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Hoffmann F, Bantel C, von Rosen FT, Jobski K. Regional Differences in Prescribing Patterns of Metamizole in Germany Based on Data from 70 Million Persons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113892. [PMID: 32486330 PMCID: PMC7312502 DOI: 10.3390/ijerph17113892] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/20/2023]
Abstract
The non-opioid analgesic metamizole (dipyrone) is commonly used in Germany despite its narrow indications and market withdrawal from several countries. In this study we analyzed prescribing patterns of metamizole focusing on regional differences. The source of data was the “Information system for health care data” which includes data from the statutory health insurance funds for about 70 million Germans. We received aggregated data of individuals with at least one metamizole prescription in 2010 as well as the number of prescribed packages by age, sex, state and district along with the number of insured persons in each stratum. We calculated prescription prevalence stratified by age, sex, state and district. Among 68.4 million insured persons (mean age: 43.6 years; 53.0% female) 5.5 million received at least one metamizole prescription (8.1%, overall 12.2 million packages). Prevalence increased with age, and women received metamizole more often than men. In adults (total prevalence: 9.4%), levels varied between 7.0% (Saxony) and 11.1% (Schleswig-Holstein), whereas on a district level use ranged from 4.3% to 14.3%. In 2010, one of 12 individuals received metamizole at least once. Noticeable were the large regional variations which certainly cannot be explained by patient-related factors.
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Affiliation(s)
- Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (F.H.); (F.T.v.R.)
| | - Carsten Bantel
- University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, 26133 Oldenburg, Germany;
| | - Frederik Tilmann von Rosen
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (F.H.); (F.T.v.R.)
| | - Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (F.H.); (F.T.v.R.)
- Correspondence: ; Tel.: +49-(0)441-798-2330
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Luque Ramos A, Hoffmann F. [Differences in chronic back pain and joint disorders among health insurance funds : Results of a cross-sectional study based on the data of the Socioeconomic Panel from 2013]. Z Rheumatol 2017; 76:238-244. [PMID: 27535275 DOI: 10.1007/s00393-016-0178-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health services research uses increasingly data from health insurance funds. It is well known that the funds differ with regard to sociodemographic characteristics and morbidity. It is uncertain if there are also differences in the prevalence of musculoskeletal disorders. OBJECTIVE To compare the sociodemographic characteristics in various health insurance funds and the prevalence of joint disorders and chronic back pain. METHOD The 30th wave (2013) of the German Socioeconomic Panel served as a database. Average age, sex distribution, nationality, education, and employment status were evaluated according to the health insurance funds. The prevalence of joint disorders and chronic back pain were also stratified according to the insurance funds and standardized according to age and sex. RESULTS A total of 19,146 participants were included. Most participants (4,934) were insured by AOK, followed by BKK (2,632) and BARMER GEK (2,398). There were huge differences among the health insurance funds with regard to the sociodemographic characteristics. For example, the proportion of unemployed insurants was between 33.3 % (IKK) and 50.6 % (AOK). The prevalence of joint disorders standardized according to age and sex (20.7 %; 95 % CI: 20.1-21.3) was between 17.4 % (95 % CI: 15.8-19.0; PKV) and 22.4 % (95 % CI: 21.1-23.6; AOK). The prevalence of chronic back pain (18.0 %; 95 % CI: 17.4-18.5) was between 13.5 % (95 % CI: 12.2-14.9; PKV) and 20.6 % (95 % CI: 19.4-21.8; AOK). CONCLUSION There are differences in the prevalence of musculoskeletal disorders among health insurance funds. The extrapolation of analyses of one health insurance fund to the German population is thus limited.
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Affiliation(s)
- A Luque Ramos
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Deutschland.
| | - F Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Deutschland
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Hense S, Luque Ramos A, Callhoff J, Albrecht K, Zink A, Hoffmann F. [Prevalence of rheumatoid arthritis in Germany based on health insurance data : Regional differences and first results of the PROCLAIR study]. Z Rheumatol 2017; 75:819-827. [PMID: 27120440 DOI: 10.1007/s00393-016-0088-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is the most common chronic inflammatory joint disease with a prevalence of up to 1 % in the adult population. OBJECTIVE This study describes the prevalence of RA diagnoses in outpatient health insurance claims data, based on different case definitions and stratified by age, sex and region of residence. METHODS Based on data from a nationwide statutory health insurance fund (BARMER GEK) from the year 2013, a cross-sectional study of insurants aged 18 years or older was conducted. The following case definitions were applied: A) a diagnosis of seropositive rheumatoid arthritis (M05) or other rheumatoid arthritis (M06) according to the international classification of diseases 10 German modification (ICD-10-GM) in at least two quarterly periods of the year 2013, B) case definition A plus determination of C‑reactive protein (CRP) or erythrocyte sedimentation rate (ESR) at least once, C) case definition B plus specific drug therapy and D) case definition A plus treatment by a rheumatologist. Raw as well as age and sex-standardized prevalences were calculated and stratified according to the federal state. RESULTS The study population consisted of 7,155,315 insurants of whom 60.2 % were female. Overall, RA prevalences for the respective case definitions were 1.62 % (A), 1.11 % (B), 0.94 % (C) and 0.64 % (D). When standardized to the German population the prevalences were 1.38 % (A), 0.95 % (B), 0.81 % (C) and 0.55 % (D). The proportion of women was approximately 80 % for all case definitions. Prevalences increased with age, peaking in the age group 70-79 years old and showing the highest values in eastern and the lowest in southern Germany for raw as well as standardized measures. CONCLUSION Regional differences in the prevalence of RA diagnoses in health insurance claims data were observed independent of age, sex and case definition. The expected prevalence according to the results of international studies was best achieved when case definitions with CRP or ESR were considered.
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Affiliation(s)
- S Hense
- Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26111, Oldenburg, Deutschland.,Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - A Luque Ramos
- Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26111, Oldenburg, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - K Albrecht
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - A Zink
- Programmbereich Epidemiologie, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland.,Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - F Hoffmann
- Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26111, Oldenburg, Deutschland.
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Fassmer AM, Garbe E, Schmedt N. Frequency and trends of disease-modifying antirheumatic drug (DMARD) use in Germany. Pharmacol Res Perspect 2016; 4:e00254. [PMID: 27713825 PMCID: PMC5045940 DOI: 10.1002/prp2.254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to analyze the population‐based frequency of classic (c‐) and biologic (b‐) disease‐modifying antirheumatic drug (DMARD) use over time, selected underlying indications and the specialty of the prescribing physicians in Germany. Based on the claims data of the German Pharmacoepidemiological Research Database (GePaRD), yearly cross‐sectional studies were conducted from 2004 to 2011. The prevalence of DMARD use was calculated as the number of persons with at least one dispensation per 1000 persons stratified by sex and age. In 2011, we also obtained the proportion of c‐ and b‐DMARDs users with diagnoses of selected indications and the proportion of dispensations by specialty of the physician. Between 2004 and 2011, the annual prevalence of b‐DMARD and c‐DMARD use increased from 0.35‰ to 1.54‰ and from 6.53‰ to 8.93‰, respectively. In 2011, the study population comprised 12.8 million insurants with a mean age of 44.0 years. During this year, among c‐DMARDs, methotrexate was prescribed most frequently (4.76‰), followed by azathioprine (1.72‰) and sulfasalazine (1.20‰). For b‐DMARDs, adalimumab (0.57‰), etanercept (0.46‰), and rituximab (0.23‰) were most frequently used. Notably, b‐DMARD users more often had a diagnosis of ankylosing spondylitis and psoriasis compared to c‐DMARD‐users (20.7% vs. 2.9% and 20.0% vs. 11.4%, respectively) and b‐DMARDs were more frequently prescribed by rheumatologists and other specialists. Our population‐based study highlights the increasing use of c‐ and b‐DMARDs in Germany. Compared to c‐DMARDs, b‐DMARDs were commonly used for indications besides rheumatoid arthritis. Future research should therefore also focus on their prescription patterns and safety aspects in indications other than RA.
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Affiliation(s)
- Alexander M Fassmer
- Department of Clinical Epidemiology Leibniz Institute for Prevention Research and Epidemiology (BIPS) Achterstrasse 30 28359 Bremen Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology Leibniz Institute for Prevention Research and Epidemiology (BIPS) Achterstrasse 30 28359 Bremen Germany
| | - Niklas Schmedt
- Department of Clinical Epidemiology Leibniz Institute for Prevention Research and Epidemiology (BIPS) Achterstrasse 3028359 Bremen Germany; Health Risk Institute GmbH Spittelmarkt 1210117 Berlin Germany
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Lange A, Prenzler A, Bachmann O, Linder R, Neubauer S, Zeidler J, Manns MP, von der Schulenburg JM. Regional differences in health care of patients with inflammatory bowel disease in Germany. HEALTH ECONOMICS REVIEW 2015; 5:29. [PMID: 26475276 PMCID: PMC4608952 DOI: 10.1186/s13561-015-0067-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/08/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The regional availability of specialized physicians is an important aspect in healthcare of patients with IBD. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?" METHODS We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated: regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed. RESULTS The study cohort was comprised of 21,771 individuals, including 9282 patients with Crohn disease and 12,489 patients with ulcerative colitis. Patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support. CONCLUSIONS The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. No clear evidence of a general healthcare undersupply in rural areas was found.
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Affiliation(s)
- Ansgar Lange
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Anne Prenzler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Oliver Bachmann
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
| | - Roland Linder
- Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany.
| | - Sarah Neubauer
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Jan Zeidler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
| | - Michael P Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
| | - J-Matthias von der Schulenburg
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Koenigsworther Platz 1, D-30167, Hannover, Germany.
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Abstract
BACKGROUND The aim of this study was to analyze the prescription of high-potency (WHO step III) opioids with respect to regional differences and to assess the proportion of opioid-naïve new users of transdermal fentanyl. METHODS Prescription claims data of the largest single German health fund (BARMER GEK) with 9.1 million insured persons from the year 2011 were used. For new users of transdermal fentanyl who had had no prescription in the preceding 6 months it was studied whether they had received other high-potency or low-potency opioids before. RESULTS A total of 18.9 million defined daily doses (DDD) of high-potency opioids were included corresponding to a mean of 208.6 DDD per 100 persons. Significant regional differences were found with lower values in the south, ranging from 145.9 DDD in Baden-Württemberg to 259.5 DDD per 100 persons in Lower Saxony. Fentanyl was the most frequently used step III opioid (40.8% of DDDs) which is nearly only given transdermally. Of the 11,184 patients with new use of transdermal fentanyl 80.7% had received no other high-potency opioid before and 52.9% had received neither low-potency nor high-potency opioids before. The first prescription exceeded the smallest available dose of 12.5 μg/h for over half of the patients starting treatment. CONCLUSIONS Although oral morphine, oxycodone and hydromorphone are recommended as first-line step III opioids, transdermal fentanyl seems to be prescribed too often as the first choice and might not be appropriate.
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Treatment of multiple sclerosis in Germany: an analysis based on claims data of more than 30,000 patients. Int J Clin Pharm 2013; 35:1229-35. [PMID: 24104761 DOI: 10.1007/s11096-013-9857-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is an incurable disease of the central nervous system. In addition to symptomatic treatment, immunomodulatory and immunosuppressant agents are used to prevent attacks and to influence the course of disease. OBJECTIVE The goal of this study was to assess the drug use of MS patients in outpatient care considering gender-related and regional differences. SETTING We analyzed outpatient claims data of the single largest German health insurance fund (about 9 million insurants) for the year 2010. METHOD Patients with MS were identified by outpatient ICD-10-GM-diagnosis code 'G35'. All age groups were included. MS-specific drug use was analysed for those patients, considering regional and gender-related differences in specific drug prescriptions. MAIN OUTCOME MEASURE Prescription rates for symptomatic treatment, relapse treatment and disease-modifying treatment. RESULTS 31,248 patients with a diagnosis of MS were identified (0.35 % of all insurants). Their mean age was 50.4 ± 14.1 years, 77.7 % of them were female. 37.6 % of the included patients were treated with disease-modifying drugs, 23.4 % got prescriptions for corticosteroids, drugs of choice for relapse therapy, and 63.1 % received symptomatic treatment as defined in the study. Women with MS were prescribed significantly more non-steroidal anti-inflammatory drugs, urinary antispasmodics, antidepressants, tranquilizer and hypnotic drugs. Regional variations were also found, with highest usage of disease-modifying drugs in eastern regions of Germany. CONCLUSION This study gives an insight into the treatment of MS in daily practice by using the claims data of a large health insurance company. The prescription rate for disease modifying drugs was relatively low suggesting that early treatment was not routine practice. Furthermore, the results indicated that women with MS were more likely to receive treatment for psychiatric symptoms and pain.
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Zeidler J, Zeidler H, Graf von der Schulenburg JM. [Therapy of rheumatoid arthritis with methotrexate. Claims data analysis of treatment patterns]. Z Rheumatol 2013; 71:900-7. [PMID: 23052404 DOI: 10.1007/s00393-012-1027-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methotrexate (MTX) is the most important disease-modifying antirheumatic drug (DMARD) and is recommended by national and international guidelines as the first choice for treatment of rheumatoid arthritis (RA). Recent studies reporting prescription data of MTX captured only patients who were treated by rheumatologists. Therefore, the aim of the present study was to analyse several aspects of the prescription of MTX based on claims data. Outpatient and inpatient diagnoses as well as prescription data was available for 9579 RA patients for the years 2005-2008. Of the patients 45% were treated exclusively with parenteral MTX, 8% were treated exclusively with oral MTX and 48% switched between both forms of application. The average weekly dosage presribed in 70% of the patients was between 10 and 25 mg. The most common DMARD combination was MTX plus leflunomide with 16%. In 16% RA patients were treated with a combination of MTX and TNF-α inhibitors. Glucocorticoids were prescribed temporarily in 81% together with MTX and supplementation with folic acid was given only in 65%. The results of this study provide important insights into the drug supply of MTX to RA patients in the German statutory health care sector. In particular, the high frequency of prescriptions of parenteral MTX and the inadequate prescription of folic acid are different from the recently published multinational recommendations of the 3E initiative for the use of MTX.
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Affiliation(s)
- J Zeidler
- Forschungsstelle für Gesundheitsökonomie, Leibniz Universität Hannover, Königsworther Platz 1, 30167, Hannover, Deutschland.
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