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Wickmann A, Kurte MS, Jeck J, Camacho L, Klinkhammer D, Kron F, Dengler R. Cost-benefit evaluation of advanced therapy lines in metastatic triple-negative breast cancer in Germany. Cost Eff Resour Alloc 2024; 22:21. [PMID: 38459569 PMCID: PMC10924420 DOI: 10.1186/s12962-024-00528-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is responsible for 10-20% cases of breast cancer and is resulting in rising healthcare costs. Thus, health-economic evaluations are needed to relate clinical outcomes and costs of treatment options and to provide recommendations of action from a health-economic perspective. METHODS We investigated the cost-benefit-ratio of approved treatment options in metastatic TNBC in Germany by applying the efficiency frontier approach. These included sacituzumab-govitecan (SG), eribulin, vinorelbine, and capecitabine. Clinical benefit was measured as (i) median overall survival (mOS) and (ii) health-related quality of life (HRQoL) in terms of time to symptom worsening (TSW). To assess medical benefits, literature was systematically reviewed in PubMed for (i) and (ii), respectively. Treatment costs were calculated considering annual direct outpatient treatment costs from a statutory healthcare payer perspective. It was intended that both, (i) and (ii), yield an efficiency frontier. RESULTS Annual direct outpatient treatment costs amounted to EUR 176,415.21 (SG), EUR 47,414.14 (eribulin), EUR 13,711.35 (vinorelbine), and EUR 3,718.84 (capecitabine). Systematic literature review of (i) and statistical analysis resulted in OS values of 14.3, 9.56, 9.44, and 7.46 months, respectively. Capecitabine, vinorelbine, and SG are part of the efficiency frontier including OS. The highest additional benefit per additional cost was determined for vinorelbine, followed by SG. Systematic review of (ii) revealed that no TSW data of TNBC patients receiving vinorelbine were available, preventing the presentation of an efficiency frontier including HRQoL. CONCLUSIONS Vinorelbine is most cost-effective, followed by SG. Health-economic evaluations support decision-makers to assess treatment options within one indication area. In Germany, the efficiency frontier can provide decision support for the pricing of innovative interventions. Results of our analysis may thus guide reimbursement determination.
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Affiliation(s)
| | - Melina Sophie Kurte
- VITIS Healthcare Group, Cologne, Germany
- Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Julia Jeck
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | | | | | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
- Faculty of Medicine, Center for Integrated Oncology (CIO ABCD), University of Cologne, University Hospital Cologne, Cologne, Germany
- FOM University of Applied Sciences, Essen, Germany
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Siefen AC, Kurte MS, Kron F. Economic effects of treating postpartum hemorrhage with vacuum-induced hemorrhage control devices - A budget impact analysis of the Jada® System in the German obstetrics setting. Eur J Obstet Gynecol Reprod Biol 2024; 294:222-230. [PMID: 38301501 DOI: 10.1016/j.ejogrb.2024.01.024] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE This study aimed to assess the budget impact of vacuum-induced hemorrhage control (VHC) devices for treating postpartum hemorrhage (PPH) from the perspective of the German statutory health insurance (SHI). STUDY DESIGN Evidence shows that treating PPH with VHC instead of uterine balloon tamponade (UBT) can reduce resource consumption (e.g., reduced number of blood transfusions and length of stay). A budget impact model combining aggregated German real-world reimbursement data of PPH cases with the assumption of resource reduction due to VHC usage was developed. Diagnosis-related groups (DRG) of PPH cases and their frequencies were collected using a publicly available database. A "downgrading mechanism" was performed, leading to a less resource-intensive DRG, i.e., resulting in a lower flat fee to be paid by SHI. Four subgroups were differentiated based on coded diagnoses and procedures: 1) PPH (O72.-) as main diagnosis, 2) PPH as secondary diagnosis, 3) UBT procedure coded, and 4) UBT or standard tamponade coded. Weighted averages of cost savings per case were calculated. RESULTS Data from 7,129 (subgroup 1), 49,523 (subgroup 2), 1,668 (subgroup 3), and 3,406 (subgroup 4) cases were retrieved. After applying the downgrading mechanism, cost savings (weighted average) resulted in 184.09 €, 210.50 €, 921.33 €, and 633.74 € for subgroups 1-4, respectively, CONCLUSION: This is the first German budget impact analysis of VHC for the treatment of PPH. Results showed the highest cost-saving potential for cases currently treated with UBT. Demonstrating not only clinical but also financial consequences of innovative treatments is crucial for the adoption into clinical practice.
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Affiliation(s)
| | - Melina S Kurte
- VITIS Healthcare Group, Cologne, Germany; Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany; Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; FOM University of Applied Sciences, Essen, Germany.
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Kurte MS, Siefen AC, Jakobs F, von Tresckow B, Reinhardt HC, Kron F. Cost-effectiveness analysis of transplant-ineligible relapsed or refractory diffuse large B-cell lymphoma treatment options-Experience of the efficiency frontier approach. Eur J Haematol 2023; 111:895-908. [PMID: 37644352 DOI: 10.1111/ejh.14095] [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: 06/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The treatment of relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) changed remarkably since the European Medicines Agency-approved chimeric antigen receptor T-cell (CAR-T) therapies (axicabtagene ciloleucel [axi-cel], lisocabtagene maraleucel [liso-cel], tisagenlecleucel [tisa-cel]) for the third-line onwards (3+L), and targeted therapies (polatuzumab vedotin-bendamustine-rituximab [pola-BR], tafasitamab-lenalidomide [Tafa-L]) for the second-line (2L) onwards. As associated rising treatment costs represent an economic burden, the cost-effectiveness of transplant-ineligible R/R DLBCL interventions was assessed from a German healthcare payer's perspective, using the efficiency frontier (EF) approach. METHODS A systematic literature review was performed to determine the clinical benefit concerning median overall survival (OS) of bendamustine-rituximab (BR), rituximab-gemcitabine-oxaliplatin (R-GemOx), axi-cel, liso-cel, tisa-cel, pola-BR, and Tafa-L. First-year treatment costs (drug and medical services costs) were calculated. Results were merged on two-dimensional graphs illustrating 2L and 3+L EFs. RESULTS Second-line EF is formed by BR (median OS 11.49 months, €23 958) and Tafa-L (45.7, €104 541), 3+L EF is formed by R-GemOx (12.0, €29 080), Tafa-L (15.5, €104 541), and axi-cel (18.69, €308 516). These interventions build the respective cost-effectiveness thresholds for novel interventions. CONCLUSIONS Using the EF approach, the currently most cost-effective interventions (based on cost-effectiveness ratios) in the indication of R/R DLBCL were identified to guide international reimbursement decisions.
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Affiliation(s)
- Melina Sophie Kurte
- Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- VITIS Healthcare Group, Cologne, Germany
| | | | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian von Tresckow
- Department of Haematology and Stem Cell Transplantation, West German Cancer Center and German Cancer consortium (DKTK partner site Essen), University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans Christian Reinhardt
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- FOM University of Applied Sciences, Essen, Germany
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Siefen AC, Eilers L, Baltin CT, Kron F. Cost Comparison of Treatment Alternatives for Pleural Effusion and Ascites from a Payer Perspective: Are There Cost Savings from Indwelling Catheters? J Palliat Med 2023; 26:1510-1520. [PMID: 37352428 PMCID: PMC10658739 DOI: 10.1089/jpm.2022.0592] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/25/2023] Open
Abstract
Background: The presence of pleural effusions and ascites in patients is often considered a marker of illness severity and a poor prognostic indicator. This study aims to compare inpatient and outpatient costs of alternative invasive treatments for ascites and pleural effusions. Methods: The retrospective single-institution study included inpatient cases treated for pleural effusion (J90 and J91) or ascites (R18) at the University Hospital Cologne (UHC) in Germany between January 01, 2020, and December 31, 2021. Costs for punctures and indwelling catheter systems (ICSs) as well as pleurodesis were analyzed in different comparator treatment pathways. Real-world data from the UHC tertiary care center were based on diagnosis-related group fees from 2020 to 2021. A simulation of outpatient expenses was carried out to compare inpatient and outpatient costs for each pathway from a payer perspective. Results: A total of 4323 cases (3396 pleural effusions and 1302 ascites) were analyzed. For ascites, inpatient implantation with home care drainage was found to be the most expensive option, with total costs of €1,918.58 per procedure, whereas outpatient puncture was the least expensive option at €60.02. For pleural effusions, the most expensive treatment pathway was pleurodesis at €8,867.84 compared with the least costly option of outpatient puncture resulting in total costs per procedure of €70.03. A break-even analysis showed that outpatient puncture remains the most inexpensive treatment option, and the ICS comprises a cost-saving potential. Longevity of several months with the use of ICSs results in both enhanced quality of life for patients and increased cost savings.
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Affiliation(s)
| | - Leonie Eilers
- VITIS Healthcare Group, Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Essen, Germany
| | - Christoph T. Baltin
- VITIS Healthcare Group, Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Essen, Germany
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Essen, Germany
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Bonn J, Baltin CT, Osterkamp V, Scheid C, Holtick U, Irsch J, Kron F. Health Economic Aspects of Platelet Concentrates: Comparing Cost and Reimbursement of Pathogen Inactivated and Conventional Platelet Concentrates in a German Comprehensive Cancer Center. Oncol Res Treat 2023; 46:362-369. [PMID: 37482056 PMCID: PMC10664333 DOI: 10.1159/000531742] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Pathogen inactivation (PI) utilizing amotosalen and UVA light (INTERCEPT® Blood System) is a well-established method for the production of safer platelet concentrates (PCs). While many studies describe clinical and logistical benefits of PI, the implications and potential challenges from a hospital management perspective have not yet been analyzed - health economic analyses considering reimbursement of PI are lacking. The objective of this analysis was to examine the real-life inpatient treatment costs from a hospital perspective and to assess the economic impact of PI-PC versus conventional PC (CONV-PC) administration in Germany. METHODS Real-life cost data for inpatient cancer cases from 2020 of the University Hospital Cologne were identified by operating and procedure codes. The German diagnosis-related groups, extra fees, case mix index (CMI), length of stay (LOS), and average resource consumption of PC were evaluated from a micro-management perspective. The potential economic impact of implementing PI-treated PCs was modeled retrospectively. RESULTS In total, 951 inpatient cases were analyzed (CMI [median 4.7-9.9], LOS [median 26 days], number of cases in intensive care units [38%]). The median DRG fee was between EUR 13,800 and EUR 26,400. According to our model, the use of PI-PC compared to CONV-PC would result in savings between EUR 184 and EUR 306 per case. CONCLUSION From a hospital management perspective, oncological cases requiring PC transfusion are associated with a high CMI (reimbursement per DRG flat fee) and moderate costs with sufficient add-on payment for PI on a case level. Investment and process costs for PI implementation can be analyzed for site-specific scenarios.
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Affiliation(s)
| | - Christoph T. Baltin
- VITIS Healthcare Group, Cologne, Germany
- Clinic and Polyclinic for Orthopaedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
- Competence Center for Medical Economics, FOM University of Applied Sciences, Essen, Germany
| | | | - Christof Scheid
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Udo Holtick
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany
- Competence Center for Medical Economics, FOM University of Applied Sciences, Essen, Germany
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, Medical Faculty and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Jeck J, Jakobs F, Kurte MS, Cornely OA, Kron F. Health-economic modelling of cost savings due to the use of rezafungin based on a German cost-of-illness study of candidiasis. JAC Antimicrob Resist 2023; 5:dlad079. [PMID: 37342199 PMCID: PMC10279419 DOI: 10.1093/jacamr/dlad079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023] Open
Abstract
Objective Candida species are responsible for fungal diseases and the development of nosocomial bloodstream infections. Treatment is resource-intensive and economically challenging for healthcare systems. Cost analyses of drugs against candidiasis, such as rezafungin, are thus of great interest to healthcare payers. Methods We conducted a cost-of-illness study of patients with Candida infections based on real-word data of the Department I of Internal Medicine, University Hospital Cologne (Germany) between 2016 and 2021. Health-economic parameters were analysed to describe the economic impact of Candida infections. Potential cost savings due to the administration of rezafungin were modelled for patients with invasive candidiasis or candidaemia based on a 5 day reduction of ICU length of stay (LOS) shown by the STRIVE study. Results We found 724 cases (652 patients) with Candida infections, of which 61% received ICU treatment (n = 442) and 29% were mechanically ventilated (n = 207). Twenty-six percent died during hospitalization (n = 185). Median LOS was 25 and 15 days, on normal wards and ICU, respectively. Median total treatment costs per case accounted for €22 820. Based on the ICU LOS reduction, the retrospective model showed a median cost-saving potential of €7175 per hospital case with invasive candidiasis or candidaemia. Accumulated cost savings for 37 patients of €283 335 were found. Conclusions Treatment of candidiasis is cost intensive due to increased hospital LOS. The ICU LOS reduction rezafungin showed in STRIVE would lead to sustainable cost savings.
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Affiliation(s)
- Julia Jeck
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- VITIS GmbH, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Melina S Kurte
- VITIS GmbH, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology Cologne (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 28 62, 50937 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 269, 50935 Cologne, Germany
- CECAD Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
- Excellence Centre for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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Baltin CT, Wulf C, Rongisch R, Lehmann C, Wingen-Heimann S, Eisenmenger N, Bonn J, Fabri M, von Stebut E, Cornely OA, Kron F. Outpatient care concept and potential inpatient cost savings associated with the administration of dalbavancin - A real-world data and retrospective cost analysis. J Infect Public Health 2023; 16:955-963. [PMID: 37099955 DOI: 10.1016/j.jiph.2023.04.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/02/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND The treatment of acute bacterial skin and skin structure infections (ABSSSI) usually involves intravenous (i.v.) antibiotics requiring hospitalisation and increasing hospital costs. Since 2014, dalbavancin is approved for ABSSSIs treatment. However, evidence of its health economic impact on the German healthcare system is still limited. METHODS Diagnosis-related groups (DRG) based cost analysis was used to evaluate real-world data (RWD) from a German tertiary care center. All patients treated with i.v. antibiotics in the Department of Dermatology and Venereology at the University Hospital of Cologne were included to detect potential cost savings from a payer perspective. Thus, for the inpatient care German diagnosis-related groups (G-DRG) tariffs, length of stay (LOS), main- and secondary DRG-diagnoses and for the outpatient setting 'Einheitlicher Bewertungsmaßstab' (EBM) codes were evaluated. RESULTS This retrospective study identified 480 inpatient cases treated for ABSSSI between January 2016 until December 2020. Complete cost data were available for 433 cases and the detection of long-hospital-stay patients based on surcharges for exceeding the upper limit LOS led to 125 cases (29%) including 67 females (54%) and 58 males (46%) with an overall mean age of 63.6 years; all treated for International Classification of Diseases (ICD -10th revision) code A46 'erysipelas'. A sub-analysis focussed on DRG J64B with a total of 92 cases exceeding the upper limit LOS by a median of 3 days resulted in a median surcharge of €636 (mean value €749; SD €589; IQR €459-€785) per case. In comparison, we calculated outpatient treatment costs of approximately €55 per case. Thus, further treatment of these patients in an outpatient setting before exceeding the upper limit LOS might result in a cost-saving potential of approximately €581 per case. CONCLUSION Dalbavancin appears a cost-efficient option to reduce inpatient treatment costs by transitioning to an outpatient setting of patients with ABSSSI potentially exceeding the upper limit LOS.
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Affiliation(s)
- Christoph T Baltin
- VITIS Healthcare Group, Cologne, Germany; FOM University of Applied Sciences, Essen, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, Cologne, Germany
| | - Carolin Wulf
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Dermatology and Venereology, Cologne, Germany
| | - Robert Rongisch
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Dermatology and Venereology, Cologne, Germany
| | - Clara Lehmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Sebastian Wingen-Heimann
- VITIS Healthcare Group, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), Cologne, Germany
| | | | | | - Mario Fabri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Dermatology and Venereology, Cologne, Germany
| | - Esther von Stebut
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Dermatology and Venereology, Cologne, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), Cologne, Germany; FOM University of Applied Sciences, Essen, Germany.
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Jeck J, Wingen-Heimann SM, Jakobs F, Kron A, Franz J, Cornely OA, Kron F. Health economic analysis of patients treated with isavuconazole in a German comprehensive cancer centre. Mycoses 2023; 66:405-411. [PMID: 36670539 DOI: 10.1111/myc.13567] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Invasive fungal diseases (IFD) are life-threatening and demand timely and appropriate treatment. Research showed that isavuconazole treatment positively affects clinical outcome and length of hospital stay (LOS). OBJECTIVES The aim of this study was to assess the hospital costs of patients diagnosed with IFD and treated with isavuconazole using real-world data from a German cancer centre. PATIENTS/METHODS Data and LOS collected from Jan-2016 to Jun-2021 at Department I of Internal Medicine, University Hospital Cologne were retrieved. Case-related resources consumed during the hospital stay across isavuconazole routes of administration (oral, parenteral, and mixed administration) were identified, quantified, valued and compared via a cost analysis that adopted the healthcare payer perspective. RESULTS In total, 101 cases with isavuconazole treatment were identified (oral: n = 22, 21.8%; parenteral: n = 59, 58.4%; mixed: n = 20, 19.8%). Median total LOS was greater in the mixed group (46.5 days; p = .009). Median ICU LOS and ventilation duration were both longest in the parenteral-only group (16 days, p = .008; 224 h, p = .003). Invasive aspergillosis was the most frequent isavuconazole indication (n = 86, 85.2%). Average hospital costs were highest in the mixed group (€ 101,226). The median overall costs of cases treated with isavuconazole was € 52,050. CONCLUSIONS Treating IFD is resource intensive, often requires intensive care and implies high rates of in-hospital mortality. Our study emphasises the high hospital treatment costs and thus the need for reimbursement systems to enable live-saving costly treatments.
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Affiliation(s)
- Julia Jeck
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany
| | - Sebastian M Wingen-Heimann
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne, Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany
| | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, University of Duisburg-Essen, Faculty of Medicine, and Essen University Hospital, Essen, Germany
| | - Anna Kron
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany.,University of Cologne, Faculty of Medicine, and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), Cologne, Germany.,National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Cologne, Germany
| | - Jennifer Franz
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany.,University of Cologne, Faculty of Medicine, and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne, Cologne, Germany.,University of Cologne, Faculty of Medicine, and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), Cologne, Germany.,University of Cologne, Faculty of Medicine, and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,University of Cologne, Faculty of Medicine, and University Hospital Cologne, Excellence Centre for Medical Mycology (ECMM), Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany.,University of Cologne, Faculty of Medicine, and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), Cologne, Germany
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Jeck J, Wingen-Heimann SM, Jakobs F, Franz J, Baltin CT, Kron A, Böll B, Kochanek M, Cornely OA, Kron F. Last Resort Antibiotics Costs and Reimbursement Analysis of Real-Life ICU Patients with Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria in Germany. Healthcare (Basel) 2022; 10:healthcare10122546. [PMID: 36554068 PMCID: PMC9778355 DOI: 10.3390/healthcare10122546] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Multidrug-resistant Gram-negative bacteria (MDR-GNB) cause serious infections and aggravate disease progression. Last resort antibiotics are effective against MDR-GNB and are reimbursed by flat rates based on German diagnosis-related groups (G-DRG). From a hospital management perspective, this analysis compared hospital reimbursement for last resort antibiotics with their acquisition costs to outline potential funding gaps. Retrospective analyses based on medical charts and real-life reimbursement data included patients with pneumonia due to MDR-GNB treated in intensive care units (ICU) of a German tertiary care hospital (University Hospital Cologne) between January 2017 and December 2020. Drug-associated hospital reimbursement of G-DRG was compared with drug acquisition costs based on preliminarily approved last resort antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-cilastatin-relebactam) according to label. Funding gaps were determined for the treatment of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and mixed infections, respectively. Most of the 31 patients were infected with Enterobacterales (n = 15; 48.4%) and P. aeruginosa (n = 13; 41.9%). Drug-associated G-DRG reimbursement varied from 44.50 EUR (mixed infection of P. aeruginosa and Enterobacterales) to 2265.27 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales). Drug acquisition costs ranged from 3284.40 EUR in ceftazidime-avibactam (minimum duration) to 15,827.01 EUR for imipenem-cilastatin-relebactam (maximum duration). Underfunding was found for all MDR-GNB, reaching from 1019.13 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales) to 14,591.24 EUR (Enterobacterales). This analysis revealed the underfunding of last resort antibiotics in German hospital treatment. Insufficient reimbursement implies less research in this field, leading to a more frequent use of inappropriate antibiotics. The cycle closes as this contributes to the development of multi-drug resistant bacteria.
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Affiliation(s)
- Julia Jeck
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Sebastian M. Wingen-Heimann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
| | - Florian Jakobs
- Department of Haematology and Stem Cell Transplantation, Faculty of Medicine and Essen University Hospital, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Jennifer Franz
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Christoph T. Baltin
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Anna Kron
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Boris Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Oliver A. Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 269, 50935 Cologne, Germany
- Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
- Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
- Center for Integrated Oncology (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Correspondence: ; Tel.: +49-176-6200-3950
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Jakobs F, Jeck J, Ahmadi P, Kron A, Kron F. Health economic analysis of third-line interventions in diffuse large B-cell lymphomas in Germany: applying the efficiency frontier. Cost Eff Resour Alloc 2022; 20:67. [PMID: 36503527 PMCID: PMC9743754 DOI: 10.1186/s12962-022-00400-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/11/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the past decades, highly innovative treatments in the field of diffuse large B-cell lymphoma (DLBCL) became available in clinical practice. The aim of this study was to assess the cost-benefit relation of third-line interventions in DLBCL from a German payer perspective. METHODS Clinical benefit of allogeneic stem cell transplantation (alloSCT), chimeric antigen receptor T cells therapy (CAR T) [tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel)] and best supportive care (BSC) was assessed in terms of median overall survival (median OS) derived from a systematic literature review in PubMed. Real-world treatment costs were retrieved from the university hospitals Cologne and Hamburg-Eppendorf. The cost-benefit relation was analysed using the efficiency frontier concept. RESULTS Median OS varied from 6.3 months in BSC to 23.5 months in CAR T (axi-cel), while median real-world treatment costs ranged likewise widely from €26,918 in BSC to €340,458 in CAR T (axi-cel). Shown by the efficiency frontier, alloSCT and axi-cel were found as most efficient interventions. CONCLUSION The efficiency frontier supports the pricing of innovative therapies, such as third-line interventions in DLBCL, in relation to appropriate comparators. Yet, studies with longer follow-up periods are needed to include studies with unreached median OS and to reflect experiences gained with CAR T in clinical practice.
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Affiliation(s)
- Florian Jakobs
- grid.5718.b0000 0001 2187 5445Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany ,VITIS Healthcare Group, Cologne, Germany
| | - Julia Jeck
- VITIS Healthcare Group, Cologne, Germany
| | - Paymon Ahmadi
- grid.9026.d0000 0001 2287 2617Faculty of Medicine and University Hospital Hamburg-Eppendorf, Center for Oncology, University of Hamburg, Hamburg, Germany
| | - Anna Kron
- VITIS Healthcare Group, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.411097.a0000 0000 8852 305XNational Network Genomic Medicine Lung Cancer, University Hospital Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany ,grid.448793.50000 0004 0382 2632FOM University of Applied Sciences, Essen, Germany
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Kron A, Scheffler M, Ihle M, Michels S, Süptitz J, Prang D, Jakobs F, Nogova L, Fischer R, Eisert A, Riedel R, Kron F, Hillmer A, Loges S, Merkelbach-Bruse S, Büttner R, Wolf J. 991P EGFR exon 20 insertions in non-small cell lung cancer (NSCLC): Impact of TP53 mutation status and value of immune checkpoint blockade (ICB). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1118] [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: 11/01/2022] Open
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Jeck J, Jakobs F, Kron A, Cornely OA, Kron F. Retrospective modelling of hospital bed capacities associated with the administration of remdesivir during the first wave of COVID-19 in a German metropolitan city. J Antimicrob Chemother 2022; 77:753-757. [PMID: 34849943 PMCID: PMC8690174 DOI: 10.1093/jac/dkab432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Internationally, healthcare systems are confronted by an ever-increasing scarcity of medical resources due to the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to investigate the impact of remdesivir on the demand of hospital bed capacities for hospitalized COVID-19 patients and to evaluate the potentially created capacities for treating additional COVID-19 patients or elective treatments at the hospital. METHODS An epidemiological model was developed that utilized the population of Cologne (Germany) during the first COVID-19 wave (first hospitalized patient-30 September 2020) to compare two scenarios: no administration of remdesivir (A) and the administration of remdesivir according to the EMA label (B). The results of the Adaptive COVID-19 Treatment Trial were used to evaluate the potential impact of remdesivir on hospital capacity. RESULTS With the first recorded patient on 2 March 2020, a total of 576 COVID-19 hospitalized patients were detected during the first wave in Cologne. Comparing both scenarios (A versus B) of the model, the administration of remdesivir increased the number of discharges from 259 to 293 (+5.8%) and fewer patients needed ICU admission [214 versus 178 (-6.3%)]. In addition, the model estimated 20 fewer deaths (scenario B). Based on a reduced length of stay, 31.4 hospital beds (57.0 versus 25.6) could have been freed by administering remdesivir to eligible patients. This would have allowed either the treatment of an additional 730 COVID-19 patients or 660 elective treatments. CONCLUSIONS In our model, remdesivir administration profoundly contributed to free hospital capacities in the metropolitan city Cologne in Germany.
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Affiliation(s)
- Julia Jeck
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
| | - Florian Jakobs
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
- National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Anna Kron
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
- National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Gleueler Straße 269, 50935 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Joseph-Stelzmann-Straße 26, 50931 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), Kerpener Straße 62, 50937 Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Am Morsdorfer Hof 12, 50933 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Kerpener Straße 62, 50937 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- FOM University of Applied Sciences, Herkulesstraße 32, 45127 Essen, Germany
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Jakobs F, Wingen-Heimann SM, Jeck J, Kron A, Cornely OA, Kron F. A budget impact analysis of bezlotoxumab versus standard of care antibiotics only in patients at high risk of CDI recurrence from a hospital management perspective in Germany. BMC Health Serv Res 2021; 21:939. [PMID: 34496836 PMCID: PMC8428130 DOI: 10.1186/s12913-021-06970-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/26/2021] [Indexed: 11/12/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) is one of the leading nosocomial infections, resulting in increased hospital length of stay and additional treatment costs. Bezlotoxumab, the first monoclonal antibody against CDI, has an 1 A guideline recommendation for prevention of CDI, after randomized clinical trials demonstrated its superior efficacy vs. placebo. Methods The budget impact analysis at hand is focused on patients at high risk of CDI recurrence. Treatment with standard of care (SoC) + bezlotoxumab was compared with current SoC alone in the 10 most associated Diagnosis Related Groups to identify, analyze, and evaluate potential cost savings per case from the German hospital management perspective. Based on variation in days to rehospitalization, three different case consolidation scenarios were assessed: no case consolidation, case consolidation for the SoC + bezlotoxumab treatment arm only, and case consolidation for both treatment arms. Results On average, the budget impact amounted to € 508.56 [range: € 424.85 - € 642.19] for no case consolidation, € 470.50 [range: € 378.75 - € 601.77] for case consolidation in the SoC + bezlotoxumab treatment arm, and € 618.00 [range: € 557.40 - € 758.41] for case consolidation in both treatment arms. Conclusions The study demonstrated administration of SoC + bezlotoxumab in patients at high risk of CDI recurrence is cost-saving from a hospital management perspective. Reduced length of stay in bezlotoxumab treated patients creates free spatial and personnel capacities for the treating hospital. Yet, a requirement for hospitals to administer bezlotoxumab is the previously made request for additional fees and a successful price negotiation.
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Affiliation(s)
- Florian Jakobs
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, University Hospital of Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany
| | - Sebastian Marcel Wingen-Heimann
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany.,Faculty of Medicine, University of Cologne, University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany
| | - Julia Jeck
- VITIS Healthcare Group, Cologne, Germany
| | - Anna Kron
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, University Hospital of Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany.,Faculty of Medicine, Center for Integrated Oncology (CIO ABCD), University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Oliver Andreas Cornely
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.,Faculty of Medicine, University of Cologne, University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,Faculty of Medicine, Center for Integrated Oncology (CIO ABCD), University of Cologne, University Hospital Cologne, Cologne, Germany.,Faculty of Medicine, University of Cologne, University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.,Faculty of Medicine, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Florian Kron
- Faculty of Medicine, Department I of Internal Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany. .,VITIS Healthcare Group, Cologne, Germany. .,FOM University of Applied Sciences, Essen, Germany. .,Faculty of Medicine, Center for Integrated Oncology (CIO ABCD), University of Cologne, University Hospital Cologne, Cologne, Germany.
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14
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Jeck J, Jakobs F, Kron A, Franz J, Cornely OA, Kron F. A cost of illness study of COVID-19 patients and retrospective modelling of potential cost savings when administering remdesivir during the pandemic "first wave" in a German tertiary care hospital. Infection 2021; 50:191-201. [PMID: 34406606 PMCID: PMC8371942 DOI: 10.1007/s15010-021-01685-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023]
Abstract
Purpose First detected in China in 2019, the novel coronavirus disease (COVID-19) has rapidly spread globally. Since then, healthcare systems are exposed to major challenges due to scarce personnel and financial resources. Therefore, this analysis intended to examine treatment costs of COVID-19 inpatients in a German single centre during the first pandemic wave in 2020 from a healthcare payer perspective. Potential cost savings were assessed considering the administration of remdesivir according to the European Medicines Agency label. Methods A retrospective medical-chart review was conducted on COVID-19 patients treated at University Hospital Cologne, Germany. Patients were clustered according to an eight-category ordinal scale reflecting different levels of supplemental oxygen. Potential cost savings due to the administration of remdesivir were retrospectively modelled based on a reduced length of stay, as shown in the Adaptive COVID-19 Treatment Trial. Results 105 COVID-19 patients were identified. There was wide variability in the service data with median treatment costs from EUR 900 to EUR 53,000 per patient, depending on major diagnosis categories and clinical severity. No supplemental oxygen was needed in 40 patients (38.1%). Forty-three (41.0%) patients were treated in intensive-care units, and 30 (69.8%) received invasive ventilation. In our model, in-label administration of remdesivir would have resulted in costs savings of EUR 2100 per COVID-19 inpatient (excluding acquisition costs). Conclusion We found that COVID-19 inpatients suffer from heterogeneous disease patterns with a variety of incurred G-DRG tariffs and treatment costs. Theoretically shown in the model, financial resources can be saved by the administration of remdesivir in eligible inpatients.
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Affiliation(s)
- Julia Jeck
- VITIS Healthcare Group, Cologne, Germany
| | - Florian Jakobs
- VITIS Healthcare Group, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Cologne, Germany
| | - Anna Kron
- VITIS Healthcare Group, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,National Network Genomic Medicine Lung Cancer, University Hospital Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
| | - Jennifer Franz
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany. .,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. .,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany. .,FOM University of Applied Sciences, Essen, Germany. .,FOM University of Applied Sciences, Aggripinawerft 4, 50678, Cologne, Germany.
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Jeck J, Wingen-Heimann SM, Thielscher C, Kron A, Bonn J, Jakobs F, Grau S, Enoch DA, Micallef C, Cornely OA, Kron F. Reimbursement of innovative pharmaceuticals in English and Spanish hospitals-The example of isavuconazole. Mycoses 2021; 64:1213-1222. [PMID: 34134179 DOI: 10.1111/myc.13336] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kron et al (Mycoses, 64, 2021, 86) found cost savings for the use of the innovative pharmaceutical isavuconazole in the inpatient setting in Germany (Bismarck-based healthcare system). Little is known about the reimbursement of innovative pharmaceuticals in the inpatient setting of Beveridge-based healthcare systems. OBJECTIVES The aim of this study was to evaluate the market access process and reimbursement of isavuconazole, exemplary for innovative pharmaceuticals, in England and Spain. PATIENTS/METHODS Market access processes of both countries were described. Focussing on typical patient clusters for isavuconazole treatment, reimbursement data regarding inpatients with (i) allogeneic haematopoietic stem cell transplantation or (ii) acute myeloid leukaemia was considered. Data were publicly available and of high topicality (England 2020/2021, Spain 2018). Discounting and a currency conversion to Euro were applied. RESULTS This study showed that market access processes of both countries are broadly similar. Further, full reimbursement of isavuconazole as an innovative pharmaceutical may lead to reduction in resource utilisation. Without medication costs, isavuconazole can thus result in cost savings for both patient clusters due to a reduction in length of stay. CONCLUSIONS Expenses for innovative pharmaceuticals may be balanced or even lead to cost savings due to a reduction in length of stay. The latter contributes to a greater patient benefit. For both healthcare system, the analyses highlighted drugs' cost-effectiveness and assessing its added value into reimbursement decisions is highly relevant.
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Affiliation(s)
- Julia Jeck
- VITIS Healthcare Group, Cologne, Germany
| | - Sebastian M Wingen-Heimann
- VITIS Healthcare Group, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany
| | | | - Anna Kron
- VITIS Healthcare Group, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Network Genomic Medicine, University Hospital Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
| | | | - Florian Jakobs
- VITIS Healthcare Group, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Network Genomic Medicine, University Hospital Cologne, Cologne, Germany
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David A Enoch
- Clinical Microbiology & Public Health Laboratory, National Infection Service, Public Health England, Addenbrookes Hospital, Cambridge, UK
| | - Christianne Micallef
- Pharmacy & Microbiology Departments, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany.,Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
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Kron A, Scheffler M, Heydt C, Ruge L, Schaepers C, Eisert AK, Merkelbach-Bruse S, Riedel R, Nogova L, Fischer RN, Michels S, Abdulla DSY, Koleczko S, Fassunke J, Schultheis AM, Kron F, Ueckeroth F, Wessling G, Sueptitz J, Beckers F, Braess J, Panse J, Grohé C, Hamm M, Kabitz HJ, Kambartel K, Kaminsky B, Krueger S, Schulte C, Lorenz J, Lorenzen J, Meister W, Meyer A, Kappes J, Reinmuth N, Schaaf B, Schulte W, Serke M, Buettner R, Wolf J. Genetic Heterogeneity of MET-Aberrant NSCLC and Its Impact on the Outcome of Immunotherapy. J Thorac Oncol 2020; 16:572-582. [PMID: 33309988 DOI: 10.1016/j.jtho.2020.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Robust data on the outcome of MET-aberrant NSCLC with nontargeted therapies are limited, especially in consideration of the heterogeneity of MET-amplified tumors (METamp). METHODS A total of 337 tumor specimens of patients with MET-altered Union for International Cancer Control stage IIIB/IV NSCLC were analyzed using next-generation sequencing, fluorescence in situ hybridization, and immunohistochemistry. The evaluation focused on the type of MET aberration, co-occurring mutations, programmed death-ligand 1 expression, and overall survival (OS). RESULTS METamp tumors (n = 278) had a high frequency of co-occurring mutations (>80% for all amplification levels), whereas 57.6% of the 59 patients with MET gene and exon 14 (METex14) tumors had no additional mutations. In the METamp tumors, with increasing gene copy number (GCN), the frequency of inactivating TP53 mutations increased (GCN < 4: 58.2%; GCN ≥ 10: 76.5%), whereas the frequency of KRAS mutations decreased (GCN < 4: 43.2%; GCN ≥ 10: 11.8%). A total of 10.1% of all the METamp tumors with a GCN ≥ 10 had a significant worse OS (4.0 mo; 95% CI: 1.9-6.0) compared with the tumors with GCN < 10 (12.0 mo; 95% confidence interval [CI]: 9.4-14.6). In the METamp NSCLC, OS with immune checkpoint inhibitor (ICI) therapy was significantly better compared with chemotherapy with 19.0 months (95% CI: 15.8-22.2) versus 8.0 months (95% CI: 5.8-10.2, p < 0.0001). No significant difference in median OS was found between ICI therapy and chemotherapy in the patients with METex14 (p = 0.147). CONCLUSIONS METex14, METamp GCN ≥ 10, and METamp GCN < 10 represent the subgroups of MET-dysregulated NSCLC with distinct molecular and clinical features. The patients with METex14 do not seem to benefit from immunotherapy in contrast to the patients with METamp, which is of particular relevance for the prognostically poor METamp GCN ≥ 10 subgroup.
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Affiliation(s)
- Anna Kron
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Carina Heydt
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Lea Ruge
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Carsten Schaepers
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Anna-Kristina Eisert
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Richard Riedel
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Lucia Nogova
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Rieke Nila Fischer
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Michels
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Diana S Y Abdulla
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Sophia Koleczko
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Jana Fassunke
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Anne M Schultheis
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Florian Kron
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany; FOM University of Applied Sciences, Essen, Germany
| | - Frank Ueckeroth
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Gabriele Wessling
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Juliane Sueptitz
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Frank Beckers
- Network Genomic Medicine, Cologne, Germany; Department of Thoracic Surgery, St. Vinzenz-Hospital Cologne, Cologne, Germany
| | - Jan Braess
- Network Genomic Medicine, Cologne, Germany; Department of Hematology and Oncology, Hospital Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Jens Panse
- Network Genomic Medicine, Cologne, Germany; Department of Internal Medicine IV, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Grohé
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Evangelische Lungenklinik Berlin, Berlin, Germany
| | - Michael Hamm
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology and Respiratory Medicine, Helios Medical Center of Hildesheim, Hildesheim, Germany
| | - Hans-Joachim Kabitz
- Network Genomic Medicine, Cologne, Germany; Department of Internal Medicine II, Clinic of Konstanz, Konstanz, Germany
| | - Kato Kambartel
- Network Genomic Medicine, Cologne, Germany; Department of Thoracic Oncology and Interventional Bronchology, Hospital Bethanien Moers, Moers, Germany
| | - Britta Kaminsky
- Network Genomic Medicine, Cologne, Germany; Department of Pneumonology and Allergology, Hospital Bethanien Solingen, Solingen, Germany
| | - Stefan Krueger
- Network Genomic Medicine, Cologne, Germany; Department of Pneumonology, Florence-Nightingale Hospital Düsseldorf, Düsseldorf, Germany
| | - Clemens Schulte
- Network Genomic Medicine, Cologne, Germany; Joint Private Practice for Hematology/Oncology, Dortmund, Germany
| | - Joachim Lorenz
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Hospital Luedenscheid, Luedenscheid, Germany
| | - Johann Lorenzen
- Network Genomic Medicine, Cologne, Germany; Department of Pathology, Hospital Dortmund, Dortmund, Germany
| | - Wolfram Meister
- Network Genomic Medicine, Cologne, Germany; Department of Thoracic Oncology and Interventional Bronchology, Helios Medical Center of Hildesheim, Hildesheim, Germany
| | - Andreas Meyer
- Network Genomic Medicine, Cologne, Germany; Department of Pulmonary Medicine, Maria Hilf Hospital GmbH, Moenchengladbach, Germany
| | - Jutta Kappes
- Network Genomic Medicine, Cologne, Germany; Department of Internal Medicine and Pneumology, Catholic Hospital Koblenz, Koblenz, Germany
| | - Niels Reinmuth
- Network Genomic Medicine, Cologne, Germany; Department of Oncology, Asklepios Clinic Munich-Gauting, Munich-Gauting, Germany
| | - Bernhard Schaaf
- Network Genomic Medicine, Cologne, Germany; Department of Respiratory Medicine and Infectious Diseases, Medical Center North of Dortmund, Dortmund, Germany
| | - Wolfgang Schulte
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology and Allergology, GFO Clinic Bonn, Bonn, Germany
| | - Monika Serke
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology and Oncology, Evangelic Hospital Hamm, Hamm, Germany
| | - Reinhard Buettner
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Network Genomic Medicine, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany.
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Kron F, Wingen-Heimann SM, Jeck J, Lazzaro C, Cornely OA, Thielscher C. Principal-agent theory-based cost and reimbursement structures of isavuconazole treatment in German hospitals. Mycoses 2020; 64:86-94. [PMID: 33034927 DOI: 10.1111/myc.13192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/14/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Isavuconazole (ISA) is a frequently used antifungal agent for the treatment of invasive fungal diseases (IFDs). However, hospital reimbursement data for ISA is limited. OBJECTIVES The primary objective of this study was to analyse the different perspectives of relevant stakeholders and the (dis)incentives for the administration of ISA in Germany. To that aim, the health economic effects of using ISA from a hospital management perspective were analysed. PATIENTS/METHODS Based on principal-agent theory (PAT), the perspectives of (a) the patient (principal) as well as (b) physicians, (c) pharmacists and iv. hospital managers (all agents) were analysed. For the evaluation of the cost-containment and reimbursement strategies of ISA, the German diagnosis-related group (G-DRG) system was used. RESULTS Hospitals individually negotiating additional payments for innovative treatment procedures (zusatzentgelte [ZE]) within the G-DRG system is a key element of hospital management for the reduction of total healthcare expenditure. Our analysis demonstrated the beneficial role of ISA in healthcare resource utilisation, primarily due to a shortened overall length of hospital stay. Depending on underlying disease, coded G-DRG and ISA formulation, large differences in total reimbursement and the amount of ZE was shown. The PAT demonstrated disincentives for hospital managers to use innovative drugs. CONCLUSIONS Based on the PAT, beneficial, detrimental and indifferent perspectives of different stakeholders regarding the usage of ISA were shown. A reduction of bureaucratic hurdles is needed in Germany for the extension of effective and innovative antifungal treatment strategies with ISA.
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Affiliation(s)
- Florian Kron
- FOM University of Applied Sciences, Cologne, Germany.,Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany.,Center for Integrated Oncology Köln Bonn, CIO Köln, University Hospital of Cologne, Cologne, Germany
| | - Sebastian M Wingen-Heimann
- FOM University of Applied Sciences, Cologne, Germany.,Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,VITIS Healthcare Group, Cologne, Germany
| | - Julia Jeck
- VITIS Healthcare Group, Cologne, Germany
| | - Carlo Lazzaro
- Health Economics Research and Consulting, Studio di Economia Sanitaria, Milan, Italy
| | - Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology Köln Bonn, CIO Köln, University Hospital of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University Hospital of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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18
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Jakobs F, Drost RMWA, Kron A, Heinen J, Hallek M, Reinhardt HC, Zander T, Kron F. Economic Impact of the Introduction of Outpatient Medical Specialist Care (ASV) of Gastrointestinal Cancer Patients from a German Hospital Management Perspective. Oncol Res Treat 2020; 43:498-505. [PMID: 32957103 DOI: 10.1159/000509618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The treatment of cancer patients in Germany is characterized by sectoral separation of the in- and outpatient care accompanied by 2 separate reimbursement systems. By introducing the Guideline of Outpatient Medical Specialist Care in accordance with §116b SGB V (ASV) in 2014, the German legislation empowers office-based physicians and hospitals to jointly provide medical care in the ambulatory setting. METHODS A 1-year period each before and after the introduction of ASV was compared by means of data from the Center for Integrated Oncology Cologne at the University Hospital of Cologne. Only adults with a reliable diagnosis of gastrointestinal tumor (GIT) were considered. RESULTS Overall, 1,872 cases were considered in the analysis showing significant (p < 0.001) higher median values of revenues across ICD-subgroups for ASV (EUR 427.46) compared to Ambulatory Treatments in Hospitals (EUR 234.21). The exemplary analysis of revenues in neoplasms of the pancreas shows EUR 173.69 on average which are only invoiceable through ASV: flat rate incl. surcharges (EUR 117.79; 68%), structure lump sum (EUR 29.49; 17%), positron-emission tomography (PET)/CT (EUR 13.53; 18%), and ASV consultation hour (EUR 12.89; 7%). DISCUSSION/CONCLUSION ASV leads to significant higher revenues across different ICD-subgroups for patients suffering from severe GIT. The collaboration of hospital and office-based physicians ensures patient-centered care with accumulated expertise and avoidance of double examinations. Thus, the inclusion of additional services in the Uniform Value Scale (invoiceable for ASV) is legitimated and enables cost-covering care for the involved parties.
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Affiliation(s)
- Florian Jakobs
- Network Genomic Medicine, University Hospital of Cologne, Cologne, Germany.,Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Anna Kron
- Network Genomic Medicine, University Hospital of Cologne, Cologne, Germany.,Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Julia Heinen
- Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany
| | - Hans Christian Reinhardt
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University Hospital of Cologne, Cologne, Germany
| | - Thomas Zander
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany.,Gastrointestinal Cancer Group Cologne (GCGC), University Hospital of Cologne, Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine, Center of Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Cologne, Germany, .,FOM University of Applied Sciences, Essen, Germany,
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Abstract
AIM The introduction of new and innovative treatment options for cancer patients is accompanied by a tremendous increase in healthcare costs. Consequently, new financing approaches are strongly needed to reduce the burden on the healthcare system. The introduction of biosimilars - biological drugs containing the active substance of an already approved reference biological drug - can potentially relieve the burden on healthcare systems. Calculating the costs for three frequently used biosimilars, we simulated the health-economic impact of biosimilars in the real world for the German healthcare system. METHODS Based on available health-economic analyses, the actual prescription and cost containment potential of biosimilars compared to the originator were calculated exemplarily for the cost-intensive therapies trastuzumab in breast cancer, rituximab in follicular lymphoma and G-CSF in supportive care. Incidence calculations were based e.g. on data from the Robert-Koch-Institution, Munich Cancer Registry, and quality indicators of certified centres. Cost calculation was based on Lauer-Taxe® (official reference for pharmaceutical price information). RESULTS The application of biosimilars would generate potential annual savings for the chosen examples of up to 4.9 Mio EUR for rituximab in follicular lymphoma, 40.5 Mio EUR for filgrastim, 56.4 Mio EUR for pegfilgrastim, and between 95.9 and 120.5 Mio EUR for trastuzumab. CONCLUSIONS The consequent use of biosimilars allows a considerable reduction of overall treatment costs, especially for cost-intensive long-term maintenance treatments and therapies with high incidences. If the option of biosimilar usage is fully exploited, enormous resources could be released within the healthcare system in order to offset financing new innovative therapies.
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Affiliation(s)
- Kai Hübel
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Dept. I of Internal Medicine, Kerpener Str. 62, 50937, Köln, Germany.
| | - Florian Kron
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Dept. I of Internal Medicine, Kerpener Str. 62, 50937, Köln, Germany; FOM University of Applied Sciences, Herkulesstraße 32; 45127, Essen, Germany.
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn, Frauenklinik St. Josefs, Salzkotten, Frauen- und Kinderklinik St. Louise, Husener Str. 81, 33098, Paderborn, Germany.
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20
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Koehler P, Mellinghoff SC, Stemler J, Otte F, Berkhoff A, Beste N, Budin S, Cornely FB, Evans JM, Fuchs F, Pesch L, Rebholz AW, Reiner O, Schmitt M, Schuckelt J, Spiertz A, Salmanton-García J, Kron F, Cornely OA. Quantifying guideline adherence in mucormycosis management using the EQUAL score. Mycoses 2020; 63:343-351. [PMID: 31876327 DOI: 10.1111/myc.13047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Mucormycosis is a difficult-to-diagnose life-threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany. METHODS We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics. RESULTS Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First-line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6-30). CONCLUSIONS We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome.
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Affiliation(s)
- Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jannik Stemler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | | | | | | | | | - Florian B Cornely
- University of Cologne, Cologne, Germany.,Medical University of Varna, Varna, Bulgaria
| | | | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | | - Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Florian Kron
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,FOM University of Applied Sciences, Essen, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
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21
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Kron A, Alidousty C, Scheffler M, Merkelbach-Bruse S, Seidel D, Riedel R, Ihle MA, Michels S, Nogova L, Fassunke J, Heydt C, Kron F, Ueckeroth F, Serke M, Krüger S, Grohe C, Koschel D, Benedikter J, Kaminsky B, Schaaf B, Braess J, Sebastian M, Kambartel KO, Thomas R, Zander T, Schultheis AM, Büttner R, Wolf J. Impact of TP53 mutation status on systemic treatment outcome in ALK-rearranged non-small-cell lung cancer. Ann Oncol 2019; 29:2068-2075. [PMID: 30165392 PMCID: PMC6225899 DOI: 10.1093/annonc/mdy333] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [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] [Indexed: 02/07/2023] Open
Abstract
Background We analyzed whether co-occurring mutations influence the outcome of systemic therapy in ALK-rearranged non-small-cell lung cancer (NSCLC). Patients and methods ALK-rearranged stage IIIB/IV NSCLC patients were analyzed with next-generation sequencing and fluorescence in situ hybridization analyses on a centralized diagnostic platform. Median progression-free survival (PFS) and overall survival (OS) were determined in the total cohort and in treatment-related sub-cohorts. Cox regression analyses were carried out to exclude confounders. Results Among 216 patients with ALK-rearranged NSCLC, the frequency of pathogenic TP53 mutations was 23.8%, while other co-occurring mutations were rare events. In ALK/TP53 co-mutated patients, median PFS and OS were significantly lower compared with TP53 wildtype patients [PFS 3.9 months (95% CI: 2.4–5.6) versus 10.3 months (95% CI: 8.6–12.0), P < 0.001; OS 15.0 months (95% CI: 5.0–24.9) versus 50.0 months (95% CI: 22.9–77.1), P = 0.002]. This difference was confirmed in all treatment-related subgroups including chemotherapy only [PFS first-line chemotherapy 2.6 months (95% CI: 1.3–4.1) versus 6.2 months (95% CI: 1.8–10.5), P = 0.021; OS 2.0 months (95% CI: 0.0–4.6) versus 9.0 months (95% CI: 6.1–11.9), P = 0.035], crizotinib plus chemotherapy [PFS crizotinib 5.0 months (95% CI: 2.9–7.2) versus 14.0 months (95% CI: 8.0–20.1), P < 0.001; OS 17.0 months (95% CI: 6.7–27.3) versus not reached, P = 0.049] and crizotinib followed by next-generation ALK-inhibitor [PFS next-generation inhibitor 5.4 months (95% CI: 0.1–10.7) versus 9.9 months (95% CI: 6.4–13.5), P = 0.039; OS 7.0 months versus 50.0 months (95% CI: not reached), P = 0.001). Conclusions In ALK-rearranged NSCLC co-occurring TP53 mutations predict an unfavorable outcome of systemic therapy. Our observations encourage future research to understand the underlying molecular mechanisms and to improve treatment outcome of the ALK/TP53 co-mutated subgroup.
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Affiliation(s)
- A Kron
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - C Alidousty
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - M Scheffler
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - S Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - D Seidel
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - R Riedel
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - M A Ihle
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - S Michels
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - L Nogova
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - J Fassunke
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - C Heydt
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - F Kron
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - F Ueckeroth
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - M Serke
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Lungenklinik Hemer des Deutschen Gemeinschafts-Diakonieverbandes GmbH, Hemer, Germany
| | - S Krüger
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Florence Nightingale Hospital, Düsseldorf, Germany
| | - C Grohe
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Evangelische Lungenklinik Berlin (Paul Gerhardt Diakonie), Berlin, Germany
| | - D Koschel
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Fachkrankenhaus Coswig, Coswig, Germany
| | - J Benedikter
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Klinikum Bogenhausen, Munich, Germany
| | - B Kaminsky
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Krankenhaus Bethanien, Solingen, Germany
| | - B Schaaf
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Center, Klinikum Dortmund GmbH, Dortmund, Germany
| | - J Braess
- Network Genomic Medicine, Cologne, Germany; Department of Oncology and Hematology, Krankenhaus Barmherzige Brueder, Regensburg, Germany
| | - M Sebastian
- Network Genomic Medicine, Cologne, Germany; Department of Oncology and Hematology, University Hospital Frankfurt (Johannes-Wolfgang Goethe Institute), Frankfurt am Main, Germany
| | - K-O Kambartel
- Network Genomic Medicine, Cologne, Germany; Department of Pneumology, Bethanien Hospital Moers-Lungenzentrum, Moers, Germany
| | - R Thomas
- Network Genomic Medicine, Cologne, Germany; Cologne Center for Genomics, University Hospital of Cologne, Cologne, Germany
| | - T Zander
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany
| | - A M Schultheis
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - R Büttner
- Network Genomic Medicine, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - J Wolf
- Network Genomic Medicine, Cologne, Germany; Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology Köln Bonn, Cologne, Germany.
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22
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Baltin C, Kron F, Urbanski A, Zander T, Kron A, Berlth F, Kleinert R, Hallek M, Hoelscher AH, Chon SH. The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy. PLoS One 2019; 14:e0221406. [PMID: 31461487 PMCID: PMC6713440 DOI: 10.1371/journal.pone.0221406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Complications after surgery for esophageal cancer are associated with significant resource utilization. The aim of this study was to analyze the economic burden of two frequently used endoscopic treatments for anastomotic leak management after esophageal surgery: Treatment with a Self-expanding Metal Stent (SEMS) and Endoscopic Vacuum Therapy (EVT). Materials and methods Between January 2012 and December 2016, we identified 60 German-Diagnosis Related Group (G-DRG) cases of patients who received a SEMS and / or EVT for esophageal anastomotic leaks. Direct costs per case were analyzed according to the Institute for Remuneration System in Hospitals (InEK) cost-accounting approach by comparing DRG payments on the case level, including all extra fees per DRG catalogue. Results In total, 60 DRG cases were identified. Of these, 15 patients were excluded because they received a combination of SEMS and EVT. Another 6 cases could not be included due to incomplete DRG data. Finally, N = 39 DRG cases were analyzed from a profit-center perspective. A further analysis of the most frequent DRG code -G03- including InEK cost accounting, revealed almost twice the deficit for the EVT group (N = 13 cases, € - 9.282 per average case) compared to that for the SEMS group (N = 9 cases, € - 5.156 per average case). Conclusion Endoscopic treatments with SEMS and EVT for anastomotic leaks following oncological Ivor Lewis esophagectomies are not cost-efficient for German hospitals. Due to longer hospitalization and insufficient reimbursements, EVT is twice as costly as SEMS treatment. An adequate DRG cost compensation is needed for SEMS and EVT.
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Affiliation(s)
- Christoph Baltin
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Florian Kron
- FOM University of Applied Sciences, Essen, Germany
- Department of Internal Medicine Med I, University Hospital of Cologne, Cologne, Germany
| | - Alexander Urbanski
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | | | - Anna Kron
- FOM University of Applied Sciences, Essen, Germany
| | - Felix Berlth
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Robert Kleinert
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine Med I, University Hospital of Cologne, Cologne, Germany
| | | | - Seung-Hun Chon
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
- * E-mail:
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23
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Piekarski F, Thalheimer M, Seyfried T, Kron F, Jung N, Sandow P, Isik S, Fuellenbach C, Choorapoikayil S, Marschall U, Winterhalter M, Wunderer F, Kloka J, Tellbach JH, Zacharowski K, Meybohm P. [Various scenarios for billing and remuneration of preoperative management of iron deficiency anemia in the German healthcare system]. Anaesthesist 2019; 68:540-545. [PMID: 31396676 DOI: 10.1007/s00101-019-0632-9] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
More than 30% of all patients undergoing surgery suffer from preoperative anemia. Iron deficiency anemia is the most common type of anemia. The diagnostics and treatment of iron deficiency anemia can be carried out before patients undergo surgery as an alternative to blood transfusion and is an interdisciplinary task. This article gives an overview of various billing modalities and payment arrangements for management of preoperative anemia in the German healthcare system.
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Affiliation(s)
- F Piekarski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland.
| | - M Thalheimer
- Qualitätsmanagement und Medizincontrolling, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Seyfried
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - F Kron
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - N Jung
- Gemeinschaftspraxis Drs. Jung, Deggingen, Deutschland
| | - P Sandow
- Hausarztpraxis Dr. P. Sandow, Berlin, Deutschland
| | - S Isik
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - C Fuellenbach
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - S Choorapoikayil
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | | | - M Winterhalter
- Klinik für Anästhesiologie und Spezielle Schmerztherapie, Klinikum Bremen Mitte, Bremen, Deutschland
| | - F Wunderer
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - J Kloka
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | | | - K Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - P Meybohm
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
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24
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Rieg S, Hitzenbichler F, Hagel S, Suarez I, Kron F, Salzberger B, Pletz M, Kern WV, Fätkenheuer G, Jung N. Infectious disease services: a survey from four university hospitals in Germany. Infection 2018; 47:27-33. [PMID: 30120718 DOI: 10.1007/s15010-018-1191-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/09/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Involvement of infectious disease (ID) specialists in the care of hospitalized patients with infections through consultation services improves the quality of care and the outcome of patients. This survey aimed to describe activities and utilization of ID consultations at four German tertiary care hospitals. METHODS A 1-month (March 2016) retrospective cross-sectional study at four university hospitals (Freiburg, Jena, Cologne and Regensburg) was performed. Only ID consultations with written documentation and bedside patient evaluation were included. Consultations were analyzed with regard to requesting departments, infections, case severity, and diagnostic and therapeutic recommendations. RESULTS In the study period, 638 ID consultations were performed in 479 patients-corresponding to 3-4 consultations per 100 inpatient cases. Patients were characterized by a high disease complexity-the mean case mix index in patients with consultation was 10.1 compared to 1.6 for all patients. ID consultations were requested by many different specialties, with approximately half of the requests coming from surgical disciplines. ID consultations resulted in revised diagnoses in 34% of the cases, provided recommendations for additional diagnostic procedures in 66%, and for modifications of antimicrobial regimens in 70% of the cases. CONCLUSIONS Infectious disease consultations were requested for patients with severe and complicated diseases and resulted in recommendations that highly impacted the diagnostic work-up and therapeutic management of patients. The results of this survey may help to estimate requirements for establishment of such services in Germany.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | | | - Stefan Hagel
- Infectious Disease, University Hospital of Jena, Jena, Germany
| | - Isabelle Suarez
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bernd Salzberger
- Infectious Diseases Unit, University Hospital of Regensburg, Regensburg, Germany
| | - Mathias Pletz
- Infectious Disease, University Hospital of Jena, Jena, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
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25
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Kron A, Riedel R, Michels S, Fassunke J, Merkelbach-Bruse S, Scheffler M, Nogova L, Fischer R, Ueckeroth F, Abdulla D, Kron F, Pauli B, Kaminsky B, Braess J, Graeven U, Grohe C, Krueger S, Büttner R, Wolf J. Impact of co-occurring genomic alterations on overall survival of BRAF V600E and non-V600E mutated NSCLC patients: Results of the Network Genomic Medicine. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Kron F, Kutsch N, Kostenko A, Dohle I, Glossmann JP, Müller D, Heimann SM, Bahlo J, von Bergwelt-Baildon M, Eichhorst B, Wolf J, Hallek M, Zander T. Economic evaluation of chronic lymphocytic leukemia from a hospital management perspective. Eur J Haematol 2016; 98:169-176. [PMID: 27727474 DOI: 10.1111/ejh.12817] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Treatment of chronic lymphocytic leukemia (CLL) is currently undergoing dramatic changes. We analyzed economic risks in hospitalized patients with CLL from a management perspective. METHODS One hundred and twelve patients with CLL hospitalized in 2013 and 2014 at the University Hospital of Cologne were analyzed. To assess profit margins (PMs) per case, diagnosis-related group (DRG) reimbursement data were merged with an internal cost accounting scheme depending on age, prognostic factors, and DRG key performance indicators. RESULTS In 112 patients, 284 cases coded by 19 different DRG with strongly fluctuating cost revenue ratios were found with an overall negative PM of €137 147. The DRG R61H was identified as the one most commonly coded (174 cases, 61.3%) with a deficit per case of €814. Subanalysis demonstrated that the payments were not cost covering due to excessive length of stay and staff costs. Significant differences in PM per case concerning age, length of stay and number of operation and procedure key (OPS) codes (P < 0.05) were found. CONCLUSION In our research-driven tertiary care hospital, inpatient treatment of patients with CLL is not cost covering. This analysis demonstrates the need for novel care/reimbursement structures in CLL. From a hospital management perspective, cost revenue controlling is crucial to avoid major economic risks.
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Affiliation(s)
- Florian Kron
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Nadine Kutsch
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Anna Kostenko
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Ines Dohle
- Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Jan-Peter Glossmann
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany.,Department of Controlling, University Hospital of Cologne, Cologne, Germany
| | - Dirk Müller
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Sebastian M Heimann
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Jasmin Bahlo
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Michael von Bergwelt-Baildon
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
| | - Thomas Zander
- Department I of Internal Medicine, Center for Integrated Oncology Cologne, University Hospital of Cologne, Cologne, Germany
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27
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Kron F, Kostenko A, Scheffler M, Glossmann JP, Fischer RN, Michels SYF, Nogova L, Hallek MJ, Zander T, Wolf J. Economic burden of clinical trials in lung cancer in a German comprehensive cancer center. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Florian Kron
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Anna Kostenko
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Jan Peter Glossmann
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Rieke Nila Fischer
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Sebastian Yves Friedrich Michels
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | | | | | - Thomas Zander
- Department 1 for Internal Medicine, Center for Integrated Oncology Köln-Bonn, University Hospital Cologne, Cologne, Germany
| | - Juergen Wolf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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28
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Kostenko A, Michels SYF, Fassunke J, Scheffler M, Merkelbach-Bruse S, Fischer RN, Gerigk M, Sueptitz J, Kron F, Glossmann JP, Buettner R, Wolf J. Survival following implementation of next-generation sequencing in routine diagnostics of advanced lung cancer: Results of the German Network Genomic Medicine. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anna Kostenko
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Sebastian Yves Friedrich Michels
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Jana Fassunke
- Institute for Pathology, University Hospital Cologne, Center for Integrated Oncology, Cologne, Germany, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Institute for Pathology, University Hospital of Cologne, Center for Integrated Oncology, Cologne, Germany
| | - Rieke Nila Fischer
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Merle Gerigk
- Institute of Pathology, University Hospital of Cologne, CIO Cologne and Bonn, Cologne, Germany
| | - Juliane Sueptitz
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Jan Peter Glossmann
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Juergen Wolf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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29
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Scheffler M, Ihle MA, Hein R, Merkelbach-Bruse S, Braegelmann J, Scheel AH, Michels SYF, Ueckeroth F, Eisert A, Gogl L, Frank R, Fischer RN, Koleczko S, Schaepers C, Kostenko A, Kron F, Hellmich M, Sos ML, Buettner R, Wolf J. Genetic heterogeneity of KRAS-mutated NSCLC: Co-occurrence of potentially targetable aberrations and evolutionary background. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Michaela A. Ihle
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Rebecca Hein
- Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Institute for Pathology, University Hospital of Cologne, Center for Integrated Oncology, Cologne, Germany
| | | | - Andreas H. Scheel
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Sebastian Yves Friedrich Michels
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Frank Ueckeroth
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Anna Eisert
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Center for Integrated Oncology (CIO) Köln Bonn, Cologne, Germany
| | - Leonie Gogl
- Lung Cancer Group Cologne, Departement I of Internal Medicine, University Hospital of Cologne, Center for Integrated oncology (CIO) Köln Bonn, Cologne, Germany
| | - Rieke Frank
- Lung Cancer Group Cologne, Department I of Internal Medicine, University Hospital of Cologne, Center for Integrated Oncology (CIO) Köln Bonn, Cologne, Germany
| | - Rieke Nila Fischer
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Sophia Koleczko
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Carsten Schaepers
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Anna Kostenko
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Florian Kron
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Martin L. Sos
- Department of Translational Genomics, University of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Juergen Wolf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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30
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Kostenko A, Glossmann JP, Michels SYF, Sueptitz J, Scheffler M, Fischer R, Markiefka B, Scheel A, De Mary P, Kron F, Buettner R, Wolf J. The network genomic medicine cost reimbursement model for implementation of comprehensive lung cancer genotyping in clinical routine. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e12556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anna Kostenko
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Jan Peter Glossmann
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Sebastian Yves Friedrich Michels
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Juliane Sueptitz
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Rieke Fischer
- Lung Cancer Group Cologne, Department I of Internal Medicine and Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Birgid Markiefka
- Institute of Pathology and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Andreas Scheel
- Institute of Pathology and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | | | - Florian Kron
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, University Hospital Cologne and Center for Integrated Oncology Köln-Bonn, Cologne, Germany
| | - Juergen Wolf
- Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn, University Hospital Cologne, Cologne, Germany
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Heimann SM, Vehreschild MJ, Cornely OA, Franke B, von Bergwelt-Baildon M, Wisplinghoff H, Kron F, Scheid C, Vehreschild JJ. A cost and resource utilization analysis of micafungin bridging for hemato-oncological high-risk patients undergoing allogeneic stem cell transplantation. Eur J Haematol 2015; 94:526-31. [DOI: 10.1111/ejh.12466] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Sebastian M. Heimann
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
| | - Maria J.G.T. Vehreschild
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne; Cologne Germany
| | - Oliver A. Cornely
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Clinical Trials Centre Cologne; ZKS Köln (BMBF01KN1106); University Hospital of Cologne; Cologne Germany
- Cluster of Excellence - Cellular Stress Responses in Aging-Associated Diseases; CECAD; University of Cologne; Cologne Germany
- Center for Integrated Oncology Köln Bonn; CIO Köln Bonn; University Hospital of Cologne; Cologne Germany
| | - Bernd Franke
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
| | - Michael von Bergwelt-Baildon
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology Köln Bonn; CIO Köln Bonn; University Hospital of Cologne; Cologne Germany
| | - Hilmar Wisplinghoff
- Institute for Medical Microbiology, Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - Florian Kron
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
| | - Christoph Scheid
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
| | - Jörg J. Vehreschild
- 1st Department of Internal Medicine; University Hospital of Cologne; Cologne Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne; Cologne Germany
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