R. Windt

Effects of a German Asthma Disease Management Program Using Sickness Fund Claims Data

The purpose of this study was to assess outcomes of a nationwide asthma disease management (DM) program in Germany. A retrospective observational study with propensity-score matching was performed using claims data of sickness funds exclusively. Effects were analyzed on the basis of a match of 317 program participants and nonparticipants with similar propensity score and age. Hospitalization or oral corticosteroid user rates were comparable in both groups, whereas there are significantly more subjects in the DM group with a prescription of an inhaled corticosteroid and fewer with a prescription of a cromolyn/reproterol combination. There are also less “doctor hoppers” in the DM group, defined as subjects with antiasthmatic drug prescriptions of at least three physicians. The results suggest that the impact of a nationwide disease management program for asthma is weak in respect of clinically relevant endpoints, but there are indications that medication in a DM program approximates asthma guidelines more closely.

Umsetzung der Aut-idem-Regelung vor und nach Einführung der Rabattverträge

OBJECTIVE Due to the aut-idem regulation pharmacies are obligated to substitute medications within the statutory health insurance system to low-priced generics or to dispense the prescribed drug (if only a compound is prescribed low-priced generics have to be dispensed). Since April 1st, 2007 pharmacies have to replace non-rebated by rebated drugs. We aimed to investigate if the prescribing of compounds and substitutions in pharmacies has changed after the introduction of rebate contracts. METHODS We used claims data of the Gmünder ErsatzKasse (GEK) and drew 3 random samples of 1,000 relevant prescriptions each in October 2006, 2007 and 2008. After that, all relevant original prescriptions were screened. RESULTS Between October in 2006, 2007 and 2008, we observed no change in prescribing compounds only (6.0 %; 7.7 %; 6.8 %; p = 0.47). Prescribing compounds was associated with, e. g. dentists, small packages (N1 vs. N3) and antiinfectives. We found a considerable increase in medications that were substituted in pharmacies (2006: 11.3 %; 2007: 29.1 %; 2008: 39.2 %; p <0.0001). CONCLUSION Only through the introduction of rebate contracts an increasing amount of substituted medications took place in pharmacies. Before that, the aut-idem regulation had no considerable regulatory effect.

Geschlechtsspezifische Inanspruchnahme bei der Arzneimittelversorgung in verschiedenen Lebensphasen

ZusammenfassungZiel des vorliegenden Beitrages ist es, die geschlechtsspezifische Arzneimittelversorgung in verschiedenen Lebensphasen exemplarisch für jeweils eine relevante Erkrankung zu analysieren. Hierzu wurde eine Kohorte von 1,7 Mio. Versicherten der Gmünder ErsatzKasse (GEK) untersucht, die in jedem Quartal des Jahres 2009 mindestens 1 Tag versichert war. Wir selektierten anschließend je Altersgruppe Personen mit ambulanten Diagnosen für folgende Erkrankungen: Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) (0 bis 17 Jahre), Hypothyreose (18 bis 49 Jahre), Osteoporose (50 bis 79 Jahre) und koronare Herzkrankheit (80 + Jahre). Die Analysen fanden auf Wirkstoffebene statt. Insgesamt zeigten sich sowohl bei den zur Behandlung der ausgewählten Erkrankungen eingesetzten Wirkstoffen geschlechtsspezifische Unterschiede (z. B. werden Mittel zur Behandlung der ADHS häufiger bei männlichen und zur Behandlung der Hypothyreose häufiger bei weiblichen Versicherten verschrieben), aber auch bei weiteren bei diesen Personengruppen eingesetzten Mitteln. Nicht immer lassen sich eindeutige Erklärungen (wie z. B. der Arzneimittelzulassungsstatus) für diese Ergebnisse finden.AbstractThe aim of the present study is to analyse sex-specific differences in drug utilisation during different phases of life using relevant diseases as examples. We used a cohort of 1.7 million subjects who were insured with the Gmünder ErsatzKasse (GEK), a German health insurance fund, for at least one day in all four quarters of 2009. We analysed subjects with outpatient diagnoses of the following diseases: attention-deficit/hyperactivity disorder (ADHD) (0–17 years), hypothyroidism (18–49 years), osteoporosis (50–79 years) and coronary heart disease (80 + years). Analysis was performed on an active-substance level. A number of differences were observed in drug treatment for the selected diseases (for example, substances for ADHD were prescribed more often in males and for hypothyroidism more often in females), as well as in prescribing practices relating to other drugs used in these groups. However, clear explanations for these differences, such as drug approval status, were not always apparent.The aim of the present study is to analyse sex-specific differences in drug utilisation during different phases of life using relevant diseases as examples. We used a cohort of 1.7 million subjects who were insured with the Gmünder ErsatzKasse (GEK), a German health insurance fund, for at least one day in all four quarters of 2009. We analysed subjects with outpatient diagnoses of the following diseases: attention-deficit/hyperactivity disorder (ADHD) (0-17 years), hypothyroidism (18-49 years), osteoporosis (50-79 years) and coronary heart disease (80 + years). Analysis was performed on an active-substance level. A number of differences were observed in drug treatment for the selected diseases (for example, substances for ADHD were prescribed more often in males and for hypothyroidism more often in females), as well as in prescribing practices relating to other drugs used in these groups. However, clear explanations for these differences, such as drug approval status, were not always apparent.

[Sex-specific differences in drug utilisation in different phases of life].

ZusammenfassungZiel des vorliegenden Beitrages ist es, die geschlechtsspezifische Arzneimittelversorgung in verschiedenen Lebensphasen exemplarisch für jeweils eine relevante Erkrankung zu analysieren. Hierzu wurde eine Kohorte von 1,7 Mio. Versicherten der Gmünder ErsatzKasse (GEK) untersucht, die in jedem Quartal des Jahres 2009 mindestens 1 Tag versichert war. Wir selektierten anschließend je Altersgruppe Personen mit ambulanten Diagnosen für folgende Erkrankungen: Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) (0 bis 17 Jahre), Hypothyreose (18 bis 49 Jahre), Osteoporose (50 bis 79 Jahre) und koronare Herzkrankheit (80 + Jahre). Die Analysen fanden auf Wirkstoffebene statt. Insgesamt zeigten sich sowohl bei den zur Behandlung der ausgewählten Erkrankungen eingesetzten Wirkstoffen geschlechtsspezifische Unterschiede (z. B. werden Mittel zur Behandlung der ADHS häufiger bei männlichen und zur Behandlung der Hypothyreose häufiger bei weiblichen Versicherten verschrieben), aber auch bei weiteren bei diesen Personengruppen eingesetzten Mitteln. Nicht immer lassen sich eindeutige Erklärungen (wie z. B. der Arzneimittelzulassungsstatus) für diese Ergebnisse finden.AbstractThe aim of the present study is to analyse sex-specific differences in drug utilisation during different phases of life using relevant diseases as examples. We used a cohort of 1.7 million subjects who were insured with the Gmünder ErsatzKasse (GEK), a German health insurance fund, for at least one day in all four quarters of 2009. We analysed subjects with outpatient diagnoses of the following diseases: attention-deficit/hyperactivity disorder (ADHD) (0–17 years), hypothyroidism (18–49 years), osteoporosis (50–79 years) and coronary heart disease (80 + years). Analysis was performed on an active-substance level. A number of differences were observed in drug treatment for the selected diseases (for example, substances for ADHD were prescribed more often in males and for hypothyroidism more often in females), as well as in prescribing practices relating to other drugs used in these groups. However, clear explanations for these differences, such as drug approval status, were not always apparent.The aim of the present study is to analyse sex-specific differences in drug utilisation during different phases of life using relevant diseases as examples. We used a cohort of 1.7 million subjects who were insured with the Gmünder ErsatzKasse (GEK), a German health insurance fund, for at least one day in all four quarters of 2009. We analysed subjects with outpatient diagnoses of the following diseases: attention-deficit/hyperactivity disorder (ADHD) (0-17 years), hypothyroidism (18-49 years), osteoporosis (50-79 years) and coronary heart disease (80 + years). Analysis was performed on an active-substance level. A number of differences were observed in drug treatment for the selected diseases (for example, substances for ADHD were prescribed more often in males and for hypothyroidism more often in females), as well as in prescribing practices relating to other drugs used in these groups. However, clear explanations for these differences, such as drug approval status, were not always apparent.

Geschlechtsspezifische Inanspruchnahme bei der Arzneimittelversorgung in verschiedenen Lebensphasen@@@Sex-specific differences in drug utilisation in different phases of life

ZusammenfassungZiel des vorliegenden Beitrages ist es, die geschlechtsspezifische Arzneimittelversorgung in verschiedenen Lebensphasen exemplarisch für jeweils eine relevante Erkrankung zu analysieren. Hierzu wurde eine Kohorte von 1,7 Mio. Versicherten der Gmünder ErsatzKasse (GEK) untersucht, die in jedem Quartal des Jahres 2009 mindestens 1 Tag versichert war. Wir selektierten anschließend je Altersgruppe Personen mit ambulanten Diagnosen für folgende Erkrankungen: Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) (0 bis 17 Jahre), Hypothyreose (18 bis 49 Jahre), Osteoporose (50 bis 79 Jahre) und koronare Herzkrankheit (80 + Jahre). Die Analysen fanden auf Wirkstoffebene statt. Insgesamt zeigten sich sowohl bei den zur Behandlung der ausgewählten Erkrankungen eingesetzten Wirkstoffen geschlechtsspezifische Unterschiede (z. B. werden Mittel zur Behandlung der ADHS häufiger bei männlichen und zur Behandlung der Hypothyreose häufiger bei weiblichen Versicherten verschrieben), aber auch bei weiteren bei diesen Personengruppen eingesetzten Mitteln. Nicht immer lassen sich eindeutige Erklärungen (wie z. B. der Arzneimittelzulassungsstatus) für diese Ergebnisse finden.AbstractThe aim of the present study is to analyse sex-specific differences in drug utilisation during different phases of life using relevant diseases as examples. We used a cohort of 1.7 million subjects who were insured with the Gmünder ErsatzKasse (GEK), a German health insurance fund, for at least one day in all four quarters of 2009. We analysed subjects with outpatient diagnoses of the following diseases: attention-deficit/hyperactivity disorder (ADHD) (0–17 years), hypothyroidism (18–49 years), osteoporosis (50–79 years) and coronary heart disease (80 + years). Analysis was performed on an active-substance level. A number of differences were observed in drug treatment for the selected diseases (for example, substances for ADHD were prescribed more often in males and for hypothyroidism more often in females), as well as in prescribing practices relating to other drugs used in these groups. However, clear explanations for these differences, such as drug approval status, were not always apparent.The aim of the present study is to analyse sex-specific differences in drug utilisation during different phases of life using relevant diseases as examples. We used a cohort of 1.7 million subjects who were insured with the Gmünder ErsatzKasse (GEK), a German health insurance fund, for at least one day in all four quarters of 2009. We analysed subjects with outpatient diagnoses of the following diseases: attention-deficit/hyperactivity disorder (ADHD) (0-17 years), hypothyroidism (18-49 years), osteoporosis (50-79 years) and coronary heart disease (80 + years). Analysis was performed on an active-substance level. A number of differences were observed in drug treatment for the selected diseases (for example, substances for ADHD were prescribed more often in males and for hypothyroidism more often in females), as well as in prescribing practices relating to other drugs used in these groups. However, clear explanations for these differences, such as drug approval status, were not always apparent.