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Winkelmann C, Neumann T, Zeidler J, Prenzler A, Vogt B, Wacker FK. Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply. ROFO-FORTSCHR RONTG 2019; 191:635-642. [PMID: 30763963 DOI: 10.1055/a-0838-6253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. METHOD This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation" for inpatients and "authorization right" for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies. RESULTS The G-BA's authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector. CONCLUSION Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures. KEY POINTS · HTAs should be a basic component of evidence-based radiology.. · G-BA's authority implicitly creates a paradox in terms of inventives to implement and finance HTAs.. · University hospitals and public funding institutions need to support studies that assess the benefit of radiological procedures.. CITATION FORMAT · Winkelmann C, Neumann T, Zeidler J et al. Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply. Fortschr Röntgenstr 2019; 191: 635 - 642.
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Affiliation(s)
- Carolin Winkelmann
- Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
| | - Thomas Neumann
- Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
| | - Anne Prenzler
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
| | - Bodo Vogt
- Chair in Empirical Economics, Otto-von-Guericke-University Magdeburg, Germany.,Chair in Health Economics, Institute of Social Medicine and Health Economics, Otto-von-Guericke-University Magdeburg, Germany.,Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Research Campus STIMULATE, Otto-von-Guericke-University Magdeburg, Germany
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Siol V, Lange A, Prenzler A, Neubauer S, Frank M. [Willingness of Students of Economics to Pay for Predictive Oncological Genetic Testing - An Empirical Analysis]. Gesundheitswesen 2017; 79:425-437. [PMID: 28575925 DOI: 10.1055/s-0035-1547300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: The present study aims to investigate the interest of young adults in predictive oncological genetic testing and their willingness to pay for such a test. Furthermore, major determinants of the 2 variables of interest were identified. Methods: 348 students of economics from the Leibniz University of Hanover were queried in July 2013 using an extensive questionnaire. Among other things, the participants were asked if they are interested in information about the probability to develop cancer in the future and their willingness to pay for such information. Data were analysed using descriptive statistics and ordinal probit regressions. Additionally marginal effects were calculated. Results: About 50% of the students were interested in predictive oncological genetic testing and were willing to pay for the test. Moreover, the participants who were willing to pay for the test partly attach high monetary values to the information that could so be obtained. The study shows that the interest of the students and their willingness to pay were primarily influenced by individual attitudes and perceptions. Conclusions: The study proves that young adults were interested in predictive genetic testing and appreciate information about their probability of develop cancer someday.
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Affiliation(s)
- V Siol
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover
| | - A Lange
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover
| | - A Prenzler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover
| | - S Neubauer
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover
| | - M Frank
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover
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Müller D, Stock S, Dintsios CM, Chernyak N, Gerber-Grote A, Gloede TD, Hermann B, Huppertz E, Jülich F, Mostardt S, Köberlein-Neu J, Prenzler A, Salize HJ, Santos S, Scheckel B, Seidl A, Wahlers K, Icks A. [Checklist for the Development and Assessment of Cost-of-Illness Studies]. Gesundheitswesen 2017; 80:744-753. [PMID: 28521377 DOI: 10.1055/s-0042-124664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cost-of-illness (CoI) studies are important instruments for estimating the socioeconomic burden of specified diseases. CoI studies provide important information about the cost structure of a disease, the resulting research need, approaches to improve aspects of care and, monetary consequences from different perspectives. This information can be useful for healthcare research and health policy. Due to heterogeneity of available Cost-of-Illness studies, the working group 'Health Economics' of the German Network for Healthcare Research (DNVF) in accordance with the German Society for Health Economics (DGGÖ) developed an instrument for the planning, conduct and assessment of CoI studies. METHODS The checklist was developed based on a systematic literature search of published national and international checklists as well as guidelines and recommendations for development and assessment of CoI studies and health economic evaluations. Structure and subject matter of the generic checklist was designed, approved and, finally, examined in a pretest by the working group. RESULTS Based on the results of the literature search (n=2 454), 58 articles were used for the identification of relevant criteria for the checklist. With respect to the results of the pretest, 6 dimensions were included in the checklist: (i) general aspects, (ii) identification of resources, (iii) description and quantification of resource consumption, (iv) valuation of resources (v) analysis and presentation of results and (vi) discussion and conclusion. In total, the 6 dimensions were operationalized through 37 items. CONCLUSION This checklist is an initial approach to improve transparency and understanding of CoI studies in terms of the extent, structure and development of the socioeconomic burden of diseases. The checklist supports the comparability of different studies and facilitates study conception.
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Affiliation(s)
- Dirk Müller
- Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln, Köln
| | - Stephanie Stock
- Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln, Köln
| | | | - Nadja Chernyak
- Institut für Versorgungsforschung und Gesundheitsökonomie, Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät, Düsseldorf
| | - Andreas Gerber-Grote
- ZAHW Gesundheit, Zurcher Hochschule fur Angewandte Wissenschaften, Winterthur, Switzerland
| | - Tristan Daniel Gloede
- Versorgungsforschung und Rehabilitationswissenschaft, Institut für Medizinsoziologie, Universität zu Köln, Köln
| | - Benita Hermann
- Versorgungsforschung und Rehabilitationswissenschaft, Institut für Medizinsoziologie, Universität zu Köln, Köln
| | - Eduard Huppertz
- GHS-HealthCare.net, Gesundheitsökonomie & Outcomes-Forschung, Niedererbach
| | - Fabian Jülich
- Market Access & Health Econom ics/Outcomes Research, Bayer Health Care, Köln
| | | | - Juliane Köberlein-Neu
- Bergisches Kompetenzzentrum für Gesundheitsökonomik und Versorgungsforschung, Bergische Universität Wuppertal Fakultat fur Wirtschaftswissenschaft - Schumpeter School of Business and Economics, Wuppertal
| | | | - Hans-Joachim Salize
- Klinik Psychiatrie und Psychotherapie. AG Versorgungsforschung, Zentralinstitut fur Seelische Gesundheit, Mannheim
| | - Sara Santos
- Medizinische Fakultät, Institut für Allgemeinmedizin, Düsseldorf
| | - Benjamin Scheckel
- Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln, Köln
| | - Astrid Seidl
- Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, Versorgung und Gesundheitsökonomie, Koln
| | - Katharina Wahlers
- Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln, Köln
| | - Andrea Icks
- Institut für Versorgungsforschung und Gesundheitsökonomie, Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät, Düsseldorf
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Schmidt K, Damm K, Prenzler A, Golpon H, Welte T. Preferences of lung cancer patients for treatment and decision-making: a systematic literature review. Eur J Cancer Care (Engl) 2015; 25:580-91. [PMID: 26676876 DOI: 10.1111/ecc.12425] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Abstract
The consideration of patient preferences in decision-making has become more important, especially for life-threatening diseases such as lung cancer. This paper aims to identify the preferences of lung cancer patients with regard to their treatment and involvement in the decision-making process. We conducted a systematic literature review from 12 electronic databases and included studies published between 2000 and 2012. A total of 20 studies were included in this review. These revealed that lung cancer patients do have preferences that should be considered in treatment decisions; however, these preferences are not homogenous. We found that patients often consider life extension to be more important than the health-related quality of life or undesirable side effects. This preference seems to depend on patient age. Nausea and vomiting are the most important side effects to be avoided; the relevance of other side effects differs highly between subgroups. The majority of lung cancer patients, nevertheless, seem to prefer a passive rather than an active role in decision-making, although the self-reported preferences differed partly from the physicians' perceptions. Overall, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques.
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Affiliation(s)
- K Schmidt
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - K Damm
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - A Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - H Golpon
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Hannover Medical School, Clinic for Pneumology, Hannover, Germany
| | - T Welte
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Hannover Medical School, Clinic for Pneumology, Hannover, Germany
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Lange A, Prenzler A, Bachmann O, Linder R, Neubauer S, Zeidler J, Manns MP, von der Schulenburg JM. Regional differences in health care of patients with inflammatory bowel disease in Germany. Health Econ Rev 2015; 5:29. [PMID: 26475276 PMCID: PMC4608952 DOI: 10.1186/s13561-015-0067-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The regional availability of specialized physicians is an important aspect in healthcare of patients with IBD. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?" METHODS We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated: regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed. RESULTS The study cohort was comprised of 21,771 individuals, including 9282 patients with Crohn disease and 12,489 patients with ulcerative colitis. Patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support. CONCLUSIONS The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. No clear evidence of a general healthcare undersupply in rural areas was found.
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Affiliation(s)
- Ansgar Lange
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Anne Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Oliver Bachmann
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
| | - Roland Linder
- Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany.
| | - Sarah Neubauer
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Jan Zeidler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Michael P Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
| | - J-Matthias von der Schulenburg
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
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Lange A, Prenzler A, Frank M, Golpon H, Welte T, von der Schulenburg JM. A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC). BMC Pulm Med 2014; 14:192. [PMID: 25471553 PMCID: PMC4269853 DOI: 10.1186/1471-2466-14-192] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/20/2014] [Indexed: 12/30/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. Methods A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. Results Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion criteria. The majority of studies analyzed the CE of first-line maintenance and second-line treatment with erlotinib. Five studies dealt with bevacizumab in first-line regimes. Gefitinib and pharmacogenomic profiling were each covered by only two studies. Furthermore, the available evidence was of only fair quality. Conclusion First-line maintenance treatment with erlotinib compared to Best Supportive Care (BSC) can be considered cost-effective. In comparison to docetaxel, erlotinib is likely to be cost-effective in subsequent treatment regimens as well. The insights for bevacizumab are miscellaneous. There are findings that gefitinib is cost-effective in first- and second-line treatment, however, based on only two studies. The role of pharmacogenomic testing needs to be evaluated. Therefore, future research should improve the available evidence and consider pharmacogenomic profiling as specified by the European Medicines Agency. Upcoming agents like crizotinib and afatinib need to be analyzed as well. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-14-192) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ansgar Lange
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str, 1, D-30159 Hannover, Germany.
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Kirstein MM, Lange A, Prenzler A, Manns MP, Kubicka S, Vogel A. Targeted therapies in metastatic colorectal cancer: a systematic review and assessment of currently available data. Oncologist 2014; 19:1156-68. [PMID: 25326159 PMCID: PMC4221380 DOI: 10.1634/theoncologist.2014-0032] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 07/09/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Survival of patients with metastatic colorectal cancer (mCRC) has been significantly improved with the introduction of the monoclonal antibodies targeting the vascular endothelial growth factor (VEGF) and the epidermal growth factor receptor (EGFR). Novel molecular-targeted agents such as aflibercept and regorafenib have recently been approved. The aim of this review is to summarize and assess the effects of molecular agents in mCRC based on the available phase II and III trials, pooled analyses, and meta-analyses/systematic reviews. METHODS A systematic literature search was conducted using the meta-database of the German Institute of Medical Documentation and Information. Criteria of the Scottish Intercollegiate Guidelines Network were used to assess the quality of the controlled trials and systematic reviews/meta-analyses. RESULTS Of the 806 retrieved records, 40 publications were included. For bevacizumab, efficacy in combination with fluoropyrimidine-based chemotherapy in first- and subsequent-line settings has been shown. The benefit of continued VEGF targeting has also been demonstrated with aflibercept and regorafenib. Cetuximab is effective with fluoropyrimidine, leucovorin, and irinotecan (FOLFIRI) in first-line settings and as a single agent in last-line settings. Efficacy for panitumumab has been shown with oxaliplatin with fluoropyrimidine in first-line settings, with FOLFIRI in second-line settings, and as monotherapy in last-line settings. Treatment of anti-EGFR antibodies is restricted to patients with tumors that do not harbor mutations in Kirsten rat sarcoma and in neuroblastoma RAS. CONCLUSION Among various therapeutic options, the future challenge will be a better selection of the population that will benefit the most from specific anti-VEGF or anti- EGFR treatment and a careful consideration of therapy sequence.
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Affiliation(s)
- Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leibniz University Hannover, Center for Health Economics Research Hannover, Hannover, Germany; Cancer Center Reutlingen, Reutlingen, Germany
| | - Ansgar Lange
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leibniz University Hannover, Center for Health Economics Research Hannover, Hannover, Germany; Cancer Center Reutlingen, Reutlingen, Germany
| | - Anne Prenzler
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leibniz University Hannover, Center for Health Economics Research Hannover, Hannover, Germany; Cancer Center Reutlingen, Reutlingen, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leibniz University Hannover, Center for Health Economics Research Hannover, Hannover, Germany; Cancer Center Reutlingen, Reutlingen, Germany
| | - Stefan Kubicka
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leibniz University Hannover, Center for Health Economics Research Hannover, Hannover, Germany; Cancer Center Reutlingen, Reutlingen, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; Leibniz University Hannover, Center for Health Economics Research Hannover, Hannover, Germany; Cancer Center Reutlingen, Reutlingen, Germany
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Abstract
BACKGROUND The aim of this study was to identify the prevalence and incidence as well as the health care costs of asthma specifically in the German setting. METHODS Two systematic literature searches were conducted in PubMed in December 2012 (updated in March 2014). All publications in German and English were included. RESULTS After review of title, abstracts and full publications, 17 relevant studies included information on the prevalence and incidence of asthma. The 12-month prevalence for adults ranges between 4.6 % and 6.34 % (children: 3.8 % - 11.8 %). At younger ages, asthma is more prevalent in boys. In adulthood, more women are affected. We identified seven cost-of-illness studies. The direct costs range between € 690.4 m and 1.36 bn. The reported health care costs depend on the perspective, the severity of disease and the database, so that a comparison of results is difficult. CONCLUSION All in all, this review underlines the epidemiological and health economic importance of asthma in Germany. Several studies on the prevalence of asthma are available, but there is little information on the current incidence of this disease. Further research is necessary for obtaining a comprehensive picture of the current health care costs.
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Affiliation(s)
- I Aumann
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover
| | - A Prenzler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - A Gillissen
- Klinik für Lungen- und Bronchialmedizin, Klinikum Kassel, Kassel School of Medicine
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Damm K, Prenzler A, Zuchandke A. Who prefers the 'cost-effectiveness ratio' prioritization approach in health-care decisions? Results of an empirical analysis. Health Expect 2014; 18:2413-24. [PMID: 24905558 DOI: 10.1111/hex.12209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The problem of resource scarcity has led to an on-going debate about priority setting in the health-care system. Prioritization via the economic-based cost-effectiveness ratio (CER), for example, is controversial and has many advocates as well as opponents. Hence, the aim of our research is to analyse the fairness consideration of the CER approach in comparison with other prioritization approaches and to investigate whether these preferences depend on the field of study. METHODS We developed and tested a unique questionnaire. Between October 2011 and January 2012, freshmen and advanced university students of medicine, law, economics, philosophy and religion in Germany were asked to choose among four prioritization approaches (CER, minimum health, random selection and age) using a dichotomous choice technique. The data were analysed by descriptive and microeconometric regression techniques. RESULTS Data on 913 students were included in the study. A majority of the students prioritized cost-effectiveness second after minimum health. Advanced economics students preferred the CER approach significantly more than did incoming economics students. The attitudes of the advanced philosophy/religion students towards the CER were significantly more negative compared with the respective freshmen. Further, gender had a strong, significant impact on attitudes: women chose the CER less often than men did (P < 0.01). CONCLUSION The results of this study indicate that attitudes presented by opinion leaders in the investigated fields of study seem to be in line with the perceptions of the respective fields' advanced students. Because of these differences, the debate on how to deal with scarce resources may remain complicated.
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Affiliation(s)
- Kathrin Damm
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Anne Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany
| | - Andy Zuchandke
- Leibniz University Hannover, Center for Risk and Insurance, Hannover, Germany
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Damm K, Vogel A, Prenzler A. Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review. Eur J Cancer Care (Engl) 2014; 23:762-72. [PMID: 24840999 DOI: 10.1111/ecc.12207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.
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Affiliation(s)
- K Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
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Damm K, Prenzler A, Zuchandke A. Does the perception of fairness and standard of care in the health system depend on the field of study? Results of an empirical analysis. BMC Health Serv Res 2014; 14:166. [PMID: 24725356 PMCID: PMC3990008 DOI: 10.1186/1472-6963-14-166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/02/2014] [Indexed: 11/10/2022] Open
Abstract
Background The main challenge in the context of health care reforms and priority setting is the establishment and/or maintenance of fairness and standard of care. For the political process and interdisciplinary discussion, the subjective perception of the health care system might even be as important as potential objective criteria. Of special interest are the perceptions of academic disciplines, whose representatives act as decision makers in the health care sector. The aim of this study is to explore and compare the subjective perception of fairness and standard of care in the German health care system among students of medicine, law, economics, philosophy, and religion. Methods Between October 2011 and January 2012, we asked freshmen and advanced students of the fields mentioned above to participate in a paper and pencil survey. Prior to this, we formulated hypotheses. The data were analysed by micro econometric regression techniques. Results Data from 1,088 students were included in the study. Medical students, freshmen, and advanced students perceive the standard of care significantly as being better than non-medical students. Differences in the perception of fairness are not significant between the freshmen of the academic disciplines; however, they increase with the number of study terms. Besides the field of study, further variables such as gender and health status have a significant impact on perceptions. Conclusions Our results show that there are differences in the perception of fairness and standard of care between academic disciplines, which might influence the interdisciplinary discussion on health care reforms and priority setting.
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Affiliation(s)
- Kathrin Damm
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Königsworther Platz 1, D-30167 Hannover, Germany.
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Frank M, Prenzler A, Eils R, Graf von der Schulenburg JM. Genome sequencing: a systematic review of health economic evidence. Health Econ Rev 2013; 3:29. [PMID: 24330507 PMCID: PMC3874598 DOI: 10.1186/2191-1991-3-29] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/02/2013] [Indexed: 05/23/2023]
Abstract
Recently the sequencing of the human genome has become a major biological and clinical research field. However, the public health impact of this new technology with focus on the financial effect is not yet to be foreseen. To provide an overview of the current health economic evidence for genome sequencing, we conducted a thorough systematic review of the literature from 17 databases. In addition, we conducted a hand search. Starting with 5 520 records we ultimately included five full-text publications and one internet source, all focused on cost calculations. The results were very heterogeneous and, therefore, difficult to compare. Furthermore, because the methodology of the publications was quite poor, the reliability and validity of the results were questionable. The real costs for the whole sequencing workflow, including data management and analysis, remain unknown. Overall, our review indicates that the current health economic evidence for genome sequencing is quite poor. Therefore, we listed aspects that needed to be considered when conducting health economic analyses of genome sequencing. Thereby, specifics regarding the overall aim, technology, population, indication, comparator, alternatives after sequencing, outcomes, probabilities, and costs with respect to genome sequencing are discussed. For further research, at the outset, a comprehensive cost calculation of genome sequencing is needed, because all further health economic studies rely on valid cost data. The results will serve as an input parameter for budget-impact analyses or cost-effectiveness analyses.
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Affiliation(s)
- Martin Frank
- Leibniz University Hannover, Center for Health Economics Research Hannover, Königsworther Platz 1, 30167, Hannover, Germany
| | - Anne Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover, Königsworther Platz 1, 30167, Hannover, Germany
| | - Roland Eils
- German Cancer Research Center, Heidelberg, Germany
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Sattelmeier J, Prenzler A, Frank M. Das Arzneimittelmarktneuordnungsgesetz (AMNOG) in der Praxis - erste Erfahrungen, Kritikpunkte und Weiterentwicklungsmöglichkeiten. Gesundh ökon Qual manag 2013. [DOI: 10.1055/s-0033-1350528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lange A, Prenzler A, Frank M, Kirstein M, Vogel A, von der Schulenburg JM. A systematic review of cost-effectiveness of monoclonal antibodies for metastatic colorectal cancer. Eur J Cancer 2013; 50:40-9. [PMID: 24011538 DOI: 10.1016/j.ejca.2013.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 07/24/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Metastatic colorectal cancer (mCRC) imposes a substantial health burden on patients and society. In recent years, advances in the treatment of mCRC have mainly resulted from the introduction of monoclonal antibodies (MoAbs). However, the application of these MoAbs considerably increases treatment costs. The objective of this article is to review and assess the economic evidence of MoAB treatment in mCRC. A systematic literature review was conducted and cost-effectiveness (CE) as well as cost-utility-studies were identified. For this, Medline, Embase, SciSearch, Cochrane, and nine other databases were searched from 2000 through February 2013 for full-text publications. The quality of the studies was assessed via a validated assessment tool (Quality of Health Economic Studies (QHES)). A total of 843 publications were screened. Of those, 15 studies involving the MoAbs bevacizumab, cetuximab and panitumumab met all inclusion criteria. Four studies analysed the CE of first-line treatment with bevacizumab and nine the CE of cetuximab in subsequent treatment lines. Two studies dealt with the CE of panitumumab. The analysis of sequential regimes and the direct comparison of two MoABs were analysed by only one study each. The quality of the included studies was high with the exception of one study. CONCLUSIONS The treatment with bevacizumab, cetuximab and panitumumab is mainly considered to be not cost-effective in patients with mCRC. However, testing for Kirsten ras oncogene (KRAS) mutation prior to the treatment with cetuximab or panitumumab is found to be clearly cost-effective compared to no testing. Future research should focus on the CE of first-line treatment with cetuximab or panitumumab and studies on upcoming agents like regorafenib and aflibercept.
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Affiliation(s)
- A Lange
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.
| | - A Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.
| | - M Frank
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.
| | - M Kirstein
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany.
| | - A Vogel
- Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany.
| | - J M von der Schulenburg
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Germany.
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Bokemeyer B, Hardt J, Hüppe D, Prenzler A, Conrad S, Düffelmeyer M, Hartmann P, Hoffstadt M, Klugmann T, Schmidt C, Weismüller J, Mittendorf T, Raspe H. Clinical status, psychosocial impairments, medical treatment and health care costs for patients with inflammatory bowel disease (IBD) in Germany: an online IBD registry. J Crohns Colitis 2013; 7:355-68. [PMID: 22503168 DOI: 10.1016/j.crohns.2012.02.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 02/08/2012] [Accepted: 02/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this cross-sectional study was to establish an online inflammatory bowel disease (IBD) registry for a first picture of the situation of IBD outpatients' treatment in Germany. METHODS Between March 2006 and July 2007 IBD outpatients from 24 gastroenterological specialist practices and two hospitals in Germany were enrolled in an Internet-based registry to evaluate the outpatients' clinical status, psychological impairments, provided health care, as well as medical treatment and medication costs. RESULTS 1032 IBD patients (ulcerative colitis/UC: 519; Crohn's disease/CD: 511; indeterminate colitis: 2) were enrolled in the study (age: 43 ± 14 years/M ± SD). Disease duration of all patients averaged 10 ± 8.5 years. In 519 UC-patients (49% male; 33% pancolitis), 66% were in remission as were 55% of CD patients (37 % male; 41 % active smokers). Associated with higher rates of disease activity (CDAI ≥ 150; CAI>4) were corticosteroids (CD, UC), topical medication (UC), relevant reported depressive symptoms (15%; 6-31%) and impairments in sexuality (21%; 9-42%). Relevant medication groups prescribed were oral aminosalicylates (UC: 70%; CD: 47%); immunosuppressive therapy - mostly azathioprine/6 MP (CD: 47%; UC: 26%), and Infliximab (CD: 8%; UC: 3%). Strongly associated with their clinical disease activity in UC as well as CD patients, 15% (6-31%) reported relevant depressive symptoms and 21% (9-42%) relevant impairments in sexuality. CONCLUSIONS The registry constitutes a large complemental database for the patient population in Germany. About one third of the IBD patients were not in clinical remission (CDAI ≥150/CAI >4) (CD: 45%; UC: 27%), although high rates of immunosuppressive drugs (CD: 47%; UC 26%) were administered. This study shows a large burden of active disease associated with an unexpectedly high (co)morbidity and high psychosocial impairments, indicating a reduced health state in IBD patients.
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Kuhlmann A, Prenzler A, Hacker J, Graf von der Schulenburg JM. Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system. Health Econ Rev 2013; 3:9. [PMID: 23551943 PMCID: PMC3637434 DOI: 10.1186/2191-1991-3-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. METHODS To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a "World with ClosureFast" with a "World without ClosureFast" over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). RESULTS In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. CONCLUSIONS Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance.
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Affiliation(s)
- Alexander Kuhlmann
- Leibniz Universität Hannover, Center for Health Economics, Hannover, Germany
| | - Anne Prenzler
- Leibniz Universität Hannover, Center for Health Economics, Hannover, Germany
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Prenzler A, Zeidler J, Braun S, von der Schulenburg JM. Bewertung von Ressourcen im Gesundheitswesen aus der Perspektive der deutschen Sozialversicherung. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lange A, Prenzler A, Zuchandke A. How do insured perceive their financial security in the event of illness?--a panel data analysis for Germany. Value Health 2012; 15:743-749. [PMID: 22867785 DOI: 10.1016/j.jval.2012.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 01/30/2012] [Accepted: 02/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE There is a lack of research regarding the subjective perception of financial security in the event of illness of insured persons. Therefore, the aim of our study was to analyze the subjective perception of financial security in the event of illness in the German setting over time and to identify major determinants of that perception. METHODS We applied a probit-adapted ordinary least squares estimation procedure including fixed effects to a balanced data set from the German Socio-Economic Panel. After correcting our data set, we included approximately 23,500 observations in our analyses. RESULTS We show that higher income and the existence of private health insurance have a positive and significant impact on the perception of financial security. Furthermore, private supplementary health insurance has a positive and significant effect on this perception; however, this is solely true for policies that cover special features during hospital stays. Experience with the health care system is also positively related to the individual's perception. Finally, our regression results illustrate that the overall perception is declining over time. CONCLUSIONS The results indicate that political decision makers are facing challenges regarding the declining subjective perception in the German health care system. Because of the positive correlation between experience and subjective perception, it can be assumed that the health care system and especially statutory health insurance are better than their presentation in the media. Hence, there is a problem of communication and information, and political decision makers face challenges in presenting the system objectively and handling the media in a proper way.
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Affiliation(s)
- Ansgar Lange
- Center for Health Economics, Leibniz University Hannover, Hannover, Germany.
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Plagemann T, Prenzler A, Mittendorf T. Considerations about the effectiveness and cost effectiveness of therapies in the treatment of hyperphosphataemia. Health Econ Rev 2011; 1:1. [PMID: 22828213 PMCID: PMC3395041 DOI: 10.1186/2191-1991-1-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 07/20/2011] [Indexed: 05/10/2023]
Abstract
Because of an elevated serum phosphate level, patients who suffer from chronic kidney failure frequently tend to have cardiovascular calcification and are therefore exposed to a higher probability of a fatal event. Phosphate binders are able to reduce these negative effects. Currently, there are primarily two groups of phosphate binders (calcium-containing and calcium-free phosphate binders) which are considered to be almost equally effective in terms of binding of free phosphate. There are, however, a few disadvantages of the two groups. While the calcium-containing binders are associated with an increased risk of hypercalcemia, which is dose dependent, calcium-free binders have been criticized as being too expensive. As the expenditure for patients suffering from chronic kidney failure increases from year to year, as a result of increasing prevalence, there is a growing need for an alternative to existing phosphate binders. The study presented here therefore summarizes available information for the novel combination preparation OsvaRen® (calcium acetate/magnesium carbonate) as an alternative therapy to the calcium-free phosphate binder Renagel® (sevelamer-hydrochloride) and to calcium-containing preparations.The results of this systematic review showed that OsvaRen® is at least equally effective in the regulation of serum phosphate level as Renagel®. In particular, OsvaRen® shows no clinically relevant difference in terms of the control of the serum calcium levels compared to Renagel® and thereby does not increase the risk of a hypercalcaemia, in contrast to pure calcium-based phosphate binders. On the other hand, Renagel® therapy is much more frequently associated with gastrointestinal side-effects, a tendency to result in higher tablet burden for patients and high medication costs. The CALMAG study showed that OsvaRen® was at least as effective and safe in terms of controlling serum phosphate and serum calcium levels as Renagel® while, at the same time, resulting in about 80% lower costs. In addition, OsvaRen® offers a lower risk of hypercalcaemia and associated subsequent costs and is thereby also superior to pure calcium-containing phosphate binders.Because of the effectiveness and tolerability of calcium acetate/magnesium carbonate, OsvaRen® offers a clinically suitable and, at the same time, cost-effective therapeutic option in the therapy of hyperphosphataemia.
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Affiliation(s)
- Thomas Plagemann
- herescon gmbh - health economic research & consulting, Hannover, Germany
| | - Anne Prenzler
- Leibniz University Hanover, Center for Health Economics, Hannover, Germany
| | - Thomas Mittendorf
- herescon gmbh - health economic research & consulting, Hannover, Germany
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Prenzler A, Yen L, Mittendorf T, von der Schulenburg JM. Cost effectiveness of ulcerative colitis treatment in Germany: a comparison of two oral formulations of mesalazine. BMC Health Serv Res 2011; 11:157. [PMID: 21729262 PMCID: PMC3146407 DOI: 10.1186/1472-6963-11-157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 07/05/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The treatment of ulcerative colitis (UC) can place a substantial financial burden on healthcare systems. The anti-inflammatory compound 5-aminosalicylic acid (5-ASA; mesalazine) is the recommended first-line treatment for patients with UC. In this analysis, the incremental cost effectiveness ratio (ICER) of two oral formulations of 5-ASA (Mezavant® and Asacol®) is examined in the treatment of patients with mild-to-moderate, active UC in Germany. METHODS A Markov cohort model was developed to assess the cost effectiveness of Mezavant compared with Asacol over a 5-year period in the German Statutory Health Insurance (SHI). Drug pricing details for 2009 were applied throughout the model, and overall resource use was determined and also fitted to 2009 from published results of a large cross sectional study of German SHI patients. Cost per quality adjusted life year (QALY) was the primary endpoint for this study. Remission rates were obtained using data from a randomised, phase III trial of Mezavant with an active Asacol reference arm and a long-term, open label, safety and tolerability trial of Mezavant. Uncertainty in the study model was assessed using one-way and probabilistic sensitivity analyses applying a Monte Carlo simulation. RESULTS Over a 5-year period, healthcare costs for patients receiving Mezavant were 624 Euro lower than for patients receiving Asacol. Additionally, patients receiving Mezavant gained 0.011 QALYs or 18 more days in remission compared with Asacol. One-way sensitivity analyses suggest that these results are driven by both differences in the acquisition cost between mesalazine formulations and differences in treatment efficacy. Furthermore, sensitivity analyses suggest a probability of 76% for cost savings and higher QALYs with Mezavant compared with Asacol. If adherence and its influence on the remission rates and the risk of developing colorectal cancer were included in the model, the results might have even been more favorable to Mezavant due to its once daily dosing regimen. CONCLUSIONS This model suggests that patients treated with Mezavant may achieve increased time in remission and higher QALYs, with lower direct costs to the SHI when compared with Asacol. Mezavant may therefore be a suitable first-line option for the induction and maintenance of remission in UC.
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Affiliation(s)
- Anne Prenzler
- Leibniz University Hannover, Center for Health Economics, Hannover, Germany
| | - Linnette Yen
- Global Health Economics and Outcomes Research Shire Pharmaceuticals, Wayne, Pennsylvania, USA
| | - Thomas Mittendorf
- Leibniz University Hannover, Center for Health Economics, Hannover, Germany
- Herescon GmbH-Health Economic Research & Consulting, Hannover, Germany
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Prenzler A, Bokemeyer B, von der Schulenburg JM, Mittendorf T. Health care costs and their predictors of inflammatory bowel diseases in Germany. Eur J Health Econ 2011; 12:273-83. [PMID: 20967482 DOI: 10.1007/s10198-010-0281-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 10/01/2010] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Detailed cost studies of inflammatory bowel diseases (IBD) for Germany are limited. Aim of this study was to collect resource-use data related to IBD via a cross-sectional study, to quantify these from the perspective of the Statutory Health Insurance (SHI) and to identify cost-driving factors. METHODS Patients with Crohn's disease (CD) or ulcerative colitis (UC) from 24 gastroenterological specialists' practices and two hospitals were enrolled in an internet-based database between March 2006 and July 2007. Outpatient services, inpatient visits as well as medication usage were recorded and evaluated from the perspective of the SHI for 2007. Disease severity was measured by the Crohn's Disease Activity Index (CDAI) and the Colitis Activity Index (CAI), respectively. Extensive statistical analyses including generalized linear modeling (gamma model with the log link) to identify cost-driving factors were performed. RESULTS Data from 1,030 patients with IBD (CD: 511; UC: 519) were collected. On average a patient with CD incurs annual costs of EUR 3,767 (± 5,895 (SD)) (among those 68.5% medication; 20.5% inpatient) and an average patient with UC incurs EUR 2,478 (± 4,591) (74% medication; 10% inpatient), whereas 10% of the patient with IBD account for 49% (CD: 50%; UC: 46%) of the costs. The regression analysis showed that especially the use of TNF-alpha-inhibitors, inpatient stays, gender as well as the severity status has a significant influence on costs. Further disease-specific impact factors were identified. CONCLUSIONS This is the first study to calculate costs due to CD and UC from the perspective of the SHI in Germany and to identify cost-driving factors. It confirms a high economic burden of IBD to payers and society.
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Affiliation(s)
- Anne Prenzler
- Leibniz University Hannover, Center for Health Economics, Koenigsworther Platz 1, 30167, Hannover, Germany.
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Prenzler A, Mittendorf T, von der Schulenburg JM, Theidel U, Montag T, Müller-Busch HC. Aspects of outpatient palliative care in Germany—a survey among office-based physicians. J Public Health (Oxf) 2011. [DOI: 10.1007/s10389-010-0360-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Icks A, Chernyak N, Bestehorn K, Brüggenjürgen B, Bruns J, Damm O, Dintsios CM, Dreinhöfer K, Gandjour A, Gerber A, Greiner W, Hermanek P, Hessel F, Heymann R, Huppertz E, Jacke C, Kächele H, Kilian R, Klingenberger D, Kolominsky-Rabas P, Krämer H, Krauth C, Lüngen M, Neumann T, Porzsolt F, Prenzler A, Pueschner F, Riedel R, Rüther A, Salize HJ, Scharnetzky E, Schwerd W, Selbmann HK, Siebert H, Stengel D, Stock S, Völler H, Wasem J, Schrappe M. [Methods of health economic evaluation for health services research]. Gesundheitswesen 2010; 72:917-33. [PMID: 20865653 DOI: 10.1055/s-0030-1262859] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. The present paper focuses on methodological issues of economic evaluation of health care technologies. It complements the Memorandum III "Methods for Health Services Research", part 2. First, general methodological principles of the economic evaluations of health care technologies are outlined. In order to adequately reflect costs and outcomes of health care interventions in the routine health care, data from different sources are required (e. g., comparative efficacy or effectiveness studies, registers, administrative data, etc.). Therefore, various data sources, which might be used for economic evaluations, are presented, and their strengths and limitations are stated. Finally, the need for methodological advancement with regard to data collection and analysis and issues pertaining to communication and dissemination of results of health economic evaluations are discussed.
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Affiliation(s)
- A Icks
- Deutsches Diabetes Zentrum an der Heinrich-Heine-Universität Düsseldorf, Institut für Biometrie und Epidemiologie, Düsseldorf.
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Prenzler A, Müller-Busch CH, Mittendorf T, Theidel U, von der Schulenburg MJ, Montag T. [Aspects of outpatient palliative care and assessment of the nursing workload. Survey among care givers in Germany]. Pflege Z 2010; 63:300-304. [PMID: 20521465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The aim of this study is to explore aspects of the health care situation of outpatient palliative patients in Germany as well as effort and workload of care from the viewpoint of involved care givers. Additionally the future development with regard to the cooperation with other health care providers is assessed. METHODS A detailed questionnaire was developed and sent to 188 outpatient care givers, all members of the German Association for Palliative Medicine, in January 2009. All data was analyzed via SPSS version 16. RESULTS 69 questionnaires were included into statistical analyses. Care givers estimate the effort of care of palliative patients as very high. 28 per cent of working time is spent on administration. Responders consider general and quantitative workload to be the highest. Most care givers assess the SAPV-directive of the Federal Joint Committee as well as the future health care situation of palliative patients and cooperation with other health care providers as good. DISCUSSION Further studies should focus on the collection of longitudinal patient data for a more comprehensive insight.
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Affiliation(s)
- Anne Prenzler
- Leibniz Universität Hannover, Forschungsstelle für Gesundheitsökonomie.
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Prenzler A, Bokemeyer B, Mittendorf T, Schulenburg JMGVD. Kosten der Colitis ulcerosa – eine Kalkulation aus der Perspektive der Gesetzlichen Krankenversicherung. Dtsch Med Wochenschr 2010; 135:281-6. [DOI: 10.1055/s-0029-1244848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prenzler A, Reddemann S, von der Schulenburg JM. Die Wahl der Perspektive bei gesundheitsökonomischen Evaluationen – eine interdisziplinäre Analyse. ACTA ACUST UNITED AC 2010. [DOI: 10.5771/1611-5821-2010-2-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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von der Schulenburg JM, Prenzler A, Schurer W. Cancer management and reimbursement aspects in Germany: an overview demonstrated by the case of colorectal cancer. Eur J Health Econ 2010; 10 Suppl 1:S21-S26. [PMID: 20012133 DOI: 10.1007/s10198-009-0194-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper provides an overview of cancer management, particularly with respect to colorectal cancer (CRC), in Germany. The information presented reflects findings from the peer-review literature and government documentation, as well as interviews with cancer and CRC specialists. Topics such as epidemiology, expenditure, CRC screening, pharmaceutical and non-pharmaceutical treatment are discussed in this paper. Furthermore, insights into the German reimbursement system with regard to cancer management as well as regulatory aspects are presented.
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Prenzler A, Mittendorf T, Conrad S, von der Schulenburg JM, Bokemeyer B. Die direkten Kosten der Versorgung von Patienten mit Morbus Crohn aus der Perspektive der Gesetzlichen Krankenversicherung. Z Gastroenterol 2009; 47:659-66. [DOI: 10.1055/s-0028-1109059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Braun S, Prenzler A, Mittendorf T, von der Schulenburg JM. [Appraisal of resource use in the German health-care system from the perspective of the statutory health insurance]. Gesundheitswesen 2009; 71:19-23. [PMID: 19173145 DOI: 10.1055/s-0028-1102930] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper gives a systematic overview of resource use that is relevant within the German health-care system from the perspective of the statutory health insurance and how these resource uses should be priced in economic analyses. This includes all relevant cost domains from ambulatory and inpatient care as well as a detailed description of relevant data resulting from drug usage. For prescriptions the legal framework (e.g., reference pricing) is applied to list all relevant co-payments or discounts (e.g., for pharmaceutical companies) which have to be considered in patented as well as off-patent drugs. The same method is applied for ambulatory services [taking the universal remuneration scheme (EBM) into account] as well as for inpatient stays (discussing certain characteristics of the German DRG system). As a result, for the first time, a pragmatic as well as a practical approach is presented to value resource usage within the German health care system in future studies from the perspective of the statutory health insurance or, in other words, the sickness funds.
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Affiliation(s)
- S Braun
- Leibniz Universität Hannover, Forschungsstelle für Gesundheitsökonomie, Königsworther Platz 1, Hannover.
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Prenzler A, Mittendorf T, von der Schulenburg J. Modellierung der Produktivitätsausfallkosten als Folge des Rauchens in Deutschland für das Jahr 2005. Gesundheitswesen 2007; 69:635-43. [DOI: 10.1055/s-2007-992781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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