Steffen Flessa

University of Greifswald, Griefswald, Mecklenburg-Vorpommern, Germany

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Publications (127)185.21 Total impact

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    ABSTRACT: Hintergrund: Die Zahl der Cochlea-Implantationen (CI) ist in den letzten Jahren stetig gestiegen. Die Ursachen hierfür liegen in einer Erweiterung der Indikationskriterien, dem demografischen Wandel, gestiegenen Lebensqualitätsansprüchen der Patienten und der gestiegenen Akzeptanz der Methode, dies vor allem durch eine verbesserte Hörleistung aufgrund technologischen Fortschritts. Die Konsequenz sind steigende Ausgaben der gesetzlichen Krankenversicherung (GKV) für die CI-Versorgung. Eine detaillierte Ermittlung der Lebenszeitkosten aus Sicht der GKV für postlingual ertaubte Jugendliche und Erwachsene ist die Grundlage für Schätzungen zukünftiger Kostenentwicklungen. Methoden: Grundlage sind Abrechnungsdaten der Medizinischen Hochschule Hannover. Unter Berücksichtigung der ferneren Lebenserwartung werden durchschnittliche Gesamtkosten der präoperativen Diagnostik, Operation, Rehabilitation und Nachsorge ermittelt und auf ihren Gegenwartswert zum Zeitpunkt der Implantation diskontiert. Ergebnisse: Die Gesamtkosten der unilateralen CI-Versorgung in Deutschland hängen negativ mit dem Alter der Erstimplantation zusammen. Der Barwert der Gesamtkosten aus Sicht der GKV liegt in Abhängigkeit des Implantationsalters zwischen 36 001 und 68 970 € ($ 42 504–$ 81 429). Die größten Kostenkomponenten sind Erstimplantation und technologiebedingte Prozessorupgrades. Diskussion: Im Vergleich zu Großbritannien scheinen die Kosten der CI-Versorgung Erwachsener in Deutschland deutlich geringer zu sein. Rehabilitation und Nachsorge verursachen in Deutschland einen geringen Anteil der Gesamtkosten. Aber auch die Kosten im ersten Jahr der Versorgung sind vergleichsweise gering. Im Hinblick auf zukünftige Ausgaben der GKV wird aufgrund von Implantatinnovationen und damit verbundenen Indikationsausweitungen ein kumulativer Kostenanstieg bei der Versorgung mit CI vermutet. Abstract Objective: The number of implantation of cochlear implants has steadily risen in recent years. Reasons for this are an extension of indication criteria, demografic change, increased quality of life needs and greater acceptance. The consequences are rising expenditure for statutory health insurance (SHI) for cochlear implantation. A detailed calculation of lifetime costs from SHI’s perspective for postlingually deafened adolescents and adults is essential in estimating future cost developments. Methods: Calculations are based on accounting data from the Hannover Medical School. With regard to further life expectancy, average costs of preoperative diagnosis, surgery, rehabilitation, follow-ups, processor upgrades and electrical maintenance were discounted to their present value at age of implantation. Results: There is an inverse relation between cost of unilateral cochlear implantation and age of initial implantation. From SHI’s perspective, the intervention costs between 36 001 and 68 970 € ($ 42 504–$ 81 429). The largest cost components are initial implantation and processor upgrades. Conclusion: Compared to the UK the cost of cochlear implantation in Germany seems to be significantly lower. In particular the costs of, rehabilitation and maintenance in Germany cause only a small percentage of total costs. Also, the costs during the first year of treatment seem comparatively low. With regard to future spending of SHI due to implant innovations and associated extension of indication, increasing cost may be suspected.
    No preview · Article · Jan 2016 · Laryngo-Rhino-Otologie
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    ABSTRACT: Background: The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives. Objective: To determine the utilization and costs of formal and informal care for PwD, indirect costs because of productivity losses of caregivers, and the associations between cost, socio-demographic and clinical variables. Methods: The analysis includes the data of 262 community-dwelling PwD and their caregivers. Socio-demographics, clinical variables, and the utilization of formal care were assessed within the baseline assessment. To evaluate informal care costs, the Resource Utilization in Dementia (RUD) questionnaire was used. Costs were calculated from a social perspective. Associations were evaluated using multiple linear and logistic regression models. Results: Formal care services were utilized less (26.3% ) than informal care (85.1% ), resulting in a cost ratio of one to ten(1,646 €; 16,473 €, respectively). In total, 29% of caregivers were employed, and every seventh (14.3% ) experienced productivity losses, which corresponded to 1,258 € annually. Whereas increasing deficits in daily living activities were associated with higher formal and higher informal costs, living alone was significantly associated with higher formal care costs and the employment of a caregiver was associated with lower informal care costs. Conclusion: Informal care contributes the most to total care costs. Living alone is a major cost driver for formal costs because of the lower availability of potential informal care. The availability of informal care is limited and productivity losses are increased when a caregiver is employed.
    No preview · Article · Dec 2015 · Journal of Alzheimer's disease: JAD
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    ABSTRACT: Background: Hospital infections with multiresistant bacteria, e.g., Methicillin-resistant Staphylococcus aureus (MRSA), cause heavy financial burden worldwide. Rapid and precise identification of MRSA carriage in combination with targeted hygienic management are proven to be effective but incur relevant extra costs. Therefore, health care providers have to decide which MRSA screening strategy and which diagnostic technology should be applied according to economic criteria. Aim: The aim of this study was to determine which MRSA admission screening and infection control management strategy causes the lowest expected cost for a hospital. Focus was set on the Point-of-Care Testing (PoC). Methods: A decision tree analytic cost model was developed, primarily based on data from peer-reviewed literature. In addition, univariate sensitivity analyses of the different input parameters were conducted to study the robustness of the results. Findings: In the basic analysis, risk-based PoC screening showed the highest mean cost savings with 14.98 € per admission in comparison to no screening. Rapid universal screening methods became favorable at high MRSA prevalence, while in situations with low MRSA transmission rates omission of screening may be favorable. Conclusion: Early detection of MRSA by rapid PoC or PCR technologies and consistent implementation of appropriate hygienic measures lead to high economic efficiency of MRSA management. Whether general or targeted screening is more efficient depends mainly on epidemiological and infrastructural parameters.
    Preview · Article · Dec 2015
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    Lawrencia Mushi · Paul Marschall · Steffen Fleßa
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    ABSTRACT: Background The cost of dialysis in low and middle-Income countries has not been systematically reviewed. The objective of this article is to systematically review peer-reviewed articles on the cost of dialysis across low and middle-income countries. Methods PubMed and Embase databases were searched for the year 1998 to March 2013, and additional studies were added from Google Scholar search. An article was included if two reviewers agreed that it had reported cost of dialysis from low and middle-Income countries. Results The annual cost per patient for hemodialysis (HD) ranged from Int$ 3,424 to Int$ 42,785, and peritoneal dialysis (PD) ranged from Int$ 7,974 to Int$ 47,971. Direct medical cost especially drugs and consumables for HD and dialysis solutions and tubing for PD were the main cost drivers. Conclusion The number of studies on the economics of dialysis in low and middle-income countries is limited. Few papers indicate that dialysis is an expensive form of treatment for the population of these countries and that the poorer countries have an over-proportional burden to finance dialysis services. Further research is needed to determine the cost of dialysis based on a standard methodology grounded on existing economic guidelines and to address the question whether dialysis should be an element of the essential package of health in resource-poor countries. Used data should be as complete as possible. In case of missing data, proxies can be used. In case of developing countries, expert interviews are often used for estimating missing information.
    Full-text · Article · Nov 2015 · BMC Health Services Research
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    ABSTRACT: Aim: Clostridium difficile-associated diarrhea (CDAD) causes heavy financial burden on healthcare systems worldwide. As with all hospital-acquired infections, prolonged hospital stays are the main cost driver. Previous cost studies only include hospital billing data and compare the length of stay in contrast to non-infected patients. To date, a survey of actual cost has not yet been conducted. Method: A retrospective analysis of data for patients with nosocomial CDAD was carried out over a 1-year period at the University Hospital of Greifswald. Based on identification of CDAD related treatment processes, cost of hygienic measures, antibiotics and laboratory as well as revenue losses due to bed blockage and increased length of stay were calculated. Results: 19 patients were included in the analysis. On average, a CDAD patient causes additional costs of € 5,262.96. Revenue losses due to extended length of stay take the highest proportion with € 2,555.59 per case, followed by loss in revenue due to bed blockage during isolation with € 2,413.08 per case. Overall, these opportunity costs accounted for 94.41% of total costs. In contrast, costs for hygienic measures (€ 253.98), pharmaceuticals (€ 22.88) and laboratory (€ 17.44) are quite low. Conclusion: CDAD results in significant additional costs for the hospital. This survey of actual costs confirms previous study results.
    Preview · Article · Nov 2015
  • Steffen Flessa · Dominik Dietz · Elisabete Weiderpass
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    ABSTRACT: Health policy support in least developing countries is needed to allocate scarce resources most efficiently and produce the maximum health at given resources. However, planners frequently face severe uncertainty of biological, economic and health service structures and parameters. This paper presents a model of cervical cancer (CUC) in Cambodia as an example of health policy support under extreme uncertainty. The projections are based on a multi-compartment dynamic policy model, specifically developed for CUC in Cambodia. The model simulates the demographic system and infections through sexual intercourse for 100 years. Data were taken from the literature and adjusted for Cambodia through interviews. CUC is an increasing problem in Cambodia and the number of deaths due to cervical cancer growths faster than the population. On average, Cambodia will lose some 5159 years of life per year due to CUC. From the alternative interventions against CUC, a “see-and-treat” approach based on VIA screening of women 30–49 years every 3 years seems to be most efficient. The results of the simulation indicate that the “see-and-treat” approach should be implemented in Cambodia. Even under strong changes of parameters and assumptions, this finding is robust. The model is currently being used in development planning. The example shows that health policy support is possible even under extreme uncertainty if the model builder employs a sufficient number of sensitivity analyses and scenarios.
    No preview · Article · Oct 2015
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    ABSTRACT: Background: Nosocomial infections are the most common complication during inpatient hospital care. An increasing proportion of these infections are caused by multidrug-resistant organisms (MDROs). This report describes an intervention study which was designed to address the practical problems encountered in trying to avoid and treat infections caused by MDROs. The aim of the HARMONIC (Harmonized Approach to avert Multidrug-resistant Organisms and Nosocomial Infections) study is to provide comprehensive support to hospitals in a defined study area in north-east Germany, to meet statutory requirements. To this end, a multimodal system of hygiene management was implemented in the participating hospitals. Methods/design: HARMONIC is a controlled intervention study conducted in eight acute care hospitals in the 'Health Region Baltic Sea Coast' in Germany. The intervention measures include the provision of written recommendations on methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and multi-resistant Gram-negative bacteria (MRGN), supplemented by regional recommendations for antibiotic prescriptions. In addition, there is theoretical and practical training of health care workers (HCWs) in the prevention and handling of MDROs, as well as targeted and critically gauged applications of antibiotics. The main outcomes of the implementation and analysis of the HARMONIC study are: (i) screening rates for MRSA, VRE and MRGN in high-risk patients, (ii) the frequency of MRSA decolonization, (iii) the level of knowledge of HCWs concerning MDROs, and (iv) specific types and amounts of antibiotics used. The data are predominantly obtained by paper-based questionnaires and documentation sheets. A computer-assisted workflow-based documentation system was developed in order to provide support to the participating facilities. The investigation includes three nested studies on risk profiles of MDROs, health-related quality of life, and cost analysis. A six-month follow-up study investigates the quality of life after discharge, the long-term costs of the treatment of infections caused by MDROs, and the sustainability of MRSA eradication. Discussion: The aim of this study is to implement and evaluate an area-wide harmonized hygiene program to control the nosocomial spreading of MDROs. Comparability between the intervention and control group is ensured by matching the hospitals according to size (number of discharges per year / number of beds) and level of care (standard or maximum). The results of the study may provide important indications for the implementation of regional MDRO management programs.
    Preview · Article · Oct 2015 · BMC Infectious Diseases
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    Lawrencia Mushi · Markus Krohn · Steffen Flessa
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    ABSTRACT: Background: Although End Stage Renal Disease (ESRD) is a disease of increasing epidemiological relevance very little is known about the cost of providing the respective dialysis services in Tanzania. This paper estimates the costs of dialysis for ESRD patients at Muhimbili National Hospital (MNH) in Tanzania in the year 2014. Methods: Cost calculations are based on the provider perspective and include only the direct cost of dialysis treatment. Cost of drugs and consumables were obtained from the price list issued by the Medical Stores Department (MSD) in Tanzania. Additional data were collected through face-to-face interview with experts at the dialysis unit. Results: MNH performs on average 442 hemodialysis per month (34 patients, with three sessions per week) with a personnel placement of 20 nurses, four nephrologists, eight registrars, one nutritionist, two biomedical engineers, four health attendants and nine dialysis machines. The respective average unit cost per hemodialysis is 176 US$. Consequently, an average patient requiring three dialyses per week (i.e. 156 dialyses per year) will cause annual costs of 27,440 US$. Conclusion: The cost of dialysis is enormous for a least developed country like Tanzania where resources and technology are rather limited. Thus, from the economic point of view, it seems rational to allocate health care budgets towards diseases that are curable, have a higher cost-effectiveness and cater for the majority of the population. However, before a final decision on allocation of budgets towards dialysis is made all effort must be invested to improve technical efficiency by cutting the enormous unit cost.
    Full-text · Article · Oct 2015
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    ABSTRACT: Background: It is well-known that dementia is undiagnosed, resulting in the exclusion of patients without a formal diagnosis of dementia in many studies. Objectives of the present analyses were (1) to determine healthcare resource utilization and (2) costs of patients screened positive for dementia with a formal diagnosis and those without a formal diagnosis of dementia, and (3) to analyze the association between having received a formal dementia diagnosis and healthcare costs. Method: This analysis is based on 240 primary care patients who screened positive for dementia. Within the baseline assessment, individual data about the utilization of healthcare services were assessed. Costs were assessed from the perspective of insurance, solely including direct costs. Associations between dementia diagnosis and costs were evaluated using multiple linear regression models. Results: Patients formally diagnosed with dementia were treated significantly more often by a neurologist, but less often by all other outpatient specialists, and received anti-dementia drugs and day care more often. Diagnosed patients underwent shorter and less frequent planned in-hospital treatments. Dementia diagnosis was significantly associated with higher costs of anti-dementia drug treatment, but significantly associated with less total medical care costs, which valuated to be € 5,123 compared, to € 5,565 for undiagnosed patients. We found no association between dementia diagnosis and costs of evidence-based non-medication treatment or total healthcare cost (€ 7,346 for diagnosed vs. € 6,838 for undiagnosed patients). Conclusion: There are no significant differences in total healthcare cost between diagnosed and undiagnosed patients. Dementia diagnosis is beneficial for receiving cost-intensive anti-dementia drug treatments, but is currently insufficient to ensure adequate non-medication treatment for community-dwelling patients.
    No preview · Article · Oct 2015 · International Psychogeriatrics

  • No preview · Article · Aug 2015 · Zeitschrift für Gastroenterologie
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    Full-text · Article · Aug 2015 · Deutsches Ärzteblatt
  • P. Erdmann · T. Fischer · S. Raths · S. Fleßa · M. Langanke

    No preview · Article · Aug 2015
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    Steffen Flessa · Michael Marx
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    ABSTRACT: In 2014 an Ebola epidemic emerged in Western Africa (particularly in Guinea, Liberia, Sierra Leone), which with regard to incidence and prevalence exceeded any previous Ebola epidemic [1]. According to estimates of the World Health Organization more than 26,000 people (including suspected cases) suffered from Ebola until April 2015. About 40 % of them died from this infectious disease [2]. The dynamics and intensity of the epidemic took many experts by surprise. Above all, it represented excessive demands on local health care systems as well as-at least initially-of international organizations tasked with coordinated intervention [3]. From a health economic perspective, especially, the complete dysfunctionality of local health care services is not surprising. The Ebola fever epidemic in Western Africa rather reveals fundamental failures in establishing health policies within those countries as well as in development policies of industrialized nations. In the following, some of these structural defects are outlined and conclusions from the Ebola epidemic are drawn.
    Preview · Article · Jul 2015 · The European Journal of Health Economics
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    Stefan Scholz · Baltazar Ngoli · Steffen Flessa
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    ABSTRACT: Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.
    Preview · Article · May 2015 · BMC Health Services Research
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    ABSTRACT: Acute and chronic pancreatitis are common gastroenterological disorders that have a fairly unpredictable long-term course often associated with unplanned hospital readmissions. Little is known about the factors that increase or decrease the risk for a hospital readmission. The aim of this study was to identify positive and negative predictive factors for hospital readmissions of patients with acute and chronic pancreatitis after in-hospital treatment. In a retrospective analysis data from the hospital information and reimbursement data system (HIS) were evaluated for 606 hospital stays for either acute or chronic pancreatitis between 2006 and 2011. Additional clinical data were obtained from a questionnaire covering quality of life and socio-economic status. A total of 973 patient variables were assessed by bivariate and multivariate analysis. Between 2006 and 2011, 373 patients were admitted for acute or chronic pancreatitis; 107 patients of them were readmitted and 266 had only one hospitalization. Predictors for readmission were concomitant liver disease, presence of a pseudocyst or a suspected tumor of the pancreas as well as alcohol, tobacco or substance abuse or coexisting mental disorders. Patients who had undergone a CT-scan were more susceptible to readmission. Lower readmissions rates were found in patients with diabetes mellitus or gallstone disease as co-morbidity. While factors like age and severity of the initial disease cannot be influenced to reduce the readmission rate for pancreatitis, variables like alcohol, tobacco and drug abuse can be addressed in outpatient programs to reduce disease recurrence and readmission rates for pancreatitis. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.
    No preview · Article · Mar 2015 · Pancreatology

  • No preview · Article · Mar 2015 · Endoskopie heute
  • Susan Raths · Olav Götz · Karen Heidorn · Steffen Fleßa
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    ABSTRACT: GERMAN Article In recent years, the trend towards closure of hospital pharmacies is unabated. One explanation is the decrease in the number of hospital beds in Germany. The assessment that external service providers can ensure the supply of a house much more efficiently, appears to be a decisive factor, too. Particularly within the logistic processes there seems to be some potential for optimization. In an empirical study the influence of automation on process structures and process times of picking was investigated. The results are particularly based on process observations and time measurements. The automation as a possible instrument to increase efficiency will be examined by comparing manual and automated picking.
    No preview · Article · Mar 2015 · Krankenhauspharmazie
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    ABSTRACT: Background: The German hospital reimbursement system (G-DRG) is incomplete for endoscopic interventions and fails to differentiate between complex and simple procedures. This is caused by outdated methods of personnel-cost allocation. Methods: To establish an up-to-date service catalogue 50 hospitals made their anonymized expense-budget data available to the German-Society-of-Gastroenterology (DGVS). 2.499.900 patient-datasets (2011 - 2013) were used to classify operation-and-procedure codes (OPS) into procedure-tiers (e. g. colonoscopy with biopsy/colonoscopy with stent-insertion). An expert panel ranked these tiers according to complexity and assigned estimates of physician time. From June to November 2014 exact time tracking data for a total 38.288 individual procedures were collected in 119 hospitals to validate this service catalogue. Results: In this three-step process a catalogue of 97 procedure-tiers was established that covers 99 % of endoscopic interventions performed in German hospitals and assigned validated mean personnel-costs using gastroscopy as standard. Previously, diagnostic colonoscopy had a relative personnel-cost value of 1.13 (compared to gastroscopy 1.0) and rose to 2.16, whereas diagnostic ERCP increased from 1.7 to 3.62, more appropriately reflecting complexity. Complex procedures previously not catalogued were now included (e. g. gastric endoscopic submucosal dissection: 16.74). Discussion: This novel service catalogue for GI-endoscopy almost completely covers all endoscopic procedures performed in German hospitals and assigns relative personnel-cost values based on actual physician time logs. It is to be included in the national coding recommendation and should replace all prior inventories for cost distribution. The catalogue will contribute to a more objective cost allocation and hospital reimbursement - at least until time tracking for endoscopy becomes mandatory. © Georg Thieme Verlag KG Stuttgart · New York.
    Full-text · Article · Mar 2015 · Zeitschrift für Gastroenterologie
  • Marly Schwendler · Claudia Hübner · Steffen Fleßa

    No preview · Article · Feb 2015 · Journal der Deutschen Dermatologischen Gesellschaft
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    Marly Schwendler · Claudia Hübner · Steffen Fleßa

    Preview · Article · Jan 2015 · Journal der Deutschen Dermatologischen Gesellschaft

Publication Stats

795 Citations
185.21 Total Impact Points


  • 2005-2015
    • University of Greifswald
      • • Faculty of Law and Economics
      • • Institute of Diagnostic Radiology and Neuroradiology
      Griefswald, Mecklenburg-Vorpommern, Germany
  • 2011
    • Deutsches Zentrum für Neurodegenerative Erkrankungen
      Bonn, North Rhine-Westphalia, Germany
  • 2004-2005
    • Universität Heidelberg
      • Institute of Public Health
      Heidelburg, Baden-Württemberg, Germany
  • 2003
    • Evangelische Hochschule Nürnberg
      Nuremberg, Bavaria, Germany
  • 2000
    • University of Applied Sciences
      Gieben, Hesse, Germany
  • 1999
    • Fachhochschule der Wirtschaft
      Paderborn, North Rhine-Westphalia, Germany