Christian Brettschneider

Christian Brettschneider
University Medical Center Hamburg - Eppendorf · Department of Health Economics and Health Services Research

PhD

About

167
Publications
24,355
Reads
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2,755
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Introduction
Christian is head of the Working Group "CEA and Mixed Methods" at the Department of Health Economics and Health Services Research (University Medical Center Hamburg-Eppendorf). Furthermore, he is core member of the Hamburg Center for Health Economics (HCHE). His research interests are: mental health (esp. dementia), geriatrics, informal care and cost-effectiveness. Additionally, he is a member of different working groups for the advancement of costing methods in the field of health economics.
Additional affiliations
December 2018 - November 2019
University Medical Center Hamburg - Eppendorf
Position
  • Head of Department
October 2018 - present
University Medical Center Hamburg - Eppendorf
Position
  • Lecturer
Description
  • Problem-based learning for Medical Students
July 2016 - present
University Medical Center Hamburg - Eppendorf
Position
  • Head of Department
Education
September 2013 - April 2016
University Medical Center Hamburg - Eppendorf
Field of study
  • Non-medical PhD-Programme
October 2002 - June 2008
University of Cologne
Field of study
  • Health Economics

Publications

Publications (167)
Article
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Purpose Higher Fit fOR The Aged (FORTA) scores have been shown to be negatively associated with adverse clinical outcomes in older hospitalized patients. This has not been evaluated in other health care settings. The aim of this study was to examine the association of the FORTA score with relevant outcomes in the prospective AgeCoDe–AgeQualiDe coho...
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Aim The aim of this study was to investigate the frequency of and the gender differences in the use of professional home care in Germany. Methods We used harmonized data from three large cohort studies from Germany (“Healthy Aging: Gender-specific trajectories into the latest life”; AgeDifferent.de Platform). Data were available for 5,393 older in...
Article
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Purpose The aim of this study was to examine the longitudinal within-association between social support and health-related quality of life among the oldest old. Methods Longitudinal data (follow-up waves 7 to 9) were used from the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large s...
Article
Introduction Only a few studies have investigated incidence and risk factors of depression in the highest age groups. This study aims to determine incidence rates as well as risk factors of incident depressive symptoms in latest life, adjusting for the competing event of mortality. Methods Data of a prospective, longitudinal, multi-centered cohort...
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Objectives Growing evidence suggests a protective effect of high mental demands at work on cognitive function in later life. However, evidence on corresponding associations in older adults at increased risk for dementia is currently lacking. This study investigates the association between mental demands at work and cognitive functioning in the popu...
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Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged...
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Background It is almost unknown whether the driving status is associated with HRQOL among individuals in highest age.AimsBased on a multicenter prospective cohort study, the objective of this study was to examine whether the driving status is associated with health-related quality of life (HRQOL) among the oldest old in Germany.Methods Cross-sectio...
Article
Background Dementia is a major economic challenge for societies worldwide. One approach of cost-of-illness studies focuses on the excess costs of people with dementia compared to costs in people without dementia. Yet, excess costs of dementia have rarely been examined. Objective To contribute to the existing evidence on excess costs of dementia by...
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Background Evidence suggests benefits of orthogeriatric co-management (OGCM) for hip fracture patients. Yet, evidence on cost-effectiveness is limited and based on small datasets. The aim of our study was to conduct an economic evaluation of the German OGCM for geriatric hip fracture patients. Methods This retrospective cohort study was based on G...
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Purpose To systematically review studies on HRQOL, measured by the WHOQOL-Bref instrument, of refugees in general and clinical populations who are settled in the community of the hosting country, and outline the differences in scores among the two population groups and across the four domains of WHOQOL-Bref (physical, psychological, social relation...
Article
Objective: Longitudinal studies investigating the link between social support and functional decline are limited among the oldest old. Thus, the aim of this study was to examine whether changes in social support are associated with functional decline among the oldest old longitudinally using panel regression models. Methods: Longitudinal data fr...
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Finding a balance between care and personal needs is often challenging for individuals caring for a person with dementia. The present study aimed to understand how primary and secondary family carers of people with dementia perceive the reconciliation of informal care and their personal life throughout the course of care. Narrative interviews with...
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Objectives Economic evaluations often use preference-based value sets (tariffs) for health-related quality of life to quantify health effects. For wellbeing at the end of life, issues beyond health-related quality of life may be important. Therefore, the ICECAP Supportive Care Measure (ICECAP-SCM), based on the capability approach, was developed. A...
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Objectives The objectives of this study were to estimate the direct and indirect excess costs of type 2 diabetes mellitus (T2D) using data representative for the German adult population and to investigate the association of sociodemographic and clinical determinants with these excess costs. Setting We calculated mean annual costs for individuals w...
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Objectives There is a lack of studies identifying the correlates of institutionalization specifically among the oldest old. Therefore, our aim was to fill this gap in knowledge. Methods Cross‐sectional data (Follow up (FU) wave 9; n=633 observations in the analytical sample) were used from the multicenter prospective cohort study “Needs, health se...
Article
Once a parent needs long-term care, intergenerational transfers from children to parents are considered as economically important. However, less is known on how child-to-parent transfers evolve, as these kinds of transfers are typically analyzed in the cross section. In the light of aging populations, this study examines how inter vivos transfers f...
Article
Purpose : To investigate the association between health-related quality of life and ego integrity among the oldest old. Materials and methods : Cross-sectional data were taken from follow-up wave 9 of the multicenter prospective cohort study “Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primar...
Article
Objectives: In the light of an increasingly diverse older population in the United States, there is an ongoing discussion how cultural factors contribute to individual long-term care (LTC) needs and service use. This study empirically assesses whether the level of acculturation and cultural differences in the importance of the family shape foreign...
Article
Introduction: There is a lack of studies examining the link between perceived autonomy and frailty among the oldest old. Therefore, our objective was to fill this gap. Methods: Data were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary...
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Introduction The aim of this study was to estimate excess costs of depression in Germany and to examine the influence of sociodemographic and socioeconomic determinants. Methods Annual excess costs of depression per patient were estimated for the year 2019 by comparing survey data of individuals with and without self-reported medically diagnosed d...
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Introduction Stroke has a long-term impact on functional status and quality of life in multiple health domains. A well-coordinated managed care program for stroke patients is crucial for ameliorating patients’ health and cost-efficient use of resources. The aim of this study is the implementation and evaluation of an optimised cross-sectoral, coord...
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Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and...
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The likelihood that a child will provide informal care to a parent varies across countries and between social groups within countries. We highlight the importance of cultural traits in children’s value of informal care and their willingness to provide informal care to a parent. We initially construct a cultural measure of the strength of family tie...
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Background Societies strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general pract...
Article
Zusammenfassung Ziel der Studie Untersuchung der Perspektive von Medizinischen Fachangestellten (MFA) bezüglich der Mitwirkung in verhaltenstherapeutisch orientierten Interventionen in der Hausarztpraxis. Methode 15 MFA (w, 39,5 Jahre), Case-Manager in einem hausarztpraxis-unterstützten Übungsprogramm für Patienten mit Panik- und Angststörung (ICD-...
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PurposeTo describe health status and health state utilities measured by the EQ-5D-3L in a population-based sample of individuals aged 85 + in Germany, and to analyze associations with basic socio-demographic variables.Methods Cross-sectional data from follow-up wave 7 (n = 761) of the German AgeCoDe Study were used. The EQ-5D-3L questionnaire was u...
Article
Objective: There is a lack of studies disentangling whether changes in frailty are associated with subsequent changes in depressive symptoms or vice versa among the oldest old. Consequently, we aimed to disentangle this link. Design: Three waves [follow-up (FU) wave 7 to FU wave 9; n = 423 individuals in the analytical sample] were used from the m...
Article
Introduction Subjective cognitive decline (SCD) is a risk condition for dementia, including dementia of Alzheimer type (DAT). Methods We report sensitivity, specificity, positive and negative predictive values (PPV, NPV) for conversion to all‐cause dementia, and DAT in different SCD types (decline in memory, assocated worries, longitudinal consite...
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Sustaining informal care-giving for people living with dementia (PWD) is a common objective of societies worldwide. Families can contribute substantially to the support of care-giving relatives. However, a deeper understanding of the impact of informal care-giving for PWD on family life is needed. Interviewing of multiple family network members-in...
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Background: Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped care model based on the German National Clinical Practice Guideline "Unipolar Depression" has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model ve...
Article
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Objectives Previous studies have observed protective effects of high mental demands at work on cognitive functioning and dementia risk. However, it is unclear what types of demands drive this effect and whether this effect is subject to a person's genetic risk. We investigated to what extent eight different types of mental demands at work together...
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Background Informal caregivers of people with dementia (PWD) are a vulnerable group, which is not only confronted with potential burdens due to caring but also with the demands of the family and working life. The state of national studies on experiencing the tensions between care, family and work is insufficient.Objective This qualitative study is...
Article
Introduction: There is a lack of studies investigating the link between time-varying factors associated with changes in frailty scores in very old age longitudinally. This is important because the level of frailty is associated with subsequent morbidity and mortality. Objective: To examine time-dependent predictors of frailty among the oldest ol...
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Background Hospitalization is a key driver of health care costs. Thus far, there are only a few longitudinal studies investigating whether changes in explanatory variables lead to hospitalization. Moreover, these longitudinal studies did not focus on individuals in highest age. Aim The purpose of the current study was to examine the correlates of...
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Mental disorders are widespread, debilitating and associated with high costs. In Germany, usual care (UC) for mental disorders is afflicted by poor coordination between providers and long waiting times. Recently, the primary alternative to UC—the gatekeeping-based general practitioners (GP) program—was extended by the collaborative Psychiatry–Neuro...
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Objectives This study aimed to compare informal caregivers/dementia caregivers to non-caregivers regarding alcohol consumption, smoking behavior, obesity, and insufficient physical activity and to identify caregiving-related factors (caregiving intensity, length of caregiving, relationship to the care recipient, and type of caregiving task) which a...
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Purpose: Mild cognitive impairment (MCI) is a widespread phenomenon, especially affecting older individuals. We will analyze in how far MCI affects different facets of quality of life (QOL). Methods: We used a sample of 903 participants (110 with MCI) from the fifth follow-up of the German Study on Ageing, Cognition, and Dementia in Primary Care...
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Objectives Social isolation is increasing in aging societies and several studies have shown a relation with worse cognition in old age. However, less is known about the association in the oldest-old (85+); the group that is at highest risk for both social isolation and dementia.Methods Analyses were based on follow-up 5 to 9 of the longitudinal Ger...
Article
Purpose To determine the prevalence of overweight and obesity, and to identify factors associated with obesity, among the oldest old. Methods For this study, data from follow-up (FU) wave 7 and FU wave 8 of the “Study on Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)”...
Preprint
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Objective Depression is associated with major patient burden. Its treatment requires complex and collaborative approaches. A stepped-care model based on the German National Clinical Practice Guideline “Unipolar Depression” has been shown to be effective. In this study we assess the cost-effectiveness of this guideline based stepped care model versu...
Article
Zusammenfassung Hintergrund und Zielsetzung Kostenberechnungen sind ein wesentlicher Bestandteil gesundheitsökonomischer Evaluationen, weisen jedoch für den deutschen Versorgungskontext teilweise große Unterschiede im methodischen Vorgehen auf. Zielsetzung der vorliegenden Artikelserie ist es, einen konsentierten Vorschlag zu den Vorgehensweisen de...
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Background Primary care is the main treatment setting for panic disorder and should be supplemented by collaborative care programs. However, shortage of mental health professionals prevents collaborative care programs from being effectively implemented. The PARADISE study showed the efficacy of a self-managed, cognitive-behavioural therapy (CBT)-or...
Article
Zusammenfassung Ziel der Studie Analyse der Beziehung zwischen depressiven Symptomen und funktionellen Beeinträchtigungen bei Hochaltrigen (85+) im Längsschnitt. Methodik Drei Wellen der multizentrischen prospektiven Kohortenstudie AgeQualiDe wurden genutzt (n = 1272 Beobachtungen). Die Geriatrische Depressionsskala wurde zur Erfassung depressiver...
Article
Objectives To examine the impact of determinants of incident dementia in three different old age groups (75–79, 80–84, 85+years) in Germany. Design Multicenter prospective AgeCoDe/AgeQualiDe cohort study with baseline and nine follow-up assessments at 1.5-year intervals. Setting Primary care medical record registry sample. Participants General p...
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Objective: To compare cost-effectiveness of integrated care with therapeutic assertive community treatment (IC-TACT) versus standard care (SC) in multiple episode psychosis. Method: 12-month IC-TACT in patients with schizophrenia-spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy-balance...
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Migration flows have been rising over the past decades and are not expected to mitigate in the future. Migrants brings along values and preferences that were shaped by their origin countries, among those, their perceptions of how societies should care for the elderly. In this study, we examine how the attitude towards informal care is shaped by the...
Article
Zusammenfassung Ziel Das Ziel der Studie ist die Validierung des Fragebogens zur Inanspruchnahme Medizinischer und nicht-medizinischer Versorgungsleistungen im Alter (FIMA). Methodik Die Selbstangaben von 1552 Teilnehmern wurden mit den Routinedaten der Krankenversicherung abgeglichen. Als Güteparameter wurden Intraklassenkorrelation (ICC), Sensiti...
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Purpose: Dealing with the high prevalence of pain among the oldest-old (+75) is becoming a major health issue. Therefore, the aim of the study was to uncover health-related lifestyle behaviors (HLB) and age-related comorbidities which may predict, influence and prevent pain in old age. Patients and methods: In this longitudinal cohort study, dat...
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Introduction Mental healthcare is one of the biggest challenges for healthcare systems. Comorbidities between different mental disorders are common, and patients suffer from a high burden of disease. While the effectiveness of collaborative and stepped care models has been shown for single disorders, comorbid mental disorders have rarely been addre...
Article
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Many persons with dementia live at home and are cared for by their relatives. If the relatives are still employed, this can lead to higher burden and losses in their work-life. The interplay between informal care-giving and working is complex. Different studies have explored this issue, but the results have not been yet synthesised. In this mixed-s...
Article
Background: The current study aimed to identify whether needs are associated with health care costs in late life longitudinally. Methods: Data were gathered from two waves (at baseline, n = 1199; at follow-up, n = 958) of a multicenter prospective cohort study (‘Late-life depression in primary care: needs, health care utilization and costs’, AgeMoo...
Article
Background and objectives: Perceptions of how societies should care for the elderly people can differ among countries. This study examines to what extent individuals' value of informal care is shaped by the politico-economic system in which they grew up and if this value adjusts once an individual lives in a different politico-economic system. Re...
Article
Aim: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. Methods: The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample...
Article
Background: Sex differences in verbal episodic memory function have been widely reported. However, sex-specific effects on rates of episodic memory decline remain controversial, and evidence is particularly scarce in the oldest-old population. Objective: We aimed to investigate sex differences in trajectories of episodic memory performance in ol...
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This analysis aims to identify and characterize symptom trajectories in primary care patients with panic disorder with/without agoraphobia (PD/AG) who participated in a primary care team based training involving elements of cognitive behavioural therapy (CBT). Growth Mixture Modeling was used to identify different latent classes of change in patien...
Article
The population of the oldest old often suffers from ill health and causes high health care costs. Yet, this group has rarely been examined. We investigated determinants of health care costs in the population of oldest olds (≥85 years) in Germany by analyzing data from a large multi-center, prospective cohort study (n=856). Health care costs per cap...
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Background Panic disorder is a mental disorder of high prevalence, which frequently co-occurs with agoraphobia. There is a lack of studies measuring excess costs of panic disorder patients with and without agoraphobia. We compared costs of panic disorder patients with or without agoraphobia with costs of the anxiety-free population in Germany. Met...
Article
Background/objective: Subjective cognitive decline (SCD) has often been associated with an increased risk for subsequent dementia. However, sex-specific associations are understudied until now. Methods: Cross-sectional and longitudinal associations over a follow-up period of up to 13 years were investigated in a sample of participants without ob...
Article
Background: To evaluate primary care practice team-supported exercises for patients with panic disorder with/without agoraphobia (PDA). Methods: This cluster randomized controlled superiority trial in 73 German primary care practices included 419 patients with PDA (mean [SD] age, 46.2 [14.4] years; 74% female). Patients were blinded to allocation...
Article
Background: We evaluated a team-based program of exercises for patients with panic disorder with or without agoraphobia (PDA) in primary care. Methods: 419 patients with PDA (mean age 46.2 years, standard deviation 14.4 years; 74% female) were included in this cluster-randomized, controlled intervention trial. The patients were blinded with resp...