[Show abstract][Hide abstract] ABSTRACT: Despite the indisputable mortality advantages of implantable cardioverter defibrillators (ICDs), no consensus exists regarding their impact on quality of life (QoL). This systematic review investigates differences in QoL between patients with ICDs and controls. We systematically searched the MEDLINE, EMBASE, Cochrane, Web of Science, and PsychINFO databases. Articles were included if they were published after the year 2000 and reported on original studies with a control group. Five randomized controlled trials with a total of 5,138 patients and 10 observational studies with a total of 1,513 patients met the inclusion criteria. Nine studies found comparable QoL for ICD recipients and patients in the control groups, three studies found an increased QoL for ICD patients, and three studies found a decreased QoL for ICD patients. The question of whether QoL relates to ICD therapy cannot be answered conclusively due to the heterogeneity of the existing studies. Lower QoL was apparent among patients with an ICD who experienced several device discharges. Medical staff should be particularly aware of the signs of both psychological and physical disorders in these patients. Further investigations on QoL in ICD patients are desirable, but ethical reasons restrict the conduct of randomized trials.
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The aim of this study was to compare the health care costs for patients using additional homeopathic treatment (homeopathy group) with the costs for those receiving usual care (control group).
Cost data provided by a large German statutory health insurance company were retrospectively analysed from the societal perspective (primary outcome) and from the statutory health insurance perspective. Patients in both groups were matched using a propensity score matching procedure based on socio-demographic variables as well as costs, number of hospital stays and sick leave days in the previous 12 months. Total cumulative costs over 18 months were compared between the groups with an analysis of covariance (adjusted for baseline costs) across diagnoses and for six specific diagnoses (depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache).
Data from 44,550 patients (67.3% females) were available for analysis. From the societal perspective, total costs after 18 months were higher in the homeopathy group (adj. mean: EUR 7,207.72 [95% CI 7,001.14-7,414.29]) than in the control group (EUR 5,857.56 [5,650.98-6,064.13]; p<0.0001) with the largest differences between groups for productivity loss (homeopathy EUR 3,698.00 [3,586.48-3,809.53] vs. control EUR 3,092.84 [2,981.31-3,204.37]) and outpatient care costs (homeopathy EUR 1,088.25 [1,073.90-1,102.59] vs. control EUR 867.87 [853.52-882.21]). Group differences decreased over time. For all diagnoses, costs were higher in the homeopathy group than in the control group, although this difference was not always statistically significant.
Compared with usual care, additional homeopathic treatment was associated with significantly higher costs. These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.
[Show abstract][Hide abstract] 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.
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.
No preview · Article · Oct 2014 · American Heart Journal
[Show abstract][Hide abstract] 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.
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.
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.
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.
No preview · Article · Dec 2013 · PharmacoEconomics - German Research Articles
[Show abstract][Hide 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.
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.
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.
No preview · Article · Nov 2013 · Journal of alternative and complementary medicine (New York, N.Y.)
[Show abstract][Hide abstract] 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.
Full-text · Article · Sep 2013 · BMC Health Services Research
[Show abstract][Hide abstract] 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).
[Show abstract][Hide abstract] 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.
No preview · Article · Jul 2013 · Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology
[Show abstract][Hide abstract] 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.
No preview · Article · Jun 2013 · PharmacoEconomics - German Research Articles
[Show abstract][Hide abstract] 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.
Full-text · Article · Mar 2013 · PharmacoEconomics
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
No preview · Article · Dec 2012 · The European Journal of Health Economics
[Show abstract][Hide abstract] ABSTRACT: Background: Specific immunotherapy is the only potentially curative therapy in patients with allergic rhinitis (AR) and allergic asthma (AA). The present study examined the effects of subcutaneous immunotherapy (SCIT) on the financial situation of the German statutory health insurance systems and measures the impact on AR/AA prevalence during the next decades. A further objective was to identify possible SCIT-treatment strategies in order to reach an efficient SCITuse. Methods: Taking population projections of the German Statistical Federal Office, the number of expected new cases (AR, AA) was calculated until 2050. Based on assumptions about the proportion of patients who received SCIT in the future, age cohorts run through a model-calculation based on Markov chains. Data on effectiveness were extracted from published literature. For determining the cost situation of SCIT pharmacies we used selling prices for Allergovit®. All future costs are discounted at a mean rate of 2%. The model calculation was supplemented by a Delphi panel. Results: Based on the current situation, a total annual economic burden of 540 million Euros is expected for care of about yearly 6 million patients with AR and AA in Germany between 2011 and 2050. Several scenarios have shown that the use of SCIT seems to be associated with cost savings from the perspective of statutory health insurances, when SCIT is offered to a larger amount of patients with moderate to severe symptoms. That would mainly driven by a reduced number of expensive patients who suffer from AA. The best effects on the future number of diseased patients could be achieved, however, if SCIT additionally would be applied to patients in earlier stages of disease. Due to the large number of patients receiving SCIT in such a scenario, the initial costs would not completely compensated by cost savings. Nevertheless, the additional costs of 300 to 350 Euros per additionally healed patient seem to be justifiable. Conclusion: From the perspective of the SHI, SCIT is a useful strategic option for preventing the progression of allergic diseases. Particularly with increased use in early disease stages, the number of healed patients is high. Potential cost savings may result from increased treatment rates in patients with advanced disease stages.
[Show abstract][Hide abstract] 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."
[Show abstract][Hide abstract] 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.
No preview · Article · Sep 2012 · International Journal of Angiology
[Show abstract][Hide abstract] 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.