from the perspective of the German social insurance system.Subjects and methodsExpenditures for MS (ICD-10 GM: G35) were evaluated retrospectively for the year 2012 from the perspective of the social insurance system. Expenditures from the German statutory health insurance, the Federal statutory pension fund, and statutory long-term care insurances were calculated based on administrative claims of a large nationwide health insurance and statistics from the Federal statutory pension fund. Additionally, expenditures of the long-term care insurances were requested by standardized questionnaire. Costs were extrapolated for all health and statutory long-term care insurances.ResultsIn the base case, extrapolated expenditures for German statutory health insurance amount to 1.062 billion €. German statutory pension funds expenses for MS were around 258.700 million € on medical rehabilitation and early retirement. Extrapolated for the whole population insured expenditures of the statutory long-term care insurances on persons with MS were approximately 372.200 million €.ConclusionThis study delivered important information regarding the economic burden of MS for the social insurance system in Germany. The top-down process of data collection yielded population-based results on the cost of illness.

Krankheitsverlauf allergischer Atemwegserkrankungen nach Behandlungsstrategie basierend auf GKV-Routinedaten

HintergrundAllergische Atemwegserkrankungen stellen ein weltweit relevantes Gesundheitsproblem dar. Die beiden wesentlichen Behandlungsstrategien sind die symptomatische Pharmakotherapie und die spezifische Immuntherapie (SIT), die als einziger kausaler Therapieansatz angesehen wird, der den natürlichen Krankheitsverlauf beeinflussen kann. Ziel dieser Arbeit ist die Beschreibung des Krankheitsverlaufs und der Medikation allergischer Atemwegserkrankungen in verschiedenen Behandlungsstrategien und Erkrankungsgruppen.MethodenDie Untersuchung basiert auf Routinedaten einer deutschen gesetzlichen Krankenkasse. Von 2007 bis 2012 wurde eine definierte Patientenkohorte beobachtet. Die Patienten wurden jedes Jahr anhand ihrer gesicherten ambulanten Diagnosen einer der folgenden Erkrankungsgruppen zugeordnet: Rhinitis, Asthma oder beide Erkrankungen zugleich. Zudem wurden Verordnungen rezeptpflichtiger Arzneimittel analysiert. Die Populationen für den Vergleich der Behandlungsstrategien beruhen auf einem Matched-Pair-Verfahren.ErgebnisseDie Studienpopulation umfasste 165.446 Patienten mit allergischen Atemwegserkrankungen. Im Jahr 2007 war Rhinitis (70 %) die größte Erkrankungsgruppe, gefolgt von Asthma (16 %) und beiden Erkrankungen (14 %). Während des Beobachtungszeitraums wiesen etwa 12 % der Rhinitis-Patienten und 28 % der Asthma-Patienten eine zusätzliche Diagnose allergischer Atemwegserkrankungen auf. Bei rund 50 % der Patienten mit beiden Erkrankungen entfiel eine der beiden Diagnosen im Beobachtungszeitraum. Bei diesen Patienten war es unter SIT im Vergleich zur symptomatischen Pharmakotherapie wahrscheinlicher, dass die Asthma-Diagnose nicht mehr dokumentiert wurde. Zudem bestand unter SIT seltener eine Verordnung von Asthma-Medikation.SchlussfolgerungDie Untersuchungsergebnisse der Diagnosen im Zeitverlauf spiegeln die wechselhafte Natur allergischer Erkrankungen wider. Trotz der Einschränkungen in der Dokumentationsgenauigkeit und des Mangels an klinischen Informationen werden im Vergleich der Behandlungsstrategien Vorteile der SIT bezüglich des Krankheitsverlaufs und der Verordnung von Asthma-Medikation sichtbar.