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Jung-Henrich J, Schlößler K, Uebel T, Chikhradze N, Suslow A, Lindner N, Fahrenkrog S, Kraft J, Hummers E, Vollmar HC, Gágyor I, Heider D, König HH, Donner-Banzhoff N. Development and implementation of a treatment pathway to reduce coronary angiograms - lessons from a failure. BMC Health Serv Res 2024; 24:527. [PMID: 38664649 PMCID: PMC11046897 DOI: 10.1186/s12913-024-10904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The rates of coronary angiograms (CA) and related procedures (percutaneous intervention [PCI]) are significantly higher in Germany than in other Organisation for Economic Co-ordination and Development (OECD) countries. The current guidelines recommend non-invasive diagnosis of coronary heart disease (CHD); CA should only have a limited role in choosing the appropriate revascularisation procedure. The aim of the present study was to explore whether improvements in guideline adherence can be achieved through the implementation of regional treatment pathways. We chose four regions of Germany with high utilisation of CAs for the study. Here we report the results of the concomitant qualitative study. METHODS General practitioners and specialist physicians (cardiologists, hospital-based cardiologists, emergency physicians, radiologists and nuclear medicine specialists) caring for patients with suspected CHD were invited to develop regional treatment pathways. Four academic departments provided support for moderation, provision of materials, etc. The study team observed session discussions and took notes. After the development of the treatment pathways, 45 semi-structured interviews were conducted with the participating physicians. Interviews and field notes were transcribed verbatim and underwent qualitative content analysis. RESULTS Pathway development received little support among the participants. Although consensus documents were produced, the results were unlikely to improve practice. The participants expressed very little commitment to change. Although this attempt clearly failed in all study regions, our experience provides relevant insights into the process of evidence appraisal and implementation. A lack of organisational skills, ignorance of current evidence and guidelines, and a lack of feedback regarding one's own clinical behaviour proved to be insurmountable. CA was still seen as the diagnostic gold standard by most interviewees. CONCLUSIONS Oversupply and overutilisation can be assumed to be present in study regions but are not immediately perceived by clinicians. The problem is unlikely to be solved by regional collaborative initiatives; optimised resource planning within the health care system combined with appropriate economic incentives might best address these issues.
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Affiliation(s)
- Jutta Jung-Henrich
- Department of General Practice/Family Medicine, Philipps-University Marburg, Karl-Frisch- Straße 4, 35043, Marburg, Germany.
| | - Kathrin Schlößler
- Department of General Practice/Family Medicine, Philipps-University Marburg, Karl-Frisch- Straße 4, 35043, Marburg, Germany
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Til Uebel
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany
| | - Nino Chikhradze
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Anastasia Suslow
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Nicole Lindner
- Department of General Practice/Family Medicine, Philipps-University Marburg, Karl-Frisch- Straße 4, 35043, Marburg, Germany
| | - Sandra Fahrenkrog
- Institute of General Practice and Family Medicine, Charité University Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Judith Kraft
- Institute of General Practice and Family Medicine, Charité University Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Eva Hummers
- Department of General Practice, Georg-August-Universität Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Josef-Schneider-Strasse 2, 97080, Würzburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, Philipps-University Marburg, Karl-Frisch- Straße 4, 35043, Marburg, Germany
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Rezvani F, Heider D, König HH, Herbarth L, Steinisch P, Schuhmann F, Böbinger H, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, Härter M, Dirmaier J. Telephone Health Coaching and Remote Exercise Monitoring (TeGeCoach) in Peripheral Arterial Occlusive Disease—a Randomized Controlled Trial. Dtsch Arztebl Int 2024:arztebl.m2024.0008. [PMID: 38269534 DOI: 10.3238/arztebl.m2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Supervised exercise programs are commonly used to treat intermittent claudication (IC). Home-based exercise programs have been developed to lower barriers to participation. We studied the effects of one such program (TeGeCoach) on self-reported walking ability in patients with IC. METHODS In a pragmatic, multicenter, randomized and controlled trial (registration number NCT03496948), 1982 patients with symptomatic IC, insured by one of three German statutory health-insurance carriers, received either telephone health coaching with remote exercise monitoring (TeGeCoach; n = 994) or routine care (n = 988). The primary outcome was the change in Walking Impairment Questionnaire (WIQ) scores 12 and 24 months after the start of the intervention (intention-to-treat analysis). The secondary outcomes were health-related quality of life, symptoms of depression or anxiety, health competence, patient activation, alcohol use, and nicotine dependence. RESULTS There was a significant difference between arms in favor of TeGeCoach in the WIQ (p<0.0001). Patients in the TeGeCoach arm had WIQ scores that were 6.30 points higher at 12 months (Bonferroni-corrected 95% CI [4.02; 8.59], Cohen's d = 0.26) and 4.55 points higher at 24 months ([2.20; 6.91], d = 0.19). They also fared better in some of the secondary outcomes at 12 months, including physical health-related quality of life and patient activation, with at least small effect sizes (d > 0.20). The average daily step count was no higher in the TeGeCoach group. CONCLUSION The observed reductions of symptom burden indicate the benefit of home-based exercise programs in the treatment of intermittent claudication. Such programs expand the opportunities for the guideline-oriented treatment of IC. Future studies should address the effect of home-based exercise programs on clinical variables, e.g., the 6-minute walk test.
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Boehlen FH, Heider D, Schellberg D, Hohls JK, Schöttker B, Brenner H, Friederich HC, König HH, Wild B. Gender-specific association of loneliness and health care use in community-dwelling older adults. BMC Geriatr 2023; 23:502. [PMID: 37605106 PMCID: PMC10441715 DOI: 10.1186/s12877-023-04201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Loneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults. METHODS Data of 2525 persons (ages 55-85 years)-participants of the fourth follow- up (2011-2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables. RESULTS In older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02). CONCLUSIONS It is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.
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Affiliation(s)
- Friederike Hildegard Boehlen
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120, Heidelberg, Germany
- Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120, Heidelberg, Germany
- Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Steinmetz C, Heinemann S, Kutschka I, Hasenfuß G, Asendorf T, Remppis BA, Knoglinger E, Grefe C, Albes JM, Baraki H, Baumbach C, Brunner S, Ernst S, Harringer W, Heider D, Heidkamp D, Herrmann-Lingen C, Hummers E, Kocar T, König HH, Krieger S, Liebold A, Martens A, Matzeder M, Mellert F, Müller C, Puls M, Reiss N, Schikora M, Schmidt T, Vestweber M, Sadlonova M, von Arnim CAF. Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial. Trials 2023; 24:533. [PMID: 37582774 PMCID: PMC10426165 DOI: 10.1186/s13063-023-07511-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/12/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients' pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors. METHODS In a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention. DISCUSSION In this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients. TRIAL REGISTRATION German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00030526). Registered on 30 January 2023.
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Affiliation(s)
- Carolin Steinmetz
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Stephanie Heinemann
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Ingo Kutschka
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University of Goettingen Medical Center, Goettingen, Germany
| | | | | | - Clemens Grefe
- Clinic and Rehabilitation Center Lippoldsberg, Wesertal, Germany
| | | | - Hassina Baraki
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | | | | | - Susann Ernst
- ZAR Center for Outpatient Rehabilitation GmbH, Ulm, Germany
| | - Wolfgang Harringer
- Department of Cardiac, Thoracic and Vascular Surgery, Braunschweig Municipal Hospital, Brunswick, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | | | - Christoph Herrmann-Lingen
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
| | - Eva Hummers
- Department of General Practice, University of Goettingen Medical Center, Goettingen, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Simone Krieger
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
| | - Andreas Liebold
- Department for Thoracic, Cardiac and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | | | - Friedrich Mellert
- Department of Cardiac Surgery, Oldenburg Hospital, Oldenburg, Germany
| | - Christiane Müller
- Department of General Practice, University of Goettingen Medical Center, Goettingen, Germany
| | - Miriam Puls
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Cardiology and Pneumology, University of Goettingen Medical Center, Goettingen, Germany
| | - Nils Reiss
- Schüchtermann-Schiller'sche Clinic, Bad Rothenfelde, Germany
| | | | - Thomas Schmidt
- Schüchtermann-Schiller'sche Clinic, Bad Rothenfelde, Germany
- Institute of Cardiology and Sports Medicine, Department Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University, Cologne, Germany
| | | | - Monika Sadlonova
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Goettingen Medical Center, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center, Goettingen, Germany
| | - Christine A F von Arnim
- Department of Geriatrics, University of Goettingen Medical Center, Robert-Koch-Straße 40, 37075, Goettingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany.
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Heider D, Rezvani F, Matschinger H, Dirmaier J, Härter M, Herbarth L, Steinisch P, Böbinger H, Schuhmann F, Krack G, Korth T, Thomsen L, Chase DP, Schreiber R, Alscher MD, Finger B, König HH. The effect of telephone health coaching and remote exercise monitoring for peripheral artery disease (TeGeCoach) on health care cost and utilization: results of a randomized controlled trial. Eur J Health Econ 2023:10.1007/s10198-023-01616-4. [PMID: 37428355 DOI: 10.1007/s10198-023-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is the third most prevalent atherosclerotic cardiovascular disease. In 2016, costs per patient associated with PAD exceeded even the health-economic burden of coronary heart disease. Although affecting over 200 million people worldwide, a clear consensus on the most beneficial components to be included in home-based exercise programs for patients with peripheral artery disease is lacking. The aim of the study was to examine the health care use and costs caused by the 12-month patient-centered 'Telephone Health Coaching and Remote Exercise Monitoring for Peripheral Artery Disease' (TeGeCoach) program in a randomized controlled trial. METHODS This is a two-arm, parallel-group, open-label, pragmatic, randomized, controlled clinical trial (TeGeCoach) at three German statutory health insurance funds with follow-up assessments after 12 and 24-months. Study outcomes were medication use (daily defined doses), days in hospital, sick pay days and health care costs, from the health insurers' perspective. Claims data from the participating health insurers were used for analyses. The main analytic approach was an intention-to-treat (ITT) analysis. Other approaches (modified ITT, per protocol, and as treated) were executed additionally as sensitivity analysis. Random-effects regression models were calculated to determine difference-in-difference (DD) estimators for the first- and the second year of follow-up. Additionally, existing differences at baseline between both groups were treated with entropy balancing to check for the stability of the calculated estimators. RESULTS One thousand six hundred eighty-five patients (Intervention group (IG) = 806; Control group (CG) = 879) were finally included in ITT analyses. The analyses showed non-significant effects of the intervention on savings (first year: - 352€; second year: - 215€). Sensitivity analyses confirmed primary results and showed even larger savings. CONCLUSION Based on health insurance claims data, a significant reduction due to the home-based TeGeCoach program could not be found for health care use and costs in patients with PAD. Nevertheless, in all sensitivity analysis a tendency became apparent for a non-significant cost reducing effect. TRIAL REGISTRATION NCT03496948 (www. CLINICALTRIALS gov), initial release on 23 March 2018.
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Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Herbarth
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Patrick Steinisch
- KKH Kaufmännische Krankenkasse Statutory Health Insurance, Hannover, Germany
| | - Hannes Böbinger
- TK Techniker Krankenkasse Statutory Health Insurance, Hamburg, Germany
| | | | - Gundula Krack
- mhplus Krankenkasse Statutory Health Insurance, Ludwigsburg, Germany
| | | | | | | | | | - Mark-Dominik Alscher
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Benjamin Finger
- Robert Bosch Gesellschaft Für Medizinische Forschung mbH, Bosch-Institute of Clinical Pharmacology, Dr. Margarete Fischer, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Shi B, Shang Y, Pei Y, Pei S, Wang L, Heider D, Zhao YY, Zheng C, Yang B, Yarlagadda S, Chou TW, Fu KK. Low Tortuous, Highly Conductive, and High-Areal-Capacity Battery Electrodes Enabled by Through-thickness Aligned Carbon Fiber Framework. Nano Lett 2020; 20:5504-5512. [PMID: 32551672 DOI: 10.1021/acs.nanolett.0c02053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Thick electrode with high-areal-capacity is a practical and promising strategy to increase the energy density of batteries, but development toward thick electrode is limited by the electrochemical performance, mechanical properties, and manufacturing approaches. In this work, we overcome these limitations and report an ultrathick electrode structure, called fiber-aligned thick or FAT electrode, which offers a novel electrode design and a scalable manufacturing strategy for high-areal-capacity battery electrodes. The FAT electrode uses aligned carbon fibers to construct a through-thickness fiber-aligned electrode structure with features of high electrode material loading, low tortuosity, high electrical and thermal conductivity, and good compression property. The low tortuosity of FAT electrode enables fast electrolyte infusion and rapid electron/ion transport, exhibiting a higher capacity retention and lower charge transfer resistance than conventional slurry-casted thick electrode design.
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Affiliation(s)
- Baohui Shi
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Yuanyuan Shang
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Yong Pei
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Shaopeng Pei
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Liyun Wang
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Dirk Heider
- Center for Composite Materials, University of Delaware, Newark, Delaware 19716, United States
- Electrical and Computer Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Yong Y Zhao
- Department of Materials Science and Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Chaolun Zheng
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Bao Yang
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Shridhar Yarlagadda
- Center for Composite Materials, University of Delaware, Newark, Delaware 19716, United States
- Electrical and Computer Engineering, University of Delaware, Newark, Delaware 19716, United States
| | - Tsu-Wei Chou
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
- Center for Composite Materials, University of Delaware, Newark, Delaware 19716, United States
| | - Kun Kelvin Fu
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716, United States
- Center for Composite Materials, University of Delaware, Newark, Delaware 19716, United States
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Rezvani F, Heider D, Härter M, König HH, Bienert F, Brinkmann J, Herbarth L, Kramer E, Steinisch P, Freudenstein F, Terhalle R, Grosse Y, Bock S, Posselt J, Beutel C, Reif F, Kirchhoff F, Neuschwander C, Löffler F, Brunner L, Dickmeis P, Heidenthal T, Schmitz L, Chase DP, Seelenmeyer C, Alscher MD, Tegtbur U, Dirmaier J. Telephone health coaching with exercise monitoring using wearable activity trackers (TeGeCoach) for improving walking impairment in peripheral artery disease: study protocol for a randomised controlled trial and economic evaluation. BMJ Open 2020; 10:e032146. [PMID: 32503866 PMCID: PMC7279623 DOI: 10.1136/bmjopen-2019-032146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Peripheral artery disease (PAD) is the third most prevalent cardiovascular disease worldwide, with smoking and diabetes being the strongest risk factors. The most prominent symptom is leg pain while walking, known as intermittent claudication. To improve mobility, first-line treatment for intermittent claudication is supervised exercise programmes, but these remain largely unavailable and economically impractical, which has led to the development of structured home-based exercise programmes. This trial aims to determine the effectiveness and cost advantage of TeGeCoach, a 12-month long home-based exercise programme, compared with usual care of PAD. It is hypothesised that TeGeCoach improves walking impairment and lowers the need of health care resources that are spent on patients with PAD. METHODS AND ANALYSIS The investigators conduct a prospective, pragmatic randomised controlled clinical trial in a health insurance setting. 1760 patients diagnosed with PAD at Fontaine stage II are randomly assigned to either TeGeCoach or care-as-usual. TeGeCoach consists of telemonitored intermittent walking exercise with medical supervision by a physician and telephone health coaching. Participants allocated to the usual care group receive information leaflets and can access supervised exercise programmes, physical therapy and a variety of programmes for promoting a healthy lifestyle. The primary outcome is patient reported walking ability based on the Walking Impairment Questionnaire. Secondary outcome measures include quality of life, health literacy and health behaviour. Claims data are used to collect total health care costs, healthcare resource use and (severe) adverse events. Outcomes are measured at baseline, 12 and 24 months. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Medical Association Hamburg. Findings are disseminated through peer-reviewed journals, reports to the funding body, conference presentations and media press releases. Data from this trial are made available to the public and researchers upon reasonable request.NCT03496948 (www.clinicaltrials.gov), Pre-results.
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Affiliation(s)
- Farhad Rezvani
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Frank Bienert
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Julia Brinkmann
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Lutz Herbarth
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Edith Kramer
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | - René Terhalle
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Yvonne Grosse
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Susanne Bock
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | - Corinna Beutel
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | - Franziska Reif
- Kaufmännische Krankenkasse, Hannover, Niedersachsen, Germany
| | | | | | | | | | | | | | | | | | - Claudia Seelenmeyer
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Mark Dominik Alscher
- Dr Margarete Fischer Bosch Institute of Clinical Pharmacology, Stuttgart, Baden-Württemberg, Germany
| | - Uwe Tegtbur
- Department of Sports Medicine, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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Matschinger H, Heider D, König HH. A Comparison of Matching and Weighting Methods for Causal Inference Based on Routine Health Insurance Data, or: What to do If an RCT is Impossible. Gesundheitswesen 2020; 82:S139-S150. [PMID: 32066197 DOI: 10.1055/a-1009-6634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to a multitude of reasons Randomized Control Trials on the basis of so-called "routine data" provided by insurance companies cannot be conducted. Therefore the estimation of "causal effects" for any kind of treatment is hampered since systematic bias due to specific selection processes must be suspected. The basic problem of counterfactual, which is to evaluate the difference between two potential outcomes for the same unit, is discussed. The focus lies on the comparison of the performance of different approaches to control for systematic differences between treatment and control group. These strategies are all based on propensity scores, namely matching or pruning, IPTW (inverse probability treatment weighting) and entropy balancing. Methods to evaluate these strategies are presented. A logit model is employed with 87 predictors to estimate the propensity score or to estimate the entropy balancing weights. All analyses are restricted to estimate the ATT (Average Treatment Effect for the Treated) Exemplary data come from a prospective controlled intervention-study with two measurement occasions. Data contain 35 857 chronically ill insurants with diabetes, congestive heart failure, arteriosclerosis, coronary heart disease or hypertension of one German sickness fund. The intervention group was offered an individual telephone coaching to improve health behavior and slow down disease progression while the control group received treatment as usual. Randomization took place before the insurants' consent to participate was obtained so assumptions of an RCT are violated. A weighted mixture model (difference-in-difference) as the causal model of interest is employed to estimate treatment effects in terms of costs distinguishing the categories outpatient costs, medication costs, and total costs. It is shown that entropy balancing performs best with respect to balancing treatment and control group at baseline for the first three moments of all 87 predictors. This will result in least biased estimates of the treatment effect.
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Lukaschek K, Mergenthal K, Heider D, Hanke A, Munski K, Moschner A, Emig M, van den Akker M, Zapf A, Wegscheider K, König HH, Gensichen J. eHealth-supported case management for patients with panic disorder or depression in primary care: Study protocol for a cRCT (PREMA). Trials 2019; 20:662. [PMID: 31791389 PMCID: PMC6889733 DOI: 10.1186/s13063-019-3751-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/23/2019] [Indexed: 12/03/2022] Open
Abstract
Background Panic disorder (PD), frequently occurring with agoraphobia (AG), and depression are common mental disorders in primary care and associated with considerable individual and societal costs. Early detection and effective treatment of depression and PD/AG are of major importance. Cognitive behavioural exposure exercises have been shown to be effective in reducing anxiety and depressive symptoms. Practice team-based case management can improve clinical outcomes for patients with chronic diseases in primary care. The present study aims at evaluating the effects and cost-effectiveness of a primary care team-based intervention using behavioural therapy elements and case management supported by eHealth components in patients with PD/AG or depression compared to treatment as usual. Methods/design This is a two-arm cluster-randomized, controlled trial (cRCT). General practices represent the units of randomisation. General practitioners recruit adult patients with depression and PD ± AG according to the International Classification of Diseases, version 10 (ICD-10). In the intervention group, patients receive cognitive behaviour therapy-oriented psychoeducation and instructions to self-managed exposure exercises in four manual-based appointments with the general practitioner. A trained health care assistant from the practice team delivers case management and is continuously monitoring symptoms and treatment progress in ten protocol-based telephone contacts with patients. Practice teams and patients are supported by eHealth components. In the control group, patients receive usual care from general practitioners. Outcomes are measured at baseline (T0), at follow-up after 6 months (T1), and at follow-up after 12 months (T2). The primary outcome is the mental health status of patients as measured by the Mental Health Index (MHI-5). Effect sizes of 0.2 standard deviation (SD) are regarded as relevant. Assuming a drop-out rate of 20% of practices and patients each, we aim at recruiting 1844 patients in 148 primary care practices. This corresponds to 12.5 patients on average per primary care practice. Secondary outcomes include depression and anxiety-related clinical parameters and health-economic costs. Discussion If the intervention is more effective than treatment as usual, the three-component (cognitive behaviour therapy, case-management, eHealth) primary care-based intervention for patients suffering from PD/AG or depression could be a valuable low-threshold option that benefits patients and primary care practice teams. Trial registration German clinical trials register, DRKS00016622. Registered on February 22nd, 2019.
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Affiliation(s)
- Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Pettenkoferstr 8a, 80336, Munich, Germany
| | - Karola Mergenthal
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Michelle Emig
- Association of Statutory Health Insurance Physicians Hesse, Frankfurt am Main, Germany
| | - Marjan van den Akker
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany.,Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.,Academic Centre of General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Pettenkoferstr 8a, 80336, Munich, Germany.
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Hohls JK, König HH, Heider D, Brenner H, Böhlen F, Matschinger H, Saum KU, Schöttker B, Haefeli WE, Hajek A, Wild B. Longitudinal association between panic disorder and health care costs in older adults. Depress Anxiety 2019; 36:1135-1142. [PMID: 31609044 DOI: 10.1002/da.22959] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/16/2019] [Accepted: 09/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze whether probable panic disorder (PD) is associated with health care costs in older age over time. METHODS Data regarding individuals aged 65 and over were derived from two waves of the ESTHER cohort study (nt1 = 2,348, nt2 = 2,090). Probable PD was assessed using the panic screening module from the Patient Health Questionnaire. Health care costs were obtained through monetary valuation of self-reported health care use data. Fixed effects regressions analyzed the association between transitions in probable PD status and change in health care costs, while adjusting for potential confounders. RESULTS On a descriptive level, study participants with a positive PD screening displayed higher three-month health care costs compared to those without (incremental costs: € 259 for t1 , € 1,544 for t2 ). Transitions in probable PD were associated with an approximate increase of 65% in outpatient health care costs (β = 0.50, p < .05). There was no significant association between probable PD transition and change in any other cost category. CONCLUSIONS Using longitudinal data, our results highlight the economic consequences of probable PD in older adults. Future research should address whether reducing PD in older adults may reduce the associated economic burden and analyze underlying mechanisms.
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Affiliation(s)
- Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Friederike Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Hohls JK, Wild B, Heider D, Brenner H, Böhlen F, Saum KU, Schöttker B, Matschinger H, Haefeli WE, König HH, Hajek A. Association of generalized anxiety symptoms and panic with health care costs in older age-Results from the ESTHER cohort study. J Affect Disord 2019; 245:978-986. [PMID: 30562680 DOI: 10.1016/j.jad.2018.11.087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Little is known specifically about the association between generalized anxiety symptoms or panic and health care costs in older age. The aim of this study was to examine the association between generalized anxiety symptoms, panic and health care costs in people aged 65 and over. METHODS Cross-sectional data from the 8-year follow-up of a large, prospective cohort study, the ESTHER study, was used. Individuals aged 65 and over, who participated in the study's home assessment, were included in this analysis (n = 2348). Total and sectoral costs were analyzed as a function of either anxiety symptoms, probable panic disorder, or a panic attack, while controlling for selected covariates, using Two Part and Generalized Linear Models. Covariates were chosen based on Andersen's Behavioral Model of Health Care Use. RESULTS There was no significant association between either of the anxiety or panic measures and total health care costs. Stratified by health care sectors, only the occurrence of a panic attack was significantly associated with incurring costs for outpatient non-physician services (OR: 1.99; 95% CI: 1.15-3.45) and inpatient services (OR: 2.14; 95% CI: 1.07-4.28). Other illness-related factors, such as comorbidities and depressive symptoms, were associated with health care costs in several models. LIMITATIONS This was a cross-sectional study relying on self-reported data. CONCLUSION This study points to an association between a panic attack and sector-specific health care costs in people aged 65 and over. Further research, especially using longitudinal data, is needed.
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Affiliation(s)
- J K Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
| | - B Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - D Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - F Böhlen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - K U Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - H Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - W E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - A Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Meid AD, Groll A, Heider D, Mächler S, Adler JB, Günster C, König HH, Haefeli WE. Prediction of Drug-Related Risks Using Clinical Context Information in Longitudinal Claims Data. Value Health 2018; 21:1390-1398. [PMID: 30502782 DOI: 10.1016/j.jval.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/12/2018] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To develop and internally validate prediction models for medication-related risks arising from overuse, misuse, and underuse that utilize clinical context information and are suitable for routine risk assessment in claims data (i.e., medication-based models predicting the risk for hospital admission apparent in routine claims data or MEDI-RADAR). METHODS Based on nationwide claims from health-insured persons in Germany between 2010 and 2012, we drew a random sample of people aged ≥65 years (N = 22,500 randomly allocated to training set, N = 7500 to validation set). Individual duration of drug supply was estimated from prescription patterns to yield time-varying drug exposure windows. Together with concurrent medical conditions (ICD-10 diagnoses), exposure to the STOPP/START (screening tool of older persons' potentially inappropriate prescriptions/screening tool to alert doctors to the right treatment) criteria was derived. These were tested as time-dependent covariates together with time-constant covariates (patient demographics, baseline comorbidities) in regularized Cox regression models. RESULTS STOPP/START variables were iteratively refined and selected by regularization to include 2 up to 11 START variables and 8 up to 31 STOPP variables in parsimonious and liberal selections in the prediction modeling. The models discriminated well between patients with and without all-cause hospitalizations, potentially drug-induced hospitalizations, and mortality (parsimonious model c-indices with 95% confidence intervals: 0.63 [0.62-0.64], 0.67 [0.65-0.68], and 0.78 [0.76-0.80]). CONCLUSIONS The STOPP/START criteria proved to efficiently predict medication-related risk in models possessing good performance. Timely detection of such risks by routine monitoring in claims data can support tailored interventions targeting these modifiable risk factors. Their impact on older peoples' medication safety and effectiveness can now be explored in future implementation studies.
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Affiliation(s)
- Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Groll
- Department of Statistics and Econometrics, University of Göttingen, Göttingen, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Mächler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
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Heider D, Matschinger H, Meid AD, Quinzler R, Adler JB, Günster C, Haefeli WE, König HH. The impact of potentially inappropriate medication on the development of health care costs and its moderation by the number of prescribed substances. Results of a retrospective matched cohort study. PLoS One 2018; 13:e0198004. [PMID: 30063697 PMCID: PMC6067698 DOI: 10.1371/journal.pone.0198004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background In the growing population of the elderly, drug-related problems are considered an important health care safety issue. One aspect of this is the prescription of potentially inappropriate medication (PIM) which is considered to increase health care costs. Objective Using data from the Health Economics of Potentially Inappropriate Medication (HEPIME) study, we aimed to analyze how the number of prescribed substances moderates the association of PIM use as defined by the German PRISCUS list and health care costs applying a longitudinal perspective. Methods An initial number of 6,849,622 insurants aged 65+ of a large German health insurance company were included in a retrospective matched cohort study. Based on longitudinal claims data from the four separate quarters of a 12-month pre-period, 3,860,842 individuals with no exposure to PIM in 2011 were matched to 508,212 exposed individuals. Exposure effects of PIM use on health care costs and the number of prescribed substances were measured based on longitudinal claims data from the four separate quarters of the 12-month post-period. Results After successful balancing for the development of numerous matching variables during the four quarters of the pre-period, exposed individuals consumed 2.1 additional prescribed substances and had higher total health care costs of 1,237 € when compared to non-exposed individuals in the 1st quarter of the post-period. Controlling for the number of prescribed substances, the difference in total health care costs between both study groups was 401 €. The average effect of one additionally prescribed substance (other than PIM) on total health care costs was increased by an amount of 137 € for those being exposed to a PIM. In quarters 2–4 of the post-period, the differences between both study groups tended to decrease sequentially. Conclusions PIM use has an increasing effect on the development of health care costs. This cost-increasing effect of PIM use is moderated by the number of prescribed substances.
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Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | | | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hajek A, Bock JO, Saum KU, Schöttker B, Brenner H, Heider D, König HH. Unterschiede in der Morbidität nach Krankenversichertenstatus im Alter. Gesundheitswesen 2018; 80:551-556. [DOI: 10.1055/s-0042-108584] [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: 10/21/2022]
Abstract
Zusammenfassung
Ziel der Studie: Es fehlen bislang Studien, die Morbiditätsunterschiede zwischen GKV und PKV in der älteren Bevölkerung untersuchen. Ziel dieser Studie ist es daher, Unterschiede in der Morbidität zwischen den Versicherten der GKV und PKV im Alter aufzudecken.
Methodik: Es wurden Daten von 2 Follow-Up-Wellen mit einem Abstand von 3 Jahren herangezogen. Diese basieren auf einer bevölkerungsbezogenen Kohortenstudie (ESTHER Studie) im Saarland. Die Morbidität wurde durch Hausarztangaben mit einem generischen Instrument (Cumulative Illness Rating Scale for Geriatrics) erfasst. Zur Schätzung wurde der Between-Schätzer herangezogen, der ausschließlich die Variation zwischen den Individuen quantifiziert. Dabei wurde im Basismodell neben dem Versichertenstatus für das Geschlecht und das Alter kontrolliert. In weiteren Modellen wurde sukzessive ebenfalls für Schulbildung, den Familienstand und das Einkommen kontrolliert.
Ergebnisse: Während in den Spezifikationen ohne Berücksichtigung des Einkommens beträchtliche Unterschiede in der Morbidität zwischen PKV- und GKV-Versicherten erkennbar waren, mindert sich dieser Effekt unter Kontrolle des Einkommens stark und war bei Männern nicht mehr signifikant.
Schlussfolgerung: Zu einem bedeutenden Teil können existierende Morbiditätsunterschiede zwischen Versicherten der GKV und PKV durch Einkommensunterschiede zwischen den beiden Gruppen erklärt werden. Dies zeigt die große Bedeutung der Ausgestaltung des Modells bei der Untersuchung von Morbiditätsunterschieden zwischen GKV und PKV auf.
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Affiliation(s)
- A. Hajek
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg
| | - J.-O. Bock
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg
| | - K.-U. Saum
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - B. Schöttker
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - H. Brenner
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
- Universität Heidelberg, Netzwerk Alternsforschung, Heidelberg
| | - D. Heider
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg
| | - H.-H. König
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg
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Hajek A, Bock JO, Saum KU, Matschinger H, Brenner H, Holleczek B, Haefeli WE, Heider D, König HH. Frailty and healthcare costs-longitudinal results of a prospective cohort study. Age Ageing 2018; 47:233-241. [PMID: 29036424 DOI: 10.1093/ageing/afx157] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/22/2017] [Indexed: 12/16/2022] Open
Abstract
Objective to investigate how frailty and frailty symptoms affect healthcare costs in older age longitudinally. Methods data were gathered from a prospective cohort study in Saarland, Germany (two waves with 3-year interval, n = 1,636 aged 57-84 years at baseline). Frailty was assessed by the five Fried frailty criteria. Frailty was defined as having at least three criteria, the presence of 1-2 criteria as 'pre-frail'. Healthcare costs were quantified based on self-reported healthcare use in the sectors of inpatient treatment, outpatient treatment, professional nursing care and informal care as well as the provision of pharmaceuticals, medical supplies and dental prostheses. Results while the onset of pre-frailty did not increase (log) total healthcare costs after adjusting for potential confounders including comorbidity, progression from non-frailty to frailty was associated with an increase in total healthcare costs (for example, costs increased by ~54 and 101% if 3 and 4 or 5 symptoms were present, respectively). This association of frailty onset with increased healthcare costs was in particular observed in the inpatient sector and for informal nursing care. Among the frailty symptoms, the onset of exhaustion was associated with an increase in total healthcare costs, whereas changes in slowness, weakness, weight loss and low-physical activity were not significantly associated with an increase in total healthcare costs. Conclusions our data stress the economic relevance of frailty in late life. Postponing or reducing frailty might be fruitful in order to reduce healthcare costs.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Saarland Cancer Registry, Saarbrücken, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Heider D, Matschinger H, Meid AD, Quinzler R, Adler JB, Günster C, Haefeli WE, König HH. Health Service Use, Costs, and Adverse Events Associated with Potentially Inappropriate Medication in Old Age in Germany: Retrospective Matched Cohort Study. Drugs Aging 2017; 34:289-301. [DOI: 10.1007/s40266-017-0441-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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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Best J, Bilgi H, Heider D, Schotten C, Manka P, Bedreli S, Gorray M, Ertle J, van Grunsven LA, Dechêne A. The GALAD scoring algorithm based on AFP, AFP-L3, and DCP significantly improves detection of BCLC early stage hepatocellular carcinoma. Z Gastroenterol 2016; 54:1296-1305. [PMID: 27936479 DOI: 10.1055/s-0042-119529] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Hepatocellular carcinoma (HCC) is one of the leading causes of death in cirrhotic patients worldwide. The detection rate for early stage HCC remains low despite screening programs. Thus, the majority of HCC cases are detected at advanced tumor stages with limited treatment options. To facilitate earlier diagnosis, this study aims to validate the added benefit of the combination of AFP, the novel biomarkers AFP-L3, DCP, and an associated novel diagnostic algorithm called GALAD. Material and methods: Between 2007 and 2008 and from 2010 to 2012, 285 patients newly diagnosed with HCC and 402 control patients suffering from chronic liver disease were enrolled. AFP, AFP-L3, and DCP were measured using the µTASWako i30 automated immunoanalyzer. The diagnostic performance of biomarkers was measured as single parameters and in a logistic regression model. Furthermore, a diagnostic algorithm (GALAD) based on gender, age, and the biomarkers mentioned above was validated. Results: AFP, AFP-L3, and DCP showed comparable sensitivities and specifities for HCC detection. The combination of all biomarkers had the highest sensitivity with decreased specificity. In contrast, utilization of the biomarker-based GALAD score resulted in a superior specificity of 93.3 % and sensitivity of 85.6 %. In the scenario of BCLC 0/A stage HCC, the GALAD algorithm provided the highest overall AUROC with 0.9242, which was superior to any other marker combination. Conclusions: We could demonstrate in our cohort the superior detection of early stage HCC with the combined use of the respective biomarkers and in particular GALAD even in AFP-negative tumors.
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Affiliation(s)
- J Best
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - H Bilgi
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - D Heider
- Straubing Center of Science, Department of Bioinformatics, Straubing, Germany
| | - C Schotten
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - P Manka
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - S Bedreli
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - M Gorray
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - J Ertle
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
| | - L A van Grunsven
- Vrije Universiteit Brussel (VUB Jette), Liver Cell Biology Laboratory, Brussels, Belgium
| | - A Dechêne
- Universitätsklinikum Essen, Klinik für Gastroenterologie und Hepatologie, Essen, Germany
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18
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Meid AD, Heider D, Adler JB, Quinzler R, Brenner H, Günster C, König HH, Haefeli WE. Comparative evaluation of methods approximating drug prescription durations in claims data: modeling, simulation, and application to real data. Pharmacoepidemiol Drug Saf 2016; 25:1434-1442. [PMID: 27633276 DOI: 10.1002/pds.4091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 02/03/2016] [Revised: 05/18/2016] [Accepted: 08/10/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to compare the predictive accuracy of different methods suggested for approximation of drug prescription durations in claims data. METHODS We expanded a well-established modeling and simulation framework to compare approximated drug prescription durations with 'true' (i.e., simulated) durations. Real claims data of persons aged ≥65 years insured by the German nationwide 'Statutory Health Insurance Fund' AOK between 2010 and 2012 provided empiric input parameters that were completed with missing information on actual dosing patterns from an observational cohort. The distinct approximation methods were based on crude measures (one tablet a day), population-averaged measures (defined daily doses), or individually-derived measures (longitudinal coverage approximation of the applied dose, COV). As a proof-of-principle, we assessed the methods' performance to predict the well-characterized bleeding risks of anticoagulant, antiplatelet, and/or non-steroidal anti-inflammatory drugs. RESULTS When applied to modeling and simulation data sets, the closest, least biased, and thus most accurate approximation was observed using the COV approximation. In a real-data example, rather similar results to an external reference were obtained for all methods. However, some of the differences between methods were meaningful, and the most reasonable and consistent results were obtained with the COV approach. CONCLUSION Based on theoretically most accurate approximations and practically reasonable estimates, the individual COV approach was preferable over the population-averaged defined daily dose technique, although the latter might be justified in certain situations. Advantages of the COV approach are expected to be even bigger for drug therapies with particularly large dosing heterogeneity. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Herrmann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
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Härter M, Dirmaier J, Dwinger S, Kriston L, Herbarth L, Siegmund-Schultze E, Bermejo I, Matschinger H, Heider D, König HH. Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled Trial. PLoS One 2016; 11:e0161269. [PMID: 27632360 PMCID: PMC5025178 DOI: 10.1371/journal.pone.0161269] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 08/02/2016] [Indexed: 01/09/2023] Open
Abstract
Background Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients’ self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC) in chronically ill patients. Methods and Findings This prospective, pragmatic randomized controlled trial compares an intervention group (IG) of participants in TBHC to a control group (CG) without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1) multiple conditions (chronic campaign), 2) heart failure (heart failure campaign), or 3) chronic mental illness conditions (mental health campaign) were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD), frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM) was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR). Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR). Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596) in the chronic campaign, of 660 (IG: 338; CG: 322) in the heart failure campaign, and of 239 (IG: 101; KG: 138) in the mental health campaign. In none of the three campaigns, there were significant differences between IG and CG in time until hospital readmission. In the chronic campaign, the probability of hospital readmission was higher in the IG than in the CG (OR = 1.13; p = 0.045); no significant differences could be found for the other two campaigns. In the heart failure campaign, the IG showed a significantly reduced number of hospital admissions (-0.41; p = 0.012), although the corresponding reduction in the number of hospital days was not significant. In the chronic campaign, the IG showed significantly increased number of DDDs. Most striking, there were significant differences in mortality between IG and CG in the chronic campaign (OR = 0.64; p = 0.005) as well as in the heart failure campaign (OR = 0.44; p = 0.001). Conclusions While TBHC seems to reduce hospitalization only in specific patient groups, it may reduce mortality in patients with chronic somatic conditions. Further research should examine intervention effects in various subgroups of patients, for example for different diagnostic groups within the chronic campaign, or duration of coaching. Trial Registration German Clinical Trials Register DRKS00000584
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Affiliation(s)
- Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Dwinger
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Isaac Bermejo
- University Medical Centre Freiburg, Freiburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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20
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Bock JO, Hajek A, Brenner H, Saum KU, Matschinger H, Haefeli WE, Schöttker B, Quinzler R, Heider D, König HH. A Longitudinal Investigation of Willingness to Pay for Health Insurance in Germany. Health Serv Res 2016; 52:1099-1117. [PMID: 27324300 DOI: 10.1111/1475-6773.12522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate factors affecting willingness to pay (WTP) for health insurance of older adults in a longitudinal setting in Germany. DATA SOURCES Survey data from a cohort study in Saarland, Germany, from 2008-2010 and 2011-2014 (n1 = 3,124; n2 = 2,761) were used. STUDY DESIGN Panel data were taken at two points from an observational, prospective cohort study. DATA COLLECTION WTP estimates were derived using a contingent valuation method with a payment card. Participants provided data on sociodemographics, lifestyle factors, morbidity, and health care utilization. PRINCIPAL FINDINGS Fixed effects regression models showed higher individual health care costs to increase WTP, which in particular could be found for members of private health insurance. Changes in income and morbidity did not affect WTP among members of social health insurance, whereas these predictors affected WTP among members of private health insurance. CONCLUSIONS The fact that individual health care costs affected WTP positively might indicate that demanding (expensive) health care services raises the awareness of the benefits of health insurance. Thus, measures to increase WTP in old age should target at improving transparency of the value of health insurances at the moment when individual health care utilization and corresponding costs are still relatively low.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Bock JO, König HH, Brenner H, Haefeli WE, Quinzler R, Matschinger H, Saum KU, Schöttker B, Heider D. Associations of frailty with health care costs--results of the ESTHER cohort study. BMC Health Serv Res 2016; 16:128. [PMID: 27074800 PMCID: PMC4831082 DOI: 10.1186/s12913-016-1360-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The concept of frailty is rapidly gaining attention as an independent syndrome with high prevalence in older adults. Thereby, frailty is often related to certain adverse outcomes like mortality or disability. Another adverse outcome discussed is increased health care utilization. However, only few studies examined the impact of frailty on health care utilization and corresponding costs. The aim of this study was therefore to investigate comprehensively the relationship between frailty, health care utilization and costs. METHODS Cross sectional data from 2598 older participants (57-84 years) recruited in the Saarland, Germany, between 2008 and 2010 was used. Participants passed geriatric assessments that included Fried's five frailty criteria: weakness, slowness, exhaustion, unintentional weight loss, and physical inactivity. Health care utilization was recorded in the sectors of inpatient treatment, outpatient treatment, pharmaceuticals, and nursing care. RESULTS Prevalence of frailty (≥3 symptoms) was 8.0%. Mean total 3-month costs of frail participants were €3659 (4 or 5 symptoms) and €1616 (3 symptoms) as compared to €642 of nonfrail participants (no symptom). Controlling for comorbidity and general socio-demographic characteristics in multiple regression models, the difference in total costs between frail and non-frail participants still amounted to €1917; p < .05 (4 or 5 symptoms) and €680; p < .05 (3 symptoms). Among the 5 symptoms of frailty, weight loss and exhaustion were significantly associated with total costs after controlling for comorbidity. CONCLUSIONS The study provides evidence that frailty is associated with increased health care costs. The analyses furthermore indicate that frailty is an important factor for health care costs independent from pure age and comorbidity. Costs were rather attributable to frailty (and comorbidity) than to age. This stresses that the overlapping concepts of multimorbidity and frailty are both necessary to explain health care use and corresponding costs among older adults.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany.,Network Aging Research, University of Heidelberg, Bergheimer Straße 20, Heidelberg, 69115, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany.,Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Strasse 55, Leipzig, 04103, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, Heidelberg, 69120, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
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22
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Meid AD, Quinzler R, Groll A, Wild B, Saum KU, Schöttker B, Heider D, König HH, Brenner H, Haefeli WE. Longitudinal evaluation of medication underuse in older outpatients and its association with quality of life. Eur J Clin Pharmacol 2016; 72:877-85. [DOI: 10.1007/s00228-016-2047-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/15/2016] [Indexed: 11/29/2022]
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23
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Bock JO, Heider D, Matschinger H, Brenner H, Saum KU, Haefeli WE, König HH. Willingness to pay for health insurance among the elderly population in Germany. Eur J Health Econ 2016; 17:149-158. [PMID: 25526928 DOI: 10.1007/s10198-014-0663-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/27/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans. METHODS Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57-84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals' WTP was elicited based on a contingent valuation method with a payment card. RESULTS Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20% of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly. DISCUSSION The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straβe 55, 04103, Leipzig, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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24
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Hajek A, Bock JO, Brenner H, Saum KU, Matschinger H, Haefeli WE, Quinzler R, Heider D, König HH. [Which Factors Affect Out-of-pocket Payments for Health Care Services Among Elderly Germans? Results of a Longitudinal Study]. Gesundheitswesen 2015; 79:e18-e25. [PMID: 26551845 DOI: 10.1055/s-0035-1564247] [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
Background: In Germany, out-of-pocket payments (OOPP) account for a large proportion of total health expenditure. However, there are only few investigations on how morbidity-related, sociodemographic and lifestyle factors affect OOPP particularly in the older population. The aim of this study was to identify factors affecting OOPP for health care services among elderly Germans in a longitudinal setting. Methods: This longitudinal study used data from 2 follow-up waves (3-year interval) from a population-based prospective cohort study (ESTHER study) collected in Saarland, Germany. At the first follow-up wave, subjects were between 57 and 84 years old. Participants provided comprehensive data including individual OOPP for the preceding 3 months. Fixed effects (FE) regressions were used to determine factors affecting OOPP. Results: Mean individual OOPP (3-month period) rose from € 119 (first wave) to € 136 (second wave). Longitudinal regressions showed that higher morbidity did not affect OOPP. Moreover, changes in sociodemographic as well as lifestyle factors were not related to changes in OOPP. Solely, exemption of OOPP reduced the dependent variable significantly. Conclusion: In contrast to cross-sectional findings for Germany, OOPP are not related to morbidity and income in this study. This underlines the complex nature of OOPP in old age and the need for longitudinal studies to gain some insight into the underlying causal factors.
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Affiliation(s)
- A Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - J-O Bock
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H Brenner
- Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum, Heidelberg
| | - K-U Saum
- Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum, Heidelberg
| | - H Matschinger
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - W E Haefeli
- Klinische Pharmakologie und Pharmakoepidemiologie, Universität Heidelberg, Heidelberg
| | - R Quinzler
- Klinische Pharmakologie und Pharmakoepidemiologie, Universität Heidelberg, Heidelberg
| | - D Heider
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - H-H König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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König HH, Lehnert T, Brenner H, Schöttker B, Quinzler R, Haefeli WE, Matschinger H, Heider D. Health service use and costs associated with excess weight in older adults in Germany. Age Ageing 2015; 44:616-23. [PMID: 25829392 DOI: 10.1093/ageing/afu120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 03/11/2014] [Accepted: 07/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND excess weight is a risk factor for numerous co-morbidities that predominantly occur in later life. This study's purpose was to analyse the association between excess weight and health service use/costs in the older population in Germany. METHODS this cross-sectional analysis used data of n = 3,108 individuals aged 58-82 from a population-based prospective cohort study. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated based on clinical examinations. Health service use was measured by a questionnaire for a 3-month period. Corresponding costs were calculated applying a societal perspective. RESULTS 21.8% of the sample were normal weight, 43.0% overweight, 25.5% obese class 1 and 9.6% obese class ≥2 according to BMI. In 42.6%, WHtR was ≥0.6. For normal weight, overweight, obese class 1 and obese class ≥2 individuals, mean costs (3-month period) of outpatient care were 384€, 435€, 475€ and 525€ (P < 0.001), mean costs of inpatient care were 284€, 408€, 333€ and 652€ (P = 0.070) and mean total costs 716€, 891€, 852€ and 1,244€ (P = 0.013). For individuals with WHtR <0.6 versus ≥0.6, outpatient costs were 401€ versus 499€ (P < 0.001), inpatient costs 315€ versus 480€ (P = 0.016) and total costs 755€ versus 1,041€ (P < 0.001). Multiple regression analyses controlling for sociodemographic variables showed a significant effect of obesity on costs of outpatient care (class 1: +72€; class ≥2: +153€) and total costs (class ≥2: +361€) while the effect of overweight was not significant. WHtR ≥0.6 significantly increased outpatient costs by +79€ and total costs by +189€. CONCLUSIONS excess weight is associated with increased service use and cost in elderly individuals, in particular in obese class ≥2 individuals.
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Affiliation(s)
- Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Lehnert
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Conrad I, Schulze B, Corrieri S, Heider D, Schomerus G, Riedel-Heller SG. The film festival “AUSNAHME|ZUSTAND” (State of Emergency)--do feature films and documentaries on mental health reduce stigma and influence help-seeking attitudes? Psychiatry Res 2014; 220:1043-50. [PMID: 25441016 DOI: 10.1016/j.psychres.2014.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 09/04/2014] [Accepted: 09/11/2014] [Indexed: 12/28/2022]
Abstract
The study aims at evaluating the impact of the Germany-wide film festival “AUSNAHME|ZUSTAND” on social distance and help-seeking attitudes of the adolescent audience. The festival, on the subject of mental health, was staged for the second time, aiming to give a podium to the topic mental health and to inform and entertain an adolescent audience that has not been in close contact with the subject before. A pre-post test was carried out to look for the effect of feature films and documentaries on social distance of the audience towards people with mental illness and on the change in help-seeking attitudes. A total of 532 young people with a mean age of 15.6 were questioned during the film festival in Leipzig. As the results show, the effect on the viewers׳ social distance and their help-seeking attitudes strongly depend on the content of the feature films and documentaries. Two films improved attitudes – one both social distance and help-seeking, one only help-seeking. One film increased social distance, and two films did not affect either outcome. Age, gender, and knowing someone with mental health problems also turned out to be decisive factors influencing the development of social distance and help-seeking attitudes. Feature films or documentaries about mental illness can reduce social distance or influence help-seeking attitudes, but effects strongly depend on the particular film.
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27
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Kinet D, Mégret P, Goossen KW, Qiu L, Heider D, Caucheteur C. Fiber Bragg grating sensors toward structural health monitoring in composite materials: challenges and solutions. Sensors (Basel) 2014; 14:7394-419. [PMID: 24763215 PMCID: PMC4029641 DOI: 10.3390/s140407394] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/04/2014] [Accepted: 04/18/2014] [Indexed: 11/16/2022]
Abstract
Nowadays, smart composite materials embed miniaturized sensors for structural health monitoring (SHM) in order to mitigate the risk of failure due to an overload or to unwanted inhomogeneity resulting from the fabrication process. Optical fiber sensors, and more particularly fiber Bragg grating (FBG) sensors, outperform traditional sensor technologies, as they are lightweight, small in size and offer convenient multiplexing capabilities with remote operation. They have thus been extensively associated to composite materials to study their behavior for further SHM purposes. This paper reviews the main challenges arising from the use of FBGs in composite materials. The focus will be made on issues related to temperature-strain discrimination, demodulation of the amplitude spectrum during and after the curing process as well as connection between the embedded optical fibers and the surroundings. The main strategies developed in each of these three topics will be summarized and compared, demonstrating the large progress that has been made in this field in the past few years.
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Affiliation(s)
- Damien Kinet
- Electromagnetism and Telecommunication Department, Faculty of Engineering, University of Mons, Boulevard Dolez 31, 7000 Mons, Belgium.
| | - Patrice Mégret
- Electromagnetism and Telecommunication Department, Faculty of Engineering, University of Mons, Boulevard Dolez 31, 7000 Mons, Belgium.
| | - Keith W Goossen
- Department of Electrical and Computer Engineering, Evans Hall Newark 202, University of Delaware, Newark, DE 19716-3130, USA.
| | - Liang Qiu
- Source Photonics, 20550 Nordhoff Street, Chatsworth, CA 91311, USA.
| | - Dirk Heider
- Department of Electrical and Computer Engineering, Evans Hall Newark 202, University of Delaware, Newark, DE 19716-3130, USA.
| | - Christophe Caucheteur
- Electromagnetism and Telecommunication Department, Faculty of Engineering, University of Mons, Boulevard Dolez 31, 7000 Mons, Belgium.
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Heider D, Matschinger H, Müller H, Saum KU, Quinzler R, Haefeli WE, Wild B, Lehnert T, Brenner H, König HH. Health care costs in the elderly in Germany: an analysis applying Andersen's behavioral model of health care utilization. BMC Health Serv Res 2014; 14:71. [PMID: 24524754 PMCID: PMC3927831 DOI: 10.1186/1472-6963-14-71] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 02/12/2014] [Indexed: 11/24/2022] Open
Abstract
Background To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen’s behavioral model of health care utilization, in the German elderly population. Methods Using a cross-sectional design, cost data of 3,124 participants aged 57–84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents’ homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Results Mean total costs per respondent were 889 € for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Conclusions Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
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Affiliation(s)
- Dirk Heider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany.
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Bock JO, Matschinger H, Brenner H, Wild B, Haefeli WE, Quinzler R, Saum KU, Heider D, König HH. Inequalities in out-of-pocket payments for health care services among elderly Germans--results of a population-based cross-sectional study. Int J Equity Health 2014; 13:3. [PMID: 24397544 PMCID: PMC3893415 DOI: 10.1186/1475-9276-13-3] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/23/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction In order to limit rising publicly-financed health expenditure, out-of-pocket payments for health care services (OOPP) have been raised in many industrialized countries. However, higher health-related OOPP may burden social subgroups unequally. In Germany, inequalities in OOPP have rarely been analyzed. The aim of this study was to examine OOPP of the German elderly population in the different sectors of the health care system. Socio-economic and morbidity-related determinants of inequalities in OOPP were analyzed. Methods This cross-sectional analysis used data of N = 3,124 subjects aged 57 to 84 years from a population-based prospective cohort study (ESTHER study) collected in the Saarland, Germany, from 2008 to 2010. Subjects passed a geriatric assessment, including a questionnaire for health care utilization and OOPP covering a period of three months in the following sectors: inpatient care, outpatient physician and non-physician services, medical supplies, pharmaceuticals, dental prostheses and nursing care. Determinants of OOPP were analyzed by a two-part model. The financial burden of OOPP for certain social subgroups (measured by the OOPP-income-ratio) was investigated by a generalized linear model for the binomial family. Results Mean OOPP during three months amounted to €119, with 34% for medical supplies, 22% for dental prostheses, 21% for pharmaceuticals, 17% for outpatient physician and non-physician services, 5% for inpatient care and 1% for nursing care. The two-part model showed a significant positive association between income (square root equivalence scale) and total OOPP. Increasing morbidity was associated with significantly higher total OOPP, and in particular with higher OOPP for pharmaceuticals. Total OOPP amounted to about 3% of disposable income. The generalized linear model for the binomial family showed a significantly lower financial burden for the wealthiest quintile as compared to the poorest one. Conclusions This is the first study providing evidence of inequalities in OOPP in the German elderly population. Socio-economic and morbidity-related inequalities in OOPP and the resulting financial burden could be identified. The results of this study may contribute to the discussion about the mechanisms causing the observed inequalities and can thus help decision makers to consider them when adapting future regulations on OOPP.
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Affiliation(s)
- Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
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Konnopka A, Kaufmann C, König HH, Heider D, Wild B, Szecsenyi J, Herzog W, Heinrich S, Schaefert R. Association of costs with somatic symptom severity in patients with medically unexplained symptoms. J Psychosom Res 2013; 75:370-5. [PMID: 24119945 DOI: 10.1016/j.jpsychores.2013.08.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/16/2013] [Accepted: 08/18/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To analyse the association of direct and indirect costs in patients with medically unexplained symptoms (MUS) with somatic symptom severity (SSS). METHODS A cross-sectional cost analysis for retrospective 6 months was conducted in 294 primary care patients with MUS. Health care utilisation and loss of productivity were measured by questionnaires. SSS was measured using the "Patient Health Questionnaire 15" (PHQ-15). Direct and indirect costs and the association of costs with SSS were analysed via multiple linear regression analysis. RESULTS Patients with MUS had average 6-month direct costs of 1098 EUR and indirect costs of 7645 EUR. For direct costs, outpatient physician visits were the most expensive single cost category (36%), followed by pharmaceuticals (25%) and hospital stays (19%). Indirect costs were predominantly caused by productivity reduction at work (56%) followed by early retirement (29%) and acute sickness absence (14%). As compared to mild SSS, moderate SSS was not significantly associated with direct, but with indirect costs (+2948 EUR; p<.001); severe SSS was associated with increased direct cost (+658 EUR; p=.001) and increased indirect costs (+4630 EUR; p<.001). Age was positively associated with direct cost (+15 EUR for each additional year; p=.015) as well as indirect cost (+104 EUR for each additional year; p<.001). CONCLUSIONS MUS are associated with relevant direct and even much higher indirect costs that strongly depend on SSS.
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Affiliation(s)
- Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Germany.
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Gensichen J, Petersen JJ, Von Korff M, Heider D, Baron S, König J, Freytag A, Krauth C, Gerlach FM, König HH. Cost-effectiveness of depression case management in small practices. Br J Psychiatry 2013; 202:441-6. [PMID: 23580379 DOI: 10.1192/bjp.bp.112.118257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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] [Indexed: 01/18/2023]
Abstract
BACKGROUND Case management undertaken by healthcare assistants in small primary care practices is effective in improving depression symptoms and adherence in patients with major depression. AIMS To evaluate the cost-effectiveness of depression case management by healthcare assistants in small primary care practices. METHOD Cost-effectiveness analysis on the basis of a pragmatic randomised controlled trial (2005-2008): practice-based healthcare assistants in 74 practices provided case management to 562 patients with major depression over 1 year. Our primary outcome was the incremental cost-effectiveness ratio (ICER) calculated as the ratio of differences in mean costs and mean number of quality-adjusted life-years (QALYs). Our secondary outcome was the mean depression-free days (DFDs) between the intervention and control group at 24-month follow-up. The study was registered at the International Standard Randomised Controlled Trial Number Registry: ISRCTN66386086. RESULTS Intervention v. control group: no significant difference in QALYs; significantly more DFDs (mean: 373 v. 311, P<0.01); no significant difference in mean direct healthcare costs (€4495 v. €3506, P = 0.16); considerably lower mean indirect costs (€5228 v. €7539, P = 0.06), resulting in lower total costs (€9723 v. €11 045, P = 0.41). The point estimate for the cost-utility ratio was €38 429 per QALY gained if only direct costs were considered, and 'dominance' of the intervention if total costs were considered. Yet, regardless of decision makers' willingness to pay per QALY, the probability of the intervention being cost-effective was never above 90%. CONCLUSIONS In small primary care practices, 1 year of case management did not increase the number of QALYs but it did increase the number of DFDs. The intervention was likely to be cost-effective.
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Affiliation(s)
- Jochen Gensichen
- Institute of General Practice and Family Medicine, Friedrich-Schiller-University/Jena University Hospital, Bachstr. 18, D-07743 Jena, Germany.
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König HH, Heider D, Rechlin T, Hoffmann P, Birker T, Heinrich S, Brettschneider C, Hierholzer C, Riedel-Heller SG, Roick C. [How does the Regional Psychiatry Budget (RPB) work in an area with initially low capacity of psychiatric hospital beds?]. Psychiatr Prax 2013; 40:430-8. [PMID: 23695948 DOI: 10.1055/s-0033-1343186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze the impact of a capitated multi-sector-financing model for psychiatric care (RPB) in the model region Rendsburg-Eckernförde on costs and effectiveness of care. METHODS In a prospective controlled cohort study 244 patients with a diagnosis according to ICD-10: F10, F2 or F3 were interviewed in the model region (MR) and compared to 244 patients from a control region (CR) financed according to the fee-for-service principle. At baseline, 1.5 years and 3.5 years follow-up patients were interviewed using measures of psychopathology (CGI-S, HONOS, SCL-90 R/GSI, PANSS, BRMAS/BRMES), functioning (GAF, SOFAS), quality of life (EQ-5 D) and service use/costs (CSSRI). RESULTS Subjective symptom severity (GSI) and functioning (GAF) developed more favourably in the MR than in the CR, the HONOS score developed slightly worse in the MR. The latter effect occurred mainly in ICD-10: F10 patients, while patients with F2/3 rather did benefit under RPB conditions. The development of total costs of care was not different between MR and CR. The potential to reduce costs of in-patient care was low due to the initially low capacity of inpatient beds. CONCLUSIONS The RPB did not reduce the total costs of mental health care, but certain diagnosis groups may benefit from improved trans-sectoral treatment flexibility.
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Affiliation(s)
- Hans-Helmut König
- Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics
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Stengler K, Olbrich S, Heider D, Dietrich S, Riedel-Heller S, Jahn I. Mental health treatment seeking among patients with OCD: impact of age of onset. Soc Psychiatry Psychiatr Epidemiol 2013; 48:813-9. [PMID: 22763495 DOI: 10.1007/s00127-012-0544-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 12/16/2011] [Accepted: 06/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Several studies have described the deficits in the health care provided to persons with obsessive-compulsive disorder (OCD), however, without making any distinction between psychiatric-psychotherapeutic professionals and general practitioners or other professionals. Also, the relation between subjectively defined early signs of the disorder, diagnosis and utilization of professional help has not yet been investigated systematically. The present study addresses these questions, using a self-rating questionnaire for patients with OCD (questionnaire on the utilization of professional help by patients with OCD). METHODS Eighty-eight patients with OCD, who came to our University Hospital Outpatient Clinic for obsessive-compulsive disorders in Leipzig, participated in the study. The questionnaire, which had been developed specially for this survey, asked study participants to remember when they had first perceived signs of their disorder and their first-time utilization of professional help. RESULTS Patients with OCD and early onset of disorder sought professional help later than did patients with later onset of disorder. When professional help was utilized, it took 2 years on average before the diagnosis was made. Patients with OCD first consulted a psychiatrist or psychotherapist and not the general practitioner as their first professional contact person. CONCLUSION First signs in the early stages of OCD, particularly with an onset in childhood and adolescence have to be diagnosed at an earlier stage for appropriate treatment. Psychiatrists and psychotherapists, not primarily general practitioners, have a particularly high demand for further education about early diagnosis and treatment of OCD.
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Affiliation(s)
- Katarina Stengler
- Department of Psychiatry and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04107 Leipzig, Germany.
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Corrieri S, Heider D, Conrad I, Blume A, Konig HH, Riedel-Heller SG. School-based prevention programs for depression and anxiety in adolescence: a systematic review. Health Promot Int 2013; 29:427-41. [DOI: 10.1093/heapro/dat001] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carrà G, Johnson S, Bebbington P, Angermeyer MC, Heider D, Brugha T, Azorin JM, Toumi M. The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC). Eur Arch Psychiatry Clin Neurosci 2012; 262:607-16. [PMID: 22427152 DOI: 10.1007/s00406-012-0305-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [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: 12/23/2011] [Accepted: 02/29/2012] [Indexed: 01/03/2023]
Abstract
Relatively little is known about rates of comorbid drug and alcohol problems in people with schizophrenia outside the USA. Most studies have recruited from single countries. Newly available data provided an unmatched opportunity to investigate the prevalence of comorbid dependence on alcohol and other psychoactive substances in people with schizophrenia in France, Germany and the UK at the same time. The European Schizophrenia Cohort study data set used semi-structured clinical interviews to establish DSM-IV diagnoses. 1,208 patients were interviewed in nine centres. The lifetime rate for comorbid dependence on any substance was highest in the UK (35 %), but considerably lower in Germany (21 %) and in France (19 %), and generally more than double the past-year rates. Dependence on alcohol and on other psychoactive substances showed similar variations (comorbid alcohol dependence: UK 26 %; Germany 18 %; France 14 %; comorbid drug dependence: UK 18 %; Germany 8 %; France 7 %). Differences within countries persisted after controlling for individual characteristics. The relative odds of dependence were higher than in the general population, but varied between countries and centres. Dependence disorders are a common problem in people with schizophrenia in Western Europe, although effective service configurations have yet to be developed. Overall, these European rates are less than those reported from the USA. Research comparing people with current comorbidity with those who are no longer dependent is needed.
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Affiliation(s)
- Giuseppe Carrà
- Department of Mental Health Sciences, University College London, UK.
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Luppa M, König HH, Heider D, Sikorski C, Leicht H, Schomerus G, Riedel-Heller SG. Direct costs associated with depressive symptoms in late life – A 4.5-year prospective study. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Corrieri S, Conrad I, Heider D, Riedel-Heller SG. Die Aufklärungsinitiative „Verrückt? Na und!“: Ergebnisse der Evaluation. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Corrieri S, Heider D, Conrad I, Riedel-Heller SG. „Schulcoaches – Seelische Fitness stärken und Selbsthilfe aktivieren“ – Ergebnisse der Evaluation der ersten Projektphase. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Konnopka A, Löbner M, Luppa M, Heider D, Heinrich S, Riedel-Heller S, Meisel HJ, Günther L, Meixensberger J, König HH. Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study. BMC Musculoskelet Disord 2012; 13:165. [PMID: 22943189 PMCID: PMC3492196 DOI: 10.1186/1471-2474-13-165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 08/21/2012] [Indexed: 11/10/2022] Open
Abstract
Background Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design. Methods A sample of 531 back pain patients was interviewed after an initial disc surgery (T0), 3 months (T1) and 15 months (T2) using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques. Results Psychiatric comorbidity was associated with significantly (p < 0.05) increased direct (+664 Euro) and indirect costs (+808 Euro) at T0. The direct cost difference predominantly resulted from medical health care utilization and was nearly unchanged at T2. Further important cost predictors were clinical variables like the presence of chronic medical disease, the number of previous disc surgeries, and time and gender. Conclusion Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.
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Affiliation(s)
- Alexander Konnopka
- Department of Medical Sociology and Health Economics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Sarlon E, Heider D, Millier A, Azorin JM, König HH, Hansen K, Angermeyer MC, Aballéa S, Toumi M. A prospective study of health care resource utilisation and selected costs of schizophrenia in France. BMC Health Serv Res 2012; 12:269-76. [PMID: 22909284 PMCID: PMC3459707 DOI: 10.1186/1472-6963-12-269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 07/23/2012] [Indexed: 11/12/2022] Open
Abstract
Background Schizophrenia is among the most burdensome and costly illnesses worldwide. To estimate the cost of schizophrenia in France, a longitudinal study was carried out between 1998 and 2002. The main objective of this study was to describe and update the cost of schizophrenia in a longitudinal, representative sample of French patients. The second objective was to identify cost drivers in the treatment of schizophrenia. Methods Based on a cohort of 288 French schizophrenic patients during 2 years of prospective follow-up, this study collected clinical, patient reported outcomes, quality of life, functioning, patient management, care giver involvement and resource utilisation data every 6 months. For each service, information was collected on the type of service, the frequency of attendance and type of intervention provided to the patient. Unit costs were based on available French databases. Mean service use and costs over the five time points were estimated using between-effects regression models. Results In the total sample of 288 patients aged 18-64 years, the mean total cost (€ 3 534) was mainly accounted for by the cost of inpatient treatment (€ 1 390) and day care (€ 1 331). The estimate of the annual cost for direct medical health care for all French schizophrenic patients was € 1 581 million, including € 621 million for inpatient treatment and € 595 million for day care (77%). The costs for medication accounted for 16.1% of total annual costs. The remaining costs (6.9%) included visits to psychiatrists, general practitioners, other physicians and psychologists. The direct resource allocation showed inpatient treatment as the main direct cost. Unemployment was identified as a major indirect cost of schizophrenia treatment. Positive and depressive schizophrenia symptoms at baseline and relapse occurrence during the follow-up period were associated with a higher cost of treatment. Health satisfaction or negative symptoms of schizophrenia at baseline were associated with lower costs. Conclusion Several cost drivers were identified. Based on the results obtained in France, we suggest further analysis of mechanisms that influence the service-specific costs for schizophrenia in other areas of the world.
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Affiliation(s)
- Emmanuelle Sarlon
- National Institue of Health and Medical Research, INSERM, U669, Paris, France
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Corrieri S, Heider D, Conrad I, Riedel-Heller SG. Evaluation des Projekts „Schulcoaches - Seelische Fitness stärken und Selbsthilfe aktivieren“: Ergebnisse der ersten Projektphase. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Corrieri S, Conrad I, Heider D, Riedel-Heller SG. Evaluation der Aufklärungsinitiative „Verrückt? Na und!“. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1322010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kessler D, Grun G, Heider D, Morgner J, Jendrossek V. 468 Concerted Action of Rab11 and Rab25 in Vesicle Trafficking During Cell Migration. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wünsch D, Fetz V, Heider D, Tenzer S, Bier C, Kunst L, Knauer S, Stauber R. Chemico-genetic strategies to inhibit the leukemic potential of threonine aspartase-1. Blood Cancer J 2012; 2:e77. [PMID: 22829979 PMCID: PMC3389164 DOI: 10.1038/bcj.2012.22] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Karow A, Reimer J, König HH, Heider D, Bock T, Huber C, Schöttle D, Meister K, Rietschel L, Ohm G, Schulz H, Naber D, Schimmelmann BG, Lambert M. Cost-effectiveness of 12-month therapeutic assertive community treatment as part of integrated care versus standard care in patients with schizophrenia treated with quetiapine immediate release (ACCESS trial). J Clin Psychiatry 2012; 73:e402-8. [PMID: 22490266 DOI: 10.4088/jcp.11m06875] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [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: 01/21/2011] [Accepted: 06/20/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare the 1-year cost-effectiveness of therapeutic assertive community treatment (ACT) with standard care in schizophrenia. ACT was specifically developed for patients with schizophrenia, delivered by psychosis experts highly trained in respective psychotherapies, and embedded into an integrated care system. METHOD Two catchment areas in Hamburg, Germany, with similar population size and health care structures were assigned to offer 12-month ACT (n = 64) or standard care (n = 56) to 120 first- and multiple-episode patients with schizophrenia spectrum disorders (DSM-IV), the latter with a history of relapse due to medication nonadherence. Primary outcome was the incremental cost-effectiveness ratio (ICER) based on mental health care costs from a payer perspective and quality-adjusted life-years (QALYs) as a measure of health effects during the 12-month follow-up period (2006-2007). RESULTS ACT was associated with significantly lower inpatient but higher outpatient costs than standard care, resulting in nonsignificantly lower total costs (P = .27). Incremental QALYs in the ACT group were 0.1 (P < .001). Thus, the point estimate for the ICER showed dominance of ACT. The probability of an ICER below 50,000 per QALY gained was 99.5%. CONCLUSIONS The implementation of a psychotherapeutically oriented schizophrenia-specific and -experienced ACT team led to an improved patient outcome with reduced need of inpatient care. Despite the introduction of such a rather "costly" ACT team, treatment in ACT was cost-effective with regard to improved quality of life at comparable yearly costs. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01081418.
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Affiliation(s)
- Anne Karow
- Department of Psychiatry and Psychotherapy, Psychosis Centre, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.
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Leicht H, Heinrich S, Heider D, Bachmann C, Bickel H, van den Bussche H, Fuchs A, Luppa M, Maier W, Mösch E, Pentzek M, Rieder-Heller SG, Tebarth F, Werle J, Weyerer S, Wiese B, Zimmermann T, König HH. Net costs of dementia by disease stage. Acta Psychiatr Scand 2011; 124:384-95. [PMID: 21838738 DOI: 10.1111/j.1600-0447.2011.01741.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate net costs of dementia by degree of severity from a societal perspective, including a detailed assessment of costs of formal and informal nursing care. METHOD In a cross-sectional study, costs of illness were analysed in 176 dementia patients and 173 matched non-demented control subjects. Healthcare resource use and costs were assessed retrospectively by means of a questionnaire. Dementia patients were classified into three disease stages, and linear regression models were applied to estimate net costs of dementia by degree of severity. RESULTS Annual net costs of dementia by stage were approximately €15 000 (mild), €32 000 (moderate) and €42 000 (severe), corresponding to US-$21 450, 45 760 and 60 060 respectively. Across disease stages, nursing care accounted for approximately three-quarters of total costs, of which half resulted from informal care. In sensitivity analyses using different valuation methods for nursing care, total costs decreased or increased by more than 20%. CONCLUSION Net costs more than double across stages of dementia. Informal care accounts for a considerable share of nursing care costs, and the approach to valuation of informal care has a large impact on cost-of-illness estimates.
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Affiliation(s)
- H Leicht
- Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Lehnert T, Heider D, Leicht H, Heinrich S, Corrieri S, Luppa M, Riedel-Heller S, König HH. Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions. Med Care Res Rev 2011; 68:387-420. [PMID: 21813576 DOI: 10.1177/1077558711399580] [Citation(s) in RCA: 478] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This systematic literature review identified and summarized 35 studies that investigated the relationship between multiple chronic conditions (MCCs) and health care utilization outcomes (i.e. physician use, hospital use, medication use) and health care cost outcomes (medication costs, out-of-pocket costs, total health care costs) for elderly general populations. Although synthesis of studies was complicated because of ambiguous definitions and measurements of MCCs, and because of the multitude of outcomes investigated, almost all studies observed a positive association of MCCs and use/costs, many of which found that use/costs significantly increased with each additional condition. Several studies indicate a curvilinear, near exponential relationship between MCCs and costs. The rising prevalence, substantial costs, and the fear that current care arrangements may be inappropriate for many patients with MCCs, bring about a multitude of implications for research and policy, of which the most important are presented and discussed.
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Affiliation(s)
- Thomas Lehnert
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Hanna Leicht
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Heinrich
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Roick C, Heider D, Günther O, Riedel-Heller S, König HH. Prädiktoren für die Niederlassungsabsicht angehender Psychiater. Ergebnisse einer postalischen Befragung junger Ärzte in Deutschland. Psychiat Prax 2011; 38:397-404. [DOI: 10.1055/s-0031-1276831] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Corrieri S, Heider D, Riedel-Heller SG, Matschinger H, König HH. Cost-effectiveness of fall prevention programs based on home visits in seniors aged over 65 years – a systematic review. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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50
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Corrieri S, Heider D, Conrad I, Riedel-Heller SG. Evaluation des Projekts „Schulcoaches – Seelische Fitness stärken und Selbsthilfe aktivieren„. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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