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Riemekasten G, Schmelz R, Schäkel K, Thaci D, Schreiber S, Röcken M, Bartz H, Ploner T, Liao X, Weber V, Manz KC, Burkhardt H, Leipe J. [Epidemiological data and medical care situation of patients with chronic inflammatory diseases in Germany : Real-world evidence on prevalence, disease combinations, care]. Z Rheumatol 2024; 83:578-586. [PMID: 38071271 PMCID: PMC11442525 DOI: 10.1007/s00393-023-01459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/01/2024]
Abstract
BACKGROUND Chronic inflammatory diseases (immune-mediated inflammatory diseases, IMID) can overlap or occur simultaneously due to clinical similarities. The resulting utilization of heathcare structures has not yet been investigated across disciplines but is of potential importance for optimizing the treatment of patients with IMID. AIM OF THE WORK Analysis of epidemiological data including utilization of care services in patients with selected IMIDs: psoriasis, psoriatic arthritis (PsA), rheumatoid arthritis (RA), ankylosing spondylitis, ulcerative colitis, Crohn's disease and connective tissue disease. MATERIAL AND METHODS In a retrospective cross-sectional analysis based on health insurances accounting data with a sample of approximately 4 million insured persons, the prevalence of the abovementioned IMID and the frequency of IMID combinations were analyzed based on documented diagnoses (ICD-10 GM). The frequency of hospitalizations and utilization of outpatient physician contacts was recorded in predefined specialist disciplines (general medicine, dermatology, gastroenterology, rheumatology) and compared with an age-adjusted and gender-adjusted reference population. RESULTS A total of 188,440 patients had at least 1 of the IMID diagnoses analyzed (4.7%), with an age peak of 61-70 years. The highest prevalence was observed for psoriasis (1.85%), followed by rheumatoid arthritis (1.38%). Combinations with at least one other IMID were relatively common (29%), with this being most common in patients with psoriatic arthritis (82.9%, of which 68.2% had psoriasis), followed by ankylosing spondylitis (27.5%) and Crohn's disease (21.6%). Compared to the reference population, patients with IMID were hospitalized more often and more frequently utilized the outpatient disciplines. DISCUSSION The study results describe that IMIDs occur in combination and that the patients make comparatively more use of care structures of different disciplines. A multidisciplinary approach could increase the efficiency of care; an evaluation is still pending.
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Affiliation(s)
- Gabriela Riemekasten
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Renate Schmelz
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Knut Schäkel
- Hautklinik, IZEH - Interdisziplinäres Zentrum für chronisch entzündliche Erkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Diamant Thaci
- Institut und Exzellenzzentrum für Entzündungsmedizin, Universität zu Lübeck, Lübeck, Deutschland
| | - Stefan Schreiber
- Klinik für Innere Medizin I und Institut für Klinische Molekularbiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | | | - Tina Ploner
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Deutschland
| | - Ximing Liao
- InGef - Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Deutschland
| | | | | | - Harald Burkhardt
- Medizinische Klinik II/Rheumatologie, Fraunhofer Institut für Translationale Medizin und Pharmakologie (ITMP), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt am Main, Frankfurt, Deutschland
| | - Jan Leipe
- Sektion Rheumatologie, V. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
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Libutzki B, Neukirch B, Reif A, Hartman CA. Somatic burden of attention-deficit/hyperactivity disorder across the lifecourse. Acta Psychiatr Scand 2024; 150:105-117. [PMID: 38804256 DOI: 10.1111/acps.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/07/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE A thorough and comprehensive knowledge base on the extent of comorbidity of attention-deficit/hyperactivity disorder (ADHD) and somatic conditions is needed. METHOD We compared the prevalence of a wide range of somatic conditions in individuals with and without ADHD and described sex and lifecourse differences. Individuals with an ADHD diagnosis (N = 87,394) and age and sex-matched individuals without an ADHD diagnosis were identified from a large health claims dataset representative of the general German population, including both primary and specialized care (N = 4.874,754). Results were provided for the full sample as well as stratified for sex and age (<12 years, 13-17 years, 18-29 years, 30-59 years, ≥60 years). RESULTS The results showed that ADHD is associated with a wide variety of somatic conditions across the entire lifecourse. Specifically neurological disorders such as Parkison's disease (odds ratio [OR]: 5.21) and dementia (OR: 2.23), sleep-related disorders (OR: 2.38) and autoimmune disorders affecting the musculoskeletal, digestive, and endocrine system (fibromyalgia OR: 3.33; lupus OR: 2.17) are strongly and significantly associated with ADHD. Additionally, ADHD is associated with higher occurrence of common acute diseases typically treated by the general practitioner, hinting at an overall general lower health status. Sex differences in somatic comorbidity were not prominent. Age differences, in contrast, stood out: in particular endocrine, cardiovascular, and neurological disorders had an early onset in individuals with compared to individuals without ADHD. CONCLUSION This research underlines the high burden of disease due to somatic conditions among individuals with ADHD. The findings indicate the need for preventive measures to reduce comorbidity.
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Affiliation(s)
- Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benno Neukirch
- Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kreutz R, Kloss S, Enders D, Abdelgawwad K, Häckl D, Schmedt N, Bonnemeier H. Comparative effectiveness of factor Xa non-vitamin K antagonist oral anticoagulants versus phenprocoumon in patients with non-valvular atrial fibrillation. Int J Cardiol 2024; 404:131894. [PMID: 38437952 DOI: 10.1016/j.ijcard.2024.131894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOACs) have largely supplanted vitamin K antagonists (VKAs) for oral anticoagulation in non-valvular atrial fibrillation (NVAF). However, data on the real-world effectiveness of NOACs vs. phenprocoumon, a VKA widely used in Germany, are limited. The RELOADED study aimed to compare effectiveness of factor Xa NOACs and phenprocoumon in NVAF in clinical practice. METHODS Patients who started on a factor Xa NOAC or phenprocoumon for NVAF during the study period were enrolled from the Institute for Applied Healthcare Research Berlin. Patients were followed from first prescription until the end of exposure or available data. Primary outcomes were analyzed by Cox proportional hazard regression models and included ischemic stroke and systemic embolism for effectiveness, and intracranial hemorrhage (ICH) for safety. Subgroups of interest were patients with diabetes and patients with renal impairment. RESULTS The total study population was 64,920; 36.3% of patients initiated phenprocoumon, 34.4% initiated rivaroxaban, 25.0% apixaban, and 4.4% edoxaban. Treatment with phenprocoumon is associated with a similar risk of ischemic stroke/systemic embolism as treatment with rivaroxaban or apixaban; while rivaroxaban (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.43-0.75) and apixaban (adjusted HR 0.43, 95% CI 0.31-0.6) were associated with a lower risk of ICH compared to phenprocoumon in NVAF patients. The use of rivaroxaban and apixaban was associated with a lower risk of developing kidney failure in patients with diabetes or renal impairment in comparison to those treated with phenprocoumon. CONCLUSION The factor Xa NOACs rivaroxaban and apixaban demonstrated similar effectiveness and lower rates of ICH compared with phenprocoumon in this study.
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Affiliation(s)
- Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Charitéplatz 1, 10117 Berlin, Germany.
| | | | - Dirk Enders
- InGef - Institute for Applied Health Research Berlin, Spittelmarkt 12, 10117 Berlin, Germany
| | | | - Dennis Häckl
- University Leipzig, Health Economics and Management, Grimmaische Straße 12, 04109 Leipzig, Germany; WIG2 - Scientific Institute for Health Economics and Health System Research, Markt 8, 04109 Leipzig, Germany
| | - Niklas Schmedt
- InGef - Institute for Applied Health Research Berlin, Spittelmarkt 12, 10117 Berlin, Germany
| | - Hendrik Bonnemeier
- University Medical Center Schleswig-Holstein, Department of Electrophysiology and Rhythmology, Arnold-Heller-Straße 3, 24105 Kiel, Germany
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Yang J, Rai KK, Seif M, Volkman HR, Ren J, Schmetz A, Gowman H, Massey L, Pather S, Nguyen JL. COVID-19-Related Work Absenteeism and Associated Lost Productivity Cost in Germany: A Population-Based Study. J Occup Environ Med 2024; 66:514-522. [PMID: 38489399 DOI: 10.1097/jom.0000000000003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The aim of the study is to estimate COVID-19 absenteeism and indirect costs, by care setting. METHODS A population-based retrospective cohort study using data from the German Statutory Health Insurance (SHI) database to define outpatient (April 2020-December 2021) and hospitalized (April 2020-October 2022) cohorts of employed working-aged individuals. RESULTS In the outpatient cohort ( N = 369,220), median absenteeism duration and associated cost was 10.0 (Q1, Q3: 5.0, 15.0) days and €1061 (530, 1591), respectively. In the hospitalized cohort ( n = 20,687), median absenteeism and associated cost was 15.0 (7.0, 32.0) days and €1591 (743, 3394), respectively. Stratified analyses showed greater absenteeism in older workers, those at risk, and those with severe disease. CONCLUSIONS The hospitalized cohort had longer absenteeism resulting in higher productivity loss. Being older, at risk of severe COVID-19 and higher disease severity during hospitalization were important drivers of higher absenteeism duration.
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Affiliation(s)
- Jingyan Yang
- From the Pfizer Inc., New York, NY (J.Y., H.R.V., J.L.N.); Institute for Social and Economic Research and Policy, Columbia University, New York, New York (J.Y.); Adelphi Real World, Bollington, United Kingdom (K.K.R., M.S., H.G., L.M.); Pfizer Inc, Collegeville, Pennsylvania (J.R.); and BioNTech Europe GmbH, Berlin, Germany (A.S., S.P.)
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Horneff G, Borchert J, Diesing J, Klaus P, Heinrich R, Dally H, Hagemann C, Kock S, Schönfelder T. Treatment Patterns in Polyarticular Juvenile Idiopathic Arthritis: A Retrospective Observational Health Claims Data Study. Life (Basel) 2024; 14:712. [PMID: 38929695 PMCID: PMC11205221 DOI: 10.3390/life14060712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: Achieving inactive disease decreases long-term joint damage in patients with polyarticular juvenile idiopathic arthritis (polyJIA). The aim of our study was to describe average time to treatment and medication changes over time. (2) Methods: Incident polyJIA patients were retrospectively identified in the InGef and WIG2 longitudinal health claims databases. Drug escalation level changes were evaluated longitudinally and cross-sectionally across three years, as follows: no treatment, glucocorticoids (GCs) and/or non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and biological disease-modifying antirheumatic drugs (bDMARDs). (3) Results: On average, newly diagnosed polyJIA patients received their first csDMARD prescription after 128 days and their first bDMARD prescription after 327 days. More patients were treated with csDMARDs than with bDMARDs at diagnosis; however, 24% and 12% (InGef and WIG2 databases, respectively) had no JIA treatment. After three years, 45% and 31% were not taking any treatments, while 18% and 36% were prescribed bDMARDs. Among patients initiating bDMARDs, most continued treatment for three years, with some switching to csDMARDs or discontinuing treatment. Patients treated only with csDMARDs took them longer, compared to those additionally taking other DMARDs. Patients treated with bDMARDs took them about twice as long as the csDMARDs they took prior. (4) Conclusion: A substantial number of patients with polyJIA are not treated as intensively as guidelines recommend.
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Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, 53757 Sankt Augustin, Germany;
- Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, 50937 Cologne, Germany
| | - Julia Borchert
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), 04109 Leipzig, Germany; (J.B.); (J.D.); (R.H.)
| | - Joanna Diesing
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), 04109 Leipzig, Germany; (J.B.); (J.D.); (R.H.)
| | - Pascal Klaus
- Pfizer Pharma GmbH, Friedrichstraße 110, 10117 Berlin, Germany; (P.K.); (H.D.); (C.H.)
| | - Ria Heinrich
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), 04109 Leipzig, Germany; (J.B.); (J.D.); (R.H.)
| | - Heike Dally
- Pfizer Pharma GmbH, Friedrichstraße 110, 10117 Berlin, Germany; (P.K.); (H.D.); (C.H.)
| | - Christine Hagemann
- Pfizer Pharma GmbH, Friedrichstraße 110, 10117 Berlin, Germany; (P.K.); (H.D.); (C.H.)
| | - Simon Kock
- InGef—Institut für Angewandte Gesundheitsforschung Berlin GmbH, Otto-Ostrowski-Straße 5, 10249 Berlin, Germany;
| | - Tonio Schönfelder
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), 04109 Leipzig, Germany; (J.B.); (J.D.); (R.H.)
- Lehrstuhl Gesundheitswissenschaften/Public Health, Technische Universität Dresden, 01062 Dresden, Germany
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Michel A, Lecomte C, Ohlmeier C, Raad H, Basedow F, Haeckl D, Beier D, Evers T. Treatment Patterns, Outcomes, and Persistence to Newly Started Heart Failure Medications in Patients with Worsening Heart Failure: A Cohort Study from the United States and Germany. Am J Cardiovasc Drugs 2024; 24:409-418. [PMID: 38573461 DOI: 10.1007/s40256-024-00643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Data are limited regarding guideline-directed medical therapy (GDMT) treatment patterns in patients with worsening heart failure (HF). METHODS We used administrative claims databases in Germany and the USA to conduct a retrospective cohort study of patients with worsening HF. Two cohorts of patients with prevalent HF and a HF hospitalization (HFH) from 2016 to 2019, alive at discharge (N = 75,140 USA; N = 47,003 Germany) were identified. Index date was the first HFH during the study period. One-year HF rehospitalization and mortality rates were calculated and a composite endpoint of both outcomes assessed using Kaplan-Meier estimation. We evaluated HF medication patterns in the 6 months before and after the index date. New users of a HF medication (at discharge/after index HFH) were followed for 1 year to evaluate persistence (no treatment gaps > 2 months) RESULTS: One-year HF rehospitalization rates were 36.2% (USA) and 47.7% (Germany). One year mortality rates were 30.0% (USA) and 23.0% (Germany), and the composite endpoint (mortality/HF rehospitalization) was reached in 55.1 % (USA) and 56.6% (Germany). Kaplan-Meier plots showed the risk for the composite endpoint was high in the early post discharge period. Comparison of patterns pre- and postindex HFH showed some increase in use of mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitor (ARNI), and triple therapy; use of angiotensin-converting enzyme (ACE) inhibitor/ angiotensin receptor blocker (ARB) plus beta-blockers remained constant/slightly declined; < 20% patients received triple therapy (ACE inhibitor/ARB plus beta-blocker plus MRA). A third of patients were new users; 1 year persistence rates were often low. CONCLUSIONS Morbidity, mortality, and rehospitalization risk is high among patients with worsening HF; uptake and continuation of GDMT is suboptimal.
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Affiliation(s)
- Alexander Michel
- Bayer Consumer Care AG, Pharmaceuticals, Peter Merian Straße 84, 4052, Basel, Switzerland.
| | | | | | | | - Frederike Basedow
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
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Leipe J, Schmelz R, Riemekasten G, Thaçi D, Henes J, Schäkel K, Pinter A, Sticherling M, Wegner J, Fusco S, Linke M, Weber V, Manz KC, Bartz H, Roecken M, Schmidt S, Hoyer BF. [Immune-mediated inflammatory diseases in Germany : A cross-sectional analysis of comorbidities and pharmacotherapy]. Z Rheumatol 2024; 83:200-209. [PMID: 36600054 PMCID: PMC10972917 DOI: 10.1007/s00393-022-01306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immune-mediated inflammatory diseases (IMID) can lead to a substantial disease burden for those affected, in particular by the concomitant occurrence of other IMIDs or in the presence of comorbidities. The care of patients with IMIDs is complex and involves various medical disciplines. OBJECTIVE To describe the burden of disease and the current routine drug treatment of patients with IMID. MATERIAL AND METHODS The retrospective cross-sectional analysis was based on statutory health insurance claims data from the InGef database. Prevalent patients with psoriasis (Pso), psoriatic arthritis (PsA), spondylarthritis (SpA), rheumatoid arthritis (RA), Crohn's disease (MC), ulcerative colitis (CU), or connective tissue disease were identified among 3,988,695 insured patients in 2018. The concomitant occurrence of different IMIDs and the extent to which patients with IMID are affected by other comorbidities compared to a reference population were investigated. The current routine drug treatment was described based on the use of predefined forms of treatment. RESULTS In the database 188,440 patients with IMID (4.7%) were identified. Compared to the reference population the prevalence of comorbidities, such as depressive episodes and cardiovascular risk factors was higher in patients with IMID. For MC, CU, RA, and PsA disease-modifying antirheumatic drugs (DMARD) and classical systemic forms of treatment were used most commonly. In Pso, SpA, and connective tissue disease nonsteroidal anti-inflammatory drugs (NSAID) were the most frequently used treatment often in combination with other drugs. CONCLUSION A considerable number of patients with IMIDs (16.9-27.5%) suffer from different diseases of the IMID group. They are frequently affected by accompanying illnesses and require interdisciplinary medical treatment.
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Affiliation(s)
- Jan Leipe
- Sektion Rheumatologie, V. Medizinische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Renate Schmelz
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Gabriela Riemekasten
- Klinik für Rheumatologie und klinische Immunologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Diamant Thaçi
- Institut und Exzellenzzentrum für Entzündungsmedizin, Universität zu Lübeck, Schleswig-Holstein, Lübeck, Deutschland
| | - Jörg Henes
- Zentrum für interdisziplinäre und klinische Immunologie, Rheumatologie und autoinflammatorische Erkrankungen (INDIRA) und innere Medizin II, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Knut Schäkel
- Hautklinik, IZEH - Interdisziplinäres Zentrum für chronisch entzündliche Erkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Andreas Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universtitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Michael Sticherling
- Hautklinik, Psoriasiszentrum, Deutsches Zentrum für Immuntherapie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Joanna Wegner
- Hautklinik und Poliklinik, Universitätsitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Stefano Fusco
- Medizinische Klinik I, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Miriam Linke
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | | | | | | | | | | | - Bimba F Hoyer
- Klinik für Innere Medizin I, Sektion Rheumatologie und klinische Immunologie, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
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Boeckling F, Stähli BE, Rudolph T, Lutz M, Schatz AS, Vogelmann T, Stueve M, West NEJ, Boone E, Erbay A, Leistner DM. Fractional flow reserve measurements and long-term mortality-results from the FLORIDA study. Front Cardiovasc Med 2024; 11:1337941. [PMID: 38404721 PMCID: PMC10885355 DOI: 10.3389/fcvm.2024.1337941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Background Randomized evidence suggested improved outcomes in fractional flow reserve (FFR) guidance of coronary revascularization compared to medical therapy in well-defined patient cohorts. However, the impact of FFR-guided revascularization on long-term outcomes of unselected patients with chronic or acute coronary syndromes (ACS) is unknown. Aims The FLORIDA (Fractional FLOw Reserve In cardiovascular DiseAses) study sought to investigate outcomes of FFR-guided vs. angiography-guided treatment strategies in a large, real-world cohort. Methods This study included patients enrolled into the German InGef Research Database. Patients undergoing coronary angiography between January 2014 and December 2015 were included in the analysis. Eligible patients had at least one inpatient coronary angiogram for suspected coronary artery disease between January 2014 and December 2015. Patients were stratified into FFR arm if a coronary angiography with adjunctive FFR measurement was performed, otherwise into the angiography-only arm. Matching was applied to ensure a balanced distribution of baseline characteristics in the study cohort. Patients were followed for 3 years after index date and primary endpoint was all-cause mortality. Results In the matched population, mortality at 3 years was 9.6% in the FFR-assessed group and 12.6% in the angiography-only group (p = 0.002), corresponding to a 24% relative risk reduction with use of FFR. This effect was most pronounced in patients in whom revascularization was deferred based on FFR (8.7% vs. 12.3%, p = 0.04) and in high-risk subgroups including patients aged ≥75 years (14.9% vs. 20.1%, p < 0.01) and those presenting with ACS (10.2% vs. 14.0%, p = 0.04). Conclusions FFR-based revascularization strategy was associated with reduced mortality at 3 years. These findings further support the use of FFR in everyday clinical practice.
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Affiliation(s)
- Felicitas Boeckling
- Department of Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Barbara E. Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tanja Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart- und Diabetes Center NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne-Sophie Schatz
- Department of Cardiology, Charité—University Medicine Berlin, Berlin, Germany
| | | | | | | | - Els Boone
- Abbott Vascular, Santa Clara, CA, United States
| | - Aslihan Erbay
- Department of Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - David M. Leistner
- Department of Medicine, Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Mihm S, Schelling J, Wölle R, Suck A, Häckl D, Weinke T, Böllinger T. [Pneumococcal Vaccination Coverage Rates (VCRs) Among Persons with Vaccine-Relevant Underlying Conditions and Persons Aged 60 Years and Older - An Analysis of Secondary Data from the Statutory Health Insurance (SHI) System]. Dtsch Med Wochenschr 2024; 149:e1-e10. [PMID: 37875123 PMCID: PMC10756767 DOI: 10.1055/a-2178-8306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND In addition to standard vaccination for patients aged 60 and older, the Standing Committee on Vaccination (STIKO) recommends immunization against pneumococci for anyone at increased risk, including patients with chronic vaccine-relevant underlying conditions. In Germany, the Robert Koch Institute (RKI) regularly publishes vaccination coverage rates (VCRs) for these patient groups, without stratifying by other parameters. This study examines VCRs of patients with underlying chronic diseases, stratified by disease groups and entities, the re-vaccination rate, and VCRs in patients aged 60 years and older. METHODS This descriptive retrospective cohort study is based on a sample of about 4 million SHI-insured patients aged 16 years and older for the years 2014 to 2019, from the Institute for Applied Health Research (InGef) database. The sample is representative of age and sex distribution in the German population. RESULTS Extrapolated to the total SHI-population, the overall pneumococcal VCR in patients aged 60 years and older was 45.9 % (of n= InGef standard vaccination cohort: 1 009 763). Among all at-risk patients aged 16 years and older with chronic underlying diseases, only 17.1 % had received an indicated vaccination (InGef indicated vaccination cohort: 1 379 680). Stratified by disease entity, those with underlying pulmonary emphysema had the highest VCR, at 39.0 % (of n= 28 121). Of those who received a vaccination due to an underlying chronic disease, only 23.9 % were re-vaccinated after 6 years (InGef re-vaccination cohort: 12 328). Across all vaccination cohorts, VCRs increased with age. DISCUSSION The recommendations made by STIKO for pneumococcal vaccination based on age or an underlying chronic condition are not being implemented adequately in Germany. Although STIKO explicitly recommends vaccination from 60 years of age, the 60 to 64-year-old age group had a strikingly low VCR (13.0 % of n=268 862). Fewer than one in five patients aged 16 years and older with an underlying chronic condition had received the recommended indicated vaccination. To adequately prevent potential disease, higher vaccination rates should be targeted. This could probably be achieved through more stringent vaccination management, appropriate software solutions with vaccination reminders, monetary incentives for achieving higher vaccination rates and documentation of vaccination status in disease management programs.
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Affiliation(s)
- Sarah Mihm
- MSD SHARP & DOHME GmbH, München, Deutschland,
| | | | | | | | - Dennis Häckl
- WIG2 GmbH, Leipzig, Deutschland,
- Universität Leipzig, Institut für öffentliche Finanzen und Public Management, Leipzig, Deutschland,
| | - Thomas Weinke
- Klinikum Ernst von Bergmann, Klinik für Gastroenterologie und Infektiologie, Potsdam, Deutschland,
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May M, Oheim R, Bovy L, Doess A, Maessen D, Neukirch B, Norris R, Williams A, Abrahamsen B. Epidemiology of Tumor-Induced Osteomalacia in Germany Based on Real World Data. Calcif Tissue Int 2023; 113:630-639. [PMID: 37980279 PMCID: PMC10673975 DOI: 10.1007/s00223-023-01148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/30/2023] [Indexed: 11/20/2023]
Abstract
Tumor-induced osteomalacia (TIO) is an ultra-rare disease caused mostly by benign tumors that secrete fibroblast growth factor-23. Because of nonspecific symptoms, the diagnostic delay is long, and therapy can be challenging. Moreover, epidemiological data on TIO are scarce owing to its rarity. Therefore, this study aimed to quantify TIO's incidence rates and prevalence in Germany. Retrospective longitudinal and cross-sectional analyses were conducted using anonymized German claims data from the statutory health insurance (SHI) database. This database, which comprises the data of approximately 5 million insurants, is a representative sample of the German population and supports national projections. As there is no unique International Statistical Classification of Diseases and Related Health Problems (ICD) code for TIO, operational categories based on different surrogates were defined to determine the prevalence and incidence rates of TIO among probable patients. This study showed that TIO has a prevalence of (documented code, advanced imaging, medication, or tumor removal) 0.187 per 100,000 persons and an incidence rate of ≤ 0.094 per 100,000 person years. This analysis provides the first epidemiological insight into German patients with TIO. Despite the general limitations associated with the analysis of SHI claims data of ultra-rare diseases, we believe that this analysis provides a sound basis for further analysis, particularly with regard to the care situation of patients with TIO.
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Affiliation(s)
- Melanie May
- Department of Payer Value & Patient Access, Kyowa Kirin GmbH, Monschauer Str. 1, 40549, Duesseldorf, Germany.
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Hospital Hamburg-Eppendorf (UKE), Lottestraße 59, 22529, Hamburg, Germany
| | - Leonore Bovy
- InGef - Institute for Applied Health Research Berlin GmbH, InGef, Otto-Ostrowski-Straße 5, 10249, Berlin, Germany
| | - Axel Doess
- Department of Payer Value & Patient Access, Kyowa Kirin GmbH, Monschauer Str. 1, 40549, Duesseldorf, Germany
| | - Dirk Maessen
- Department of Franchise Nephrology, Kyowa Kirin GmbH, Monschauer Str. 1, 40549, Duesseldorf, Germany
| | - Benno Neukirch
- Hochschule Niederrhein, University of Applied Sciences, Competence Center Routine Data, Reinarzstraße 49, 47805, Krefeld, Germany
| | - Raeleesha Norris
- InGef - Institute for Applied Health Research Berlin GmbH, InGef, Otto-Ostrowski-Straße 5, 10249, Berlin, Germany
| | - Angela Williams
- Department of HEOR, Kyowa Kirin International Ltd, 2 Globeside, Fieldhouse Lane, Marlow, SL7 1HZ, UK
| | - Bo Abrahamsen
- Department of Medicine 1, Holbæk Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark
- Department of Clinical Research, University of Southern Denmark (SDU), Campusvej 55, 5230, Odense, Denmark
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de Lepper M, Stephan AJ, Wölle R, Wang W, Jacob C, Schneider KM, Buxmann H, Goelz R, Hamprecht K, Kummer P, Modrow S, Greiner W, Luzak A, Reuschenbach M. Burden of sequelae and healthcare resource utilization in the first year of life in infants born with congenital cytomegalovirus (cCMV) infection in Germany: A retrospective statutory health insurance claims database analysis. PLoS One 2023; 18:e0293869. [PMID: 37972113 PMCID: PMC10653416 DOI: 10.1371/journal.pone.0293869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/21/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection can have a broad range of manifestations. This study aimed to assess cCMV-associated sequelae and healthcare resource utilization (HCRU) in infants during the first year of life in Germany. METHODS A retrospective, controlled cohort study using German claims data from the Institute for Applied Health Research Berlin (InGef) database was conducted. cCMV-associated sequelae and HCRU during the first year of life were assessed by matching (1:60) infants with at least one inpatient/outpatient cCMV diagnosis (ICD-10-GM: P35.1) ≤90 days after birth (cCMV90 cohort) and infants with at least one inpatient cCMV diagnosis plus specific sequelae ≤21 days after birth (cCMV21-S) to infants without cCMV or CMV (ICD-10-GM: B25) diagnosis (control group), respectively. Outcomes were analyzed during the first 365 days of life. RESULTS Between 2014-2018, we identified 54 newborns for cCMV90 and 24 newborns for cCMV21-S cohort. Compared to the 3,240 and 1,440 controls, respectively, more cCMV90 infants (83.3% vs. 41.9%, p<0.01) presented with at least one sequela during the first year of life, including intrauterine growth retardation (42.6% vs. 5.3%, p<0.01), sensorineural hearing loss (SNHL) to deafness (38.9% vs. 2.2%, p<0.01), and motor development disorders (33.3% vs. 10.9%, p<0.01). Further, 13.0% of cCMV90 infants (vs. 2.3%, p<0.01) suffered from visual impairment. In cCMV21-S cohort, intrauterine growth retardation (79.2% vs. 6.0%, p<0.01), prematurity (54.2% vs. 7.3%, p<0.01), and motor development disorders (50.0% vs. 11.0%, p<0.01) were the most frequent sequelae. Infants in the cCMV90 and cCMV21-S cohort had, on average, 7.3 times and 9.5 times more hospitalizations and 2.0 times and 2.1 times more outpatient physician visits than their respective controls (p<0.01). Hospitalized infants with cCMV stayed, on average, significantly longer in hospital compared to their controls (cCMV90 cohort: 30.3 days vs. 9.0 days, p<0.01; cCMV21-S cohort: 46.5 days vs. 9.3 days, p<0.01). CONCLUSIONS cCMV-infection shows a considerable disease and healthcare burden during the first year of life. More than 80% of the identified newborns with cCMV suffered from at least one associated sequela during the first year of life, including long-term sequelae such as SNHL (40%) and visual impairment (13%). Additional steps for prevention of cCMV infection and associated sequelae as well as a comprehensive monitoring of disease burden are needed.
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Affiliation(s)
- Marion de Lepper
- Department of Medical Affairs, MSD Sharp & Dohme GmbH, Munich, Germany
| | | | - Regine Wölle
- Department of Market Access, MSD Sharp & Dohme GmbH, Munich, Germany
| | - Wei Wang
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States of America
| | | | | | - Horst Buxmann
- Division for Neonatology, Department for Children and Adolescents, Main-Kinzig-Kliniken GmbH, Gelnhausen, Germany
| | - Rangmar Goelz
- Department of Neonatology, University Children´s Hospital Tuebingen, Tuebingen, Germany
| | - Klaus Hamprecht
- Institute for Medical Virology and Epidemiology of Viral Diseases, University of Tuebingen, Tuebingen, Germany
| | - Peter Kummer
- Department of Otolaryngology, Section of Phoniatrics and Pediatric Audiology, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Modrow
- Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Agnes Luzak
- Department of Market Access, MSD Sharp & Dohme GmbH, Munich, Germany
| | - Miriam Reuschenbach
- Global Medical and Scientific Affairs, MSD Sharp & Dohme GmbH, Munich, Germany
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Assaf C, Dobos G, Zech IM, Doess A, May M, Jadasz J. Epidemiologie reifzelliger T- und NK-Zell-Lymphome in Deutschland - Eine repräsentative Querschnittanalyse von GKV-Routinedaten: Epidemiology of mature T/NK-cell lymphomas in Germany - A representative cross-sectional study based on SHI claims data. J Dtsch Dermatol Ges 2023; 21:1320-1328. [PMID: 37946651 DOI: 10.1111/ddg.15187_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungHintergrundPrimäre kutane Lymphome sind seltene lymphoproliferative Neoplasien und gehören zur heterogenen Gruppe der Non‐Hodgkin‐Lymphome. Sie umfassen ein klinisch und histologisch breites Spektrum an Manifestationsformen, wobei kutane T‐Zell‐Lymphome (CTCL) mit 73% am häufigsten sind. Aufgrund der Seltenheit der Erkrankungen sind bevölkerungsbasierte Untersuchungen zur Versorgungssituation und Epidemiologie kaum vorhanden.Patienten und MethodikAuf Basis anonymisierter, alters‐ und geschlechtsadjustierter GKV‐Routinedaten von circa fünf Millionen gesetzlich Krankenversicherten wurde im Sechsjahreszeitraum (2012–2017) eine retrospektive Analyse zur Bestimmung von Prävalenz, Inzidenz und Letalität von Patienten mit reifzelligen T/NK‐Zell Lymphomen in Deutschland durchgeführt.ErgebnisseInsgesamt 1336 T‐Zell‐Lymphom‐Patienten konnten im Beobachtungszeitraum identifiziert werden. Die Sechsjahres‐Prävalenz liegt demnach zwischen 27,35 und 43,58 pro 100 000 Einwohner. Die Patienten waren zu 65% männlich mit einem durchschnittlichen Alter von 66 Jahren (SD 15). Es verstarben 246 Patienten (circa 20 %) innerhalb der 6 Jahre, pro Jahr bis zu 7 %. Die ermittelte Inzidenz bei 153 identifizierten Patienten im Jahr 2017 liegt bei 3,65 bis 3,92 pro 100 000 Einwohner.SchlussfolgerungenErstmalig in Deutschland wurden mithilfe von Abrechnungsdaten der gesetzlichen Krankenversicherung (GKV‐Routinedaten), valide epidemiologische Erkenntnisse von Patienten mit reifzelligen T‐ und NK‐Zell Lymphomen gewonnen. Weitere Analysen für tiefergehende Einblicke in die Versorgung der Patienten mit dieser seltenen Erkrankung sind wünschenswert.
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Affiliation(s)
- Chalid Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld, Krefeld
- Institute for Molecular Medicine, Medical School Hamburg, Hamburg
- Klinik für Dermatologie, HELIOS Klinikum Schwerin, universitärer Campus der Medical School Hamburg, Schwerin
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, gemeinsame Medizinische Fakultät Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
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13
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Fiehn C, Zinke S, Haas JS, Meise D, Theil J, Gurrath M, Orzechowski HD. Real-world treatment persistence in patients with rheumatoid arthritis initiating DMARDs in Germany-a health insurance claims data analysis. Z Rheumatol 2023; 82:739-753. [PMID: 36757417 PMCID: PMC10627963 DOI: 10.1007/s00393-023-01323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To investigate treatment patterns in patients with rheumatoid arthritis (RA) in Germany who had previously received conventional synthetic (cs) or biologic (b) disease-modifying antirheumatic drugs (DMARDs). METHODS Patients with RA who initiated treatment with a csDMARD, bDMARD, or Janus kinase (JAK) inhibitor between 2017 and 2018 and who had previously received csDMARD or bDMARD therapy were retrospectively selected from the Institute for Applied Health Research Berlin GmbH (InGef). Time on treatment and discontinuation risk were assessed using the Kaplan-Meier method. Cox regression identified variables associated with an increased discontinuation risk. RESULTS A total of 990 patients had received prior csDMARD therapy; 375 had received prior bDMARD therapy. Tumor necrosis factor (TNF)-α inhibitors and JAK inhibitors were the most commonly prescribed DMARD class in those previously treated with a csDMARD or bDMARD, respectively. In both cohorts, more patients received DMARD monotherapy than combination therapy. In the prior csDMARD cohort, median time on treatment was 276, 252, and 148 days with JAK inhibitors, TNF‑α inhibitors, and csDMARDs, respectively, and those treated with JAK or TNF‑α inhibitors were less likely to discontinue treatment than those on csDMARDs (log-rank test p-value < 0.01 for both comparisons); no significant differences were found within the prior bDMARD cohort. CONCLUSION This is among the first detailed analyses of RA treatment patterns in a real-world setting in Germany since the introduction of JAK inhibitors. TNF‑α inhibitors were the most commonly prescribed DMARD after failure of an initial csDMARD, while JAK inhibitors were the most common among patients previously treated with a bDMARD. In both groups, monotherapy with bDMARD or targeted synthetic DMARD was common. In the prior csDMARD cohort, treatment duration was significantly longer with JAK or TNF‑α inhibitors than with csDMARDs.
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Affiliation(s)
- Christoph Fiehn
- Rheumatology and Clinical Immunology Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Germany.
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Assaf C, Dobos G, Zech IM, Doess A, May M, Jadasz J. Epidemiology of mature T/NK-cell lymphomas in Germany - A representative cross-sectional study based on SHI claims data. J Dtsch Dermatol Ges 2023; 21:1320-1327. [PMID: 37845021 DOI: 10.1111/ddg.15187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Primary cutaneous lymphomas (PCL) are rare skin tumors of lymphoproliferative neoplasms and belong to the heterogeneous group of non-Hodgkin's lymphomas. PCL encompass a broad spectrum of clinical and histologic manifestations, with cutaneous T-cell lymphoma (CTCL) being the most common (73%). Due to the rarity of the diseases, population-based studies of care and epidemiology are limited. PATIENTS AND METHODS Based on anonymized, age- and sex-adjusted SHI (statutory health insurance) claims data of approximately five million SHI-insured patients, a retrospective analysis was conducted over a six-year period (2012-2017) to determine the prevalence, incidence, and lethality in patients with mature-cell T/NK-cell lymphoma in Germany. RESULTS A total of 1,336 patients with T-cell lymphoma were identified during the observation period. The six-year prevalence ranged from 27.35 to 43.58 per 100,000. Patients were 65% male with a mean age of 66 years (SD 15). There were 246 patients (approx. 20%) who died within the 6 years, up to 7% per year. The calculated incidence in 153 identified patients in 2017 is 3.65 to 3.92 per 100,000. CONCLUSIONS For the first time, valid epidemiologic findings of patients with mature T-cell and NK-cell lymphomas were obtained using SHI claims data in Germany. Further analyses are needed to gain a deeper insight into the healthcare reality of patients with this rare disease.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology and Venerology, HELIOS Klinikum Krefeld, Krefeld, Germany
- Institute for Molecular Medicine, Hamburg Medical School, Hamburg, Germany
- Department of Dermatology, HELIOS Klinikum Schwerin, University Campus of the Hamburg Medical School, Schwerin, Germany
| | - Gabor Dobos
- Clinic for Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Joint Faculty of Medicine of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
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15
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Ben Khaled N, Mörtl B, Beier D, Reiter FP, Pawlowska-Phelan D, Teufel A, Rössler D, Schwade DF, Philipp A, Kubisch I, Ehmer U, Geier A, Lange CM, Mayerle J, Berger-Thürmel K, De Toni EN, Munker S. Changing treatment landscape associated with improved survival in advanced hepatocellular carcinoma: a nationwide, population-based study. Eur J Cancer 2023; 192:113248. [PMID: 37672814 DOI: 10.1016/j.ejca.2023.113248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND AIMS The treatment of hepatocellular carcinoma (HCC) is undergoing a historic transformation with the approval of several new systemic therapies in the last few years. This study aimed to examine the impact of this changing landscape on survival and costs in a Western nationwide, real-world cohort. METHODS A nationwide representative claims database (InGef) was screened for HCC cases between 2015 and 2020. Survival in an era with only sorafenib (period A, January 2015 to July 2018) and after approval of lenvatinib and other systemic treatments (period B, August 2018 to December 2020) was analysed. Health care costs were assessed. RESULTS We identified 2876 individuals with HCC in the study period. The proportion of patients receiving systemic therapy increased significantly over time, from 11.8% in 2015 to 15.1% in 2020 (p < 0.0001). The median overall survival in period B was 6.5 months (95% confidence interval [CI]: 4.9-8.9) and in period A was 5.3 months (95% CI: 4.5-6.3; p = 0.046). In period B, the median overall survival with lenvatinib was 9.7 months (95% CI: 6.3-18.4) versus 4.8 months with sorafenib (95% CI: 4.0-7.1, p = 0.008). Costs for prescription drugs per patient increased from €6150 in 2015 to €9049 in 2020 (p < 0.0001), and costs for outpatient care per patient increased from €1646 to €2149 (p = 0.0240). CONCLUSION The approval of new systemic therapies resulted in a survival benefit in patients with HCC. The magnitude of the effect is modest and associated with a moderate increase in health costs.
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Affiliation(s)
- Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Institute of Molecular Oncology and Functional Genomics, School of Medicine, TU München, Munich, Germany.
| | - Bernhard Mörtl
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Florian P Reiter
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | | | - Andreas Teufel
- Department of Medicine II, Division of Hepatology, Division of Bioinformatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Daniel F Schwade
- Institute of Molecular Oncology and Functional Genomics, School of Medicine, TU München, Munich, Germany
| | - Alexander Philipp
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Ilja Kubisch
- Department of Internal Medicine II, Gastroenterology, Hepatology, Endocrinology, Metabolic Disorders, Oncology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Ursula Ehmer
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Internal Medicine II, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Andreas Geier
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany; Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Christian M Lange
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Karin Berger-Thürmel
- Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital, LMU Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany; Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Stefan Munker
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany; Department of Pharmaceutical Biology, LMU Munich, Munich, Germany
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Burgio NM, Jennessen S. [PraeKids: diagnosis prevalence of life-threatening and life-limiting diseases in children and adolescents in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03704-5. [PMID: 37284862 DOI: 10.1007/s00103-023-03704-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/17/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In Germany, a prevalence of approximately 50,000 children and adolescents living with life-threatening and life-limiting diseases is currently assumed. This number, which is communicated in the supply landscape, is based on a simple transfer of empirical data from England. METHODS In cooperation with the German National Association of Health Insurance Funds (GKV-SV) and the Institute for Applied Health Research Berlin GmbH (InGef), the billing data of the specific treatment diagnoses documented by statutory health insurance funds for the years 2014-2019 were analyzed and - for the first time - prevalence data of affected 0‑ to 19-year-olds were collected. In addition, the data from InGef was used to calculate the prevalence by diagnosis grouping, the Together for Short Lives (TfSL) groups 1-4, and based on the (updated) coding lists from the English prevalence studies. RESULTS The data analysis determined a prevalence range of 319,948 (InGef - adapted Fraser list) to 402,058 (GKV-SV), with consideration of the TfSL groups. The TfSL‑1 group represents the largest group with 190,865 patients. DISCUSSION AND CONCLUSION This study is the first to provide the prevalence of 0‑ to 19-year-olds living with life-threatening or life-limiting diseases in Germany. Since the case definitions and the included care settings (outpatient/inpatient) differ in the research design, the prevalence values collected from the GKV-SV and InGef are also different. Due to the very heterogeneous course of the diseases, chances of survival, and mortality rates, no direct conclusions can be drawn for palliative and hospice care structures.
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Affiliation(s)
- Nadja Melina Burgio
- Abteilung Pädagogik bei Beeinträchtigungen der körperlich-motorischen Entwicklung, Institut für Rehabilitationswissenschaften, Kultur‑, Sozial- und Bildungswissenschaftliche Fakultät, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland.
| | - Sven Jennessen
- Abteilung Pädagogik bei Beeinträchtigungen der körperlich-motorischen Entwicklung, Institut für Rehabilitationswissenschaften, Kultur‑, Sozial- und Bildungswissenschaftliche Fakultät, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Deutschland
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Podmore B, Beier D, Burisch J, Genestin E, Haeckl D, Nagel O, Qizilbash N, Schwartz DA, Vavricka SR, Bennett D, Dignass A. Malignancy rates in Crohn's disease patients with perianal fistula: A German retrospective cohort study. United European Gastroenterol J 2023. [PMID: 37140403 DOI: 10.1002/ueg2.12396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease are at increased risk of colorectal and extra-intestinal cancer. However, the overall cancer risk in patients with Crohn's disease (CD) with perianal fistulas (PF) (CPF) and those with CD without PF (non-PF CD) is unclear. OBJECTIVE To describe the prevalence and incidence of cancer in patients with CPF and non-PF CD, and to estimate incidence rate ratio (IRR) of cancer between CPF and non-PF CD groups. METHODS A retrospective cohort study was conducted using the German InGef (Institute for Applied Health Research Berlin) research database. Patients with a CD record and PF from 1 January 2013 to 31 December 2014 were identified and followed up from 1 January 2015 until the first occurrence of cancer, end of health insurance contributing data, death, or end of study period (31 December 2020). Prevalence of any type of cancer including patients with CD diagnosed with cancer in the selection period and incidence of cancer excluding patients with CD diagnosed with cancer in the selection period were calculated. RESULTS In total, 10,208 patients with CD were identified. Of 824 patients with CPF (8.1%), 67 had had a malignancy (6-year period crude malignancy prevalence 8.13% [95% confidence interval (CI) 6.36%-10.21%]), which was lower than patients with non-PF CD (19.8% [95% CI 19%-20.6%]). Incidence (per 100,000 person-years) in patients with CPF was 1184 (95% CI 879-1561) and in non-PF CD was 2365 (95% CI 2219-2519). There was no significant difference in the adjusted IRR of cancer for the CPF group compared with the non-PF CD group (0.83 [95% CI 0.62-1.10]; p = 0.219). CONCLUSION There was no significant difference in the incidence of any cancer in patients with CPF compared with non-PF CD. However, patients with CPF had a higher numerical risk of cancer than the general German population.
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Affiliation(s)
| | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital, Amager and Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | - Dennis Haeckl
- WIG2 GmbH, Leipzig, Germany
- Faculty of Economics and Management Science, Leipzig University, Leipzig, Germany
| | - Oliver Nagel
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | | | - David A Schwartz
- Vanderbilt University Medical Center in Nashville, Nashville, Tennessee, USA
| | - Stephan R Vavricka
- Center of Gastroenterology and Hepatology, Zürich, Switzerland
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - Dimitri Bennett
- Takeda Development Center Americas, Inc., Cambridge, Massachusetts, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
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Gaul C, Seidel K, Heuck A, Silaidos C, Mrosowsky T, Eberhardt A, Fritz B, Jacob C. Real-world treatment patterns and healthcare resource utilization among migraine patients: A German claims database analysis. J Med Econ 2023; 26:667-678. [PMID: 37126606 DOI: 10.1080/13696998.2023.2207413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
AIMS Despite migraine being one of the most common neurological diseases, affected patients are often not effectively treated. This analysis describes the burden of migraine in Germany and assesses real-world treatment patterns and healthcare resource utilization (HCRU) of preventive-treated migraine patients from the perspective of the Statutory Health Insurance. METHODS A retrospective analysis was conducted using InGef Research Database claims data from 2018-2019. Migraine patients were stratified into cohorts by acute and preventive treatment status. Patients on preventive treatment were further stratified according to type of prophylaxis received. Disease burden in preventively treated migraine patients was reported via treatment patterns, pathways, and comorbidities. HCRU was assessed through outpatient provider visits, hospitalizations, and sick leave. RESULTS 160,164 adult migraine patients were identified, of which 55,378 (34.6%) were prescribed preventive treatment with conventional (n = 25,984, 46.9%), calcitonin gene-related peptide monoclonal antibody (CGRP mAb) (n = 613, 1.1%), or off-label therapies (n = 28,781, 52.0%). 936 (1.7%) patients received Botulinum Neurotoxin Type A (BoNTA). CGRP mAb-treated patients had a high rate of triptan prescriptions (2018: 95.5%; 2019: 88.9%), migraine-related hospitalizations (2018: 33.0%; 2019: 21.0%), and sick leave (2018: 26.8%; 2019: 22.5%). A high proportion of CGRP mAb- and BoNTA-treated patients was diagnosed with abdominal and pelvic pain (34.3% and 36.2%) and low back pain (34.1% and 35.3%). These patients also showed a high prevalence of depressive episodes (49.1% and 50.1%) and chronic pain disorders (37.5% and 32.9%). LIMITATIONS This study focused on descriptive analyses which do not allow for assessment of causality when comparing treatment groups. CONCLUSIONS Disease burden was high in patients receiving CGRP mAbs suggesting that patients treated preventively with CGRP mAbs shortly after product launch in Germany were severely affected chronic migraine patients. The same may be true for patients receiving BoNTA who also showed an increased disease burden.
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Affiliation(s)
- Charly Gaul
- Headache Center Frankfurt, Dalbergstraße 2, 65929 Frankfurt am Main, Germany
| | | | - Alexander Heuck
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Carmina Silaidos
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Thora Mrosowsky
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Alice Eberhardt
- Former employee of AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
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Hu T, Podmore B, Barnett R, Beier D, Galetzka W, Qizilbash N, Heckl D, Boellinger T, Weaver J. Healthcare resource utilization and cost of pneumococcal disease in children in Germany, 2014-2019: a retrospective cohort study. Pneumonia (Nathan) 2023; 15:7. [PMID: 36964592 PMCID: PMC10039501 DOI: 10.1186/s41479-023-00105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/05/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Since the introduction of higher valency pneumococcal conjugate vaccines in 2009, recent estimates on the economic burden of pediatric pneumococcal disease (PD) in Germany have been lacking. This study estimates healthcare resource utilization (HCRU) and medical cost associated with PDs in children < 16 years old in Germany from 2014-2019. METHODS A nationally representative sample from the Institute for Applied Health Research (InGef) German claims database was used, covering approximately 5% of the total German population. Episodes of pneumococcal pneumonia (PP), all-cause pneumonia (ACP), invasive pneumococcal disease (IPD), and acute otitis media (AOM) in children aged < 16 years were identified using ICD-10-GM codes. HCRU was estimated from annual rates of outpatient visits, outpatient antibiotic prescriptions and inpatient admissions, divided by person-years (PY) at-risk. Average direct medical costs per episode were estimated as the total cost of all HCRU, divided by the total number of episodes. The Mann-Kendall test was used to assess monotonic time trends from 2014-2019. RESULTS During 2014-2019, 916,805 children aged < 16 years were followed up for a total of 3,608,716 PY. The average costs per episode for out-versus inpatient care associated with PP and ACP were €67 (95% CI 58-76) versus €2,606 (95% CI 1,338-3,873), and €63 (95% CI 62-63) versus €620 (95% CI 598-641), respectively. For IPD, the average medical cost per episode for out-versus inpatients were €30 (95% CI 19-42) versus €6,051 (95% CI 3,323-8,779), respectively. There were no significant trends in HCRU or costs for IPD or pneumonia over the study period, except for a significant reduction in ACP outpatient visits. A significant decrease in rate of outpatient visits and antibiotic prescribing for recurrent AOM was observed, in addition to an increase in rates of hospital admissions for simple AOM. This was paralleled by a significant increase in inpatient costs per episode for treating AOM overall, and simple AOM, over the study period. CONCLUSIONS The HCRU and cost per episode of pneumonia and IPD did not vary significantly from 2014-2019, but increased for AOM. The economic burden of pneumonia, IPD, and AOM remains substantial in Germany.
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Affiliation(s)
| | - Bélène Podmore
- OXON Epidemiology, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Wolfgang Galetzka
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Nawab Qizilbash
- OXON Epidemiology, London, UK
- London School of Hygiene & Tropical Medicine, London, UK
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Libutzki B, Neukirch B, Kittel-Schneider S, Reif A, Hartman CA. Risk of accidents and unintentional injuries in men and women with attention deficit hyperactivity disorder across the adult lifespan. Acta Psychiatr Scand 2023; 147:145-154. [PMID: 36464800 PMCID: PMC10107297 DOI: 10.1111/acps.13524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is associated with risk-taking behavior, leading to accidents and unintentional injuries (summarized here as incidents). Main aim of this study is to determine if men and women with and without ADHD differ in the risk of mild (treated outpatient) and severe (treated inpatient) incidents across the adult lifespan (age groups: 18-29; 30-59, and ≥60 years). Secondary aim: investigate the role of comorbid mental disorders and drugs for the treatment of these comorbidities, and ADHD-medication. METHODS Using anonymized German claims data (N = 4,575,027), adults with ADHD diagnosis during 2016-2019 (N = 17,041) were compared with a 1:4 age and sex-matched group without ADHD diagnosis. Regression analyses statistically tested group differences. RESULTS Incidents occur in a U-shaped form across the adult lifespan. Individuals with ADHD show the same pattern but at a substantially increased risk of both mild and severe incidents throughout the lifespan. Women without ADHD are at lower risk in young adulthood than men but at higher risk in older adulthood. Women with ADHD show the same pattern for severe incidents, but for mild incidents they have the highest risk throughout the lifespan. Co-occurring anxiety disorder and the use of psycholeptics and ADHD-medication decreased the incident risk. CONCLUSION We extend available knowledge which has hitherto focused on young adult males and traffic accidents. ADHD is associated with increased incidents across the adult lifespan, with distinct patterns regarding age, sex, and incident severity. An accurate diagnosis of ADHD in adulthood provides the first step towards prevention of accidents and unintentional injuries.
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Affiliation(s)
- Berit Libutzki
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Benno Neukirch
- Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Stürzebecher PE, Schorr JJ, Klebs SHG, Laufs U. Trends and consequences of lipoprotein(a) testing: Cross-sectional and longitudinal health insurance claims database analyses. Atherosclerosis 2023; 367:24-33. [PMID: 36764050 DOI: 10.1016/j.atherosclerosis.2023.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/09/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Lipoprotein(a) (Lp(a)) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Our goal was to characterize patients undergoing Lp(a) testing and to assess the impact of Lp(a) testing on treatment changes and subsequent ASCVD events. METHODS A cross-sectional and a longitudinal claims data analysis were performed on 4 million patient records in Germany. Patients were followed up for a maximum of 4 years. RESULTS In 2015 and 2018, 0.25% and 0.34% of patients were tested, respectively. Testing was more frequent in younger women in the overall population, and in men in the ASCVD population. Patients tested for Lp(a) had more comorbidities and higher ASCVD risk compared to matched control patients. ASCVD hospitalizations were more frequent prior to the first Lp(a) test (5.55 vs 1.42 per 100/person-years). The mortality rate of the Lp(a)-tested cohort and the control group was similar. Mortality was lower in patients with prior ASCVD and Lp(a) testing compared to matched controls with prior ASCVD and no Lp(a) test (2.30 vs 3.64 per 100/person-years, p <0.001). Patients with Lp(a) test received more laboratory examinations and cardiovascular medications and had more visits with specialized physicians. CONCLUSIONS Lp(a) testing is rarely performed even in patients with very high cardiovascular risk. Patients tested for Lp(a) have more comorbidities and a higher ASCVD risk. Lp(a) testing is associated with more intensive preventive treatment and with positive effects on clinical outcomes and survival. The data support the value of Lp(a) measurements to characterize ASCVD risk and to improve ASCVD prevention.
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Affiliation(s)
- Paulina E Stürzebecher
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, 04103, Germany.
| | | | | | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, 04103, Germany
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Stephan AJ, de Lepper M, Wölle R, Luzak A, Wang W, Jacob C, Schneider KM, Buxmann H, Goelz R, Hamprecht K, Kummer P, Modrow S, Greiner W, Reuschenbach M. Healthcare costs of congenital cytomegalovirus (cCMV) disease in infants during the first two years of life: a retrospective German claims database analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:8. [PMID: 36691023 PMCID: PMC9872342 DOI: 10.1186/s12962-022-00411-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection can cause severe neurological damage, growth retardation, hearing loss, and microcephaly in infants. We aimed at assessing healthcare costs of infants with recorded cCMV diagnosis in an administrative claims database in the first 2 years of life. METHODS We conducted a retrospective, controlled cohort study using German claims data from the Institute for Applied Health Research Berlin (InGef) database. Incremental healthcare costs during the first and second year of life were assessed by matching (1:60) infants with cCMV diagnoses ≤ 90 days after birth (cCMV90 cohort) to infants without cCMV diagnosis ("representative" controls) and infants with cCMV diagnoses ≤ 21 days after birth plus specific symptoms (cCMV21-S) to infants without cCMV and any ICD-10-GM records (besides Z00-Z99) until 4th preventive health check-up ("healthy" controls). Due to missing data, mean imputation was applied for aids and remedies costs. RESULTS We identified 54 and 24 infants born 2014-2018 for the cCMV90 and cCMV21-S cohorts, respectively. During the first year, mean (median) healthcare costs were significantly higher in cCMV90 cases vs. "representative" controls (€22,737 (€9759) vs. €3091 (€863), p < 0.001), with 87.2% inpatient costs. Healthcare costs for cCMV21-S cases compared to "healthy" controls were €34,498 (€20,924) vs. €680 (€569), p < 0.001. Differences decreased for both comparisons in the second year but remained statistically significant. CONCLUSIONS cCMV comprises a considerable economic burden for the German healthcare system (€19,646 to €33,818 higher mean costs for infants with recorded cCMV diagnosis in the first year of life). Attempts should be made to reduce this burden.
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Affiliation(s)
- Anna-Janina Stephan
- grid.476255.70000 0004 0629 3457Department of Market Access, MSD Sharp & Dohme GmbH, Munich, Germany
| | - Marion de Lepper
- grid.476255.70000 0004 0629 3457Department of Medical Affairs, MSD Sharp & Dohme GmbH, Munich, Germany
| | - Regine Wölle
- grid.476255.70000 0004 0629 3457Department of Market Access, MSD Sharp & Dohme GmbH, Munich, Germany
| | - Agnes Luzak
- grid.476255.70000 0004 0629 3457Department of Market Access, MSD Sharp & Dohme GmbH, Munich, Germany
| | - Wei Wang
- grid.417993.10000 0001 2260 0793Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ USA
| | | | | | - Horst Buxmann
- Department for Children and Adolescents, Division for Neonatology, Main-Kinzig-Kliniken GmbH, Gelnhausen, Germany
| | - Rangmar Goelz
- grid.488549.cDepartment of Neonatology, University Children’s Hospital, Tuebingen, Germany
| | - Klaus Hamprecht
- grid.10392.390000 0001 2190 1447Institute for Medical Virology and Epidemiology of Viral Diseases, University of Tuebingen, Tuebingen, Germany
| | - Peter Kummer
- grid.411941.80000 0000 9194 7179Section of Phoniatrics and Pediatric Audiology, Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Modrow
- grid.411941.80000 0000 9194 7179Institute of Medical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Greiner
- grid.7491.b0000 0001 0944 9128Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Miriam Reuschenbach
- grid.476255.70000 0004 0629 3457Global Medical and Scientific Affairs, MSD Sharp & Dohme GmbH, Munich, Germany
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Douros A, Basedow F, Cui Y, Dimakos J, Walker J, Enders D, Tagalakis V. Effectiveness and Safety of Direct Oral Anticoagulants Among Octogenarians with Venous Thromboembolism: An International Multidatabase Cohort Study. Am J Med 2023; 136:79-87.e7. [PMID: 36150513 DOI: 10.1016/j.amjmed.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects of direct oral anticoagulants (DOACs) among octogenarian patients with venous thromboembolism remains poorly understood. To address this knowledge gap, our study aimed to assess the effectiveness and safety of DOACs compared to vitamin K antagonists (VKAs) among octogenarians with venous thromboembolism. METHODS We conducted an international cohort study using administrative health care databases from Québec, Canada, and Germany. We assembled 2 population-based cohorts of octogenarians with incident venous thromboembolism initiating treatment with DOACs or VKAs. The study period spanned from January 2012 to the most recent date of data availability (Québec: December 2016; Germany: December 2019). Using an as-treated exposure definition, we compared use of DOACs to use of VKAs, applying inverse probability of treatment weighting based on high-dimensional propensity scores to balance exposure groups. Cox proportional hazards models estimated site-specific hazard ratios (HRs) and 95% confidence intervals (CIs) of recurrent venous thromboembolism, major bleeding, and all-cause mortality. The results were meta-analyzed using random-effects models. RESULTS Overall, our study included 6737 octogenarians with venous thromboembolism (Québec: n = 2556; Germany: n = 4181) who initiated use of DOACs (n = 3778) or VKAs (n = 2959). When compared to VKAs, DOACs were associated with similar risks of recurrent venous thromboembolism (weighted HR, 0.80; 95% CI, 0.43-1.46; I2 = 0.00), major bleeding (weighted HR, 0.96; 95% CI, 0.57-1.63; I2 = 0.59), and all-cause mortality (weighted HR, 1.04; 95% CI, 0.81-1.34; I2 = 0.00). CONCLUSIONS Among octogenarians with venous thromboembolism, DOACs showed a comparable effectiveness and safety compared to VKAs. Our results support the use of DOACs in this high-risk group.
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Affiliation(s)
- Antonios Douros
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ying Cui
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Jenny Dimakos
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jochen Walker
- InGef - Institute for Applied Health Research, Berlin, Germany
| | - Dirk Enders
- InGef - Institute for Applied Health Research, Berlin, Germany
| | - Vicky Tagalakis
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Division of General Internal Medicine, Jewish General Hospital, Montreal, QC, Canada.
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Economic burden of secondary hyperparathyroidism in Germany: a matched comparison. Int Urol Nephrol 2022; 55:1291-1300. [PMID: 36480088 PMCID: PMC10105662 DOI: 10.1007/s11255-022-03425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022]
Abstract
Abstract
Purpose
Secondary hyperparathyroidism (SHPT) of renal origin is a progressive complication in chronic kidney disease (CKD) and is associated with serious osseous and non-osseous complications, CKD progression, and economic burden for healthcare systems worldwide. We aimed at assessing characteristics, healthcare resource utilization, and costs of incident SHPT patients in CKD stage 3 (CKD3) and 4 (CKD4), using administrative claims data.
Methods
German claims data were used to identify CKD3 and CKD4 patients, who were stratified by the occurrence of incident SHPT. Patients with SHPT were matched 1:1 to non-SHPT patients with the same CKD stage using propensity scores. Matched groups were compared during a 2-year follow-up period.
Results
Overall, 1156 CKD3 and 517 CKD4 incident SHPT patients and their respective matches were identified. Mean number of all-cause hospitalizations were significantly higher among SHPT patients (2.7 vs. 2.0 in CKD3, 2.8 vs. 1.5 in CKD4) during follow-up. Similarly, the mean number of outpatient encounters was significantly higher among the SHPT cohorts (95.0 vs. 64.3 in CKD3, 101.4 vs. 49.8 in CKD4). SHPT patients progressed to CKD5 more often (6.1% vs. 1.2% from CKD3, 26.7% vs. 2.9% from CKD4, both P < 0.01) resulting in a higher proportion of dialysis (6.1% vs. 1.3% in CKD3, 22.1% vs. 3.7% in CKD4, both P < 0.01). Consequently, average all-cause healthcare costs significantly increased per patient (€19,477 vs. €15,115 in CKD3, €25,921 vs. €12,265 in CKD4).
Conclusions
Patients with CKD3&4 and incident SHPT of renal origin presented with significantly higher healthcare resource utilization and costs, as well as increased disease progression compared to non-SHPT patients.
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Scheid C, Kudernatsch R, Eckart M, Feig C, Straub V, Libutzki B, Mahlich J. Treatment Pathways and Health Outcomes of German Patients with Chronic Graft-Versus-Host Disease After Allogeneic Hematopoietic Cell Transplantation: A Retrospective Health Claims Data Analysis. Drugs Real World Outcomes 2022; 9:577-588. [PMID: 35779205 PMCID: PMC9712900 DOI: 10.1007/s40801-022-00320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although chronic graft-versus-host-disease (cGvHD) is an important long-term complication after allogenic hematopoietic cell transplantation (allo-HCT) and is associated with increased healthcare resource utilization, real-world evidence is scarce. OBJECTIVES The aim of the study was to evaluate survival of patients with cGvHD in Germany and to analyze hospitalization and treatment patterns. PATIENTS AND METHODS Based on a German claims database with 4.9 million enrollees, a retrospective longitudinal analysis covering a 6-year period between 2013 and 2018 was conducted. Patients with allo-HCT in 2014 or 2015 (index date) and no record of transplantation or documentation of GvHD 365 days prior to index were included. Patients who subsequently developed a cGVHD were compared with those who did not develop a cGVHD within 3 years after index date. cGVHD cases were identified based on documented International Classification of Diseases, Tenth Revision (ICD-10) diagnosis and treatment algorithms. Since the onset of cGvHD is defined at 100 days after allo-HCT, only those alive beyond day 100 were considered in the survival analysis. Patients who did not survive the first 100 days after allo-HCT were censored to prevent a selection bias due to early mortality within patients without GvHD. Survival rates were plotted using the Kaplan-Meier estimator. The number of hospitalizations and average lengths of stay as well as treatment patterns were descriptively examined. RESULTS Overall, 165 cGvHD patients were identified and compared with 43 patients without cGVHD. Short-term survival rates were better for patients with cGvHD; the 6-month survival probability was 95.8% for patients with cGVHD and 83.7% for patients without cGVHD. However, long-term survival was better in patients without GvHD; The 30-month survival probability was 65.5% for patients with cGVHD and 76.7% for patients without cGVHD. While overall 90% of cGvHD patients were hospitalized at least once, the share was only half for patients without GvHD (44%). 78.2% of patients with cGVHD received corticosteroids in combination with other predefined immunosuppressants. CONCLUSION Findings from this study reveal a high disease burden associated with cGvHD. This underlines the high medical need for new interventional strategies to improve survival and morbidity after allo-HCT.
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Affiliation(s)
- Christof Scheid
- Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Marie Eckart
- Janssen-Cilag GmbH, Johnson & Johnson Platz 1, 41470, Neuss, Germany
| | - Chiara Feig
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Dusseldorf, Germany
| | - Vincent Straub
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Dusseldorf, Germany
| | - Berit Libutzki
- HGC Healthcare Consultants GmbH, Graf-Adolf-Platz 15, 40213, Dusseldorf, Germany
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, Groningen, The Netherlands
| | - Jörg Mahlich
- DICE, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Dusseldorf, Germany.
- Miltenyi Biomedicine, Friedrich-Ebert-Straße 68, 51429, Bergisch Gladbach, Germany.
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Horneff G, Borchert J, Heinrich R, Kock S, Klaus P, Dally H, Hagemann C, Diesing J, Schönfelder T. Incidence, prevalence, and comorbidities of juvenile idiopathic arthritis in Germany: a retrospective observational cohort health claims database study. Pediatr Rheumatol Online J 2022; 20:100. [PMID: 36384690 PMCID: PMC9670409 DOI: 10.1186/s12969-022-00755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) describes heterogenous categories of chronic inflammatory rheumatic conditions of unknown origin in children and adolescents. Epidemiological data in the literature vary, depending on geographic location, ethnicity and the case definition used. We evaluated epidemiology, especially that of the categories defined by the International League of Associations for Rheumatology (ILAR). METHODS Using data from two different longitudinal health claims databases (WIG2 and InGef) from January 1st, 2013 to December 31st, 2019, we looked at patients aged 2 to 15 years old with at least one main inpatient or two secondary inpatient/verified outpatient ICD-10 diagnoses in at least two different quarters within one calendar year. We calculated prevalence and incidence (per 100,000 patients) and extrapolated data to the entire German population, looking at differences in gender and age groups. Additionally, we collected data on "other" not necessary comorbidities in our JIA patient population. RESULTS Of the 3-4 million patients in the databases (respectively) in 2018, we found a total of 546 (WIG2) and 849 (InGef) patients that met our JIA case definition, with an incidence of 34 (29-41) and 60 (53-67) and prevalence of 133 (122-145) and 168 (157-179). Both incidence and prevalence throughout the age range were mostly higher in females than males, however the difference between females and males increased with increasing age. Of the ILAR categories, oligoarthritis was the most prevalent (70 and 91 per 100,000), with about half of our JIA patients in this category, followed by undifferentiated arthritis (49 and 56 cases per 100,000) and rheumatoid factor negative (RF-) (31 and 39 per 100,000). Incidence in 2018 was the highest in these three categories. Atopic dermatitis, vasomotor and allergic rhinitis, and uveitis were the pre-defined comorbidities seen most often in both databases. CONCLUSION This study provides current incidence and prevalence JIA data in Germany, contributing to knowledge on burden of disease and tools for healthcare planning.
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Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany ,grid.411097.a0000 0000 8852 305XDepartment of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Julia Borchert
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany
| | - Ria Heinrich
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany
| | - Simon Kock
- Institute for Applied Health Research (InGef), Berlin, Germany
| | - Pascal Klaus
- grid.476393.c0000 0004 4904 8590Pfizer Pharma GmbH, Berlin, Germany
| | - Heike Dally
- grid.476393.c0000 0004 4904 8590Pfizer Pharma GmbH, Berlin, Germany
| | | | - Joanna Diesing
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany
| | - Tonio Schönfelder
- Scientific Institute for Health Economics and Health System Research (WIG2 GmbH), Leipzig, Germany. .,Lehrstuhl Gesundheitswissenschaften/ Public Health, Technische Universität Dresden, Dresden, Germany.
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Clinical and economic burden of pneumococcal disease among individuals aged 16 years and older in Germany. Epidemiol Infect 2022; 150:e204. [PMID: 36345842 PMCID: PMC9987016 DOI: 10.1017/s0950268822001182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This study assessed the incidence rate of all-cause pneumonia (ACP) and invasive pneumococcal disease (IPD) and associated medical costs among individuals aged ≥16 in the German InGef database from 2016 to 2019. Incidence rate was expressed as the number of episodes per 100 000 person-years (PY). Healthcare resource utilisation was investigated by age group and by risk group (healthy, at-risk, high-risk). Direct medical costs per ACP/IPD episode were estimated as the total costs of all inpatient and outpatient visits. The overall incidence rate of ACP was 1345 (95% CI 1339-1352) and 8.25 (95% CI 7.76-8.77) per 100 000 PY for IPD. For both ACP and IPD, incidence rates increased with age and were higher in the high-risk and at-risk groups, in comparison to the healthy group. ACP inpatient admission rate increased with age but remained steady across age-groups for IPD. The mean direct medical costs per episode were €8075 (95% CI 7121-9028) for IPD and €1454 (95% CI 1426-1482) for ACP. The aggregate direct medical costs for IPD and ACP episodes were estimated to be €8.5 million and €248.9 million respectively. The clinical and economic burden of IPD and ACP among German adults is substantial regardless of age.
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Deb A, Podmore B, Barnett R, Beier D, Galetzka W, Qizilbash N, Haeckl D, Boellinger T, Johnson KD, Weiss T. Pneumococcal vaccination coverage in individuals (16-59 years) with a newly diagnosed risk condition in Germany. BMC Infect Dis 2022; 22:753. [PMID: 36171549 PMCID: PMC9517976 DOI: 10.1186/s12879-022-07736-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Despite recommendations from the German Standing Committee on Vaccination (STIKO), pneumococcal vaccination coverage remains low in vulnerable populations. This study estimated the pneumococcal vaccination coverage rate (VCR) and timing among individuals aged 16–59 years in Germany who were recommended to receive pneumococcal vaccination, according to STIKO. Methods A retrospective cohort analysis was conducted using the German InGef database. Individuals aged 16 to 59 years diagnosed with at least one “at-risk” (chronic disease) or “high-risk” (e.g., immunocompromising) condition considered to be at-risk of pneumococcal infection were identified at the time of first diagnosis, between January 1, 2016 and December 31, 2018, and followed up until December 31, 2019. The percentage of cumulative pneumococcal VCR with 95% confidence interval (CI) was reported for each calendar year of follow-up. Results There were 334,292 individuals followed for a median of 2.38 (interquartile range (IQR) 1.63–3.13) person years. For individuals aged 16–59 years diagnosed with an incident risk condition in 2016, pneumococcal VCR increased from 0.44% (95% CI 0.41–0.48) in 2016 to 1.24% (95% CI 1.18–1.30) in 2019. In 2019, VCRs were higher in individuals with high-risk conditions compared with at-risk conditions (2.24% (95% CI 2.09–2.40) vs. 0.90% (95% CI 0.85–0.96)). In 2019, VCRs were higher in individuals aged 50 to 59 years compared with individuals aged 16 to 49 years (2.25% (95% CI 2.10–2.41) vs. 0.90% (95% CI 0.84–0.96)). Similar trends were observed in individuals with newly diagnosed risk conditions identified in 2017 and in 2018. Older age, influenza vaccination and increasing number of risk conditions increased the likelihood of pneumococcal vaccination. Median time to vaccination from diagnosis of the risk condition was shorter for high-risk conditions (369.5 days (IQR 155.8–702.0)) compared to at-risk conditions (435.5 days (IQR 196.3–758.8)). Conclusion Despite recommendations from STIKO, pneumococcal vaccination coverage remains very low and with long delays in vulnerable individuals aged 16–59 in Germany. Further efforts are required to increase immunization levels and shorten time to vaccination among individuals 16–59 years of age developing conditions with higher susceptibility to pneumococcal infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07736-1.
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Affiliation(s)
| | - Bélène Podmore
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Wolfgang Galetzka
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Nawab Qizilbash
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
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Link H, Thompson SF, Tian M, Haas JS, Meise D, Maas C, Dimitrov S. A comparative assessment of neutropenia events, healthcare resource use, and costs among cancer patients treated with lipegfilgrastim compared with pegfilgrastim in Germany. Support Care Cancer 2022; 30:9317-9327. [PMID: 36076105 DOI: 10.1007/s00520-022-07353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We assessed the occurrence of neutropenia and febrile neutropenia (FN) and the associated healthcare resource in cancer patients receiving myelosuppressive chemotherapy in combination with pegfilgrastim versus lipegfilgrastim. METHODS This is a retrospective analysis using a German health insurance claims database. Adults receiving chemotherapy with a prescription code for pegfilgrastim (n = 734) or lipegfilgrastim (n = 346) were observed over a 1-year follow-up period. Patient subgroups were analyzed according to cancer type and FN risk. FN risk was based on the chemotherapy regimen and any additional neutropenia risk factors. Outcomes were adjusted via regression analysis. RESULTS Most patients were classified as high FN risk (70.0% pegfilgrastim; 65.6% lipegfilgrastim cohort). The mean age was 58.2 years in the pegfilgrastim cohort and 58.0 years in the lipegfilgrastim cohort, with more female patients than male patients (77.3% vs 79.8%, respectively), and the majority had breast cancer (64.9% and 68.8%, respectively). Overall, 10.0% and 10.4% of patients receiving pegfilgrastim or lipegfilgrastim experienced a neutropenia event (p = 0.82), with 4.4% and 3.5% of patients experiencing a FN event (p = 0.49). The mean neutropenia event-related healthcare costs were €604 and €441 for the pegfilgrastim and lipegfilgrastim cohorts; among patients with lymphoma, these costs were significantly greater (p = 0.03) with pegfilgrastim (€1,612) versus lipegfilgrastim (€382). The mean all-cause hospitalizations were significantly (p < 0.01) higher for lymphoma patients receiving pegfilgrastim (2.76) versus lipegfilgrastim (1.60). CONCLUSION Overall, patients treated with pegfilgrastim and lipegfilgrastim were comparable in terms of neutropenia occurrences in the 1-year follow-up. In patients with lymphoma, neutropenia event-related healthcare costs and all-cause hospitalizations were significantly higher with pegfilgrastim compared with lipegfilgrastim in this study; however, this should be interpreted with caution in light of the limited sample size and the absence of clinical information.
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Affiliation(s)
- Hartmut Link
- Private Practice Hematology and Oncology, Kaiserslautern, Germany.
| | | | - Marc Tian
- TEVA Pharmaceuticals Industries Ltd., West Chester, PA, USA
| | | | | | | | - Stamen Dimitrov
- TEVA Pharmaceuticals Europe, HQ Amsterdam, Amsterdam, Netherlands
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Incidence of graft-versus-host-disease in Germany: evidence from health care claims data. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Reuschenbach M, Mihm S, Wölle R, Schneider KM, Jacob C, Greiner W, Hampl M, Goodman E. Healthcare resource utilization and costs in 23-25-year-old women with human papillomavirus (HPV) associated anogenital diseases in Germany - a retrospective analysis of statutory health insurance claims data. BMC Health Serv Res 2022; 22:1002. [PMID: 35932066 PMCID: PMC9356499 DOI: 10.1186/s12913-022-08397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Human papilloma virus (HPV) causes multiple anogenital diseases including cervical cancer and is the most common sexually transmitted infection. Healthcare resource utilization (HRU) associated with HPV-related anogenital diseases includes diagnostic and disease specific treatment regimens. A recent study showed disease burden of young women aged 23–25 years, who were the first populations eligible to receive HPV vaccination after its introduction in Germany. Cost for the German statutory health insurance (SHI) due to HPV‑related anogenital diseases in this population are unknown. This study aimed at assessing HRU and costs related to HPV-associated anogenital diseases for the Germany SHI. Methods We used a retrospective, matched cohort design to leverage the prior identified cohort of 23–25-year-old women born between 1989–1992 diagnosed with HPV-related anogenital disease from the Institute for Applied Health Research Berlin (InGef) Research Database. German SHI claims data from 2012–2017 were analyzed. The prior identified cases were matched (direct, without replacement) to women without anogenital diseases (1:10 ratio). HRU and costs for inpatient care, outpatient care, and pharmaceutical during a 3-year observation period were determined for both cases and controls and increments between the groups were assessed. Results 2,972 women diagnosed with anogenital diseases (cases) who were matched to 29,720 women without anogenital diseases (controls). Cases had more outpatient visits (52.4 visits vs. 39.2 visits) and more cases (45.2% vs. 31.7%) were hospitalized at least once in the 3‑year observation period. Most common outpatient procedures performed in cases were conization of the cervix uteri (4.4% cases; n < 5 controls), followed by other excision and destruction of diseased tissue of the cervix uteri (3.1% in cases; 0.0% in controls). Median difference in total healthcare costs of €684 (mean difference: €1,089, 95%CI: €752–1,426) suggest that HPV-related anogenital diseases were responsible for approximately €3.2 Million more healthcare costs for the identified cases in the four birth cohorts within the 3‑year observation period in the InGef Research Database. Costs were mainly driven by outpatient care (41.6% of total costs). Conclusion In Germany, HPV-related anogenital diseases among young women are associated with considerable HRU and financial expenditures, mostly driven by outpatient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08397-1.
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Affiliation(s)
- Miriam Reuschenbach
- Global Medical and Scientific Affairs, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Sarah Mihm
- Department of Market Access, MSD Sharp and Dohme GmbH, Munich, Germany
| | - Regine Wölle
- Department of Market Access, MSD Sharp and Dohme GmbH, Munich, Germany
| | | | | | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Monika Hampl
- Department of Obstetrics and Gynecology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Elizabeth Goodman
- Center for Observational and Real-World Evidence (CORE), Merck and Co., Inc, Rahway, NJ, USA.
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Schruf E, Biermann MH, Jacob J, Häckl D, Reinhardt M, Hertl M, Wohlrab J. Lichen planus in Deutschland - Epidemiologie, Behandlung und Komorbidität. Eine retrospektive Krankenkassendatenanalyse. J Dtsch Dermatol Ges 2022; 20:1101-1111. [PMID: 35971586 DOI: 10.1111/ddg.14808_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
HINTERGRUND UND ZIELE Lichen planus (LP) ist eine chronisch entzündliche Hauterkrankung, die eine große Belastung für die betroffenen Patienten darstellt. Es liegen jedoch nur wenige Daten zu dieser Erkrankung vor. Ziel dieser Studie ist es, das Wissen über die Epidemiologie und die Behandlungsmuster des LP anhand von Abrechnungsdaten deutscher Krankenkassen zu erweitern. PATIENTEN UND METHODEN Diese retrospektive Beobachtungsstudie nutzte die InGef-Forschungsdatenbank. Es wurden prävalente und inzidente LP-Patienten aus den Jahren 2015 und 2018 identifiziert. Für demografische Charakteristika, Behandlungsmuster und Komorbidität wurden deskriptive Statistiken berechnet. ERGEBNISSE Die Prävalenz des LP lag bei 95,9 und die Inzidenz bei 20,1 pro 100 000 Personen im Jahr 2018, was 79 605 prävalenten LP-Fällen in Deutschland entspricht. Die erste LP-Diagnose wurde in der Regel von einem Dermatologen oder Hausarzt gestellt. Drei Viertel der inzidenten und die Hälfte der prävalenten Patienten erhielten eine topische Therapie, meist ohne zusätzliche systemische Therapie. Die Komorbidität des LP stand im Einklang mit bereits bekannten Assoziationen. SCHLUSSFOLGERUNGEN Die verfügbaren Therapieoptionen sind nach wie vor begrenzt, was den ungedeckten Bedarf an sicheren und wirksamen systemischen Behandlungsmodalitäten unterstreicht. Der LP ist häufig mit klinisch relevanter systemischer Komorbidität verbunden. Zusammengenommen könnten diese Beobachtungen zu einem verbesserten Verständnis der Krankheitslast führen und das diagnostische Bewusstsein für diese Erkrankung unter Klinikern schärfen.
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Affiliation(s)
- Eva Schruf
- Novartis Pharma GmbH, Nürnberg, Deutschland
| | | | - Josephine Jacob
- InGef-Institut für angewandte Gesundheitsforschung Berlin GmbH, Berlin, Deutschland
| | - Dennis Häckl
- WIG2 GmbH, Leipzig, Deutschland.,Universität Leipzig, Leipzig, Deutschland
| | | | - Michael Hertl
- Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Johannes Wohlrab
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
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Hohmann C, Ludwig M, Walker J, Iliadis C, Schipper JH, Baldus S, Pfister R. Real-world anticoagulatory treatment after percutaneous mitral valve repair using MitraClip: a retrospective, observational study on 1300 patients. Clin Res Cardiol 2022; 111:889-899. [PMID: 35220447 PMCID: PMC9334399 DOI: 10.1007/s00392-022-01988-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
AIMS This study sought to investigate current anticoagulatory treatment patterns and clinical outcome in patients undergoing transcatheter mitral valve repair (MitraClip). METHODS AND RESULTS In a retrospective study of a German claims database (InGef research database), anticoagulatory treatment regimens were assessed using any drug prescription post discharge within the first 90 days after MitraClip procedure. Clinical events between 30 days and 6 months were examined by treatment regime. The study population comprised 1342 patients undergoing MitraClip procedure between 2014 and 2018. 22.4% received antiplatelet monotherapy, 20.8% oral anticoagulation (OAC) plus antiplatelet therapy, 19.4% OAC monotherapy, 11.7% dual antiplatelet therapy, 2.8% triple therapy and 21.0% did not receive any anticoagulatory drugs. 63% of patients with OAC received non-vitamin-K antagonist oral anticoagulants (NOAC). A total of 168 patients were newly prescribed OAC after MitraClip, of whom 12 patients (7.1%) had no diagnosis of atrial fibrillation or venous thromboembolism. 40% of patients with OAC prior to MitraClip did not have any OAC after MitraClip. The adjusted risk of all-cause mortality was significantly increased in patients with no anticoagulatory treatment (HR 3.84, 95% CI 2.33-6.33, p < 0.0001) when compared to antiplatelet monotherapy whereas the other regimes were not significantly different. CONCLUSIONS This large real-world data analysis demonstrates a heterogeneous spectrum of prescriptions for anticoagulant therapies after MitraClip. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted for controlled trials in order to establish evidence-based recommendations on anticoagulatory treatment after percutaneous mitral valve repair.
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Affiliation(s)
- Christopher Hohmann
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Marion Ludwig
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Christos Iliadis
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan-Hendrik Schipper
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine, Department III for Internal Medicine, Heart Center, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Schruf E, Biermann MH, Jacob J, Häckl D, Reinhardt M, Hertl M, Wohlrab J. Lichen planus in Germany - epidemiology, treatment, and comorbidity. A retrospective claims data analysis. J Dtsch Dermatol Ges 2022; 20:1101-1110. [PMID: 35913102 PMCID: PMC9546356 DOI: 10.1111/ddg.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Lichen planus (LP) is a chronic inflammatory skin disease and is a major burden for affected patients. However, data on this condition are scarce. This study aims to expand the knowledge on the epidemiology and treatment patterns of LP using German health claims data. PATIENTS AND METHODS This retrospective observational study was based on the InGef research database. Prevalent and incident LP patients were identified in the years 2015 and 2018. Descriptive statistics were calculated for demographic characteristics, treatment patterns, and comorbidity. RESULTS The prevalence of LP was 95.9 and the incidence was 20.1 per 100,000 individuals in 2018, corresponding to 79,605 prevalent LP cases in Germany. The first LP diagnosis was generally documented by a dermatologist or a primary care physician. Three-quarters of the incident and half of the prevalent patients received topical therapy, mostly without further systemic therapy. Comorbidity in LP patients was consistent with previously known associations. CONCLUSIONS Available treatment options remain limited, underscoring the unmet need for safe and efficacious systemic treatment modalities. Lichen planus is frequently accompanied by clinically relevant systemic comorbidity. Taken together, these observations may improve our understanding of the burden of this disease and increase diagnostic awareness among clinicians.
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Affiliation(s)
| | | | - Josephine Jacob
- InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Dennis Häckl
- WIG2 GmbH, Leipzig, Germany.,University Leipzig, Leipzig, Germany
| | | | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität, Marburg, Germany
| | - Johannes Wohlrab
- University Hospital and Polyclinic for Dermatology and Venerology, Martin Luther University, Halle (Saale), Germany
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Blaschke K, Hellmich M, Samel C, Listl S, Schubert I. Association between Periodontal Treatment and Healthcare Costs in Patients with Coronary Heart Disease: A Cohort Study Based on German Claims Data. Dent J (Basel) 2022; 10:dj10070133. [PMID: 35877407 PMCID: PMC9320253 DOI: 10.3390/dj10070133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
There is empirical evidence of an association between periodontitis and coronary heart disease (CHD). However, it is uncertain whether periodontal treatment in CHD patients might lead to reduced healthcare costs. This study aims to assess the association between periodontal treatment and healthcare costs in newly diagnosed CHD patients. Data from 21,263 adults who were continuously insured between 2011 and 2016 and who were newly diagnosed with CHD in 2013 were selected from a German claims database. The study population was differentiated by the utilization of periodontal treatment. The average treatment effect (ATE) of periodontal treatment on healthcare costs (total, inpatient, outpatient, drugs) was investigated using weighted Poisson regression models conditional on covariates and is shown as a ratio (of geometric means). Periodontal treatment was documented for 4.7% of the persons in the study population. Newly diagnosed CHD patients showed an ATE of 0.98 for total healthcare cost (95% CI 0.90–1.06), 0.79 for inpatient costs (95% CI 0.61–1.04), and 0.95 for drug costs (95% CI 0.87–1.04). A statistically significant 7% increase in outpatient costs was shown (95% CI 1.01–1.13). Despite a lack of statistical significance in most cases, the study provides evidence of a meaningful decrease in inpatient costs after periodontal treatment. Further studies are needed.
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Affiliation(s)
- Katja Blaschke
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
- Correspondence:
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (M.H.); (C.S.)
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany; (M.H.); (C.S.)
| | - Stefan Listl
- Department of Dentistry—Quality and Safety of Oral Healthcare, Radboud University—Radboudumc (RIHS), 6525 EX Nijmegen, The Netherlands;
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany;
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Holthuis E, Smits E, Spentzouris G, Beier D, Enders D, Gini R, Bartolini C, Mazzaglia G, Penning-van Beest F, Herings R. Increased Risk of Stroke Due to Non-adherence and Non-persistence with Direct Oral Anticoagulants (DOACs): Real-World Analyses Using a Nested Case-Control Study from The Netherlands, Italy and Germany. Drugs Real World Outcomes 2022; 9:597-607. [PMID: 35790603 DOI: 10.1007/s40801-022-00317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND A high degree of adherence to direct oral anticoagulants is essential for reducing the risk of ischaemic stroke and systemic embolism in patients with atrial fibrillation, owing to the rapid decline in anticoagulation activity when doses are omitted (i.e. rebound effect). OBJECTIVE We aimed to assess the relationship between non-adherence and non-persistence with direct oral anticoagulants and the incidence of ischaemic stroke in patients with atrial fibrillation. METHODS A nested case-control study was conducted in the Netherlands, Italy and Germany among patients with atrial fibrillation starting direct oral anticoagulants between the drug approval date and the end of database availability. Patients with an ischaemic stroke during the follow-up were selected as cases and compared with matched controls (matched on age ± 5 years, sex, year of cohort entry date and CHA2DS2-VASc-score at cohort entry date). The cohort entry date was the first dispensing date. Study patients were those aged ≥ 45 years, with ≥ 1 year database history, ≥ 1 year follow-up and at least two direct oral anticoagulant dispensings after the cohort entry date. Adherence and persistence to direct oral anticoagulant treatment were defined as the proportion of days covered ≥ 80% or direct oral anticoagulant continuous use between the cohort entry date and the index date (i.e. date of ischaemic stroke), respectively. RESULTS In The Netherlands, Italy and Germany, 105 cases and 395 controls, 1580 cases and 6248 controls, and 900 cases and 3570 controls were included, respectively. Odds ratios (ORs) for stroke among current users who were non-adherent compared to adherent users were 0.43 (95% confidence interval [CI] 0.09-1.96) in The Netherlands, 1.11 (95% CI 0.98-1.26) in Italy and 1.21 (95% CI 1.01-1.45) in Germany. The risk of stroke was significantly higher among non-persistent users compared with persistent users in all three databases [OR 1.56 (95% CI 1.00-2.44), OR 1.48 (1.32-1.65) and OR 1.91 (95% CI 1.64-2.22), respectively]. In The Netherlands and Germany, the risk of stroke was higher the longer a patient had stopped using direct oral anticoagulants. CONCLUSIONS Both non-adherence (in Germany) and non-persistence increased the risk of stroke, either using a once-daily or twice-daily regime.
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Affiliation(s)
- Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | | | - Dominik Beier
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
| | - Dirk Enders
- InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany
| | - Rosa Gini
- Agenzi Regionali di Sanità della Toscana, Firenze, Italy
| | | | - Giampiero Mazzaglia
- Center for Public Health Research (CESP), University of Milan-Bicocca, Milan, Italy
| | - Fernie Penning-van Beest
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.,Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hohmann C, Lutz M, Vignali S, Borchert K, Seidel K, Braun S, Baldus S, Näbauer M. Clinical outcomes in patients receiving edoxaban or phenprocoumon for prevention of stroke in atrial fibrillation: a German real-world cohort study. Thromb J 2022; 20:37. [PMID: 35787710 PMCID: PMC9251920 DOI: 10.1186/s12959-022-00395-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Appropriate and timely anticoagulant therapy with vitamin K antagonists (VKAs) or non-vitamin K oral antagonists (NOACs) is essential for stroke prevention in non-valvular atrial fibrillation (NVAF). Comparative data regarding effectiveness and safety for edoxaban vs phenprocoumon, the predominant VKA in Germany, are scarce. Objectives The study evaluates effectiveness and safety of edoxaban vs phenprocoumon in NVAF patients in a German real-world setting. Methods German statutory health insurance claims data of the Institute for Applied Health Research Berlin (InGef) Research Database from 2014 until 2019 were analyzed. In NVAF patients, new users of edoxaban and phenprocoumon were compared to assess effectiveness (stroke/systemic embolism (SE)) and safety (bleeding) during therapy. Hazard ratios (HR) were estimated through multiple outcome-specific cox proportional hazard models adjusting for baseline characteristics. Outcomes of geriatric patients were analyzed in subgroup analyses. Results Between 2015 and 2018, 7,975 and 13,319 NVAF patients newly initiated treatment with edoxaban or phenprocoumon. After adjusting for baseline confounders, the risk of stroke/SE (HR: 0.85, 95% CI: 0.70–1.02) was numerically but not significantly lower, while the risk of major bleeding (HR: 0.69, 95% CI: 0.58–0.81) was significantly lower for edoxaban. In the geriatric subgroups, homogenous results compared to the main analysis were obtained. Conclusion The results of this real-world analysis indicated better effectiveness and safety outcomes in patients with NVAF initiating edoxaban treatment compared to phenprocoumon. The findings confirm that the beneficial effects observed in the pivotal ENGAGE AF-TMI 48 trial can also be achieved in real-world use of edoxaban. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-022-00395-x.
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Affiliation(s)
- Christopher Hohmann
- Department III for Internal Medicine, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Magnus Lutz
- Daiichi Sankyo Deutschland GmbH, Zielstattstr. 48, 81379, Munich, Germany
| | - Sheila Vignali
- Daiichi Sankyo Deutschland GmbH, Zielstattstr. 48, 81379, Munich, Germany
| | | | | | | | - Stephan Baldus
- Department III for Internal Medicine, Heart Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Michael Näbauer
- Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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Neugebauer S, Griesinger F, Dippel S, Heidenreich S, Gruber N, Chruscz D, Lempfert S, Kaskel P. Use of algorithms for identifying patients in a German claims database: learnings from a lung cancer case. BMC Health Serv Res 2022; 22:834. [PMID: 35765059 PMCID: PMC9241287 DOI: 10.1186/s12913-022-07982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The analysis of statutory health insurance (SHI) data is a little-used approach for understanding treatment and care as well as resource use of lung cancer (LC) patients in Germany. The aims of this observational, retrospective, longitudinal analysis of structured data were to analyze the healthcare situation of LC patients in Germany based on routine data from SHI funds, to develop an algorithm that sheds light on LC types (non-small cell / NSCLC vs. small cell / SCLC), and to gain new knowledge to improve needs-based care. METHODS Anonymized billing data of approximately four million people with SHI were analyzed regarding ICD-10 (German modification), documented medical interventions based on the outpatient SHI Uniform Assessment Standard Tariff (EBM) or the inpatient Operations and Procedure Code (OPS), and the dispensing of prescription drugs to outpatients (ATC classification). The study included patients who were members of 64 SHI funds between Jan-1st, 2015 and Dec-31st, 2016 and who received the initial diagnosis of LC in 2015 and 2016. RESULTS The analysis shows that neither the cancer type nor the cancer stage can be unambiguously described by the ICD-10 coding. Furthermore, an assignment based on the prescribed medication provides only limited information: many of the drugs are either approved for both LC types or are used off-label, making it difficult to assign them to a specific LC type. Overall, 25% of the LC patients were unambiguously identifiable as NSCLC vs SCLC based on the ICD-10 code, the drug therapy, and the billing data. CONCLUSIONS The current coding system appears to be of limited suitability for drawing conclusions about LC and therefore the SHI patient population. This makes it difficult to analyze the healthcare data with the aim of gathering new knowledge to improve needs-based care. The approach chosen for this study did not allow for development of a LC differentiation algorithm based on the available healthcare data. However, a better overview of patient specific needs could make it possible to modify the range of services provided by the SHI funds. From this perspective, it makes sense, in a first step, to refine the ICD-10 system to facilitate NSCLC vs. SCLC classification.
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Grants
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- #1659 OSTIC 2021-ms-0264 MSD SHARP & DOHME, Haar, Germany
- MSD SHARP & DOHME, Haar, Germany
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Affiliation(s)
- Sina Neugebauer
- MSD SHARP & DOHME GmbH, Levelingstrasse 4A, 81673, Munich, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Internal Medicine-Oncology, Pius Hospital, Medical Campus University of Oldenburg, Cancer Center Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Sabine Dippel
- Organon GmbH, Weystrasse 20, 6006, Lucerne, Switzerland
| | | | - Nina Gruber
- MSD SHARP & DOHME GmbH, Levelingstrasse 4A, 81673, Munich, Germany
| | - Detlef Chruscz
- CONVEMA Versorgungsmanagement GmbH, Karl-Marx-Allee 90A, 10243, Berlin, Germany
| | - Sebastian Lempfert
- HCSL Healthcare Consulting Sebastian Lempfert e.K., Bekwisch 32, 22848, Norderstedt, Germany
| | - Peter Kaskel
- MSD SHARP & DOHME GmbH (former address of MSD), Lindenplatz 1, 85540, Haar, Germany.
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Stephan AJ, Reuschenbach M, Saxena K, Prabhu VS, Jacob C, Schneider KM, Greiner W, Wölle R, Hampl M. Healthcare Costs and Resource Use Associated With Cervical Intraepithelial Neoplasia and Cervical Conization: A Retrospective Study of German Statutory Health Insurance Claims Data. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:128-139. [PMID: 36755814 PMCID: PMC9135472 DOI: 10.36469/001c.35329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/19/2022] [Indexed: 05/14/2023]
Abstract
Background: Cervical intraepithelial neoplasia (CIN) can be a consequence of human papillomavirus (HPV) infection. High-grade CIN (CIN2/CIN3) may develop from persistent HPV infection and progress to cervical cancer if left untreated. Management of CIN includes conservative surveillance or ablation and excision by conization. Internationally, CIN and its treatment generate a considerable economic burden, but no current data regarding costs and resource use from the perspective of the German statutory health insurance exist. Objectives: The aim of this study was to explore the health economic burden in women with CIN diagnoses who either underwent cervical conization or were managed conservatively. Methods: We conducted a retrospective claims data analysis using the InGef Research Database from 2013 to 2018. Healthcare costs and resource utilization in a 24-month observation period (1:1:1 matching) were compared in 18- to 45-year-old women with CIN (1-3) who underwent a conization procedure (study cohort 1) and in women with CIN (1-3) who did not undergo conization (study cohort 2) to women with neither CIN nor conization (control group). Results: For each group, 2749 women were identified. Mean total healthcare costs after 24 months were higher in study cohort 1 (€4446, P<.01) and study cohort 2 (€3754, P=.09) compared with the control group (€3426). Comparing study cohort 1 and 2 to controls, mean differences were highest in age groups 41-45 years (cohort 1: €5115 vs €3354, P<.01; cohort 2: €4152 vs €3354, P=.14). Significantly more women were hospitalized at least once in study cohort 1 (57.46%, P<.01) and study cohort 2 (38.74%, P<.01) compared with the control group (31.14%). Frequency of outpatient physician visits was significantly higher in both study cohorts (43.23 visits, P<.01 and 38.60 visits, P<.01) compared with the control group (32.07 visits). Conclusion: Our results revealed 30% and 10% increased total healthcare costs in women with CIN undergoing invasive treatment (study cohort 1) and conservative management (study cohort 2), respectively, compared with a control group of women with no CIN in a 2-year follow-up period.
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Affiliation(s)
| | | | - Kunal Saxena
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc
| | | | | | | | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University
| | - Regine Wölle
- Department of Market Access, MSD Sharp & Dohme GmbH
| | - Monika Hampl
- Department of Gynecology, University of Duesseldorf
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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Versorgungsstruktur der Patienten mit Mycosis fungoides und Sézary-Syndrom in Deutschland - Versorgungsforschung auf Basis von GKV-Routinedaten. J Dtsch Dermatol Ges 2022; 20:643-652. [PMID: 35578415 DOI: 10.1111/ddg.14725_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin.,Hopital Saint-Louis, AP-HP, Paris, Frankreich
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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Care structure of patients with mycosis fungoides and Sézary syndrome in Germany - Care research based on SHI claims data. J Dtsch Dermatol Ges 2022; 20:643-651. [PMID: 35499207 DOI: 10.1111/ddg.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCLs) are rare forms of non-Hodgkin's lymphoma of T-cell origin that occur mainly in the skin. The most common form is mycosis fungoides (MF), but Sézary syndrome (SS), a more aggressive form of CTCL, is another relevant subgroup. Due to the rare nature of the disease, population-based studies of the epidemiology and disease burden and insights into care delivery are limited. PATIENTS AND METHODS Based on an anonymized, age and sex-adjusted routine dataset comprising approximately five million people with statutory health insurance, a retrospective, longitudinal healthcare research study was conducted over a six-year period (2012-2017). RESULTS In 55 % of patients with MF and SS, the initial diagnosis was documented in an outpatient setting; in 59 % of cases by a dermatologist. Immunophenotyping by flow cytometry is considered an important investigative tool for the detection and follow-up surveillance of blood involvement of cutaneous lymphomas, as the disease stage is the most important prognostic factor in MF and SS; this was performed in only 10 % of patients. The first-line treatment was topical (76 %), in particular with corticosteroids (66 %). CONCLUSIONS The findings from this healthcare research point to the need for increased guideline-based care.
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Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin]
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin].,Hopital Saint-Louis, AP-HP, Paris, France
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Schnabel RB, Witt H, Walker J, Ludwig M, Geelhoed B, Kossack N, Schild M, Miller R, Kirchhof P. Machine learning-based identification of risk-factor signatures for undiagnosed atrial fibrillation in primary prevention and post-stroke in clinical practice. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:16-23. [PMID: 35436783 PMCID: PMC9745664 DOI: 10.1093/ehjqcco/qcac013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/24/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022]
Abstract
AIMS Atrial fibrillation (AF) carries a substantial risk of ischemic stroke and other complications, and estimates suggest that over a third of cases remain undiagnosed. AF detection is particularly pressing in stroke survivors. To tailor AF screening efforts, we explored German health claims data for routinely available predictors of incident AF in primary care and post-stroke using machine learning methods. METHODS AND RESULTS We combined AF predictors in patients over 45 years of age using claims data in the InGef database (n = 1 476 391) for (i) incident AF and (ii) AF post-stroke, using machine learning techniques. Between 2013-2016, new-onset AF was diagnosed in 98 958 patients (6.7%). Published risk factors for AF including male sex, hypertension, heart failure, valvular heart disease, and chronic kidney disease were confirmed. Component-wise gradient boosting identified additional predictors for AF from ICD-codes available in ambulatory care. The area under the curve (AUC) of the final, condensed model consisting of 13 predictors, was 0.829 (95% confidence interval (CI) 0.826-0.833) in the internal validation, and 0.755 (95% CI 0.603-0.890) in a prospective validation cohort (n = 661). The AUC for post-stroke AF was of 0.67 (95% CI 0.651-0.689) in the internal validation data set, and 0.766 (95% CI 0.731-0.800) in the prospective clinical cohort. CONCLUSION ICD-coded clinical variables selected by machine learning can improve the identification of patients at risk of newly diagnosed AF. Using this readily available, automatically coded information can target AF screening efforts to identify high-risk populations in primary care and stroke survivors.
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Affiliation(s)
- Renate B Schnabel
- Corresponding author. Tel: +49-1522-2816064, Fax: +49 (0)40 7410-55310,
| | - Henning Witt
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Jochen Walker
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | - Marion Ludwig
- InGef - Institute for Applied Health Research Berlin GmbH, Spittelmarkt 12, 10117 Berlin, Germany
| | - Bastian Geelhoed
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany
| | | | - Marie Schild
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany
| | - Robert Miller
- Pfizer Pharma GmbH, Linkstraße 10, 10785 Berlin, Germany,Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany,Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, Edgbaston, Birmingham UK
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Burden of CIN2+ diagnoses and conizations in women aged 18-45 years-a retrospective secondary data analysis of German statutory health insurance claims data. Arch Gynecol Obstet 2022; 306:2077-2092. [PMID: 35420356 PMCID: PMC9633516 DOI: 10.1007/s00404-022-06548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022]
Abstract
Purpose High grade cervical intraepithelial neoplasia (CIN2+) may progress to cervical cancer. They may be detected by screening and are usually treated by conization. This study aimed at assessing annual proportions of screening, prevalent and incident CIN2+ diagnoses, as well as proportions of (re-)conizations during 24 months follow-up after conization in Germany. Methods A descriptive retrospective claims data analysis of the years 2013–2018 was conducted using the InGef Research Database. Women aged 18–45 years with CIN2+ diagnoses were identified by ICD-10-GM codes (N87.1, N87.2, D06.-, and C53.-). Cervical conizations were identified by OPS codes (5–671.0* or 5–671.1*). Screening participation was identified by EBM codes (01730, 01733, 32819 or 32820). Annual proportions were calculated as women with the respective documented codes divided by all women in the respective age group per calendar year. Results Overall annual proportions of screened women spanned from 60.01 to 61.33% between 2013 and 2018. The overall annual prevalence of CIN2+ diagnoses (regardless of screening participation) ranged from 0.72 to 0.84% between 2013 and 2018, with highest proportions observed in women aged 27–45 years. Also, CIN2+ incidence was highest in women 27–45 years. Annual proportion of women undergoing conization was 0.24% in 2013 and 0.21% in 2018. During a 24-month follow-up period after conization, 2.91% of women underwent a re-conization 3 months or later after the initial conization. Conclusion This analysis demonstrates a considerable burden of CIN2+, conizations and re-conizations in Germany, especially in women aged 27–45 years. This highlights the need for intensified prevention efforts such as expanding human papillomavirus (HPV) vaccination. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-022-06548-7.
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Hu T, Podmore B, Barnett R, Beier D, Galetzka W, Qizilbash N, Haeckl D, Weaver J, Boellinger T, Mihm S, Petigara T. Incidence of acute otitis media in children < 16 years old in Germany during 2014-2019. BMC Pediatr 2022; 22:204. [PMID: 35418046 PMCID: PMC9006409 DOI: 10.1186/s12887-022-03270-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute otitis media (AOM) remains a common infection in children despite the introduction of pneumococcal conjugate vaccines. This study estimated AOM incidence rates (IRs) over time in children < 16 years old in Germany following PCV13 introduction. METHODS AOM episodes were identified in the InGef healthcare claims database from 2014-2019 in children aged < 16 years. Each AOM episode was classified as either simple or recurrent. Recurrent AOM was defined as 3 or more episodes identified within a 6-month period; or 4 or more episodes within a 12-month period with at least one episode in the prior 6 months. AOM-related surgical procedures within 12 months and complications within 21 days of an AOM episode were also identified. Annual IRs were calculated as number of episodes/child-years (CY) at risk. 95% Confidence intervals (95%CI) were calculated using the Wilson method. The Mann-Kendall test was used to assess trends over time. RESULTS Between 2014 and 2019, the study population comprised 916,805 children with 327,726 AOM episodes, of which 15% (49,011) of all episodes were identified as recurrent AOM and 85% (278,715) as simple AOM. There were significant declines in AOM (p = 0.003) in the study population overall and in all age groups over the study period; from 101 (95%CI 101-102)/1000 CY to 79 (95%CI 78-80)/1000 CY in the total study population, from 209 (95%CI 206-212)/1000 CY to 147 (95%CI 145-150)/1000 CY in < 2-year-olds, from 239 (95%CI 237-242) to 179 (95%CI 177-182)/1000 CY in 2-4-year-olds, and from 50 (95%CI 49-50) to 38 (95%CI 37-39)/1000 CY in 5-15-year-olds. No significant trends were identified for AOM-related surgical procedures over the study period; however, AOM-related complications overall increased (p = 0.003). CONCLUSION Between 2014 and 2019, AOM incidence overall declined in children aged 0-15 years in Germany. Over the study period, the incidence of complicated AOM cases increased, however the incidence of AOM-related surgical procedures remained constant. Despite the impact of PCV13, the burden associated with AOM in Germany remains substantial.
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Affiliation(s)
| | - Bélène Podmore
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - Dominik Beier
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Wolfgang Galetzka
- InGef - Institute for Applied Health Research Berlin GmbH, Berlin, Germany
| | - Nawab Qizilbash
- OXON Epidemiology, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
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Saußele S, Kohlbrenner K, Vogelmann T, Schubert T. Incidence, Prevalence and Real-World Treatment Patterns in Chronic Myeloid Leukemia: Results from a Population Representative German Claims Data Analysis. Oncol Res Treat 2022; 45:400-407. [PMID: 35340007 DOI: 10.1159/000524284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
Abstract
Introduction Real-world data on usage of 1st, 2nd and 3rd generation tyrosine kinase inhibitor (TKIs) in chronic myeloid leukemia (CML) is scarce. This study therefore aimed to analyze the use of different TKIs used in 1st- and 2nd-line treatment and the frequency of TKI switches in CML. Methods This observational study was based on the InGef research database, an anonymized representative claims dataset in Germany (n= 4 million). An incidence and prevalence patient CML cohort was followed for 5 and 3 years. Analyses regarding incidence, prevalence and therapy distribution were performed descriptively. Results 151 patients were included in the incidence and 636 patients in the prevalence cohort. This resulted in an incidence of 1.8 (95%-confidence interval [CI]: 1.34 - 2.20) and a prevalence of 14.9 (95%-CI 13.70 - 16.03) per 100,000 inhabitants. For the incidence cohort, data on 1st-line therapy was available for 124 patients and distributed across imatinib (N=52), nilotinib (N=44), dasatinib (N=12), chemotherapies as hydroxycarbamide (N=11) and ponatinib/bosutinib (N=5). 26% of patients switched TKI therapy at least once in three years. In the prevalence cohort, 423 patients (66.5%) had claims on existing or newly emerged cardiovascular diseases (CD). No significant differences (p=0.32) between TKIs in patients with CD were found. Discussion Every fourth patient switched TKI therapy within the first three years after treatment initiation. Switches were more likely when hints of disease progression or intolerability were observable in the database.
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Affiliation(s)
- Susanne Saußele
- Department of Haematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Kohlbrenner
- Department of Haematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
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Hradetzky E, Ohlmeier C, Brinkmann C, Schild M, Galetzka W, Schmedt N, John T, Kaleth D, Gothe H. Epidemiology and routine care treatment of patients with hip or knee osteoarthritis and chronic lower back pain: real-world evidence from Germany. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Aim
Musculoskeletal disorders are a major public health problem in most developed countries. As a main cause of chronic pain, they have resulted in an increasing prescription of opioids worldwide. With regard to the situation in Germany, this study aimed at estimating the prevalence of musculoskeletal diseases such as chronic low back pain (CLBP) and hip/knee osteoarthritis (OA) and at depicting the applied treatment patterns.
Subject and methods
German claims data from the InGef Research Database were analyzed over a 6-year period (2011–2016). The dataset contains over 4 million people, enrolled in German statutory health insurances. Inpatient and outpatient diagnoses were considered for case identification of hip/knee OA and CLBP. The World Health Organization (WHO) analgesic ladder was applied to categorize patients according to their pain management interventions. Information on demographics, comorbidities, and adjuvant medication was collected.
Results
In 2016, n = 2,693,481 individuals (50.5% female, 49.5% male) were assigned to the study population; 62.5% of them were aged 18–60 years. In 2016, n = 146,443 patients (5.4%) with CLBP and n = 307,256 patients (11.4%) with hip/knee OA were identified. Of those with pre-specified pain management interventions (CLBP: 66.3%; hip/knee OA: 65.1%), most patients received WHO I class drugs (CLBP: 73.6%; hip/knee OA: 68.7%) as the highest level.
Conclusion
This study provides indications that CLBP and hip/knee OA are common chronic pain conditions in Germany, which are often subjected to pharmacological pain management. Compared to non-opioid analgesic prescriptions of the WHO I class, the dispensation of WHO class II and III opioids was markedly lower, though present to a considerable extent.
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Care reality of menopausal women in Germany: healthcare research using quantitative (SHI claims data) and qualitative (survey) data collection. Arch Gynecol Obstet 2022; 306:513-521. [PMID: 35253085 PMCID: PMC9349310 DOI: 10.1007/s00404-022-06457-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/12/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The transition from the fertile phase of life to menopause is associated with numerous physical changes. Hormone replacement therapy (HRT), as the most effective and efficient form of drug treatment, involves the use of oestrogens and progestins with the aim of increasing health-related quality of life through symptom reduction, sleep improvement and affect enhancement. METHODS The medical care situation and disease burden of menopausal women was investigated by means of a survey of 1000 women aged 45-60 years on the topics of quality of life, menopause and HRT and a quantitative, longitudinal healthcare study based on an anonymised and age- and sex-adjusted Statutory Health Insurance (SHI) routine data set with approximately four million anonymous insured persons per year. RESULTS Out of more than half a million women aged 35-70 years, and with statutory health insurance, (n = 613,104), 14% (n = 82,785) had climacteric disorder documented as a first diagnosis in 2014. The proportion of women with the climacteric disorder, who were prescribed HRT on an outpatient basis, was 21%; according to the forsa survey, 50% of the women surveyed felt moderate to poorly/very poorly informed about treatment options. CONCLUSION Findings from the health insurance research conducted with different data sources (survey and SHI claims data) indicate the need for increasing awareness and providing an early and informative education on HRT and its risks and benefits.
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Is there an unmet medical need for palliative care services in Germany? Incidence, prevalence, and 1-year all-cause mortality of palliative care sensitive conditions: real-world evidence based on German claims data. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01319-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Abstract
Aim
To characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.
Subject and methods
The study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.
Results
The incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).
Conclusions
In Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.
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Drewe-Boss P, Enders D, Walker J, Ohler U. Deep learning for prediction of population health costs. BMC Med Inform Decis Mak 2022; 22:32. [PMID: 35114978 PMCID: PMC8812208 DOI: 10.1186/s12911-021-01743-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Accurate prediction of healthcare costs is important for optimally managing health costs. However, methods leveraging the medical richness from data such as health insurance claims or electronic health records are missing. Methods Here, we developed a deep neural network to predict future cost from health insurance claims records. We applied the deep network and a ridge regression model to a sample of 1.4 million German insurants to predict total one-year health care costs. Both methods were compared to existing models with various performance measures and were also used to predict patients with a change in costs and to identify relevant codes for this prediction. Results We showed that the neural network outperformed the ridge regression as well as all considered models for cost prediction. Further, the neural network was superior to ridge regression in predicting patients with cost change and identified more specific codes. Conclusion In summary, we showed that our deep neural network can leverage the full complexity of the patient records and outperforms standard approaches. We suggest that the better performance is due to the ability to incorporate complex interactions in the model and that the model might also be used for predicting other health phenotypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01743-z.
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Affiliation(s)
- Philipp Drewe-Boss
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Strasse 10, 13125, Berlin, Germany.
| | - Dirk Enders
- Institute for Applied Health Research (InGef), Spittelmarkt 12, 10117, Berlin, Germany
| | - Jochen Walker
- Institute for Applied Health Research (InGef), Spittelmarkt 12, 10117, Berlin, Germany
| | - Uwe Ohler
- Berlin Institute for Medical Systems Biology, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Robert-Rössle-Strasse 10, 13125, Berlin, Germany
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Kallweit U, Nilius G, Trümper D, Vogelmann T, Schubert T. Prevalence, incidence, and health care utilization of patients with narcolepsy: a population-representative study. J Clin Sleep Med 2022; 18:1531-1537. [PMID: 35088707 DOI: 10.5664/jcsm.9910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Previous estimated prevalence of narcolepsy in Europe was 47 patients per 100,000 persons, with a yearly incidence of 0.64-1.37 per 100,000. However, analyses of representative datasets from large cohorts are limited. This study aimed to estimate the population-based diagnostic prevalence and incidence of narcolepsy in Germany, and to describe these patients and their health care resource utilization. METHODS This study used the InGef research database, an anonymized representative dataset of 4 million persons covered by statutory health insurance in Germany. Patients with confirmed narcolepsy diagnoses in 2018 were included. Mid-p exact tests were used to calculate 95%-confidence intervals. Patients with narcolepsy diagnoses and narcolepsy-targeting therapy in 2014-2018 were included to describe health care resource utilization in the year prior to diagnosis. RESULTS In 2018 diagnostic prevalence was estimated as 17.88 (95%-CI 16.45-19.40), and 12-month incidence as 0.79 (0.52-1.15) per 100,000 persons. 46% patients were in psycho-behavioral therapeutic treatment and 61% of employees had sick-leave days. One in three patients was hospitalized for any cause. 28% received antibiotics. CONCLUSIONS Diagnostic prevalence was lower, but incidence was consistent with previous reports, though previous estimates may diverge in terms of age/gender-distributions. Patients showed a substantial utilization of health care resources, including sick leave and hospitalization. Almost half the patients underwent psycho-behavioral treatment in the year prior to diagnosis, which might indicate high burden of psychiatric symptoms. The increased use of antibiotics could indicate more frequent infections than in the general population.
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Affiliation(s)
- Ulf Kallweit
- Universität Witten/Herdecke, Klin. Schlaf- und Neuroimmunologie, Institut für Immunologie, Witten, Germany
| | - Georg Nilius
- Universität Witten/Herdecke, Klin. Schlaf- und Neuroimmunologie, Institut für Immunologie, Witten, Germany.,KEM
- Evang. Kliniken Essen-Mitte gGmbH, Pneumologie, Essen, Germany
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