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Soares Andrade CA, Shahin B, Dede O, Akpeji AO, Ajene CL, Albano Israel FE, Varga O. The burden of type 2 diabetes mellitus in states of the European Union and United Kingdom at the national and subnational levels: A systematic review. Obes Rev 2023; 24:e13593. [PMID: 37401729 DOI: 10.1111/obr.13593] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 03/31/2023] [Accepted: 05/21/2023] [Indexed: 07/05/2023]
Abstract
Type 2 diabetes mellitus (T2D) is a highly prevalent disease worldwide, with an equally increased expenditure associated with it. We aimed to longitudinally evaluate the epidemiologic and economic burden of T2D in the current member states of the European Union and the United Kingdom (EU-28). The present systematic review is registered on PROSPERO (CRD42020219894), and it followed the PRISMA guidelines. Eligibility criteria comprised original observational studies in English reporting economic and epidemiological data for T2D in member states of the EU-28. Methodological assessment was performed with the Joanna Briggs Institute (JBI) Critical Appraisal Tools. The search retrieved 2253 titles and abstracts. After study selection, 41 studies were included in the epidemiologic analysis and 25 in the economic analysis. Economic and epidemiologic studies covered only 15 member states with reported data between 1970 and 2017, resulting in an incomplete picture. For children in particular, limited information is available. The prevalence, incidence, mortality, and expenditure of the T2D population have increased across the decades in member states. Therefore, policies should aim to prevent or reduce the burden of T2D in the EU and consequently mitigate the expenditure on T2D.
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Affiliation(s)
| | - Balqees Shahin
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
| | - Onisoyonivosekume Dede
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
| | - Anne Omagu Akpeji
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
| | - Comfort-Lucia Ajene
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
| | | | - Orsolya Varga
- Faculty of Medicine, Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
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D. Meid A, Wirbka L, Moecker R, Ruff C, Weissenborn M, E. Haefeli W, M. Seidling H. Mortality and Hospitalizations Among Patients Enrolled in an Interprofessional Medication Management Program. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:253-260. [PMID: 37070272 PMCID: PMC10366959 DOI: 10.3238/arztebl.m2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Measures for improving medication safety in outpatient care are often complex and involve medication reviews. Over the period 2016-2022 (with a preceeding one-year pilot phase), an interprofessional medication management program- the Medicines Initiative Saxony-Thuringia (Arzneimittelinitiative Sachsen-Thüringen, ARMIN)-was implemented in two German federal states. More than 5000 patients received a medication review by the end of 2019 by a team composed of physicians and pharmacists and were provided with joint, continuous care thereafter. METHODS In the framework of a retrospectively registered cohort study, the mortality and hospitalizations of this population (5033 patients) were studied using routine data from a statutory health insurer (observation period 2015-2019) and compared with those of a control group (10 039 patients) determined from the routine data by propensity score matching. Mortality was compared by survival analysis (Cox regression), and hospitalization rates were compared in terms of event probabilities within two years of enrollment in the medication management program. Robustness was tested in multiple sensitivity analyses. RESULTS Over the observation period, 9.3% of the ARMIN participants and 12.9% of persons in the control group died (hazard ratio of the adjusted Cox regression, 0.84; 95% confidence interval [0.76; 0.94], P = 0.001). In the first two years after inclusion, the ARMIN participants were hospitalized just as often as the persons in the control group (52.4% versus 53.4%; odds ratio from the adjusted model, 1.04 [0.96; 1.11], P = 0.347). The effects were consistent in sensitivity analyses. CONCLUSION In this retrospective cohort study, participation in the ARMIN program was associated with a lower risk of death. Exploratory analyses provide clues to the potential origin of this association.
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Affiliation(s)
- Andreas D. Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Lucas Wirbka
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Robert Moecker
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Carmen Ruff
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
| | - Marina Weissenborn
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Walter E. Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
| | - Hanna M. Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital
- Cooperation Unit Clinical Pharmacy, Heidelberg University
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Kirsch F, Becker C, Schramm A, Maier W, Leidl R. Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:607-619. [PMID: 32006188 PMCID: PMC7214389 DOI: 10.1007/s10198-020-01158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/06/2020] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. METHODS The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. RESULTS The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). CONCLUSION Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.
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Affiliation(s)
- Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Christian Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
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Gansen FM. Health economic evaluations based on routine data in Germany: a systematic review. BMC Health Serv Res 2018; 18:268. [PMID: 29636046 PMCID: PMC5894241 DOI: 10.1186/s12913-018-3080-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 03/28/2018] [Indexed: 02/02/2023] Open
Abstract
Background Improved data access and funding for health services research have promoted the application of routine data to measure costs and effects of interventions within the German health care system. Following the trend towards real world evidence, this review aims to evaluate the status and quality of health economic evaluations based on routine data in Germany. Methods To identify relevant economic evaluations, a systematic literature search in the databases PubMed and EMBASE was complemented by a manual search. The included studies had to be full economic evaluations using German routine data to measure either costs, effects, or both. Study characteristics were assessed with a structured template. Additionally, the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to measure quality of reporting. Results In total, 912 records were identified and 35 studies were included in the further analysis. The majority of these studies was published in the past 5 years (n = 27, 77.1%) and used insurance claims data as a source of routine data (n = 30, 85.7%). The most common method used for handling selection bias was propensity score matching. With regard to the reporting quality, 42.9% (n = 15) of the studies satisfied at least 80% of the criteria on the CHEERS checklist. Conclusions This review confirms that routine data has become an increasingly common data source for health economic evaluations in Germany. While most studies addressed the application of routine data, this analysis reveals deficits in considering methodological particularities and in reporting quality of economic evaluations based on routine data. Nevertheless, this review demonstrates the overall potential of routine data for economic evaluations. Electronic supplementary material The online version of this article (10.1186/s12913-018-3080-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabia Mareike Gansen
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Grazer Str. 2a, 28359, Bremen, Germany.
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Kellner C, Kuniss N, Kloos C, Müller UA, Müller N. No selection, but higher satisfaction of people participating in the disease management programme diabetes type 2 in Germany. Acta Diabetol 2018; 55:363-367. [PMID: 29383585 DOI: 10.1007/s00592-018-1106-2] [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: 12/01/2017] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Abstract
AIMS We analysed metabolic control, complications and satisfaction in people with and without DMP participation. METHODS We retrospectively analysed the German data of the GUIDANCE study. The general practices included (n = 38) were selected from the physicians' register of the Thuringian Association of Statutory Health Insurance Physicians. Half of the practices (n = 19) participated in the DMP "Diabetes mellitus type 2". RESULTS Nine hundred and fifty-nine people were included in the analysis. Of these, 541 (56.4%) were enrolled in the DMP and 418 (43.6%) not. There was no difference between the two groups (DMP vs. no DMP) regarding age (67.8 vs. 67.6y), gender (female 50.6 vs. 52.2%), diabetes duration (9.8 vs. 9.5y), BMI (31.3 vs. 30.7 kg/m2), HbA1c (7.2 vs. 7.2%), systolic blood pressure (139 vs. 140 mm Hg) or antihypertensive drug (89.5 vs. 88.8%). More DMP participants had regular screening of diabetic late complications: retinopathy 84.7 versus 69.9% (p < 0.001); polyneuropathy 93.0 versus 52.6% (p < 0.001). Chronic kidney disease was more frequent in DMP participants (15.0 vs. 9.3%, p = 0.005). Treatment satisfaction was higher in participants enrolled in the DMP (31.1 vs. 30.0; p = 0.002). CONCLUSIONS DMP participants do not exhibit positive selection. Process quality and treatment satisfaction are higher in DMP participants.
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Affiliation(s)
- Christiane Kellner
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Nadine Kuniss
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christof Kloos
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Ulrich Alfons Müller
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Nicolle Müller
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Borisenko O, Mann O, Duprée A. Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling. BMC Surg 2017; 17:87. [PMID: 28774333 PMCID: PMC5543597 DOI: 10.1186/s12893-017-0284-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective. Methods State-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€). Results Over 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs. Conclusions Bariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.
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Affiliation(s)
| | - Oliver Mann
- University Medical Center Hamburg, Hamburg, Germany
| | - Anna Duprée
- University Medical Center Hamburg, Hamburg, Germany
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Röttger J, Blümel M, Busse R. Selective enrollment in Disease Management Programs for coronary heart disease in Germany - An analysis based on cross-sectional survey and administrative claims data. BMC Health Serv Res 2017; 17:246. [PMID: 28372554 PMCID: PMC5379615 DOI: 10.1186/s12913-017-2162-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background In 2002, Disease Management Programs (DMPs) were introduced within the German healthcare system with the aim to increase the quality of chronic disease care. Due to the enrollment procedures, it can be assumed a) that only certain patients actively decide to enroll in a DMP and/or b) that only certain patients get the recommendation for DMP enrollment from their physician. How strong this assumed effect of self- and/or professional selection is, is still unclear. Methods We used data from a cross-sectional postal-survey linked on individual level with administrative claims data from a German sickness fund. The sample consisted of individuals suffering from coronary heart disease (CHD) who i) were either enrolled in the respective DMP or ii) fulfilled the disease related criteria for enrollment but were not enrolled. We applied multivariate logistic regression analyses to assess factors on patient level associated with DMP enrollment. Results We included 7070 individuals in our analyses. Male sex, higher age and receiving old age pension, a higher Charlson Score and a diagnosis of type 2 diabetes increased the odds for DMP-CHD enrollment significantly. Individuals with a diagnosed myocardial infarction (MI) were also more likely to be enrolled in the DMP-CHD. We found a significant interaction effect for MI and sex, indicating that the association between MI and DMP enrollment is stronger for women than for men. Conclusion DMP-enrollees and non-enrollees differ in various factors. Studies analyzing the effectiveness of DMP-CHD should carefully take into account these group differences. Furthermore, the results suggest that the DMP-CHD assessed reaches men better than women.
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Affiliation(s)
- Julia Röttger
- Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany.
| | - Miriam Blümel
- Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technical University Berlin, and Centre for Health Economics Research, Strasse des 17. Juni 135, 10623, Berlin, Germany
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Kostev K, Rockel T, Jacob L. Impact of Disease Management Programs on HbA1c Values in Type 2 Diabetes Patients in Germany. J Diabetes Sci Technol 2017; 11:117-122. [PMID: 27246670 PMCID: PMC5375061 DOI: 10.1177/1932296816651633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim was to analyze the impact of disease management programs on HbA1c values in type 2 diabetes mellitus (T2DM) patients in Germany. METHODS This study included 9017 patients followed in disease management programs (DMPs) who started an antihyperglycemic treatment upon inclusion in a DMP. Standard care (SC) patients were included after individual matching (1:1) to DMP cases based on age, gender, physician (diabetologist versus nondiabetologist care), HbA1c values at baseline, and index year. The main outcome was the share of patients with HbA1c <7.5% or 6.5% after at least 6 months and less than 12 months of therapy in DMP and SC groups. Multivariate logistic regression models were fitted with HbA1c level as a dependent variable and the potential predictor (DMP versus SC). RESULTS The mean age was 64.3 years and 54.7% of the patients were men. The mean HbA1c level at baseline was equal to 8.7%. In diabetologist practices, 64.7% of DMP patients and 55.1% of SC patients had HbA1c levels <7.5%, while 23.4% of DMP patients and 16.9% of SC patients had HbA1c levels <6.5% ( P values < .001). By comparison, in general practices, 72.4% of DMP patients and 65.7% of SC patients had HbA1c levels <7.5%, while 29.0% of DMP patients and 25.4% of SC patients had HbA1c levels <6.5% ( P values < .001). DMPs increased the likelihood of HbA1c levels lower than 7.5% or 6.5% after 6 months of therapy in both diabetologist and general care practices. CONCLUSION The present study indicates that the enrollment of T2DM patients in DMPs has a positive impact on HbA1c values in Germany.
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Affiliation(s)
- Karel Kostev
- IMS Health, Frankfurt, Germany
- Karel Kostev, DMSc, PhD, IMS Health, Epidemiology, Darmstädter Landstraße 1089, 60598 Frankfurt am Main, Germany.
| | | | - Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
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Desmedt M, Vertriest S, Hellings J, Bergs J, Dessers E, Vankrunkelsven P, Vrijhoef H, Annemans L, Verhaeghe N, Petrovic M, Vandijck D. Economic Impact of Integrated Care Models for Patients with Chronic Diseases: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:892-902. [PMID: 27712719 DOI: 10.1016/j.jval.2016.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/12/2016] [Accepted: 05/02/2016] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To assess the costs and potential financial benefits of integrated care models for patients with chronic diseases, that is, type 2 diabetes mellitus, schizophrenia, and multiple sclerosis, respectively. METHODS A systematic search of the literature was performed using EMBASE, MEDLINE, and Web of Science. Studies that conducted a cost analysis, considered at least two components of the chronic care model, and compared integrated care with standard care were included. RESULTS Out of 575 articles, 26 were included. Most studies examined integrated care models for type 2 diabetes mellitus (n = 18) and to a lesser extent for schizophrenia (n = 6) and multiple sclerosis (n = 2). Across the three disease groups, the incremental cost per patient per year ranged from - €3860 to + €613.91 (x¯ = - €533.61 ± €902.96). The incremental cost for type 2 diabetes mellitus ranged from - €1507.49 to + €299.20 (x¯ = - €518.22 ± + €604.75), for schizophrenia from - €3860 to + €613.91 (x¯ = - €677.21 ± + €1624.35), and for multiple sclerosis from - €822 to + €339.43 (x¯ = - €241.29 ± + €821.26). Most of the studies (22 of 26 [84.6%]) reported a positive economic impact of integrated care models: for type 2 diabetes mellitus (16 of 18 [88.9%]), schizophrenia (4 of 6 [66.7%]), and multiple sclerosis (1 of 2 [50%]). CONCLUSIONS In this systematic literature review, predominantly positive economic impacts of integrated care models for patients with chronic diseases were found.
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Affiliation(s)
- Melissa Desmedt
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
| | - Sonja Vertriest
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; AZ Delta, Roeselare, Belgium
| | - Jochen Bergs
- Faculty of Business Economics, Hasselt University, Hasselt, Belgium
| | - Ezra Dessers
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | | | - Hubertus Vrijhoef
- Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; National University Singapore and National University Health System, Singapore
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Faculty of Medicine and Health Sciences, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Riedl R, Robausch M, Berghold A. The Evaluation of the Effectiveness of Austrians Disease Management Program in Patients with Type 2 Diabetes Mellitus - A Population-Based Retrospective Cohort Study. PLoS One 2016; 11:e0161429. [PMID: 27532885 PMCID: PMC4988720 DOI: 10.1371/journal.pone.0161429] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 08/05/2016] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the effectiveness of the Austrian Disease Management Program (DMP) 'Therapie aktiv-Diabetes im Griff' for patients with type 2 diabetes mellitus concerning patient-relevant outcomes (mortality, myocardial infarction and stroke) and costs. METHODS Based on routine health insurance data, we conducted a population-based retrospective cohort study using a propensity score (PS) matched control group design. The DMP-group consists of participants enrolled in the program during 2008 and 2009 (n = 7181). Out of 208.532 patients with no participation in the DMP up to 2013, PS-matched controls were selected with a matching ratio 1:3. In the PS-model, patient's characteristics, form of antidiabetic drug therapy, several prescriptions, the number of hospital admissions and days, main discharge diagnoses and costs at baseline were included. RESULTS Over a follow-up period of four years, we observed a significantly lower mortality rate in the DMP-group (9.4%) in comparison with the control group (15.9%, p<0.001). The cumulative number of hospital days and mean annual hospital costs were lower for DMP-participants resulting in significantly lower mean annual total costs, amounting to € 8226.80 per patient in the DMP-group and € 9231.10 in the control group respectively (p<0.001). CONCLUSIONS The evaluation shows a survival benefit and an average reduction of costs for participants in the DMP compared with the control-group. Despite we took great effort to ensure comparable groups, we cannot entirely rule out an influence by residual and unmeasured confounding due to the observational study design and the use of routine data. However, the results indicate that the disease management program implemented in Austria improves quality of care for patients with type 2 diabetes mellitus.
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Affiliation(s)
- Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Martin Robausch
- Controlling Department (ÄIRCON), Lower Austria Health Insurance Fund, St. Pölten, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
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Fullerton B, Pöhlmann B, Krohn R, Adams JL, Gerlach FM, Erler A. The Comparison of Matching Methods Using Different Measures of Balance: Benefits and Risks Exemplified within a Study to Evaluate the Effects of German Disease Management Programs on Long-Term Outcomes of Patients with Type 2 Diabetes. Health Serv Res 2016; 51:1960-80. [PMID: 26841379 DOI: 10.1111/1475-6773.12452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To present a case study on how to compare various matching methods applying different measures of balance and to point out some pitfalls involved in relying on such measures. DATA SOURCES Administrative claims data from a German statutory health insurance fund covering the years 2004-2008. STUDY DESIGN We applied three different covariance balance diagnostics to a choice of 12 different matching methods used to evaluate the effectiveness of the German disease management program for type 2 diabetes (DMPDM2). We further compared the effect estimates resulting from applying these different matching techniques in the evaluation of the DMPDM2. PRINCIPAL FINDINGS The choice of balance measure leads to different results on the performance of the applied matching methods. Exact matching methods performed well across all measures of balance, but resulted in the exclusion of many observations, leading to a change of the baseline characteristics of the study sample and also the effect estimate of the DMPDM2. All PS-based methods showed similar effect estimates. Applying a higher matching ratio and using a larger variable set generally resulted in better balance. Using a generalized boosted instead of a logistic regression model showed slightly better performance for balance diagnostics taking into account imbalances at higher moments. CONCLUSION Best practice should include the application of several matching methods and thorough balance diagnostics. Applying matching techniques can provide a useful preprocessing step to reveal areas of the data that lack common support. The use of different balance diagnostics can be helpful for the interpretation of different effect estimates found with different matching methods.
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Affiliation(s)
- Birgit Fullerton
- Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany.
| | - Boris Pöhlmann
- AQUA Institute (Institute for Applied Quality Improvement and Research in Health Care), Göttingen, Germany
| | - Robert Krohn
- AQUA Institute (Institute for Applied Quality Improvement and Research in Health Care), Göttingen, Germany
| | - John L Adams
- Department of Research and Evaluation, Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, CA
| | - Ferdinand M Gerlach
- Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Antje Erler
- Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany
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Kirsch F. A systematic review of Markov models evaluating multicomponent disease management programs in diabetes. Expert Rev Pharmacoecon Outcomes Res 2015; 15:961-84. [DOI: 10.1586/14737167.2015.1108191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fuchs S, Henschke C, Blümel M, Busse R. Disease management programs for type 2 diabetes in Germany: a systematic literature review evaluating effectiveness. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:453-63. [PMID: 25019922 DOI: 10.3238/arztebl.2014.0453] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Disease management programs (DMPs) are intended to improve the care of persons with chronic diseases. Despite numerous studies there is no unequivocal evidence about the effectiveness of DMPs in Germany. METHOD We conducted a systematic literature review in the MEDLINE, EMBASE, Cochrane Library, and CCMed databases. Our analysis included all controlled studies in which patients with type 2 diabetes enrolled in a DMP were compared to type 2 diabetes patients receiving routine care with respect to process, outcome, and economic parameters. RESULTS The 9 studies included in the analysis were highly divergent with respect to their characteristics and the process and outcome parameters studied in each. No study had data beyond the year 2008. In 3 publications, the DMP patients had a lower mortality than the control patients (2.3%, 11.3%, and 7.17% versus 4.7%, 14.4%, and 14.72%). In 2 publications, DMP participation was found to be associated with a mean survival time of 1044.94 (± 189.87) days, as against 985.02 (± 264.68) in the control group. No consistent effect was seen with respect to morbidity, quality of life, or economic parameters. 7 publications from 5 studies revealed positive effects on process parameters for DMP participants. CONCLUSION The observed beneficial trends with respect to mortality and survival time, as well as improvements in process parameters, indicate that DMPs can, in fact, improve the care of patients with diabetes. Further evaluation is needed, because some changes in outcome parameters (an important indicator of the quality of care) may only be observable over a longer period of time.
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Affiliation(s)
- Sabine Fuchs
- Department of Health Care Management, Technische Universität Berlin, Shared authorship: Fuchs, Henschke and Blümel have equally contributed to the article
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[Analysis of type 2 diabetes-induced late effects based on administrative data of social insurance in Austria and implications for the evaluation of the DMP diabetes mellitus]. Wien Med Wochenschr 2014; 164:313-9. [PMID: 25069758 DOI: 10.1007/s10354-014-0291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
The present study analyses administrative data of medical services related to the distribution of diabetes mellitus type 2-induced late effects. Pseudonymous statutory health insurance data of all Austrian social security institutions for the years 2006/2007 in outpatient and inpatient (performance and diagnostic data) setting were used. Type 2 diabetics have been identified by prescribed medication. The specific late effects were defined as endpoints and the respective diagnoses and health performances were extracted. The study population included 7,945,774 insured. The percentage of the defined late effects was significantly higher in diabetics than in persons from the general population, with exception for kidney transplantation. The risk of a late effect was greatest among diabetics for an amputation. The results of this study can be used as a baseline for the evaluation of DMP diabetes. The administrative data used are limited for answering the defined research questions. Anyway, the data quality must be improved and unified in Austria.
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Improving care of post-infarct patients: effects of disease management programmes and care according to international guidelines. Clin Res Cardiol 2013; 103:237-45. [PMID: 24287605 DOI: 10.1007/s00392-013-0643-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac disease management programmes (CHD-DMPs) and secondary cardiovascular prevention guidelines aim to improve complex care of post-myocardial infarction (MI) patients. In Germany, CHD-DMPs, in addition to incorporating medical care according to guidelines (guideline-care), also ensure regular quarterly follow-up. Thus, our aim was to examine whether CHD-DMPs increase the frequency of guideline-care and whether CHD-DMPs and guideline-care improve survival over 4 years. METHODS The study included 975 post-MI patients, registered by the KORA-MI Registry (Augsburg, Germany), who completed a questionnaire in 2006. CHD-DMP enrolment was reported by physicians. Guideline-care was based on patient reports regarding medical advice (smoking, diet, or exercise) and prescribed medications (statins and platelet aggregation inhibitors plus beta-blockers or renin-angiotensin inhibitors). All-cause mortality until December 31, 2010 was based on municipal registration data. Cox regression analyses were adjusted for age, sex, education, years since last MI, and smoking and diabetes. RESULTS Physicians reported that 495 patients were CHD-DMP participants. CHD-DMP participation increased the likelihood of receiving guideline-care (odds ratio 1.55, 95% CI 1.20; 2.02) but did not significantly improve survival (hazard rate 0.90, 95% CI 0.64-1.27). Guideline-care significantly improved survival (HR 0.41, 95% CI 0.28; 0.59). Individual guideline-care components, which significantly improved survival, were beta-blockers, statins and platelet aggregation inhibitors. However, these improved survival less than guideline-care. CONCLUSIONS This study shows that CHD-DMPs increase the likelihood of guideline care and that guideline care is the important component of CHD-DMPs for increasing survival. A relatively high percentage of usual care patients receiving guideline-care indicate high quality of care of post-MI patients. Reasons for not implementing guideline-care should be investigated.
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Rathmann W, Scheidt-Nave C, Roden M, Herder C. Type 2 diabetes: prevalence and relevance of genetic and acquired factors for its prediction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:331-7. [PMID: 23762204 PMCID: PMC3673039 DOI: 10.3238/arztebl.2013.0331] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 01/08/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The epidemiology of type 2 diabetes in Germany is of major societal interest, as is the question of the predictive value of genetic and acquired risk factors. METHODS We present clinically relevant aspects of these topics on the basis of a selective review of pertinent literature retrieved by a PubMed search that centered on population-based studies. RESULTS The German Health Interview and Examination Survey for Adults (Studie zur Gesundheit Erwachsener in Deutschland [DEGS1], 2008-2011) revealed that diabetes was diagnosed in 7.2% of the population aged 18 to 79 years (women 7.4%, men 7.0%). These figures are two percentage points higher than those found in the preceding national survey (1998). The percentage of cases that were not captured by these surveys is estimated at 2% to 7% depending on the method. Independently of personal factors (the individual's life style), it seems that living in a disadvantaged region characterized by high unemployment, air pollution, and poor infrastructure raises the risk of diabetes. Moreover, type 2 diabetes has a substantial hereditary component. More than 60 genetic regions have been identified to date that affect the risk of type 2 diabetes, yet all of them together account for only 10% to 15% of the genetic background of the disease. CONCLUSION The prevalence of type 2 diabetes in Germany has risen in recent years. The discovery of new genetic variants that confer a higher risk of developing the disease has improved our understanding of insulin secretion in diabetes pathogenesis rather than the prediction of individual diabetes risk ("personalized medicine").
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Affiliation(s)
- Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf
| | | | - Michael Roden
- Department of Endocrinology and Diabetology, Heinrich-Heine-Universität Düsseldorf
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf
| | - Christian Herder
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf
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