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Bischoff MS, Skrypnik D, Fiori W, Schöffski O, Böckler D. [Cost-revenue aspects of endovascular treatment of distal aortic arch pathologies with respect to the introduction of a new thoracic side-branch prosthesis]. Chirurgie (Heidelb) 2024:10.1007/s00104-024-02072-3. [PMID: 38498124 DOI: 10.1007/s00104-024-02072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND The standard vascular surgical procedure (SV) for the treatment of distal aortic arch pathologies involves a hybrid approach using a left carotid-subclavian bypass and thoracic endovascular aortic repair. Considering the introduction of a thoracic side branch prosthesis (TBE), the aim of this study was to analyze the cost-revenue aspects of both procedures. MATERIAL AND METHODS A retrospective analysis was conducted on cases treated by SV from 2017 to 2022. To draw conclusions regarding the use of TBE, the main diagnoses and procedures of SV were recoded based on current classifications (ICD/OPS 2023) for revenue calculations and regrouped according to aG-DRG 2023. An OPS modification and regrouping were performed for modeling TBE revenues. RESULTS A total of 13 cases were identified (mean age 62.5 ± 13.8 years; 10 males). After regrouping, the following DRGs were obtained: F42Z in N = 5, F51A in N = 4, F08B in N = 2, and F07A and F36B each in N = 1. The total revenue after regrouping was € 666,514.13, including an additional payment (ZE) of € 132,729.14. With the modeled application of TBE, a total revenue of € 659,212.19 was achieved. Compared to SV, this represents a revenue decrease of € 16,886.71 (changed DRG), but with an increase in ZE revenue by € 65,559.78 (different ZE). The use of TBE resulted in a saving of 74 occupancy days, including 13.5 days in intensive care. CONCLUSION A cost coverage seems probable with a change in the procedure, despite the yet to be determined pricing of TBE. This is highly dependent on the coding quality and the future development of ZE, given the annually changing DRG relative weights. Precise and transparent performance and cost documentation are essential for determining the pricing.
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Affiliation(s)
- Moritz S Bischoff
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - Denis Skrypnik
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Wolfgang Fiori
- DRG-Research-Group, Roeder & Partner Ärzte PartG, Senden, Deutschland, Am Dorn 10, 48308
| | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Deutschland, Lange Gasse 20, 90403
| | - Dittmar Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
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Wolfschmidt-Fietkau A, Ochmann U, Hiller J, Nowak D, Schöffski O, Drexler H. [Economic Relevance of Preventable Prohibitions of Employment in Bavarian Schools]. Gesundheitswesen 2024. [PMID: 38467151 DOI: 10.1055/a-2251-5727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION According to the Maternity Protection Act, an occupational risk of infection (e. g. in childcare) - combined with individual immunity gaps - can result in an irresponsible risk for pregnant women in the workplace. If this risk cannot be eliminated by any other means, the employer must impose a prohibition of employment (PE) for the pregnant woman concerned. We classified PE as preventable if the underlying immunity gaps could have been closed by immunisation prior to pregnancy. METHODS From 01.09.2016 to 25.03.2020, 1922 pregnant employees of Bavarian state schools obtained medical counselling on their occupational risk of infection as part of a research project. If the individual combination of occupational-risk profile and immunity status resulted in an irresponsible risk for the pregnancy, a PE was recommended by the attending physician. We determined the proportion of PE that would have theoretically been preventable by full immunisation prior to pregnancy and approximated the resulting - theoretically preventable - loss of working hours and personnel costs. RESULTS In 425 cases (22%), a PE was deemed necessary by the attending physician, whereby 193 (45%) were retrospectively classified as theoretically preventable. Of these cases, 53 PE (27%) were temporary (valid until the 20th week of pregnancy) and 140 were long-term (valid for the complete duration of the pregnancy). Based on these results, we approximated a loss of 2,746 working weeks for our collective, which entails theoretically preventable personnel costs totalling 5,763,305 € for the observation period of our study (3.6 years). We then extrapolated estimates for all employees of Bavarian state schools and found a loss of 4,260 working weeks and theoretically preventable personnel costs amounting to almost 8,941,000 € per year during our observation period. CONCLUSION Theoretically preventable PE caused by immunity gaps can entail a considerable loss of working hours and high personnel costs. Therefore, we should step up measures aimed at improving vaccination rates in women and increasing their willingness to be vaccinated. In view of the changes in legal and regulatory conditions in Germany since 2020, new investigations should be made as soon as there is sufficient data after the general employment prohibitions due to the SARS-CoV-2-pandemic have been lifted.
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Affiliation(s)
- Anna Wolfschmidt-Fietkau
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Uta Ochmann
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Julia Hiller
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - Oliver Schöffski
- Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Hans Drexler
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
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Emmert M, Schindler A, Heppe L, Sander U, Patzelt C, Lauerer M, Nagel E, Frömke C, Schöffski O, Drach C. Referring physicians' intention to use hospital report cards for hospital referral purposes in the presence or absence of patient-reported outcomes: a randomized trial. Eur J Health Econ 2024; 25:293-305. [PMID: 37052802 PMCID: PMC10858825 DOI: 10.1007/s10198-023-01587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to explore the relevance of publicly available hospital performance information from the perspective of referring physicians. METHODS We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May-June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs. RESULTS Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (p = 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387, p < .001). However, referring physicians have doubts as to whether HRCs can help them. We identified "complication rate" and "the number of cases treated" as most important for the hospital referral decision making; PROs were rated slightly less important. CONCLUSIONS This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention.
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Affiliation(s)
- Martin Emmert
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany.
| | - Anja Schindler
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Laura Heppe
- School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander-University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Uwe Sander
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Christiane Patzelt
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Michael Lauerer
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany
| | - Eckhard Nagel
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany
| | - Cornelia Frömke
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Oliver Schöffski
- School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander-University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Cordula Drach
- School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander-University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
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Emmert M, Rohrbacher S, Meier F, Heppe L, Drach C, Schindler A, Sander U, Patzelt C, Frömke C, Schöffski O, Lauerer M. The elicitation of patient and physician preferences for calculating consumer-based composite measures on hospital report cards: results of two discrete choice experiments. Eur J Health Econ 2023:10.1007/s10198-023-01650-2. [PMID: 38102524 DOI: 10.1007/s10198-023-01650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences of both patients as well as referring physicians regarding publicly available hospital quality information METHODS: Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients' and referring physicians' preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models RESULTS: Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (p < 0.001 each). Among patients, "Postoperative complication rate" (20.6%; level range of 1.164) was rated highest, followed by "Mobility at hospital discharge" (19.9%; level range of 1.127), and ''The number of cases treated" (18.5%; level range of 1.045). In contrast, referring physicians valued most the ''One-year revision surgery rate'' (30.4%; level range of 1.989), followed by "The number of cases treated" (21.0%; level range of 1.372), and "Postoperative complication rate" (17.2%; level range of 1.123) CONCLUSION: We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting.
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Affiliation(s)
- Martin Emmert
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany.
| | - Stefan Rohrbacher
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany
| | - Florian Meier
- Department of Management and Economics, SRH Wilhelm Löhe University of Applied Sciences, 90763, Fürth, Germany
| | - Laura Heppe
- School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander-University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Cordula Drach
- School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander-University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Anja Schindler
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Uwe Sander
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Christiane Patzelt
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Cornelia Frömke
- Department of Information and Communication, Faculty for Media, Information and Design, University of Applied Sciences and Arts, Hannover, Germany
| | - Oliver Schöffski
- School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander-University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Michael Lauerer
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444, Bayreuth, Germany
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Fischer A, Schöffski O, Nießen A, Hamm A, Langan EA, Büchler MW, Billmann F. Retroperitoneoscopic adrenalectomy may be superior to laparoscopic transperitoneal adrenalectomy in terms of costs and profit: a retrospective pair-matched cohort analysis. Surg Endosc 2023; 37:8104-8115. [PMID: 37658201 PMCID: PMC10519868 DOI: 10.1007/s00464-023-10395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/13/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND A direct comparison of the cost-benefit analysis of retroperitoneoscopic adrenalectomy (RPA) versus the minimally invasive transperitoneal access (LTA) approach is currently lacking. We hypothesized that RPA is more cost effective than LTA; promising significant savings for the healthcare system in an era of ever more limited resources. METHODS We performed a monocentric retrospective observational cohort study based on data from our Endocrine Surgery Registry. Patients who were operated upon between 2019 and 2022 were included. After pair-matching, both cohorts (RPA vs. LTA) were compared for perioperative variables and treatment costs (process cost calculation), revenue and profit. RESULTS Two homogenous cohorts of 43 patients each (RPA vs. LTA) were identified following matching. Patient characteristics between the cohorts were comparable. In terms of both treatment-associated costs and profit, the RPA procedure was superior to LTA (costs: US$5789.99 for RPA vs. US$6617.75 for LTA, P = 0.043; profit: US$1235.59 for RPA vs. US$653.33 for LTA, P = 0.027). The duration of inpatient treatment and comorbidities significantly influenced the cost of treatment and the overall profit. CONCLUSIONS RPA appears not only to offer benefits over LTA in terms of perioperative morbidity and length of hospital stay, but also has a superior financial cost/benefit profile.
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Affiliation(s)
- Andreas Fischer
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Oliver Schöffski
- Fachbereich Wirtschaftswissenschaften, Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-University Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Germany
| | - Anna Nießen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Alexander Hamm
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Ewan A Langan
- Department of Dermatology, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Dermatological Science, University of Manchester, Manchester, UK
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Heinrich F, Cordts I, Günther R, Stolte B, Zeller D, Schröter C, Weyen U, Regensburger M, Wolf J, Schneider I, Hermann A, Metelmann M, Kohl Z, Linker RA, Koch JC, Radelfahr F, Schönfelder E, Gardt P, Mohajer-Peseschkian T, Osmanovic A, Klopstock T, Dorst J, Ludolph AC, Schöffski O, Boentert M, Hagenacker T, Deschauer M, Lingor P, Petri S, Schreiber-Katz O. Economic evaluation of Motor Neuron Diseases: a nationwide cross-sectional analysis in Germany. J Neurol 2023; 270:4922-4938. [PMID: 37356024 PMCID: PMC10511618 DOI: 10.1007/s00415-023-11811-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Motor Neuron Diseases (MND) are rare diseases but have a high impact on affected individuals and society. This study aims to perform an economic evaluation of MND in Germany. METHODS Primary patient-reported data were collected including individual impairment, the use of medical and non-medical resources, and self-rated Health-Related Quality of Life (HRQoL). Annual socio-economic costs per year as well as Quality-Adjusted Life Years (QALYs) were calculated. RESULTS 404 patients with a diagnosis of Amyotrophic Lateral Sclerosis (ALS), Spinal Muscular Atrophy (SMA) or Hereditary Spastic Paraplegia (HSP) were enrolled. Total annual costs per patient were estimated at 83,060€ in ALS, 206,856€ in SMA and 27,074€ in HSP. The main cost drivers were informal care (all MND) and disease-modifying treatments (SMA). Self-reported HRQoL was best in patients with HSP (mean EuroQoL Five Dimension Five Level (EQ-5D-5L) index value 0.67) and lowest in SMA patients (mean EQ-5D-5L index value 0.39). QALYs for patients with ALS were estimated to be 1.89 QALYs, 23.08 for patients with HSP and 14.97 for patients with SMA, respectively. Cost-utilities were estimated as follows: 138,960€/QALY for ALS, 525,033€/QALY for SMA, and 49,573€/QALY for HSP. The main predictors of the high cost of illness and low HRQoL were disease progression and loss of individual autonomy. CONCLUSION As loss of individual autonomy was the main cost predictor, therapeutic and supportive measures to maintain this autonomy may contribute to reducing high personal burden and also long-term costs, e.g., care dependency and absenteeism from work.
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Affiliation(s)
- Felix Heinrich
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Isabell Cordts
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- German Center for Neurodegenerative Diseases (DZNE), 01307 Dresden, Germany
| | - Benjamin Stolte
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany
| | - Daniel Zeller
- Department of Neurology, University of Würzburg, 97080 Würzburg, Germany
| | - Carsten Schröter
- Hoher Meißner Clinic, Neurology, 37242 Bad Sooden-Allendorf, Germany
| | - Ute Weyen
- Department of Neurology, Ruhr-University Bochum, BG-Kliniken Bergmannsheil, 44789 Bochum, Germany
| | - Martin Regensburger
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Center for Rare Diseases Erlangen (ZSEER), University Hospital Erlangen, 91054 Erlangen, Germany
| | - Joachim Wolf
- Department of Neurology, Diakonissen Hospital Mannheim, 68163 Mannheim, Germany
| | - Ilka Schneider
- Department of Neurology, Martin-Luther University Halle/Saale, 06120 Halle, Germany
- Department of Neurology, Klinikum Sankt Georg, 04129 Leipzig, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section “Albrecht-Kossel”, Department of Neurology, University Medical Center Rostock, University of Rostock, 18147 Rostock, Germany
- German Center for Neurodegenerative Diseases Rostock/Greifswald, 18147 Rostock, Germany
| | - Moritz Metelmann
- Department of Neurology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Zacharias Kohl
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Ralf A. Linker
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Jan Christoph Koch
- Department of Neurology, University Medicine Göttingen, 37075 Göttingen, Germany
| | - Florentine Radelfahr
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
| | - Erik Schönfelder
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Pavel Gardt
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Tara Mohajer-Peseschkian
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Alma Osmanovic
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
- Essener Zentrum Für Seltene Erkrankungen (EZSE), Universitätsmedizin Essen, University Hospital Essen, Essen, Germany
| | - Thomas Klopstock
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, Ludwig Maximilian University of Munich, 80336 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Johannes Dorst
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Albert C. Ludolph
- Department of Neurology, University of Ulm, 89081 Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), 89081 Ulm, Germany
| | - Oliver Schöffski
- Chair of Health Management, School of Business, Economics and Society, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, 90403 Nuremberg, Germany
| | - Matthias Boentert
- Department of Neurology with the Institute of Translational Neurology, University Hospital Münster, 48149 Münster, Germany
- Department of Medicine, UKM Marienhospital, 48565 Steinfurt, Germany
| | - Tim Hagenacker
- Department of Neurology, University Medicine Essen, 45147 Essen, Germany
| | - Marcus Deschauer
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Paul Lingor
- Department of Neurology, Klinikum Rechts Der Isar, Technical University of Munich, 81675 Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 80336 Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), 80336 Munich, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, Carl-Neuberg Straße 1, 30625 Hannover, Germany
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7
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Mühlenfeld N, Vollrath JT, Hörauf JA, Schöffski O, Sterz J, Riemenschneider J, Störmann P, Marzi I, Verboket RD. [Costs-revenue deficit of outpatient treatment of minor injuries in the emergency department]. Unfallchirurgie (Heidelb) 2023; 126:433-440. [PMID: 35796817 DOI: 10.1007/s00113-022-01205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND Many patients with minor injuries hastily present in the emergency department and tie up resources and personnel there. OBJECTIVE To establish the cost-revenue relationship of outpatient care of minor injuries in the traumatology emergency department. MATERIAL AND METHODS The calculation was based on the uniformly billed emergency flat rates of the uniform assessment standard (EBM). Using the current collective bargaining agreements for physicians and nurses, per minute costs were calculated. The time required for treatment was determined on the basis of 100 reference patients with minor injuries. The case cost calculation with the respective resources was carried out with the operational controlling of the University Hospital Frankfurt. RESULTS A total of 4088 patients with minor injuries who presented in 2019 were included. Most common reasons for presentation were contusions of the lower (31.9%; n = 1303) and upper extremities (16.6%; n = 677). A time expenditure of 166.7 min per day for the medical staff and 213.8 min per day for nursing staff was calculated. A total revenue of 29,384.31 € and total costs of 69,591.22 € were calculated. Thus, a revenue deficit of -40,206.91 € can be calculated for the year 2019. This corresponds to a monetary deficit of 9.84 € per patient. CONCLUSION There is a shortage of the medical resource "personnel" to satisfactorily and economically manage the nowadays high volume of self-presenting pedestrian patients with minor injuries. The current remuneration of the treatment of minor injuries by the uniform assessment scale is insufficient for the hospital sector.
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Affiliation(s)
- Nils Mühlenfeld
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Jan Tilmann Vollrath
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Jason-Alexander Hörauf
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Jasmina Sterz
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Julia Riemenschneider
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Philipp Störmann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ingo Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - René D Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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8
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Kast K, Adelhardt T, Schöffski O. Transitional Care Model in Germany: Findings from an economic analysis of a randomized controlled trial. Z Evid Fortbild Qual Gesundhwes 2023:S1865-9217(23)00039-9. [PMID: 37127456 DOI: 10.1016/j.zefq.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/31/2023] [Accepted: 03/13/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The statutory discharge management system in German hospitals does not provide adequate transitional care for geriatric patients. The American Transitional Care Model (TCM), where a qualified professional supports the patient for a period before, during, and after discharge, could help to address this problem. In this study, we compared both approaches from an economic perspective. Our research questions were: (1) How do treatment costs per person differ when geriatric patients are supported according to the TCM compared with routine discharge management? (2) What are the intervention costs? METHODS The present economic analysis was part of a randomized controlled trial conducted at a hospital in Germany. In this study, geriatric patients in the intervention group received care according to TCM and those in the control group received routine care. We obtained data from the hospital and a health insurance company. In a cost-cost analysis, we compared the treatment costs per patient incurred in both study groups. In cases where higher costs occurred in the intervention group, we also conducted a cost-utility analysis, using the 12-Item Short Form Survey questionnaire to collect quality-of-life data for the Quality Adjusted Life Years calculation. Intervention costs were calculated on the basis of staff salaries, working hours, and the cost of acquiring the necessary equipment. RESULTS The intervention group consisted of 109 geriatric patients, the control group of 119. The average quality-of-life score was slightly higher in the intervention group, but the difference was not significant. On average, the intervention group was less expensive. However, for individual cost types (e.g., rehabilitation), the intervention group incurred higher costs than the control group. The differences between the study groups were not significant for all cost types (p > 0.05). Intervention costs were estimated to be approximately 800 euros per patient. DISCUSSION The TCM approach leads to savings. However, the quantum of savings will depend on intervention costs, which vary in practice. After outlier exclusion, an unfavorable incremental cost-effectiveness ratio is observed for the TCM approach. CONCLUSION From an economic perspective, TCM in its present form provides no additional value to patient care compared with routine discharge management. However, we see an urgent need to optimize the existing discharge management system to ensure better transitional care for those affected. Therefore, we recommend that different TCM components should be tested in further studies to address the questions that could not be clarified in the present study.
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Affiliation(s)
- Kristina Kast
- Chair of Health Care Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany.
| | - Thomas Adelhardt
- Chair of Health Care Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Oliver Schöffski
- Chair of Health Care Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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9
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Hofauer B, Pförringer D, Schöffski O, Zhu Z, Offergeld C. [Digital health applications in otorhinolaryngology]. HNO 2023; 71:304-310. [PMID: 36734998 PMCID: PMC10125941 DOI: 10.1007/s00106-022-01271-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the passing of the "Digital Care Act" by the German Bundestag at the end of 2019, it was made possible, among other things, for digital health applications to be reimbursed by statutory health insurance companies under certain conditions. The aim of this work is to identify digital health applications related to ear, nose, and throat medicine and to describe the underlying evidence. MATERIALS AND METHODS The digital health applications register was analyzed to identify digital health applications with an indication area relating to an otorhinolaryngologic disease. Digital health applications were included that were either permanently or provisionally included, or currently deleted if further information was available. The underlying evidence was assessed according to the recommendations of the Oxford Center for Evidence-Based Medicine for therapeutic studies. RESULTS A total of six digital health applications with a direct or indirect connection to otorhinolaryngology were identified, three of which were permanently and two provisionally included in the directory. One digital health application has currently been withdrawn by the manufacturer. The permanently recorded digital health applications are based on evidence level 1b. CONCLUSION The introduction of digital health applications is sometimes also discussed critically, but they represent an innovative approach and various digital health applications with a high level of underlying evidence are already available, especially for the ear, nose, and throat area.
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Affiliation(s)
- Benedikt Hofauer
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Zhaojun Zhu
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - Christian Offergeld
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland
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10
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Blunck D, Schöffski O. Hyaluronic acid treatment versus standard of care in chronic wounds in a German setting: Cost‐effectiveness analysis. Health Sci Rep 2023; 6:e969. [DOI: 10.1002/hsr2.969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Dominik Blunck
- Department of Health Management, Institute of Management Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU) Nuremberg Germany
| | - Oliver Schöffski
- Department of Health Management, Institute of Management Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU) Nuremberg Germany
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11
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Franzen D, Bodmer C, Ehrenbaum S, Steinack C, Opitz I, Docter K, Schöffski O. Cost-effectiveness analysis of surgical lung volume reduction compared with endobronchial valve treatment in patients with severe emphysema. Swiss Med Wkly 2022; 152:40008. [PMID: 36509427 DOI: 10.57187/smw.2022.40008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung volume reduction, either by surgery or bronchoscopically by endobronchial valve treatment have been shown to be a cost-effective alternative compared with conservative therapy. However, there is no comparative analysis of lung volume reduction by surgery and bronchoscopic lung volume reduction using endobronchial valves. OBJECTIVES The aim of this retrospective study was to provide a cost-effectiveness analysis of lung volume reduction by surgery compared with bronchoscopic lung volume reduction using endobronchial valves. METHODS The effectiveness of lung volume reduction was assessed using forced expiratory volume in the first second (FEV1), residual volume (RV) and 6-minute walking distance (6MWD), measured at baseline and at 4 to 12 weeks. Cost unit accounting derived from SwissDRG was used as a surrogate of the costs from the payer's perspective. RESULTS In total, 67 patients (37 men and 30 women) with a mean age of 68.3 ± 7.4 years were included. Both clinical effectiveness and costs were comparable between surgical and bronchoscopic lung reduction. The incremental cost-effectiveness ratios (ICERs) for bronchoscopic compared with lung volume reduction by surgery for FEV1, RV and 6MWD were -101, 4 and 58, respectively. For RV and 6MWD, it could be shown that endobronchial valve treatment is justified as a probably cost-effective alternative to lung volume reduction by surgery. Endobronchial valve treatment resulted in an improvement of 0.25 quality-adjusted life years (QALYs) and an ICER of € 7657 per QALY gained. CONCLUSION A robust statement on the superiority of one of the two procedures in terms of cost-effectiveness cannot be made from the present study. Therefore, the study is not suitable for resource allocation. Two upcoming trials comparing lung volume reduction surgery and endobronchial valve treatment may be able to answer this question.
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Affiliation(s)
- Daniel Franzen
- Departement of Pulmonology, University Hospital Zurich, Switzerland.,Department of Internal Medicine, Spital Uster, Switzerland
| | - Christa Bodmer
- Departement of Pulmonology, University Hospital Zurich, Switzerland
| | - Simon Ehrenbaum
- Division of Heart, Vessel and Thorax, University Hospital Zurich, Switzerland
| | - Carolin Steinack
- Departement of Pulmonology, University Hospital Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Katrin Docter
- Division of Health Management, School of Business, Economics and Society, Friedrich-Alexander University, Nuremberg, Germany
| | - Oliver Schöffski
- Division of Health Management, School of Business, Economics and Society, Friedrich-Alexander University, Nuremberg, Germany
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12
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Ellmann S, Maryschok M, Schöffski O, Emmert M. The German COVID-19 Digital Contact Tracing App: A Socioeconomic Evaluation. Int J Environ Res Public Health 2022; 19:14318. [PMID: 36361198 PMCID: PMC9654962 DOI: 10.3390/ijerph192114318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic posed challenges to governments in terms of contact tracing. Like many other countries, Germany introduced a mobile-phone-based digital contact tracing solution ("Corona Warn App"; CWA) in June 2020. At the time of its release, however, it was hard to assess how effective such a solution would be, and a political and societal debate arose regarding its efficiency, also in light of its high costs. This study aimed to analyze the effectiveness of the CWA, considering prevented infections, hospitalizations, intensive care treatments, and deaths. In addition, its efficiency was to be assessed from a monetary point of view, and factors with a significant influence on the effectiveness and efficiency of the CWA were to be determined. Mathematical and statistical modeling was used to calculate infection cases prevented by the CWA, along with the numbers of prevented complications (hospitalizations, intensive care treatments, deaths) using publicly available CWA download numbers and incidences over time. The monetized benefits of these prevented cases were quantified and offset against the costs incurred. Sensitivity analysis was used to identify factors critically influencing these parameters. Between June 2020 and April 2022, the CWA prevented 1.41 million infections, 17,200 hospitalizations, 4600 intensive care treatments, and 7200 deaths. After offsetting costs and benefits, the CWA had a net present value of EUR 765 m in April 2022. Both the effectiveness and efficiency of the CWA are decisively and disproportionately positively influenced by the highest possible adoption rate among the population and a high rate of positive infection test results shared via the CWA.
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Affiliation(s)
- Stephan Ellmann
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany
| | - Markus Maryschok
- School of Business, Economics and Society, Chair for Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403 Nürnberg, Germany
| | - Oliver Schöffski
- School of Business, Economics and Society, Chair for Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403 Nürnberg, Germany
| | - Martin Emmert
- Faculty of Law, Business and Economics, Institute for Healthcare Management and Health Sciences, University of Bayreuth, Prieserstraße 2, 95444 Bayreuth, Germany
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13
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Pecqueux M, Riediger C, Distler M, Oehme F, Bork U, Kolbinger FR, Schöffski O, van Wijngaarden P, Weitz J, Schweipert J, Kahlert C. The use and future perspective of Artificial Intelligence-A survey among German surgeons. Front Public Health 2022; 10:982335. [PMID: 36276381 PMCID: PMC9580562 DOI: 10.3389/fpubh.2022.982335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023] Open
Abstract
Purpose Clinical abundance of artificial intelligence has increased significantly in the last decade. This survey aims to provide an overview of the current state of knowledge and acceptance of AI applications among surgeons in Germany. Methods A total of 357 surgeons from German university hospitals, academic teaching hospitals and private practices were contacted by e-mail and asked to participate in the anonymous survey. Results A total of 147 physicians completed the survey. The majority of respondents (n = 85, 52.8%) stated that they were familiar with AI applications in medicine. Personal knowledge was self-rated as average (n = 67, 41.6%) or rudimentary (n = 60, 37.3%) by the majority of participants. On the basis of various application scenarios, it became apparent that the respondents have different demands on AI applications in the area of "diagnosis confirmation" as compared to the area of "therapy decision." For the latter category, the requirements in terms of the error level are significantly higher and more respondents view their application in medical practice rather critically. Accordingly, most of the participants hope that AI systems will primarily improve diagnosis confirmation, while they see their ethical and legal problems with regard to liability as the main obstacle to extensive clinical application. Conclusion German surgeons are in principle positively disposed toward AI applications. However, many surgeons see a deficit in their own knowledge and in the implementation of AI applications in their own professional environment. Accordingly, medical education programs targeting both medical students and healthcare professionals should convey basic knowledge about the development and clinical implementation process of AI applications in different medical fields, including surgery.
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Affiliation(s)
- Mathieu Pecqueux
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Carina Riediger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Florian Oehme
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Fiona R. Kolbinger
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- Else Kröner Fresenius Center for Digital Health (EKFZ) Dresden, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Oliver Schöffski
- Chair of Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), National Center for Tumor Diseases Dresden (NCT/UCC), Heidelberg, Germany
| | - Johannes Schweipert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
| | - Christoph Kahlert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, German Cancer Research Center (DKFZ), National Center for Tumor Diseases Dresden (NCT/UCC), Heidelberg, Germany
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14
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Poeppl TB, Dimas E, Sakreida K, Kernbach JM, Markello RD, Schöffski O, Dagher A, Koellinger P, Nave G, Farah MJ, Mišić B, Bzdok D. Pattern learning reveals brain asymmetry to be linked to socioeconomic status. Cereb Cortex Commun 2022; 3:tgac020. [PMID: 35702547 PMCID: PMC9188625 DOI: 10.1093/texcom/tgac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022] Open
Abstract
Socioeconomic status (SES) anchors individuals in their social network layers. Our embedding in the societal fabric resonates with habitus, world view, opportunity, and health disparity. It remains obscure how distinct facets of SES are reflected in the architecture of the central nervous system. Here, we capitalized on multivariate multi-output learning algorithms to explore possible imprints of SES in gray and white matter structure in the wider population (n ≈ 10,000 UK Biobank participants). Individuals with higher SES, compared with those with lower SES, showed a pattern of increased region volumes in the left brain and decreased region volumes in the right brain. The analogous lateralization pattern emerged for the fiber structure of anatomical white matter tracts. Our multimodal findings suggest hemispheric asymmetry as an SES-related brain signature, which was consistent across six different indicators of SES: degree, education, income, job, neighborhood and vehicle count. Hence, hemispheric specialization may have evolved in human primates in a way that reveals crucial links to SES.
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Affiliation(s)
- Timm B Poeppl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Department of Health Management, School of Business, Economics and Society, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Emile Dimas
- Department of Biomedical Engineering, McConnell Brain Imaging Center (BIC), Montreal Neurological Institute (MNI), Faculty of Medicine, School of Computer Science, McGill University, Montreal, Quebec, Canada
| | - Katrin Sakreida
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Julius M Kernbach
- Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Ross D Markello
- McConnell Brain Imaging Center (BIC), Montreal Neurological Institute (MNI), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Oliver Schöffski
- Department of Health Management, School of Business, Economics and Society, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
| | - Alain Dagher
- Montreal Neurological Institute (MNI), McGill University, Montreal, Quebec, Canada
| | - Philipp Koellinger
- Department of Economics, School of Business and Economics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Gideon Nave
- Marketing Department, The Wharton School, University of Pennsylvania, Philadelphia, United States of America
| | - Martha J Farah
- Center for Neuroscience & Society, University of Pennsylvania, Philadelphia, United States of America
| | - Bratislav Mišić
- McConnell Brain Imaging Center (BIC), Montreal Neurological Institute (MNI), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Center (BIC), Montreal Neurological Institute (MNI), Faculty of Medicine, School of Computer Science, McGill University, Montreal, Quebec, Canada
- Mila – Quebec Artificial Intelligence Institute, Montreal, Quebec, Canada
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15
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Clasen K, Gani C, Schroeder C, Riess O, Zips D, Schöffski O, Clasen S. The patients view on genetics and functional imaging for precision medicine: a willingness-to-pay analysis. Per Med 2022; 19:103-112. [PMID: 34984920 DOI: 10.2217/pme-2021-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose: Willingness-to-pay (WTP) analyses can support allocation processes considering the patients preferences in personalized medicine. However, genetic testing especially might imply ethical concerns that have to be considered. Methods: A WTP questionnaire was designed to compare preferences for imaging and genetic testing in cancer patients and to evaluate potential ethical concerns. Results: Comparing the options of imaging and genetics showed comparable WTP values. Ethical concerns about genetic testing seemed to be minor. Treatment success was the top priority irrespective of the diagnostic modality. In general, the majority of patients considered personalized medicine to be beneficial. Conclusion: Most patients valued personalized approaches and rated the benefits of precision medicine of overriding importance irrespective of modality or ethical concerns.
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Affiliation(s)
- Kerstin Clasen
- Department of Radiation Oncology, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Cihan Gani
- Department of Radiation Oncology, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics & Applied Genomics, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Calwerstraße 7, Tübingen, 72076, Germany
| | - Olaf Riess
- Institute of Medical Genetics & Applied Genomics, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Calwerstraße 7, Tübingen, 72076, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Medical Faculty & University Hospital, Eberhard Karls University Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tübingen, Hoppe-Seyler-Straße 3, Tübingen, 72076, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Lange Gasse 20, Nuremberg, 90403, Germany
| | - Stephan Clasen
- Department of Diagnostic & Interventional Radiology, District Hospital Reutlingen, Steinenbergstraße 31, Reutlingen, 72764, Germany
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16
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Schanz M, Schöffski O, Kimmel M, Oberacker T, Göbel N, Franke UFW, Alscher MD, Ketteler M, Schricker S. Under-recognition of Acute Kidney Injury after Cardiac Surgery in the ICU Impedes Early Detection and Prevention. Kidney Blood Press Res 2021; 47:50-60. [PMID: 34775389 DOI: 10.1159/000519536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with high morbidity and mortality; therefore, prevention is important. The aim of this study was to systematically assess AKI incidence after cardiac surgery as documented in clinical routine compared to the real incidence because AKI may be under-recognized in clinical practice. Further, its postoperative management was compared to Kidney Disease: Improving Global Outcomes (KDIGO) recommendations because recognition and adequate treatment represent the fundamental cornerstone in the prevention and management of AKI. METHODS This retrospective single-center study included n = 100 patients who underwent cardiac surgery with cardiopulmonary bypass. The coded incidence of postoperative AKI during intensive care unit stay after surgery was compared to the real AKI incidence. Furthermore, conformity of postoperative parameters with KDIGO recommendations for AKI prevention and management was reviewed. RESULTS We found a considerable discrepancy between coded and real incidence, and conformity with KDIGO recommendations was found to be relatively low. The coded incidence was significantly lower (n = 12 vs. n = 52, p < 0.05), representing a coding rate of 23.1%. Regarding postoperative management, 90% of all patients had at least 1 episode with mean arterial pressure <65 mm Hg within the first 72 h. Furthermore, regarding other preventive parameters (avoiding hyperglycemia, stopping angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, avoiding contrast media, and nephrotoxic drugs), only 10 patients (20.8%) in the non-AKI group and in 5 (9.6%) subjects in the AKI group had none of all the above potential AKI-promoting factors. CONCLUSIONS AKI recognition in everyday clinical routine seems to be low, especially in lower AKI stages, and the current postoperative management still offers potential for optimization. Possibly, higher AKI awareness and stricter postoperative management could already achieve significant effects in prevention and treatment of AKI.
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Affiliation(s)
- Moritz Schanz
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Martin Kimmel
- Division of Nephrology, Hypertension and Autoimmune Disorders, Department of Internal Medicine, Alb-Fils Kliniken, Göppingen, Germany
| | - Tina Oberacker
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tübingen, Stuttgart, Germany
| | - Nora Göbel
- Department of Cardiovascular Surgery, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Ulrich F W Franke
- Department of Cardiovascular Surgery, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Mark Dominik Alscher
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Markus Ketteler
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
| | - Severin Schricker
- Division of General Internal Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany
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17
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Steeb T, Wessely A, Petzold A, Brinker TJ, Schmitz L, Leiter U, Garbe C, Schöffski O, Berking C, Heppt MV. Evaluation of Long-term Clearance Rates of Interventions for Actinic Keratosis: A Systematic Review and Network Meta-analysis. JAMA Dermatol 2021; 157:1066-1077. [PMID: 34347015 DOI: 10.1001/jamadermatol.2021.2779] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Importance Multiple interventions are available for the treatment of actinic keratosis (AK). However, most randomized clinical trials and meta-analyses focus on short-term efficacy outcomes. Objective To investigate and synthesize the long-term efficacy (≥12 months) of interventions for AK from parallel-arm randomized clinical trials. Data Sources Searches in MEDLINE, Embase, and Central were conducted from inception until April 6, 2020. The reference lists of the included studies and pertinent trial registers were hand searched. The study was completed February 27, 2021. Study Selection Two reviewers screened the titles and abstracts of 2741 records. Finally, 17 published reports (original studies and follow-up reports) referring to 15 independent randomized clinical trials with an overall sample size of 4252 patients were included. Data Extraction and Synthesis Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analysis (NMA) of each outcome was conducted with a frequentist approach. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidance for NMA was used to assess the certainty of evidence. The revised Cochrane risk-of-bias tool for randomized clinical trials was used to evaluate the methodologic quality. Main Outcomes and Measures Participant complete clearance, participant partial clearance, and lesion-specific clearance were the outcomes, with each assessed at least 12 months after the end of treatment. Results Data from 15 independent randomized clinical trials including 4252 patients were extracted and synthesized. Ten studies were included in an NMA for the outcome of participant complete clearance, with photodynamic therapy with aminolevulinate (ALA-PDT) showing the most favorable risk ratio (RR) compared with placebo (RR, 8.06; 95% CI, 2.07-31.37; GRADE, moderate), followed by imiquimod, 5% (RR, 5.98; 95% CI, 2.26-15.84; GRADE, very low), photodynamic therapy with methyl aminolevulinate (MAL-PDT) (RR, 5.95; 95% CI, 1.21-29.41; GRADE, low), and cryosurgery (RR, 4.67; 95% CI, 1.36-16.66; GRADE, very low). Similarly, ALA-PDT had the highest RR in the NMA for lesion-specific clearance (RR, 5.08; 95% CI, 2.49-10.33; GRADE, moderate). No NMA was possible for participant partial clearance owing to poor reporting of this outcome. Conclusions and Relevance This systematic review and network meta-analysis found that therapy including ALA-PDT, imiquimod, 5%, MAL-PDT, and cryosurgery was associated with significant long-term efficacy in the NMA. This study provides data for a possible use in an evidence-based framework for selecting interventions with sustained lesion clearance.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Anne Petzold
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lutz Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany.,Institute of Dermatopathology, MVZ Corius DermPathBonn, Bonn, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Oliver Schöffski
- School of Business, Economics and Society, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nürnberg, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Erlangen, Germany.,Comprehensive Cancer Center Erlangen-European Metropolitan Region of Nürnberg, Erlangen, Germany
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Kast K, Wachter CP, Schöffski O, Rimmele M. Economic evidence with respect to cost-effectiveness of the transitional care model among geriatric patients discharged from hospital to home: a systematic review. Eur J Health Econ 2021; 22:961-975. [PMID: 33839965 PMCID: PMC8275561 DOI: 10.1007/s10198-021-01301-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/26/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND The German hospital-to-home discharge management of geriatric patients has long been criticized. The implementation of the American Transitional Care Model (TCM) could help to reduce readmissions and costs. The objective of this review was to check the scientific evidence of the cost-effectiveness of the TCM. METHODS A systematic literature search in six databases for the time period of 26 years was conducted. The studies had to meet all pre-defined inclusion criteria. The data extraction is based on a criteria chart from literature. The methodological quality was assessed using the tools of the National Heart, Lung, and Blood Institute as well as the Consensus Health Economic Criteria list. The results transferability to German health care system was explained based on the criteria from the literature. RESULTS Three American studies met all criteria. They showed partial cost analyses but no full economic analyses. It could be assumed that the economic effect of the TCM changes over time. The costs of a care coordinator could not be determined because few detailed information was reported. The TCM may have negative consequences for hospitals. The results are not transferable to Germany. CONCLUSION There is no scientific evidence for the cost-effectiveness of the defined TCM. The optimal TCM duration still needs to be clarified. A detailed overview with units and prices and an additional consideration of the hospital perspective could help to make the information more transparent when deciding about the TCM implementation. A full economic analysis under German conditions or for similar European countries is necessary.
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Affiliation(s)
- Kristina Kast
- Chair of Health Care Management, Law and Economics Faculty of the Friedrich-Alexander University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany.
| | - Carl-Philipp Wachter
- Chair of Health Care Management, Law and Economics Faculty of the Friedrich-Alexander University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Oliver Schöffski
- Chair of Health Care Management, Law and Economics Faculty of the Friedrich-Alexander University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Martina Rimmele
- Medical Faculty of the Friedrich-Alexander University of Erlangen-Nuremberg, Institute for Biomedicine of Aging, Kobergerstr. 60, 90408, Nuremberg, Germany
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Steeb T, Wessely A, Petzold A, Brinker TJ, Schmitz L, Schöffski O, Berking C, Heppt MV. Long-term recurrence rates of actinic keratosis: A systematic review and pooled analysis of randomized controlled trials. J Am Acad Dermatol 2021; 86:1116-1119. [PMID: 33872716 DOI: 10.1016/j.jaad.2021.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Anne Petzold
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lutz Schmitz
- Department of Dermatology, Ruhr-University, Bochum, Germany; Institute of Dermatopathology, Bonn, Germany
| | - Oliver Schöffski
- School of Business, Economics and Society, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nürnberg, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen, Erlangen, Germany.
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20
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Steeb T, Wessely A, Harlaß M, Heppt F, Koch EAT, Leiter U, Garbe C, Schöffski O, Berking C, Heppt MV. A Systematic Review and Meta-Analysis of Interventions for Actinic Keratosis from Post-Marketing Surveillance Trials. J Clin Med 2020; 9:jcm9072253. [PMID: 32679902 PMCID: PMC7408895 DOI: 10.3390/jcm9072253] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 12/18/2022] Open
Abstract
Multiple interventions are available for the treatment of actinic keratosis (AK) showing high efficacy in pivotal trials. However, data from post-marketing surveillance studies have received little attention until now. Here, we systematically investigate interventions for AK from post-marketing surveillance trials as a proxy for real-world efficacy and tolerability. A systematic literature search was conducted in Medline, Embase, and CENTRAL. Pertinent trial registers were hand-searched until 25 March 2020. Results were pooled using a random-effects model to calculate pooled proportions and relative risks (RR) or were described qualitatively. Eleven records with a total sample size of n = 4109 were included. Three of the studies had an active-controlled design, while seven were single-armed. Participant complete clearance ranged from 23.1% for diclofenac sodium 3% gel to 88.9% for ingenol mebutate 0.05% gel. The lesion-specific clearance rate for photodynamic therapy (PDT) was 74% (95% confidence interval (CI) 56–87%). The recurrence rate was significantly higher for diclofenac sodium 3% in comparison to imiquimod 5% cream (RR 1.10, 95% CI 1.02–1.1.8) and ranged from 10.6% for ingenol mebutate 0.015% gel to 23.5% for PDT. Few patients discontinued the trials due to adverse events. The results from the majority of the post-marketing surveillance studies deviated from those of pivotal trials.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (F.H.); (E.A.T.K.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (F.H.); (E.A.T.K.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Matthias Harlaß
- Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands;
| | - Franz Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (F.H.); (E.A.T.K.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Elias A. T. Koch
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (F.H.); (E.A.T.K.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany; (U.L.); (C.G.)
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany; (U.L.); (C.G.)
| | - Oliver Schöffski
- School of Business, Economics and Society, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 90403 Nürnberg, Germany;
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (F.H.); (E.A.T.K.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (F.H.); (E.A.T.K.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-8535747
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21
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Gudd K, Meier F, Lindenthal J, Wambach V, Schöffski O. [Potentially inappropriate medication in a German practice network-who prescribes what to whom?]. Z Gerontol Geriatr 2019; 53:647-654. [PMID: 31773247 DOI: 10.1007/s00391-019-01660-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) carries the risk of increased drug side effects for older people. The prevalence data are known but no descriptive analyses of prescription behavior as a starting point for reducing PIM have yet been conducted. OBJECTIVE The aim of the study was to analyze PIM prescription in the outpatient sector and to identify risk groups where increased awareness of the issue is needed. MATERIAL AND METHODS The basis for the investigation was the data set of the AOK Bavaria health insurance, which contains anonymized prescription data of a practice network for patients aged 65 years and older from 2010 to 2014. The Priscus list was used to identify the PIM. RESULTS There were 410,934 prescriptions during the investigation period. The prevalence of PIM was 5.60%. Family doctors prescribed 5.39% PIM and specialists for neurology, psychiatry and psychotherapy (NPP) prescribed 16.36% PIM. Regardless of the medical discipline, PIM from the drug groups psycholeptics, psychoanaleptics and antihypertensive drugs were most frequently prescribed. For men and women PIM accounted for 4.50% and 6.31%, respectively, of the prescriptions during the period. In terms of age groups older women received PIM most frequently. CONCLUSION In the case of specialists for NPP a high prevalence of prescriptions for PIM could be established; however, in absolute terms family doctors prescribed significantly more PIM overall. This mainly affected women and especially those between 80 and 84 years old. In the future family doctors should be made more aware with respect to the prescription of psychopharmaceuticals and antihypertensive drugs to older women.
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Affiliation(s)
- Katharina Gudd
- Lehrstuhl für Gesundheitsmanagement, Institut für Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nürnberg, Deutschland.
| | | | | | - Veit Wambach
- Qualität und Effizienz eG, Nürnberg, Deutschland
| | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Institut für Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nürnberg, Deutschland
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22
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Peine A, Hallawa A, Schöffski O, Dartmann G, Fazlic LB, Schmeink A, Marx G, Martin L. A Deep Learning Approach for Managing Medical Consumable Materials in Intensive Care Units via Convolutional Neural Networks: Technical Proof-of-Concept Study. JMIR Med Inform 2019; 7:e14806. [PMID: 31603430 PMCID: PMC6819012 DOI: 10.2196/14806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/18/2019] [Accepted: 08/13/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND High numbers of consumable medical materials (eg, sterile needles and swabs) are used during the daily routine of intensive care units (ICUs) worldwide. Although medical consumables largely contribute to total ICU hospital expenditure, many hospitals do not track the individual use of materials. Current tracking solutions meeting the specific requirements of the medical environment, like barcodes or radio frequency identification, require specialized material preparation and high infrastructure investment. This impedes the accurate prediction of consumption, leads to high storage maintenance costs caused by large inventories, and hinders scientific work due to inaccurate documentation. Thus, new cost-effective and contactless methods for object detection are urgently needed. OBJECTIVE The goal of this work was to develop and evaluate a contactless visual recognition system for tracking medical consumable materials in ICUs using a deep learning approach on a distributed client-server architecture. METHODS We developed Consumabot, a novel client-server optical recognition system for medical consumables, based on the convolutional neural network model MobileNet implemented in Tensorflow. The software was designed to run on single-board computer platforms as a detection unit. The system was trained to recognize 20 different materials in the ICU, while 100 sample images of each consumable material were provided. We assessed the top-1 recognition rates in the context of different real-world ICU settings: materials presented to the system without visual obstruction, 50% covered materials, and scenarios of multiple items. We further performed an analysis of variance with repeated measures to quantify the effect of adverse real-world circumstances. RESULTS Consumabot reached a >99% reliability of recognition after about 60 steps of training and 150 steps of validation. A desirable low cross entropy of <0.03 was reached for the training set after about 100 iteration steps and after 170 steps for the validation set. The system showed a high top-1 mean recognition accuracy in a real-world scenario of 0.85 (SD 0.11) for objects presented to the system without visual obstruction. Recognition accuracy was lower, but still acceptable, in scenarios where the objects were 50% covered (P<.001; mean recognition accuracy 0.71; SD 0.13) or multiple objects of the target group were present (P=.01; mean recognition accuracy 0.78; SD 0.11), compared to a nonobstructed view. The approach met the criteria of absence of explicit labeling (eg, barcodes, radio frequency labeling) while maintaining a high standard for quality and hygiene with minimal consumption of resources (eg, cost, time, training, and computational power). CONCLUSIONS Using a convolutional neural network architecture, Consumabot consistently achieved good results in the classification of consumables and thus is a feasible way to recognize and register medical consumables directly to a hospital's electronic health record. The system shows limitations when the materials are partially covered, therefore identifying characteristics of the consumables are not presented to the system. Further development of the assessment in different medical circumstances is needed.
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Affiliation(s)
- Arne Peine
- Department of Intensive Care Medicine and Intermediate Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,Clinomic GmbH, Aachen, Germany
| | - Ahmed Hallawa
- Department of Intensive Care Medicine and Intermediate Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,Chair for Integrated Signal Processing Systems, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Oliver Schöffski
- Chair of Health Management, School of Business, Economics and Society, Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | - Guido Dartmann
- Clinomic GmbH, Aachen, Germany.,Research Area Distributed Systems, Trier University of Applied Sciences, Trier, Germany
| | - Lejla Begic Fazlic
- Research Area Distributed Systems, Trier University of Applied Sciences, Trier, Germany
| | - Anke Schmeink
- Clinomic GmbH, Aachen, Germany.,Research Area Information Theory and Systematic Design of Communication Systems, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,Clinomic GmbH, Aachen, Germany
| | - Lukas Martin
- Department of Intensive Care Medicine and Intermediate Care, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,Clinomic GmbH, Aachen, Germany
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Verboket R, Verboket C, Schöffski O, Tlatlik J, Marzi I, Nau C. [Costs and proceeds from patients admitted via the emergency room with mild craniocerebral trauma]. Unfallchirurg 2019; 122:618-625. [PMID: 30306215 DOI: 10.1007/s00113-018-0566-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The introduction of the diagnosis-related groups (DRG) in 2003 radically changed the billing of the treatment costs. From the very beginning, trauma surgeons questioned whether the introduction of the DRG could have a negative impact on the care of the severely injured. "Trauma centers in need" was the big catchword warning against shortfalls at trauma centers due to the billing via DRG. This situation was confirmed in the first publications after introduction of the DRG, showing a clearly deficient level of care of polytrauma cases. Over the years, adjustments have led to an improvement in the remuneration for polytraumatized patients. In the emergency room, polytrauma is not always the final diagnosis. A considerable proportion of patients are only slightly injured, but must be admitted via the emergency room due to the circumstances of the accident or suspected diagnosis at the scene of the accident to exclude life-threatening injuries. In this study, patients with the billing diagnosis of mild craniocerebral trauma were selected as an example. The proportion of these patients was 22% during the period of observation in 2017. For these patients, the proportional costs during treatment were calculated. It could be shown that 60.36% of the costs during a 2‑day treatment of these patients were incurred in the emergency room. Costs for material and personnel could not be considered. Despite not including these expenses, the costs were never covered for any of these patients. For patients with slight injuries after trauma management in the emergency room, the present adjustments to the DRG system by increasing the basic case value seem to be insufficient. Additional remuneration for these patients seems absolutely justified to further ensure adequate quality of care.
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Affiliation(s)
- René Verboket
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | | | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Johanna Tlatlik
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ingo Marzi
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Christoph Nau
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Uniklinik Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Speer T, Mühlbradt T, Fastner C, Schöffski O, Schröder S. Erratum zu: Simulationstraining als Teil des klinischen Risikomanagements. Anaesthesist 2019; 68:293. [DOI: 10.1007/s00101-019-0591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Kolb B, Emmert M, Sander U, Patzelt C, Schöffski O. Do German public reporting websites provide information that office-based physicians consider before referring patients to hospital? A four-step analysis. Z Evid Fortbild Qual Gesundhwes 2018; 137-138:42-53. [PMID: 30190204 DOI: 10.1016/j.zefq.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/18/2018] [Accepted: 07/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND In recent years, many different performance frameworks and quality assurance systems have been developed to measure health care quality. In Germany, an external quality assurance system for hospitals was introduced in 2005. The data of these systems are often reported by public reporting websites (PRWs) to inform patients and other stakeholders interested in health care systems about health care providers' quality. However, publication is obligatory (at least in Germany) for most of the existing quality assurance measures; some may be reported voluntarily. An important target group for this information is the group of all office-based physicians as they are crucial for patients' hospital choice. However, public reporting initiatives in Germany and other countries have not increased the use of quality reports for hospital choice. OBJECTIVES (1) To summarize the criteria that office-based physicians consider to be of high, medium, and low importance for hospital selection when referring patients and (2) to examine whether German public reporting websites (PRWs) provide these hospital-related criteria. METHODS The analysis comprised four steps: 1) Five databases were systematically searched for peer-reviewed English- and German-language literature. 2) The selection of articles was based on compliance with inclusion criteria, and all the criteria relevant to the referral of patients to hospital were extracted. 3) The criteria were then divided into five main categories: structural quality, process quality, outcome quality, patient experience, and referring physicians' experience. In addition, the criteria were classified into three importance categories (high-, medium-, and low-priority criteria) according to their relevance to the referral decision. 4) We investigated whether German PRWs publicly report high-priority criteria. RESULTS A total of N=11 articles published in peer-reviewed journals met our inclusion criteria. The studies were published in Germany (n=4), the Netherlands (n=3), Denmark, France, Norway, and the USA (n=1 each). In total, N=86 criteria were identified, most of them relating to structural quality (n=43) and process quality (n=26). We found just n=3 outcome quality criteria, only one of which fell in the high-priority category (breast cancer indicators with clinically relevant differences). In total, n=25 low-, n=40 medium-, and n=34 high-priority criteria could be established, which is due to the fact that some criteria had been investigated in several studies evaluating the importance of some criteria differently. Most of the high-priority criteria were related to process quality. All the high-priority structural quality criteria and high-priority outcome quality criteria were available on German PRWs, whereas just 38.5 % of those relating to process quality could be identified on these portals. We also identified 66.7 % of the high-priority criteria regarding patient experience and 50.0 % concerning the referring physicians' experience. Overall, a larger amount of low- and medium-priority criteria are available on German PRWs than high-priority criteria. DISCUSSION A substantial amount of hospital information regarding structural quality and outcome quality is available on German PRWs. However, the development of further process quality criteria (which are currently underrepresented) should be considered, for example whether hospital physicians continue the medication initiated by office-based doctors. Also, hospital quality reports should be tailored for specific user groups, for instance for referring gynecologists or referring general practitioners (GPs).
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Affiliation(s)
- Benjamin Kolb
- University of Applied Sciences and Arts Hannover, Hannover, Germany.
| | - Martin Emmert
- Chair of Health Management, Friedrich-Alexander-University Erlangen-Nuremberg, Nürnberg, Germany
| | - Uwe Sander
- University of Applied Sciences and Arts Hannover, Hannover, Germany
| | | | - Oliver Schöffski
- Chair of Health Management, Friedrich-Alexander-University Erlangen-Nuremberg, Nürnberg, Germany
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Adelhardt T, Hessemer S, Heckel M, Herbst FA, Stiel S, Ostgathe C, Schöffski O. Kosten von multiresistenten Erregern in der stationären Palliativversorgung. Gesundh ökon Qual manag 2018. [DOI: 10.1055/a-0651-6448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDie Studie beschäftigt sich mit den finanziellen Auswirkungen des Auftretens von multiresistenten Erregern auf einer palliativmedizinischen Station eines
deutschen Universitätskrankenhauses. Ziele der Studie sind eine Analyse der Kostentreiber sowie ein Kostenvergleich zwischen MRE-positiven und -negativen
Patienten. Zur Analyse der Kostendaten der auf der betreffenden Palliativstation behandelten Patienten wurde ein retrospektives Studiendesign mit einer
Fall-Kontroll-Analyse gewählt. Die analysierten Daten umfassen dabei neben Kostendaten wie beispielsweise den Gesamtkosten bzw. den Kosten für den Pflegedienst
auch die Verweildauer und demografische Daten der Patienten wie das Alter. Der Vergleich der Kostenunterschiede zwischen MRE-negativen und MRE-positiven
Patienten wurde mittels t-Test durchgeführt. Eine multivariate Regressionsanalyse wurde zur Identifikation der Kostentreiber verwendet.
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Affiliation(s)
- Thomas Adelhardt
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
| | - Stefanie Hessemer
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
| | - Maria Heckel
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg
| | | | - Stephanie Stiel
- Hannover Medical School, Institute for General Practice, Hannover
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg
| | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
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Willems LM, Richter S, Watermann N, Bauer S, Klein KM, Reese JP, Schöffski O, Hamer HM, Knake S, Rosenow F, Strzelczyk A. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany from 2003 to 2013 - A ten-year overview. Epilepsy Behav 2018; 83:28-35. [PMID: 29649671 DOI: 10.1016/j.yebeh.2018.03.025] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022]
Abstract
This study evaluated trends in resource use and prescription patterns in patients with active epilepsy over a 10-year period at the same outpatient clinic of a German epilepsy center. We analyzed a cross-sectional patient sample of consecutive adults with active epilepsy over a 3-month period in 2013 and compared them with equally acquired data from the years 2003 and 2008. Using validated patient questionnaires, data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded. A total of 198 patients (mean age: 39.6±15.0years, 49.5% male) were enrolled and compared with our previous assessments in 2003 (n=101) and 2008 (n=151). In the 2013 cohort, 75.8% of the patients had focal epilepsy, and the majority were taking antiepileptic drugs (AEDs) (39.9% monotherapy, 59.1% polytherapy). We calculated epilepsy-specific costs of €3674 per three months per patient. Direct medical costs were mainly due to anticonvulsants (20.9% of total direct costs) and to hospitalization (20.8% of total direct costs). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2013. Indirect costs of €1795 in 2013 were mainly due to early retirement (55.0% of total indirect costs), unemployment (26.5%), and days off due to seizures (18.2%). In contrast to our previous findings from 2003 and 2008, our data show a stagnating cost increase with slightly reduced total costs and balanced direct and indirect costs in patients with active epilepsy. These findings are accompanied by an ongoing cost-neutral increase in the prescription of 'newer' and non-enzyme-inducing AEDs. However, the number and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Saskia Richter
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Nina Watermann
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Karl Martin Klein
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Jens-Peter Reese
- Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany
| | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University, Nuremberg, Germany
| | - Hajo M Hamer
- Epilepsy Center, Department of Neurology, Friedrich-Alexander-University, Erlangen, Germany
| | - Susanne Knake
- Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe-University, Frankfurt am Main, Germany; Epilepsy Center Hessen, Department of Neurology, Philipps-University, Marburg, Germany.
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Meszmer N, Jaegers L, Schöffski O, Emmert M. [Do online ratings reflect structural differences in healthcare? The example of German physician-rating websites]. Z Evid Fortbild Qual Gesundhwes 2018; 131-132:73-80. [PMID: 29331281 DOI: 10.1016/j.zefq.2017.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous surveys have shown that patient satisfaction varies with the regional supply of physicians. Online ratings on physician-rating websites represent a relatively new instrument to display patient satisfaction results. The aim of this study was (1) to assess the current state of online ratings for two medical disciplines (dermatologists and ear, nose and throat (ENT) specialists), and (2) to analyze online derived patient satisfaction results according to the physician density in Germany. METHODS We collected online ratings for 420 dermatologists and 450 ear, nose, and throat (ENT) specialists on twelve German physician-rating websites. We analyzed the online ratings according to the physician density (low, medium, high physician density). For this purpose, we collected secondary data from both physician-rating websites and the regional associations of statutory health insurance physicians. Data analysis was performed using Median tests and Chi-square tests. RESULTS In total, 10,239 online ratings for dermatologists and 8,168 online ratings for ENT specialists were analyzed. Almost all dermatologists (99.3 %) and ENT specialists (98.9 %) were listed on one of the physician-rating websites. A total of 93.5 % of all listed dermatologists and 96.9 % of ENT-specialists were rated on at least one of the physician-rating websites. Significant differences were found in the distribution (i.e., percentage of listed or rated physicians) of the ratings according to the regional physician density on only one physician-rating website (p<0.001). Furthermore, online ratings were shown to be better in regions with a higher physician density on two physician-rating website. On jameda.de, for example, dermatologist ratings were better in regions with a higher physician density compared to regions with a lower number of physicians (average rating: 2.16 vs. 2.67; p<0.001). CONCLUSIONS Online ratings of dermatologists and ENT specialists hardly differ in terms of regional physician density. Physician-rating websites thus do not appear to be appropriate to mirror differences in the health service delivery structure. Our findings thus do not confirm the results from previously published studies.
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Affiliation(s)
- Nina Meszmer
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Fachbereich Wirtschaftswissenschaften, Lehrstuhl für Gesundheitsmanagement, Nürnberg, Deutschland.
| | - Lena Jaegers
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Fachbereich Wirtschaftswissenschaften, Lehrstuhl für Gesundheitsmanagement, Nürnberg, Deutschland
| | - Oliver Schöffski
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Fachbereich Wirtschaftswissenschaften, Lehrstuhl für Gesundheitsmanagement, Nürnberg, Deutschland
| | - Martin Emmert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Fachbereich Wirtschaftswissenschaften, Juniorprofessur für Versorgungsmanagement, Nürnberg, Deutschland
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Bierbaum M, Schöffski O, Schliemann B, Kösters C. Cost-utility analysis of dynamic intraligamentary stabilization versus early reconstruction after rupture of the anterior cruciate ligament. Health Econ Rev 2017; 7:8. [PMID: 28168633 PMCID: PMC5293706 DOI: 10.1186/s13561-017-0143-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/06/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the cost-effectiveness of the dynamic intraligamentary stabilization (DIS) technique in comparison with reconstructive surgery (ACLR) in the treatment of isolated anterior cruciate ligament (ACL) ruptures from the perspective of the community of insured citizens in Germany. METHODS Because of the specific decision problem at hand, namely that with DIS the procedure has to take place within 21 days after the initial trauma, a decision tree was developed. The time horizon of the model was set to 3 years. Input data was taken from official tariffs, payer data, the literature and assumptions based on expert opinion when necessary. RESULTS The decision tree analysis identified the DIS strategy as the superior one with 2.34 QALY versus 2.26 QALY for the ACLR branch. The higher QALY also came with higher costs of 5,398.05 € for the DIS branch versus 4,632.68 € for the ACLR branch respectively, leading to an ICER of 9,092.66 € per QALY. Results were robust after sensitivity analysis. Uncertainty was examined via probabilistic sensitivity analysis resulting in a slightly higher ICER of 9,567.13 € per QALY gained. CONCLUSION The DIS technology delivers an effective treatment for the ACL rupture at a favorable incremental cost-effectiveness ratio.
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Affiliation(s)
- Martin Bierbaum
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nuremberg, Germany
| | - Oliver Schöffski
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nuremberg, Germany
| | - Benedikt Schliemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Clemens Kösters
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Emmert M, Meszmer N, Jablonski L, Zinth L, Schöffski O, Taheri-Zadeh F. Public release of hospital quality data for referral practices in Germany: results from a cluster-randomised controlled trial. Health Econ Rev 2017; 7:33. [PMID: 28952136 PMCID: PMC5615085 DOI: 10.1186/s13561-017-0171-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/22/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate the impact of different dissemination channels on the awareness and usage of hospital performance reports among referring physicians, as well as the usefulness of such reports from the referring physicians' perspective. DATA SOURCES/STUDY SETTING Primary data collected from a survey with 277 referring physicians (response rate = 26.2%) in Nuremberg, Germany (03-06/2016). STUDY DESIGN Cluster-randomised controlled trial at the practice level. Physician practices were randomly assigned to one of two conditions: (1) physicians in the control arm could become aware of the performance reports via mass media channels (Mass Media, [Formula: see text]=132, [Formula: see text]=147); (2) physicians in the intervention arm also received a printed version of the report via mail (Mass and Special Media, [Formula: see text]=117; [Formula: see text]=130). PRINCIPAL FINDINGS Overall, 68% of respondents recalled hospital performance reports and 21% used them for referral decisions. Physicians from the Mass and Special Media group were more likely to be aware of the performance reports (OR 4.16; 95% CI 2.16-8.00, p < .001) but not more likely to be influenced when referring patients into hospitals (OR 1.73; 95% CI 0.72-4.12, p > .05). On a 1 (very good) to 6 (insufficient) scale, the usefulness of the performance reports was rated 3.67 (±1.40). Aggregated presentation formats were rated more helpful than detailed hospital quality information. CONCLUSIONS Hospital quality reports have limited impact on referral practices. To increase the latter, concerns raised by referring physicians must be given more weight. Those principally refer to the underlying data, the design of the reports, and the lack of important information.
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Affiliation(s)
- Martin Emmert
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Nina Meszmer
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Lisa Jablonski
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Lena Zinth
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Oliver Schöffski
- School of Business and Economics, Health Services Management, University of Erlangen-Nuremberg, Lange Gasse 20 90403 Nuremberg, Nuremberg, Germany
| | - Fatemeh Taheri-Zadeh
- Media, Information and Design Department of Information and Communication, University of Applied Sciences and Arts, Hannover, Germany
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Abstract
OBJECTIVE The modern Japanese health care system was established during the Meiji period (1868-1912) using the example of Germany. In this paper, the funding and remuneration of health services and products in Japan are described. The focus lies on the mechanisms used to implement health policy goals and to control costs. METHOD Selective literature search. RESULTS All permanent residents in Japan are enrolled in one of more than 3,000 compulsory health funds. Employees and public servants are covered through company or government-related health insurance schemes. Independent workers, the unemployed and the pensioners are usually assigned to health insurance plans managed by local city governments. The elderly over 75 years are insured through special health funds managed at the prefectural level. To correct the fiscal disparities among the health insurance programs, a risk adjustment is realized by compensatory financial transfers between the funds and substantial subsidies from the central and local governments. The statutory benefits package that is identical for all insurance plans is regulated in a single comprehensive schedule. All the covered health services and products are listed with the fees and compensations, and the conditions for the service providers to be remunerated are also stated. This fee and compensation schedule is regularly revised every 2 years under the leadership of the Ministry of Health, Labor and Welfare. The revisions are intended to contain health expenditures and to set incentives for the achievement of health policy goals. CONCLUSION The funding of the Japanese health care system and the risk adjustment mechanisms among health funds are well established and show a rather static character. The short- and mid-term development of the system is mainly controlled on the side of the expenditures through the unique and comprehensive fee and compensation schedule. The regular revisions of this schedule permit to react at relatively short notice to evolving situations, and through a policy of small improvements, target an optimization of the system as a whole.
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Adelhardt T, Hessemer S, Docter K, Sieber C, Ostgathe C, Schöffski O. [Costs of Medial Care of MRSA Patients at the End-of-Life in a Geriatric Ward]. Gesundheitswesen 2017; 80:910-915. [PMID: 28499320 DOI: 10.1055/s-0043-101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The present study addresses the financial effects of incidences of MRSA in the geriatric ward of a German hospital on patients receiving end-of-life care. The main cost drivers will be identified and the costs calculated. METHODOLOGY A retrospective analysis for a period of one year was conducted for the geriatric ward of a German hospital. In addition to the duration of the patient's stay and the total costs of his/her case, individual cost categories such as personnel and material costs were also examined. In order to enable a cost comparison of MRSA-positive and MRSA-negative patients, matching was used. T-tests were used for purposes of comparison with the case groups. FINDINGS A total of 107 cases were included in the study; in 27 of these cases, MRSA was detected. Patients with MRSA were found to have a longer average stay and to incur higher average costs. There were no statistically significant differences in the duration of hospital stay between MRSA-positive and MRSA-negative patients. Furthermore, no statistically significant differences were seen in the total costs per case. Significantly higher daily personnel costs for nursing staff were observed for MRSA-positive patients in the case group of patients with lower than average total costs. For MRSA-positive patients, these costs amounted to € 97.18, while MRSA-negative patients incurred € 80.44 in costs. Costs of doctors, medical technicians and non-medical personnel and material costs for infrastructure showed an opposite tendency. If the case groups for different total costs are not considered, no significant differences between MRSA-positive and MRSA-negative patients were found for the individual cost categories examined. CONCLUSIONS Although we demonstrated that MRSA-positive patients had longer stays and caused higher overall costs in the geriatric ward, we did not find any statistically significant differences between MRSA-positive and MRSA-negative patients. One of the main cost drivers in the care of MRSA-positive patients was identified as the daily personnel costs for nursing staff. Analysing processes related to patients' nursing care can be the first step in attempts to make care for MRSA-positive patients more effective and efficient.
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Affiliation(s)
- Thomas Adelhardt
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
| | - Stefanie Hessemer
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
| | - Katrin Docter
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
| | - Cornel Sieber
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Nürnberg
| | - Christoph Ostgathe
- Palliativmedizinische Abteilung, Universitätsklinikum Erlangen, Erlangen
| | - Oliver Schöffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
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Schöffski P, Wozniak A, Schöffski O, van Eycken L, Debiec-Rychter M. Overcoming Cost Implications of Mutational Analysis in Patients with Gastrointestinal Stromal Tumors: A Pragmatic Approach. Oncol Res Treat 2016; 39:811-816. [DOI: 10.1159/000453057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/27/2016] [Indexed: 11/19/2022]
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Strzelczyk A, Bergmann A, Biermann V, Braune S, Dieterle L, Forth B, Kortland LM, Lang M, Peckmann T, Schöffski O, Sigel KO, Rosenow F. Neurologist adherence to clinical practice guidelines and costs in patients with newly diagnosed and chronic epilepsy in Germany. Epilepsy Behav 2016; 64:75-82. [PMID: 27732920 DOI: 10.1016/j.yebeh.2016.07.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to evaluate physician adherence to the German Neurological Society guidelines of 2008 regarding initial monotherapy and to determine the cost-of-illness in epilepsy. METHODS This was an observational cohort study using health data routinely collected at 55 outpatient neurology practices throughout Germany (NeuroTransData network). Data on socioeconomic status, course of epilepsy, anticonvulsive treatment, and direct and indirect costs were recorded using practice software-based questionnaires. RESULTS One thousand five hundred eighty-four patients with epilepsy (785 male (49.6%); mean age: 51.3±18.1years) were enrolled, of whom 507 were newly diagnosed. Initial monotherapy was started according to authorization status in 85.9%, with nonenzyme-inducing drugs in 94.3% of all AEDs. Drugs of first choice by guideline recommendations were used in 66.5%. Total annual direct costs in the first year amounted to €2194 (SD: €4273; range: €55-43,896) per patient, with hospitalization (59% of total direct costs) and anticonvulsants (30%) as the main cost factors. Annual total direct costs decreased by 29% to €1572 in the second year, mainly because of a 59% decrease in hospitalization costs. The use of first choice AEDs did not influence costs. Chronic epilepsy was present in 1077 patients, and total annual direct costs amounted to €1847 per patient, with anticonvulsants (51.0%) and hospitalization (41.0%) as the main cost factors. Potential cost-driving factors in these patients were active epilepsy and focal epilepsy syndrome. CONCLUSION This study shows excellent physician adherence to guidelines regarding initial monotherapy in adults with epilepsy. Newly diagnosed patients show higher total direct and hospital costs in the first year upon diagnosis, but these are not influenced by adherence to treatment guidelines.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany.
| | | | - Valeria Biermann
- Department of Health Management, Friedrich-Alexander-University (FAU), Erlangen-Nuremberg, Germany
| | | | | | | | - Lena-Marie Kortland
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Michael Lang
- NeuroTransData, NTD Study Group, Neuburg, Germany
| | | | - Oliver Schöffski
- Department of Health Management, Friedrich-Alexander-University (FAU), Erlangen-Nuremberg, Germany
| | | | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University, Frankfurt am Main, Germany; Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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Rump A, Schöffski O. The German and Japanese health care systems: an international comparison using an input-output model. Public Health 2016; 141:63-73. [PMID: 27932017 DOI: 10.1016/j.puhe.2016.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/06/2016] [Accepted: 06/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The German and Japanese health care systems have common roots, but have evolved differently. Whereas the German system is often considered as expensive and poorly efficient, people in Japan are viewed as healthy and health care as comparatively cheap. In this study, we compared the quality, the effectiveness and efficiency of the German and Japanese health care systems. STUDY DESIGN This study includes comparative health care data analysis. METHOD The quality and effectiveness of the German and Japanese health care systems were analyzed using an input-output model including 12 countries based on health indicators published by the OECD. Besides the invested resources, a risk-related input dimension was used for risk adjustment. The efficiency of the systems was assessed by relating the average output to the health expenses per capita. RESULTS Health risks seem qualitatively different in Germany and Japan, but at the aggregate level, lifestyle does not seem to be an outstanding explanatory factor for health outcome differences between both countries. For investments in health resources, Germany is in a top position, whereas in the international comparison, the outcome is rather poor. The resources invested in Japan are also high, but slightly less than in Germany, whereas on average, the outcome is better. However, in the international comparison, resources as well as results in Japan show a very high variability. Relating the average output to the health expenses per capita indicates that on the average, the health care system in Japan is more efficient than in Germany. CONCLUSION Germany and Japan have a quality problem with their health care systems. In Germany there is a transmission failure from structural to outcome quality that might be related to coordination problems between the outpatient and inpatient sector. Japan shows an unbalanced system that may be suspected to have a quality problem as a whole. As the development of the remuneration system including quality requirements is under the direct responsibility and guidance of the Ministry of Health in Japan, the issue might however be more easily solved in Japan than in Germany. Although on average, health care seems more efficient in Japan than in Germany, taking into account health as well as long-term care expenses and uncertainties related to exchange rate adjustments, the higher efficiency of the Japanese system becomes questionable.
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Affiliation(s)
- A Rump
- Institut für Radiobiologie der Bundeswehr, Germany.
| | - O Schöffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Stingl JC, Kaumanns KL, Claus K, Lehmann ML, Kastenmüller K, Bleckwenn M, Hartmann G, Steffens M, Wirtz D, Leuchs AK, Benda N, Meier F, Schöffski O, Holdenrieder S, Coch C, Weckbecker K. Individualized versus standardized risk assessment in patients at high risk for adverse drug reactions (IDrug) - study protocol for a pragmatic randomized controlled trial. BMC Fam Pract 2016; 17:49. [PMID: 27112273 PMCID: PMC4845354 DOI: 10.1186/s12875-016-0447-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/14/2016] [Indexed: 02/02/2023]
Abstract
Background Elderly patients are particularly vulnerable to adverse drug reactions, especially if they are affected by additional risk factors such as multimorbidity, polypharmacy, impaired renal function and intake of drugs with high risk potential. Apart from these clinical parameters, drug safety and efficacy can be influenced by pharmacogenetic factors. Evidence-based recommendations concerning drug-gene-combinations have been issued by international consortia and in drug labels. However, clinical benefit of providing information on individual patient factors in a comprehensive risk assessment aiming to reduce the occurrence and severity of adverse drug reactions is not evident. Purpose of this randomized controlled trial is to compare the effect of a concise individual risk information leaflet with standard information on risk factors for side effects. Methods/Design The trial was designed as a prospective, two-arm, randomized, controlled, multicenter, pragmatic study. 960 elderly, multimorbid outpatients in general medicine are included if they take at least one high risk and one other long-term drug (polymedication). As high risk “index drugs” oral anticoagulants and antiplatelets were chosen because of their specific, objectively assessable side effects. Following randomization, test group patients receive an individualized risk assessment leaflet evaluating their personal data concerning bleeding- and thromboembolic-risk-scores, potential drug-drug-interactions, age, renal function and pharmacogenetic factors. Control group patients obtain a standardized leaflet only containing general information on these criteria. Follow-up period is 9 months for each patient. Primary endpoint is the occurrence of a thromboembolic/bleeding event or death. Secondary endpoints are other adverse drug reactions, hospital admissions, specialist referrals and medication changes due to adverse drug reactions, the patients’ adherence to medication regimen as well as health related quality of life, mortality and resulting costs. Discussion Despite extensive evidence of risk factors for adverse drug reactions, there are few prospective trial data about an individualized risk assessment including pharmacogenetic information to increase patient safety. By conducting a health economic analysis, we will evaluate if the application of an individualized drug therapy in daily routine is cost-effective. Trial registration German Clinical Trials Register: DRKS00006256, date of registration 09/01/15.
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Affiliation(s)
- Julia Carolin Stingl
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.,Centre for Translational Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Katharina Luise Kaumanns
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany. .,Centre for Translational Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Katrin Claus
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.,Centre for Translational Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Marie-Louise Lehmann
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.,Centre for Translational Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Kathrin Kastenmüller
- Institute of General Practice and Family Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Markus Bleckwenn
- Institute of General Practice and Family Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Gunther Hartmann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Steffens
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.,Centre for Translational Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Dorothee Wirtz
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Ann-Kristin Leuchs
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Norbert Benda
- Research Division, Federal Institute for Drugs and Medical Devices, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany
| | - Florian Meier
- Department of Economics and Management, Wilhelm Löhe University of Applied Sciences, Merkurstraße 41, 90763, Fürth, Germany
| | - Oliver Schöffski
- Department of Health Management, University of Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Germany
| | - Stefan Holdenrieder
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Christoph Coch
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Pohl-Dernick K, Meier F, Maas R, Schöffski O, Emmert M. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list. BMC Health Serv Res 2016; 16:109. [PMID: 27039188 PMCID: PMC4818863 DOI: 10.1186/s12913-016-1366-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. METHODS Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. RESULTS In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. CONCLUSIONS The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.
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Affiliation(s)
- Katharina Pohl-Dernick
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany.
| | - Florian Meier
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
| | - Renke Maas
- Institute of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Fahrstr. 17, 91054, Erlangen, Germany
| | - Oliver Schöffski
- Chair of Health Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
| | - Martin Emmert
- Junior Professor for Health Services Management, Institute of Management (IFM), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Lange Gasse 20, 90403, Nuremberg, Germany
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Amler N, Felder S, Mau W, Merkesdal S, Schöffski O. [Instruments for Measuring the Effects of Early Intervention on Maintaining and Restoring Ability to Work in Germany: Opinion of an Interdisciplinary Working Group]. Gesundheitswesen 2015; 80:79-86. [PMID: 26695541 DOI: 10.1055/s-0041-110678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In projects on early intervention, a wide variety of instruments is used for the measurement of intervention effects on preservation or restoration of ability to work. The aim of the present work was to propose an appropriate instrument or a range of appropriate instruments that enable diverse interventional approaches to be compared, and data quality to be improved. METHODS A systematic literature search was conducted to map the currently existing measuring instruments. In addition, based on structured interviews with leaders of existing early intervention projects or representatives of other interventional approaches, knowledge and application of the measuring instruments in Germany were determined. In the context of a working meeting, a recommendation was formulated based on the results of the literature search and interviews. RESULTS AND COMMENTS There is currently no instrument that could be recommended without reservation for the stated purpose. Based on the results of the literature search and the interviews, the working group recommends using, as a first step, the Work Ability Index (WAI, focus on work ability) and the Work Productivity and Activity Impairment Questionnaire (WPAI, focus on absenteeism and presenteeism). German-language versions of both questionnaires are freely available and offer a good compromise in terms of psychometric quality criteria, as well as of practicality and applicability. The measuring instruments should be developed further, with the goal of establishing an optimized instrument that combines the strengths of the two instruments. CONCLUSION In Germany, use of WAI and the WPAI in as many early intervention approaches as possible will help improve the database, allowing better comparability. However, the focus of further research must be to develop an optimized instrument from elements of WAI and WPAI, in order to be able to measure ability to work as well as the effects of an intervention on preservation or restoration of the ability to work, regardless of the setting.
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Affiliation(s)
- N Amler
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
| | - S Felder
- Wirtschaftswissenschaftliche Fakultät, Universität Basel, Basel
| | - W Mau
- Institut für Rehabilitationsmedizin, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - S Merkesdal
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover
| | - O Schöffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg
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Soergel P, Schöffski O, Hillemanns P, Hille-Betz U, Kundu S. Increasing Liability Premiums in Obstetrics – Analysis, Effects and Options. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1546252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- P. Soergel
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
| | - O. Schöffski
- Chair of Health Management, Erlangen-Nürnberg University, Nuremberg
| | - P. Hillemanns
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
| | - U. Hille-Betz
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
| | - S. Kundu
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
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Soergel P, Schöffski O, Hillemanns P, Hille-Betz U, Kundu S. Increasing Liability Premiums in Obstetrics - Analysis, Effects and Options. Geburtshilfe Frauenheilkd 2015; 75:367-376. [PMID: 26028694 PMCID: PMC4437753 DOI: 10.1055/s-0035-1545955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 10/23/2022] Open
Abstract
Whenever people act, mistakes are made. In Germany, it is thought that a total of 40 000 cases of malpractice occur per year. In recent years, costs for liability insurance have risen significantly in almost all spheres of medicine as a whole. Liability in the health care sector is founded on the contractual relationship between doctor and patient. Most recently, case law developed over many years has been codified with the Patients' Rights Act. In obstetrics, the focus of liability law is on brain damage caused by hypoxia or ischemia as a result of management errors during birth. The costs per claim are made up of various components together with different shares of damage costs (increased needs, in particular therapy costs and nursing fees, acquisition damage, treatment costs, compensation). In obstetrics in particular, recent focus has been on massively increased liability payments, also accompanied by higher liability premiums. This causes considerable financial burdens on hospitals as well as on midwives and attending physicians. The premiums are so high, especially for midwives and attending physicians, that professional practice becomes uneconomical in some cases. In recent years, these circumstances have also been intensely debated in the public sphere and in politics. However, the focus here is on the occupation of midwife. In 2014, in the GKV-FQWG (Statutory Health Insurance - Quality and Further Development Act), a subsidy towards the occupational liability premium was defined for midwives who only attended a few deliveries. However, to date, a complete solution to the problem has not been found. A birth will never be a fully controllable risk, but in rare cases will always end with injury to the child. The goal must be to minimise this risk, through good education and continuous training, as well as constant critical analysis of one's own activities. Furthermore, it seems sensible, especially in non-clinical Obstetrics, to look at the current study data more closely. Among the many solutions which have been proposed, such as the development of quality management, risk management and prevention, better remuneration, a waiver on recourse claims by social insurance underwriters, a cap on damage costs of liability insurers, state liability, an indemnity fund, a system change to Medical Treatment Risk Insurance, as well as a discussion on whether or not it makes sense to use non-clinical obstetrics for the prevention of a further increase in premiums, not one stands out as being especially convincing. On the contrary, a meaningful coordination of various concepts should follow. What seems sensible is a higher remuneration per birth, taking into account the liability premiums as well as, in the medium term, the establishment of a liability fund which, from a certain limit upwards, steps in as liable third party.
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Affiliation(s)
- P. Soergel
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
| | - O. Schöffski
- Chair of Health Management, Erlangen-Nürnberg University, Nuremberg
| | - P. Hillemanns
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
| | - U. Hille-Betz
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
| | - S. Kundu
- Department of Gynaecology and Obstetrics, Hanover Medical School, Hanover. Abteilung für Gynäkologie und Geburtshilfe, Medizinischen Hochscule Hannover
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Gizewski ER, Forsting M, Krombach GA, Schöffski O. [Health technology assessment (HTA). Developments in healthcare and potential for radiology]. Radiologe 2015; 54:589-98. [PMID: 24844855 DOI: 10.1007/s00117-014-2695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CLINICAL/METHODICAL ISSUE Cost-intensive measures and procedures, such as also employed in radiology, have far-reaching economic implications in respect to increasing expenditure with limited resources. STANDARD RADIOLOGICAL METHODS Health technology assessment (HTA) describes the systematic evaluation of medical procedures and technologies which in recent years has been introduced by many countries into healthcare politics. ASSESSMENT In many cases HTA analyses can be directly implemented into practice as shown by the examples given in this article; however, in the current form of HTA the practical implementation for radiology often presents the problem that the cost-benefit ratio does not yet have a comprehensive view in the HTA report but is limited to a subsection, e.g. current costs versus sensitivity of a method. Since its inception radiology has had a high power of innovation and new developments will also substantially determine the future years. These procedures must not only be evaluated with respect to feasibility but also in the sense of the HTA in the total concept. PRACTICAL RECOMMENDATIONS In radiology there are also a large number of possibilities for radiologists not only as passive consumers of HTA reports but also to become active participants in this process, an opportunity which should be taken advantage of.
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Affiliation(s)
- E R Gizewski
- Univ.-Klinik für Neuroradiologie, Zentrum für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich,
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Hollederer A, Braun GE, Dahlhoff G, Drexler H, Engel J, Gräßel E, Häusler E, Heide H, Heuschmann PU, Hörl G, Imhof H, Kaplan M, Kasperbauer R, Klemperer D, Kolominsky-Rabas P, Kuhn J, Lang M, Langejürgen R, Lankes A, Leidl R, Liebl B, Loss J, Ludewig K, Mansmann U, Melcop N, Nagels K, Nowak D, Pfundner H, Reuschenbach B, Schneider A, Schneider W, Schöffski O, Schreiber W, Voigtländer S, Wildner M, Zapf A, Zellner A. [Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. Gesundheitswesen 2014; 77:180-5. [PMID: 25422951 DOI: 10.1055/s-0034-1389915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.
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Affiliation(s)
- A Hollederer
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - G E Braun
- Forschungszentrum für Management im Gesundheitswesen, Universität der Bundeswehr München, Neubiberg
| | | | - H Drexler
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Friedrich-Alexander-Universität (FAU), Erlangen
| | - J Engel
- Tumorregister München (TRM), Ludwig-Maximilians-Universität (LMU), München
| | - E Gräßel
- Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Friedrich-Alexander-Universität (FAU), Erlangen
| | - E Häusler
- Deutsche Rentenversicherung, Bayern Süd, München
| | - H Heide
- Bayerisches Staatsministerium für Gesundheit und Pflege (StMGP), München
| | - P U Heuschmann
- Institut für Klinische Epidemiologie und Biometrie, Julius-Maximilians-Universität Würzburg
| | - G Hörl
- Bayerisches Staatsministerium für Gesundheit und Pflege (StMGP), München
| | - H Imhof
- Bayerische Staatsregierung, Patienten- und Pflegebeauftragter, München
| | - M Kaplan
- Bayerische Landesärztekammer, München
| | | | - D Klemperer
- Fakultät Angewandte Sozialwissenschaften, Hochschule Regensburg
| | - P Kolominsky-Rabas
- Interdisziplinäres Zentrum für Health Technology Assessment (HTA) und Public Health, Friedrich-Alexander-Universität (FAU), Erlangen
| | - J Kuhn
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - M Lang
- Bayerisches Staatsministerium für Bildung und Kultus, Wissenschaft und Kunst (StMBW), München
| | - R Langejürgen
- Verband der Ersatzkassen e.V. (vdek), Landesvertretung Bayern, München
| | - A Lankes
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - R Leidl
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München, Neuherberg
| | - B Liebl
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - J Loss
- Medizinische Soziologie, Institut für Epidemiologie und Präventivmedizin, Universität Regensburg
| | | | - U Mansmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität (LMU), München
| | - N Melcop
- Bayerische Landeskammer der Psychologischen Psychotherapeuten und der Kinder- und Jugendlichenpsychotherapeuten, München
| | - K Nagels
- Institut für Medizinmanagement und Gesundheitswissenschaften (IMG), Universität Bayreuth
| | - D Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Universität München
| | - H Pfundner
- Wirtschaftsverband der forschenden Pharma-Unternehmen (vfa), Berlin
| | - B Reuschenbach
- Katholische Stiftungsfachhochschule, Fachbereich Pflege, München
| | - A Schneider
- Institut für Allgemeinmedizin, Klinikum rechts der Isar, Technische Universität München
| | - W Schneider
- Zentrum für Interdisziplinäre Gesundheitsforschung (ZIG), Universität Augsburg
| | - O Schöffski
- Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-Universität (FAU), Nürnberg
| | - W Schreiber
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirksklinikum Mainkofen, Deggendorf
| | - S Voigtländer
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - A Zapf
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
| | - A Zellner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL), Nürnberg, Oberschleißheim
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Bierbaum M, Grad MO, Wulff H, Kewenig S, Schöffski O. [Development and implementation of an integrated care pathway at the POLIKUM health centers using the example of anemia]. Internist (Berl) 2014; 55:470-7. [PMID: 24577343 DOI: 10.1007/s00108-014-3462-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Integrated treatment pathways are an appropriate means for increasing the quality of treatment and outcome via process optimization. Taking the POLIKUM Health Centers as an example, we intend to demonstrate how the implementation can be effected for the indication of anemia. METHOD The development and implementation were executed by an interdisciplinary workgroup in several workshops. In addition, the diagnoses and hemoglobin values of all patients with requests for hemograms were obtained and analyzed at two locations. RESULTS Developing the pathway required significantly greater efforts than initially planned. The biggest challenge was to adequately map the complexity of the different forms of anemia and, concomitantly, to design a pathway that can actually be realized in everyday life. Moreover, evaluation of the patient data demonstrated that there are a large number of cases where existing anemias are not reflected in the respective diagnoses. CONCLUSION While the ultimate effects of the new pathway cannot yet be assessed conclusively, it was possible to obtain valuable findings for practical use even at this point. Despite the limitations of the sample, the surprisingly high number of undetected anemias should give physicians cause for taking diagnostic measures even in patients with mild anemia.
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Affiliation(s)
- M Bierbaum
- LS für Gesundheitsmanagement, FAU Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Deutschland,
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Pohl-Dernick K, Meier F, Maas R, Schöffski O, Emmert M. Potentially Inappropriate Medication in the Elderly - Relevance and Economics of the 30 Top-Selling Priscus Agents in Germany. Value Health 2014; 17:A508. [PMID: 27201558 DOI: 10.1016/j.jval.2014.08.1551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K Pohl-Dernick
- Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - F Meier
- Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - R Maas
- Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - O Schöffski
- Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - M Emmert
- Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
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Amler N, Becker T, Bierbaum M, Schöffski O. Cost-Effectiveness of Targeted Pharmacotherapy - A Systematic Review of the Literature. Value Health 2014; 17:A407. [PMID: 27200991 DOI: 10.1016/j.jval.2014.08.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- N Amler
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - T Becker
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - M Bierbaum
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - O Schöffski
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Wein A, Emmert M, Merkel S, Harich HD, Siebler J, Thiemann R, Lamberti C, Göttler B, Fries S, Kiani A, Schlag R, Grüner M, Steinbild S, Eberl S, Pohl-Dernick K, Dörje F, Horbach T, Schöffski O, Neurath MF, Hohenberger W. Palliative Treatment of Colorectal Cancer with Secondary Metastasis Resection in Germany - Impact of the Multidisciplinary Treatment Approach on Prognosis and Cost: The Northern Bavaria IVOPAK I Project. Oncology 2014; 88:103-21. [DOI: 10.1159/000368246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022]
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Meier F, Maas R, Sonst A, Patapovas A, Müller F, Plank-Kiegele B, Pfistermeister B, Schöffski O, Bürkle T, Dormann H. Adverse drug events in patients admitted to an emergency department: an analysis of direct costs. Pharmacoepidemiol Drug Saf 2014; 24:176-86. [PMID: 24934134 DOI: 10.1002/pds.3663] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE Several economic evaluations of adverse drug events (ADEs) exist, but the underlying methodology has not been standardized so far. The aim of the study was to combine prospective, intensive pharmacovigilance methods, and standardized accounting data to calculate direct costs of community-acquired ADEs (caADEs) contributing to emergency department (ED) admission and subsequent hospitalization. METHODS A prospective observational study with three phases extending over 2 years was implemented in a 749 bed tertiary care hospital with an annual ED census of approximately 45 000 patients. The patient records of all adult non-trauma ED admissions were systematically analyzed by a team of emergency physicians, clinical pharmacologists, and pharmacists for potential ADE. Associated diagnosis related group costs were extracted from standardized accounting data. RESULTS Of 2262 patients attending the ED during the study periods, the hospitalization of 366 patients (16.2%) was related to one or more caADEs of which 97.5% were considered predictable and 62.0% were classified as preventable. The mean caADE-related diagnosis related group costs were €2743 (95% bias-corrected and accelerated CI: €2498 to €3018). Extrapolated to a national scale, this corresponds to caADE-related costs of €2.245bn for the German health insurance funds, annually. Costs of €1.310bn could be attributed to events classified as predictable and preventable. CONCLUSIONS In an ED, caADEs are frequent, and a significant proportion of these events and their related costs appear to be predictable and preventable. The ED as a first-line provider for ADE cases appears to be an appropriate environment to implement strategic and operative improvements for enhanced patient safety.
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Affiliation(s)
- Florian Meier
- Department of Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Abstract
INTRODUCTION In clinical practice there are medical and economic reasons against the thoughtless use of packed red blood cells (rbc). Therefore, in searching for alternatives (therapy of anemia) the total costs of allogeneic blood transfusions must be considered. Using a practical example this article depicts the actual costs and possible alternatives from the point of view of a hospital in Germany. METHOD To determine the total costs of allogeneic blood transfusions the actual resource consumption associated with blood transfusions was collated and analyzed at the St. Marien-Hospital in Vechta. RESULTS The authors were able to show that the actual procurement costs (average. 97 EUR) represent only 55 % of the total costs of 176 EUR. The additional expenses are allocated to personnel (78 %) and materials (22 %). Alternatives, such as i.v. iron substitution or stimulation of erythropoesis might be the more economical solution especially if only purchase prices are compared and the total costs of allogeneic blood transfusions are not considered. DISCUSSION Analyzing a single hospital limits generalization of the results; however, in the international context the results can be recognized as plausible. So far there have been no comprehensive studies on the true costs of blood preparations, therefore, this article represents a first starting point for closing this gap by conducting additional studies.
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Affiliation(s)
- C Hönemann
- Abteilung für Anästhesie und operative Intensivmedizin, Katholische Kliniken Oldenburger Münsterland gemeinnützige GmbH, St. Marienhospital Vechta, Marienstr. 6-8, 79377, Vechta, Deutschland.
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Abstract
A high disease prevalence, the presentation in older age, a frequently slowly progressing course of disease, and high costs make diagnosis and therapy of prostate cancer a special challenge for urologists. Effective prevention of the disease may help to resolve some of the problems mentioned above. Two randomised, controlled studies prove that effective chemoprevention of prostate cancer is possible using 5-α reductase inhibitors (finasteride, dutasteride) (LoE 1) both in individuals at low and those at high risk developing prostate cancer. Furthermore, there is evidence that other compounds, e.g. selective estrogen receptor modulators (SERMs), non-steroidal anti-inflammatory drugs (NSAIDs) and statins might also be effective. This review investigates potential risks and benefits of chemoprevention including a consideration of health economic aspects. The authors conclude that chemoprevention in a high risk cohort using 5-α reductase inhibitors is a viable option and may even be cost effective. In consequence, the options of chemoprevention in prostate cancer should be further explored in an open and unbiased way.
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Affiliation(s)
- Bernd J Schmitz-Dräger
- Urologie, Schön Klinik Nürnberg/Fürth, Urologie 24, c/o Europa-Allee 1, 90763, Fürth, Germany,
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Barth J, Hammerschmidt T, Vollmar J, Bierbaum M, Schöffski O. [Mechanics and effects of European reference pricing for vaccines in Germany according to §130a Abs. 2 SGB V: an analysis using the example of influenza vaccines]. Gesundheitswesen 2013; 76:e7-e13. [PMID: 24081570 DOI: 10.1055/s-0033-1351272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES On 01 January 2011 the bill for the reorganisation of the pharmaceutical market became effective. Since that time there is a European reference pricing (ERP) system for vaccines in order to bring down the German vaccine prices to an assumed lower European level. This study describes the implementation, functioning and effect of this new system. For influenza vaccines the impact of ERP on the price level and spread of prices is analysed. METHODS The description of the mechanism is based on the law and corresponding regulations of the head association of sickness funds (GKV-SV). The analysis of vaccine prices is based on the data of the i:data report (status of 01 September 2011) of ifap Service Institute. RESULTS The European reference price is calculated as the average price of the manufacturer-selling-prices of the corresponding vaccine in the 4 countries of the European Union whose gross national income comes closest to the German one and in which the vaccine is distributed. The relied prices are weighted by sales and purchasing power parities of the respective countries. This analysis suggests that in particular the practical implementation of the reference price system should be further improved and specified. The calculation of the reference prices should ensure price comparability. In addition, significant problems remain in the deduction of discounts, because no distinction is made in the documentation of vaccinating doctors, whether vaccination was performed as a compulsory or statutory benefit. The comparison of the manufacturer-selling-prices of individual influenza vaccines with the corresponding reference prices shows an enlargement of the existing price differences, which have evolved in a competitive environment, after the implementation of the reference pricing -system. CONCLUSIONS There is still a need for improvement in implementing the reference pricing system. In the most competitive vaccine market of influenza vaccines, the ERP-system lowers the prices, but seems to distort the market prices.
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Affiliation(s)
- J Barth
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg
| | | | - J Vollmar
- GlaxoSmithKline GmbH & Co. KG, München
| | - M Bierbaum
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg
| | - O Schöffski
- Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg
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