Thomas Reinhold

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (76)146.37 Total impact

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    ABSTRACT: Background and aims Implantable cardioverter-defibrillator (ICD) remote follow-up and ICD remote monitoring (RM) are established means of ICD follow-up. The reduction of the number of in-office visits and the time to decision is proven, but the true clinical benefit is still unknown. Cost and cost-effectiveness of RM remain leading issues for its dissemination. The MONITOR-ICD study has been designed to assess costs, cost-effectiveness and clinical benefits of RM versus standard-care follow-up in a prospective multicenter randomized-controlled trial. Methods and results Patients indicated for single- or dual-chamber ICD are eligible for the study and are implanted an RM capable Biotronik ICD. ICD programming and alert-based clinical responses in the RM group are highly standardized by protocol. As of December 2011, recruitment has been completed and 416 patients have been enrolled. Subjects are followed for a minimum of 12 months and a maximum of 24 months, ending in January 2013. Disease-specific costs from a societal perspective have been defined as primary endpoint and will be compared between RM and standard-care groups. Secondary endpoints include ICD shocks (including appropriate and inappropriate shocks), cardiovascular hospitalizations and cardiovascular mortality and additional health economic endpoints. Conclusions The MONITOR-ICD study will be an important randomized RM study to report data on a primary economic endpoint in 2014. Its results on ICD shocks will add to the currently available evidence on clinical benefit of RM. Clinicaltrials.gov identifier: NCT 00787683.
    American Heart Journal 10/2014; 168(4). DOI:10.1016/j.ahj.2014.04.021 · 4.56 Impact Factor
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    ABSTRACT: Background Stroke is one of the main causes of morbidity and mortality in both men and women in the European Union. It is the third leading cause of death and the most common cause of disability in adults worldwide. The Federal Statistical Office of Germany reported total costs of € 8.1 billion for 2008 due to approximately 200,000 strokes per year. Demographic change will lead to a further increase in stroke incidence. There are few economic studies on the costs associated with stroke. Methods We performed a retrospective review of the medical, hospital and drug claims data in the database of a German statutory health insurance covering about 5 million insurees. The data for patients suffering from stroke were extracted by using the documented hospital ICD-10 codes during 2004 and 2005. For these patients we reviewed and summarized all the charges incurred over a one-year period after the initial index event on the basis of weekly costs and from the third party payer’s perspective. Results 18,106 patients who experienced stroke during 2004 or 2005 were identified and selected. 30% of these patients died during the period of data availability. Mean total costs per patient during the first year after stroke were approximately € 11,822. The attributable costs of stroke were € 3,573. The main proportion of total annual costs occurred during the period of acute care. Four weeks after the initial stroke event the costs reached 50% of total annual costs and were mainly driven by inpatient costs. The mean duration of hospital stay of acute inpatients was 1.86 weeks. Conclusion From a third party payer’s perspective, stroke is associated with a considerable economic burden. These costs, in particular are incurred during periods of inpatient stays. For this reason, effective stroke prevention and efficient inpatient process and therapy management need to be first priority.
    12/2013; 8(2):97-107. DOI:10.1007/BF03320768
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    ABSTRACT: Abstract Objectives: Acupuncture is increasingly used in patients with allergic asthma, but there is a lack of evidence on the cost-benefit relationship of this treatment. The aim of this study was to assess economic aspects of additional acupuncture treatment in patients with allergic bronchial asthma compared to patients receiving routine care alone. Design, subjects, intervention, outcome measures: In a randomized controlled trial, patients with allergic bronchial asthma were either allocated to a group receiving acupuncture immediately or a waiting-list control group. Both groups were free to use routine care treatment. The resource consumption, costs, and health-related quality of life were evaluated at baseline, and after 3 and 6 months by using statutory health insurance information and standardized questionnaires. Main economic outcome parameters were direct and indirect cost differences during the study period and the incremental cost-effectiveness ratio (ICER) of acupuncture treatment. Results: Three hundred and six (306) patients (159 acupuncture; 147 controls) were included (mean age 46.5±13.11 years, female 57.2%) and were comparable at baseline. Acupuncture treatment was associated with significantly higher costs compared to control patients (overall costs: €860.76 [95% confidence interval (CI) 705.04-1016.47] versus €518.80 [95% CI 356.66-680.93]; p=0.003; asthma-related costs: €517.52 [95% CI 485.63-549.40] versus €144.87 [95% CI 111.70-178.05]; p<0.001). These additional costs seem essentially driven by acupuncture costs themselves (€378.40 [95% CI 367.10-389.69]). However, acupuncture was associated with superior effectiveness in terms of quality-adjusted life years (QALYs). Resulting ICER lay between €23,231 (overall) and €25,315 (diagnosis-specific) per additional QALY. When using German acupuncture prices of year 2012, the ICER would improve to €12.810 (overall) versus €14,911 (diagnosis-specific) per QALY gained. Conclusions: Treating patients who have allergic bronchial asthma with acupuncture in addition to routine care resulted in additional costs and better effects in terms of patients' quality of life. Acupuncture therefore seems to be a useful and cost-effective add-on treatment.
    Journal of alternative and complementary medicine (New York, N.Y.) 11/2013; 20(3). DOI:10.1089/acm.2012.0719 · 1.52 Impact Factor
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    Value in Health 11/2013; 16(7):A357. DOI:10.1016/j.jval.2013.08.202 · 2.89 Impact Factor
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    ABSTRACT: Herpes zoster (HZ) is a self-limiting painful skin rash affecting mostly individuals from 50 years of age. The main complication is postherpetic neuralgia (PHN), a long-lasting pain after rash has resolved. A HZ-vaccine has recently been licensed in Europe for individuals older than 50 years. To support an informed decision-making for a potential vaccination recommendation, we conducted a health economic evaluation to identify the most cost-effective vaccination strategy. We developed a static Markov-cohort model, which compared a vaccine-scenario with no vaccination. The cohort entering the model was 50 years of age, vaccinated at age 60, and stayed over life-time in the model. Transition probabilities were based on HZ/PHN-epidemiology and demographic data from Germany, as well as vaccine efficacy (VE) data from clinical trials. Costs for vaccination and HZ/PHN-treatment (in Euros; 2010), as well as outcomes were discounted equally with 3% p.a. We accounted results from both, payer and societal perspective. We calculated benefit-cost-ratio (BCR), number-needed-to-vaccinate (NNV), and incremental cost-effectiveness ratios (ICERs) for costs per HZ-case avoided, per PHN-case avoided, and per quality-adjusted life-year (QALY) gained. Different target age-groups were compared to identify the most cost-effective vaccination strategy. Base-case-analysis as well as structural, descriptive-, and probabilistic-sensitivity-analyses (DSA, PSA) were performed. When vaccinating 20% of a cohort of 1 million 50 year old individuals at the age of 60 years, approximately 20,000 HZ-cases will be avoided over life-time. The NNV to avoid one HZ (PHN)-case was 10 (144). However, with a BCR of 0.34 this vaccination-strategy did not save costs. The base-case-analysis yielded an ICER of 1,419 (20,809) Euros per avoided HZ (PHN)-case and 28,146 Euros per QALY gained. Vaccination at the age of 60 was identified in most (sensitivity) analyses to be the most cost-effective vaccination strategy. In DSA, vaccine price and VE were shown to be the most critical input-data. According to our evaluation, HZ-vaccination is expected to avoid HZ/PHN-cases and gain QALYs to higher costs. However, the vaccine price had the highest impact on the ICERs. Among different scenarios, targeting individuals aged 60 years seems to represent the most cost-effective vaccination-strategy.
    BMC Health Services Research 09/2013; 13(1):359. DOI:10.1186/1472-6963-13-359 · 1.66 Impact Factor
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    ABSTRACT: Subcutaneous specific immunotherapy (SCIT) is an effective treatment attenuating the progression of allergic asthma. To date, there is a lack of studies investigating the economic consequences of SCIT on health care expenditures. A health-economic piggy-back analysis of SCIT was conducted based on a RCT that enrolled 65 children and adolescents with allergic asthma. Patients were allocated into two groups: A group receiving SCIT with a high-dose hypoallergenic house dust mite preparation plus asthma medication and a control group receiving only asthma medication. For both groups asthma control was achieved before the start of the SCIT treatment and was maintained during the study. Both, costs and cost-effectiveness of SCIT with the high-dose hypoallergenic house dust mite preparation were investigated based on total medication costs, incremental medication costs and treatment effects (measured as lung function), respectively. A bootstrap analysis was performed to validate the results. A steady decline in medication costs could be observed in the SCIT group one year after treatment start compared to the control group. This cost trend became statistically significant 3 years after SCIT started. The calculated potential savings in the SCIT group correlated with an improved lung function. The distribution of the bootstrap results revealed that the probability of SCIT having a superior effectiveness compared to the control group is around 90%. SCIT with a high-dose hypoallergenic preparation received by children and adolescents suffering from mite induced allergic asthma reduces the allergic medication intake and has cost-saving effects. Additional costs associated with SCIT may be completely compensated by drug cost savings 4 years after end of SCIT. Additionally, SCIT is superior compared to routine care as measured by the lung function that improved in SCIT-treated patients. Trial registration: (EudraCT no. 2004 -- 003892 -- 35).
    09/2013; 3(1):30. DOI:10.1186/2045-7022-3-30
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    ABSTRACT: Allergic rhinitis (AR) is a frequent allergic disorder with a significant economic effect on health care costs and productivity. To assess the cost-effectiveness of acupuncture for patients with seasonal AR (SAR) in Germany. The present analysis was part of the Acupuncture in Seasonal Allergic Rhinitis (ACUSAR) trial, a 3-arm randomized, controlled, multicenter trial in patients with SAR, comparing acupuncture plus rescue medication (RM), penetrating sham acupuncture plus RM, and a control group receiving RM alone. Measures for health economic analyses were costs and health-related quality of life. Incremental cost-effectiveness ratio was calculated for different scenarios on the duration of acupuncture effects and was expressed as costs per quality-adjusted life-year gained. The study was conducted from society's and from a third-party payer's perspective. From 422 initially randomized patients, a total of 364 patients with complete data on costs and quality of life were included in the health economic evaluation. Patients receiving acupuncture or sham acupuncture caused higher costs than patients in the RM group. Patients in the acupuncture group gained significantly more quality-adjusted life-years compared with the RM group. Depending on different scenarios, the incremental cost-effectiveness ratio for acupuncture patients was between €31,241 (approximately US $38.569) and €118,889 (approximately US $146,777) from society's perspective and between €20,807 (approximately US $25,688) and €74,585 (approximately US $92.080) from a third-party payer's perspective. Acupuncture is an effective intervention that results in improved quality of life in patients with SAR. However, in times of limited resources for health care, acupuncture for AR may not be a cost-effective intervention. clinicaltrials.gov Identifier: NCT00610584.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 07/2013; 111(1):56-63. DOI:10.1016/j.anai.2013.04.008 · 2.75 Impact Factor
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    ABSTRACT: Introduction Heart failure is a frequent cause of morbidity and mortality (particularly post myocardial infarction) and has been moved into the focus of public health care in the last few years. Apart from patho-physiological, clinical, and epidemiological research questions, health economic aspects are increasingly becoming more important. Objective The present model determines the epidemiological and health economic disease burden of post myocardial infarction heart failure in Germany. Methods Basis for the analysis was a literature review of relevant publications since 1990. The incidence of post myocardial infarction heart failure was estimated for two scenarios and, using a Markov model, the course of the disease and the associated use of resources over a period of nine years was calculated. Subsequently, the annual cost of all prevalent cases was determined. Results The calculation of the incidence in Germany varies between 50,000 (best case scenario) and 90,000 (worst case scenario) per year. These patients cause total costs of € 1.4–2.5 billion during the selected observation period (direct costs account for approx. 55 %). The prevalence per year is estimated to be 250,000 to 450,000. These patients cause a financial burden of approximately € 0.9–1.6 billion per year. The majority is due to hospital treatment (€ 0.3–0.5 billion) and the loss of productivity due to premature mortality (€ 0.2–0.4 billion). Apart from the monetary consequences, it has to be assumed that heart failure reduces the quality of life for these patients by about 50 % compared to that of the normal population at a comparable age. Conclusion In light of the heavy financial burden in particular due to hospital treatment and loss of productivity associated with the manifestation of heart failure, an early and effective therapy of the initial myocardial infarction (e. g. by adequate lysis or PTCA therapy) is essential. If heart failure nevertheless develops after myocardial infarction, best possible secondary prevention strategies are necessary.
    06/2013; 3(1):25-39. DOI:10.1007/BF03321561
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    ABSTRACT: Atrial fibrillation (AF), a supraventricular tachycardia disorder, is the most common sustained cardiac arrhythmia affecting 1-2 % of the general population. Prevalence is highly related to age, with every fourth individual older than 40 years old developing AF during his lifetime. Due to an aging population, the prevalence of AF is estimated to at least double within the next 50 years. This article presents AF-related cost-of-illness studies and reviews 19 cost-effectiveness studies and six cost studies published roughly over the past decade, which have compared different antiarrhythmic medications for AF. A systematic literature search for studies published between June 2000 and December 2011 was conducted in PubMed using the combination of keywords ((atrial fibrillation OR atrial flutter) AND cost). Current cost-effectiveness analyses of dronedarone and the pill-in-the-pocket strategy are subject to substantial uncertainties with regard to clinical benefit. Comparing rate control with rhythm control, a cost-effectiveness advantage for rate control was shown in several but not all studies. Within antiarrhythmic drug treatments, magnesium added onto ibutilide was shown to be more cost effective than ibutilide alone. Comparing chemical and electrical cardioversion, the latter was recommended as more cost effective from the healthcare system perspective in all reviewed studies but one. Catheter ablation appeared more cost effective than antiarrhythmic drugs in the medium to long run after 3.2-63.9 years. Admissions to hospital, inpatient care and interventional procedures as well as mortality benefit are key drivers for the cost effectiveness of AF medications. No clear cost-effectiveness advantage emerged for one specific antiarrhythmic drug from the studies that compared antiarrhythmic agents. Rate control as well as catheter ablation appear more cost effective than rhythm control in the treatment of AF. Rate control treatment also seems more cost effective than electrical cardioversion in AF patients.
    PharmacoEconomics 03/2013; 31(3):195-213. DOI:10.1007/s40273-013-0028-7 · 3.34 Impact Factor
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    ABSTRACT: One in five children visiting a homeopathic physician suffers from atopic eczema. We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional) with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis) at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents' expectation. The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9-19.5] vs. 14.9 [10.4-19.4], p = 0.741). The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974). Total costs were higher in the homoeopathic versus the conventional group (months 31-36 200.54 Euro [132.33-268.76] vs. 68.86 Euro [9.13-128.58], p = 0.005). Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs.
    PLoS ONE 01/2013; 8(1):e54973. DOI:10.1371/journal.pone.0054973 · 3.53 Impact Factor
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    ABSTRACT: After acquiring a varicella virus infection, the virus can reactivate and cause herpes zoster (HZ)-a painful skin rash. A complication of HZ is long-term persistence of pain after the rash has resolved (so-called postherpetic neuralgia, PHN). We aimed to describe the epidemiology of HZ/PHN and to estimate HZ/PHN-related costs in the German statutory health insurance (SHI) system (~85 % of the total population). Treatment data of one large SHI was utilized, containing data on approximately 240,000 insured and their utilisation of services in 2004-2009. Identification of HZ- and PHN-cases was performed based on 'International Statistical Classification of Diseases' and specific medications using a control-group design. Incidences per 1,000 person-years (PY) and cost-of-illness for 1 year following HZ-onset considering the payer and societal perspective were calculated. All amounts were inflated to 2010 Euros. Population-figures were standardised and extrapolated to the total SHI-population in Germany in 2010. A mean annual incidence of 5.79 HZ-cases per 1,000 PY was observed, translating into an estimated 403,625 HZ-cases per year in the total SHI-population. Approximately 5 % of HZ-cases developed PHN. One HZ-case caused on average 210 and 376 of costs from the payer and societal perspective, respectively. The development of PHN generated additional costs of 1,123 ( 1,645 societal perspective). Total annual HZ/PHN-related costs were estimated at 182 million ( 105 million) to society (payer). HZ and PHN place a considerable burden on the German SHI-system. Since HZ-vaccines will soon be available, a health-economic evaluation of these vaccines should be conducted.
    The European Journal of Health Economics 12/2012; DOI:10.1007/s10198-012-0452-1 · 2.10 Impact Factor
  • Value in Health 11/2012; 15(7):A394. DOI:10.1016/j.jval.2012.08.1118 · 2.89 Impact Factor
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    ABSTRACT: Published congress abstract (11. Deutschen Kongress für Versorgungsforschung und 4. Nationalen Präventionskongress, 27. bis 29. September 2012). Full article published as "Kohler, S., Nocon, M., Müller-Riemenschneider, F., Reinhold, T., & Willich, S. N. (2012). Der Präventionsatlas Berlin-Brandenburg: Strukturierte Informationen zu Prävention und Gesundheitsförderung [The Berlin-Brandenburg Altas of Prevention: Structured information on prevention and health promotion]. In W. Kirch, T. Hoffmann, & H. Pfaff (Eds.), Prävention und Versorgung (pp. 138–147). Stuttgart: Thieme."
    DMW - Deutsche Medizinische Wochenschrift 09/2012; 137(S 03). DOI:10.1055/s-0032-1323342 · 0.55 Impact Factor
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    ABSTRACT: Critical limb ischemia (CLI) has a significant impact on patients' quality of life (QoL). Despite cost utility evaluations being required by different authorities, data on patient health preferences and utilities for CLI are scarce. Hence, the objective of this study was to assess the impact of CLI on health preferences and health status of affected patients, and to generate health state utilities. In the International Study, 200 patients with CLI (stages III and IV according to Fontaine scale) were interviewed by trained interviewers with a discrete choice instrument, a standard gamble (SG), and the EuroQol-five dimension (EQ-5D) questionnaires (Marten Meesweg, Rotterdam, Netherland). Conjoint analysis showed that a planned amputation (33%) was the most relevant health attribute followed by ambulatory function (25%) and chronic pain (15%). Non-dependence on caregiver impacted on patient health state preference considerably, whereas healing of ulcer/skin lesions had less impact. Preference values obtained from the SG were 0.84, for an amputation subpopulation arriving at 0.70. The EQ-5D index values as well as the EQ-5D visual analog scale for patients with CLI were 0.56. The QoL data of patients with CLI result in decreased QoL and preference values with a planned amputation.
    International Journal of Angiology 09/2012; 21(3):139-46. DOI:10.1055/s-0032-1324738
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    Reinhold T, Stefan Kohler
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    ABSTRACT: Das Angebot an Gesundheitsvorsorge und Präventionsleistungen hat in den vergangenen Jahren stetig zugenommen. Dennoch sind Stress und andere gesundheitliche Belastungen weit verbreitet. Der Anteil der Raucher ist in Berlin und Brandenburg überdurchschnittlich hoch. Die Länder Berlin und Brandenburg erleichtern mit einem Präventionsatlas die Nutzung regionaler Angebote zu Prävention und Gesundheitsförderung.
    Gesundheitsstandort Berlin-Brandenburg, Edited by Berliner Wirtschaftsgespräche e.V., 08/2012: pages 51; Kulturbuch-Verlag., ISBN: 9783889613356
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    ABSTRACT: Einleitung Vorhofflimmern gilt als die häufigste Rhythmusstörung des Herzens und als ein entscheidender Risikofaktor arterieller Thromboembolien. Die Häufigkeit des Krankheitsbildes „Vorhofflimmern“ wird aufgrund der Entwicklung der Altersstruktur der Bevölkerung sowie der verbesserten Therapie akuter und chronischer Herzerkrankungen weiter zunehmen. Zielstellung Primäre Ziele der vorliegenden Analyse waren die Beschreibung von Patientencharakteristika, die Bewertung der mit Vorhofflimmern assoziierten Ressourceninanspruchnahme und die Abschätzung der damit verbundenen direkten Behandlungs- und Folgekosten. Sekundäre Ziele waren die Identifikation von Einflussaktoren auf die Kosten und die Art des Vorhofflimmerns. Methoden Die Analyse basiert auf dem repräsentativen ATRIUM-Register (Ambulantes Register zur Morbidität des Vorhofflimmerns), einer prospektiven, multizentrischen Kohortenstudie, bei der Eigenschaften und Ressourceninanspruchnahme konsekutiv eingeschlossener Patienten von Allgemein- und Hausärzten dokumentiert wurden. Die dokumentierte Ressourceninanspruchnahme wurde anschließend mit Kosten bewertet. Die vorliegenden Ergebnisse basieren auf der Baseline-Dokumentation und beziehen sich auf den Zeitraum ab 12 Monate vor Studieneinschluss. Ergebnisse Insgesamt wurden 3.667 Patienten (Alter 72,1±9,2 Jahre; 58% Männer) eingeschlossen, die bei 730 ärztlichen Leistungserbringern in Behandlung waren und alle Einschlusskriterien erfüllten. Die Patienten hatten durchschnittlich 2,4±1,0 unterschiedliche bekannte Risikofaktoren, am häufigsten Hypertonus (84% aller Patienten). Häufigste Begleiterkrankungen waren Herzinsuffizienz (43%) und koronare Herzerkrankung (KHK, 35%). Arzneimittel zur oralen Antikoagulation (86%) und Betarezeptorenblocker (75%) gehörten zu den am häufigsten verordneten Medikamenten. Bei einem Drittel der Betroffenen wurde während der letzten 12 Monate eine spezifische Vorhofflimmertherapie (z. B. medikamentöse Konversion, Kardioversion) durchgeführt. Die krankheitsspezifischen Gesamtkosten der Patienten betrugen 3.274±5.134 Euro, wobei die akute (stationäre) Vorhofflimmerbehandlung mit mittleren Kosten von 1.639±3.623 Euro pro Patient den größten Anteil an den Gesamtkosten hatte. Patienten mit hohen Kosten sind signifikant jünger und haben mehr Begleiterkrankungen. Schlussfolgerung Vorhofflimmern ist mit deutlichen patientenbezogenen Zusatzkosten assoziiert, die insbesondere durch Aufwendungen im Rahmen der stationären Versorgung bedingt werden. Neue, innovative Behandlungsstrategien scheinen insbesondere dann ein Einsparpotenzial zu bieten, wenn sie in der Lage sind, nachgelagerte Hospitalisierungen, entweder durch Vorhofflimmern direkt oder durch Folgeereignisse verursacht, zu vermeiden.
    Herz 08/2012; 37(5). DOI:10.1007/s00059-011-3575-8 · 0.91 Impact Factor
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    ABSTRACT: Coronary heart disease is an important disorder in Western industrialized societies, with regard to both the epidemiologic and economic burden of illness. A modern therapeutic strategy consists of coronary interventions and the implantation of drug-eluting vascular stents. The cost-effectiveness of such drug-eluting stents has been an important subject of health-economic evaluation research in recent years. This article presents two examples of such studies and deals with the question whether existing study projects are able to provide sufficient evidence for allocation decisions in health care. On this basis we discuss important challenges for future health economic analysis. A key conclusion is the need for long-term and cross-sectoral evaluation strategies that could be based on routinely collected health care data. Supplemented by health economic results from clinical trials, the use of such data would lead to a broader data basis for allocation decisions in health care.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 05/2012; 55(5):693-9. · 1.01 Impact Factor
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    ABSTRACT: Die koronare Herzerkrankung gehört zu den sowohl epidemiologisch als auch ökonomisch bedeutendsten Krankheitsbildern in westlichen Industriegesellschaften. Zur Therapie werden im Rahmen von Koronarinterventionen heute häufig medikamentenbeschichtete Gefäßstents implantiert, deren Kosteneffektivität in den letzten Jahren zunehmend Gegenstand gesundheitsökonomischer Forschung war. Der vorliegende Beitrag stellt exemplarisch zwei solche Untersuchungen vor und untersucht insbesondere die Frage, ob die bereits vorliegenden Studienergebnisse überhaupt ausreichend Evidenz für Allokationsentscheidungen im Gesundheitswesen liefern können. Davon ausgehend, werden wichtige Herausforderungen für zukünftige gesundheitsökonomische Analysen diskutiert. Eine wesentliche Schlussfolgerung ist die Forderung nach langfristig angelegten und sektorenübergreifenden Evaluationsstrategien, für die routinemäßig erhobene Informationen im Gesundheitswesen eine mögliche Datenbasis liefern können. Ergänzt um gesundheitsökonomische Ergebnisse aus klinischen Studien, bietet sich so eine breitere Grundlage für Allokationsentscheidungen im Gesundheitswesen.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 05/2012; 55(5). DOI:10.1007/s00103-012-1468-5 · 1.01 Impact Factor
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    ABSTRACT: To apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital's interventional radiology department. After providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers (physicians, nurses, and other staff in referring departments, e.g., vascular surgery), providers (interventional radiologists, nurses, technicians, and staff of the angiography suite), and specialists of the hospital's controlling department. A generally binding and standardized process map was created, describing the entire procedure for a patient in whom the radiological intervention of PTA or stent treatment is contemplated from admission to the department of vascular surgery until discharge after successful treatment. This visualization tool assists in better understanding (especially given natural staff fluctuation over time) and efficiently organizing PTA and stent procedures. Process mapping can be applied for streamlining workflow in healthcare, especially in interdisciplinary settings. By defining exactly what a business entity does, who is responsible, to what standard a process should be completed, and how the success can be assessed, this technique can be used to eliminate waste and inefficiencies from the workplace while providing high-quality goods and services easily, quickly, and inexpensively. MAIN MESSAGES : • Process mapping can be used in a university hospital's interventional radiology department. • Process mapping can describe the patient's entire process from admission to PTA/stent placement until discharge. • Process mapping can be used in interdisciplinary teams (e.g., referrers, providers, and controlling specialists). • Process mapping can be used in order to more efficiently organize PTA and stent placement procedures. • Process mapping can assist in better understanding and efficiently organizing procedures in standardized fashion.
    02/2012; 3(4):329-36. DOI:10.1007/s13244-012-0147-2
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    ABSTRACT: Atrial fibrillation (Afib) is considered to be the most frequent form of cardiac dysrhythmia and is well known as a key risk factor for arterial thromboembolism. The incidence of Afib will increase in the future due to demographic changes as well as improved treatment options for acute and chronic heart diseases. The primary objectives of this analysis were to describe patient characteristics, to assess the resource consumption associated with Afib and to measure costs of direct treatment as well as consequential costs. A secondary objective was to identify factors that influence the costs or the type of Afib. The analysis is based on the representative ATRIUM register (Ambulantes Register zur Morbidität des Vorhofflimmerns, Ambulatory register on morbidity of atrial fibrillation), a prospective, multicenter cohort study in which general practitioners and family doctors documented the characteristics and resource utilization of consecutively enrolled patients. The documented resource consumption use was subsequently valued with unit costs. The presented results are focused on the baseline documentation and refer to the period 12 months before enrollment. A total of 3,667 patients (mean age 72.1±9.2 years, 58% men) fulfilled all inclusion criteria and were included by a total of 730 doctors. The patients had an average of 2.4±1.0 risk factors and the most common was hypertension (84% of patients). The most commonly observed comorbidities were heart failure (43%) and coronary heart disease (CHD, 35%). Medicines for oral anticoagulation (86%) and beta blockers (75%) were the most frequently prescribed drugs. A total of 1/3 of all patients received a specific kind of Afib therapy (e. g. drug conversion, cardioversion) during the past 12 months. The disease-specific mean costs of the patients were 3,274±5,134 Euro, while the acute (inpatient) treatment represented the largest proportion of these total costs (1,639±3,623 Euro). Patients with high treatment costs were significantly younger and suffered from more concomitant diseases. Atrial fibrillation is associated with significant patient-related attributable costs that are caused particularly by expenditures of inpatient stay. New, innovative treatment strategies seem to offer particular potential savings if they are able to reduce the number of hospitalizations due to Afib itself or subsequent cardiac events.
    Herz 02/2012; 37(5):534-42. · 0.91 Impact Factor

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1k Citations
146.37 Total Impact Points

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  • 2007–2014
    • Charité Universitätsmedizin Berlin
      • Institute for Social Medicine, Epidemiology and Health Economics
      Berlín, Berlin, Germany
  • 2008–2013
    • Universitätsklinikum Freiburg
      Freiburg an der Elbe, Lower Saxony, Germany
  • 2010
    • Steinbeis Hochschule Berlin
      Berlín, Berlin, Germany
    • Klinikum Kassel
      Cassel, Hesse, Germany
  • 2006
    • University of Hamburg
      Hamburg, Hamburg, Germany