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Stöber A, Marijic P, Kurz C, Schwarzkopf L, Kirsch F, Schramm A, Leidl R. Does uptake of specialty care affect HRQoL development in COPD patients beneficially? A difference-in-difference analysis linking claims and survey data. Eur J Health Econ 2023; 24:1561-1573. [PMID: 36637677 PMCID: PMC10550862 DOI: 10.1007/s10198-022-01562-7] [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: 04/04/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There is an evidence gap on whether the choice of specialty care beneficially affects health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). This study analyzes how newly initiated pulmonologist care affects the generic and disease-specific HRQoL in COPD patients over a period of 1 year. METHODS We linked claims data with data from two survey waves to investigate the longitudinal effect of specialty care on HRQoL using linear Difference-in-Difference models based on 1:3 propensity score matched data. Generic HRQoL was operationalized by EQ-5D-5L visual analog scale (VAS), and disease-specific HRQoL by COPD assessment test (CAT). Subgroup analyses examined COPD patients with low (GOLD AB) and high (GOLD CD) exacerbation risk. RESULTS In contrast to routine care patients, pulmonologists' patients (n = 442) experienced no significant deterioration in HRQoL (VAS - 0.0, p = 0.9870; CAT + 0.5, p = 0.0804). Models unveiled a small comparative advantage of specialty care on HRQoL (mean change: CAT - 0.8, VAS + 2.9), which was especially pronounced for GOLD AB (CAT - 0.7; VAS + 3.1). CONCLUSION The uptake of pulmonologist care had a statistically significant, but not clinically relevant, beneficial impact on the development of HRQoL by slowing down overall HRQoL deterioration within 1 year. Including specialty care more appropriately in COPD management, especially at lower disease stages (GOLD AB), could thus improve patients' health outcome.
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Affiliation(s)
- Alisa Stöber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany.
- Pettenkoffer School of Public Health, Munich, Germany.
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.
| | - Pavo Marijic
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Christoph Kurz
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institut Fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Anja Schramm
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2023; 143:6741-6751. [PMID: 37306776 PMCID: PMC10258736 DOI: 10.1007/s00402-023-04929-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. METHODS The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. RESULTS Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). CONCLUSION Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany.
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany.
- Environmental Health Center at Helmholtz Munich, Munich, Germany.
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Orthopaedic Praxis Munich-Nymphenburg, Munich, Germany
| | - Johannes Beckmann
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Katharina Bredow
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Reiner Leidl
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Schatz C, Plötz W, Beckmann J, Leidl R, Buschner P. The impact of primary patella resurfacing on health-related quality of life outcomes and return to sport in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2023; 143:6731-6740. [PMID: 37289223 PMCID: PMC10248965 DOI: 10.1007/s00402-023-04930-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Primary patella resurfacing (PPR) in primary total knee arthroplasty (TKA) is a topic without clear clinical evidence. Using Patient Reported Outcome Measurements (PROM), previous work found TKA patients without PPR to have more pain postoperatively, but little is known whether this may impede patients from returning to their usual leisure sport. This observational study aimed at evaluating the treatment effect of PPR, with PROMs and return to sport (RTS). MATERIALS AND METHODS 156 primary TKA patients were retrospectively included from August 2019 to November 2020, from a single hospital in Germany. PROMs were measured with the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and the EuroQoL Visual Analog Scale (EQ-VAS), preoperatively and 1 year postoperatively. Leisure sport with three levels of intensity (never, sometimes, regular) were requested. The treatment effect of PPR was evaluated with a difference-in-difference (DiD) approach, with several confounders. RESULTS Descriptively, the mean WOMAC total score and the mean WOMAC pain score were postoperatively better with PPR, ( - 4.8 points, - 1.1 points), then without PPR. The mean improvements of the WOMAC total score were better with PPR ( - 7.8 points). Mean improvements for the WOMAC pain score were also better with PPR ( - 1.2 points). Mean EQ-VAS were postoperatively similar, and the mean improvements were better with PPR (3.4 points). Rate of RTS was 93% for patients with PPR and 95% for patients without PPR. The DiD revealed minor differences in PROMs and RTS, not to result in statistically significant treatment effects. CONCLUSIONS There was no treatment effect for TKA with PPR, regarding PROMs and RTS, and descriptive differences were below published thresholds for clinical relevance. Rate of RTS was high for all patients, regardless of PPR. For the two endpoint categories, there was no measurable advantage of TKA with PPR over TKA without PPR.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany.
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany.
- Environmental Health Center at Helmholtz Munich, Munich, Germany.
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
- Klinikum Rechts Der Isar, Technical University Munich, Munich, Germany
- Orthopedic Praxis Munich-Nymphenburg, Munich, Germany
| | - Johannes Beckmann
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Reiner Leidl
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Pedron S, Laxy M, Radon K, Le Gleut R, Castelletti N, Noller JMG, Diefenbach MN, Hölscher M, Leidl R, Schwettmann L. Socioeconomic and risk-related drivers of compliance with measures to prevent SARS-CoV-2 infection: evidence from the Munich-based KoCo19 study. BMC Public Health 2023; 23:860. [PMID: 37170091 PMCID: PMC10173220 DOI: 10.1186/s12889-023-15759-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Although a growing share of the population in many countries has been vaccinated against the SARS-CoV-2 virus to different degrees, social distancing and hygienic non-pharmaceutical interventions still play a substantial role in containing the pandemic. The goal of this study was to investigate which factors are correlated with a higher compliance with these regulations in the context of a cohort study in the city of Munich, southern Germany, during the summer of 2020, i.e. after the first lockdown phase. METHODS Using self-reported compliance with six regulations and personal hygiene rules (washing hands, avoiding touching face, wearing a mask, keeping distance, avoiding social gatherings, avoiding public spaces) we extracted two compliance factor scores, namely compliance with personal hygiene measures and compliance with social distancing regulations. Using linear and logistic regressions, we estimated the correlation of several socio-demographic and risk perception variables with both compliance scores. RESULTS Risk aversion proved to be a consistent and significant driver of compliance across all compliance behaviors. Furthermore, being female, being retired and having a migration background were positively associated with compliance with personal hygiene regulations, whereas older age was related with a higher compliance with social distancing regulations. Generally, socioeconomic characteristics were not related with compliance, except for education, which was negatively related with compliance with personal hygiene measures. CONCLUSIONS Our results suggest that for a targeted approach to improve compliance with measures to prevent SARS-CoV-2 infection, special attention should be given to younger, male and risk-prone individuals.
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Affiliation(s)
- Sara Pedron
- Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany.
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.
- German Center for Diabetes Research (DZD), Neuherberg, Germany.
| | - Michael Laxy
- Professorship of Public Health and Prevention, Technical University of Munich, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Katja Radon
- Center for International Health, Institute for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Ronan Le Gleut
- Core Facility Statistical Consulting, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Munich, Germany
| | - Noemi Castelletti
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany
- Institute of Radiation Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | | | - Maximilian Nikolaus Diefenbach
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Michael Hölscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany
- Center for International Health, University Hospital, Ludwig Maximilian University, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig Maximilian University, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Department of Health Services Research, School of Medicine and Health Sciences, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
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Hodiamont F, Schatz C, Schildmann E, Syunyaeva Z, Hriskova K, Rémi C, Leidl R, Tänzler S, Bausewein C. Correction to: The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care. BMC Palliat Care 2023; 22:56. [PMID: 37161423 PMCID: PMC10170856 DOI: 10.1186/s12904-023-01178-5] [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: 05/11/2023] Open
Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- Charité ? Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Oncological Palliative Care & Charité Comprehensive Cancer Center, Berlin, Germany
| | - Zulfiya Syunyaeva
- Charité Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Berlin, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Susanne Tänzler
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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Hodiamont F, Schatz C, Schildmann E, Syunyaeva Z, Hriskova K, Rémi C, Leidl R, Tänzler S, Bausewein C. The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care. BMC Palliat Care 2023; 22:36. [PMID: 37024852 PMCID: PMC10077306 DOI: 10.1186/s12904-023-01151-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year. METHODS Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10-12/2019 and 10-12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital's cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests. RESULTS Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro). CONCLUSIONS The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Oncological Palliative Care & Charité Comprehensive Cancer Center, Berlin, Germany
| | - Zulfiya Syunyaeva
- Charité Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Berlin, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Susanne Tänzler
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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Tarricone R, Banks H, Ciani O, Brouwer W, Drummond MF, Leidl R, Martelli N, Sampietro-Colom L, Taylor RS. An Accelerated Access Pathway for Innovative High-risk Medical Devices under the new European Union Medical Devices and Health Technology Assessment Regulations? Analysis and Recommendations. Expert Rev Med Devices 2023; 20:259-271. [PMID: 36987818 DOI: 10.1080/17434440.2023.2192868] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The new European Union (EU) Regulations for medical devices (MDs) and health technology assessment (HTA) are welcome developments that will hopefully increase the quality of clinical evidence for MDs and reduce fragmentation in the EU market access process. To fully exploit anticipated benefits, their respective assessment processes should be closely coordinated, particularly for promising, highly innovative MDs. Accelerated approval is worth exploring for certain categories of high-risk MDs to keep the EU regulatory process competitive compared to ad-hoc accelerated MD approval processes elsewhere (e.g., US). AREAS COVERED Problems observed in worldwide accelerated drug and MD regulatory approval programs are reviewed, including greater uncertainty in pre-market clinical evidence generation and lack of oversight for post-approval evidence requirements. Implications for MD approval, HTA and coverage are explored. EXPERT OPINION Through analysis of two decades of drug and MD accelerated approval programs worldwide, recommendations for an Accelerated Access Pathway for select innovative, high-risk MDs are proposed that can fit the EU context, leverage the two new regulations, increase opportunities for Expert Panels to provide timely advice regarding manufacturers' evidence generation plans along the MD lifecycle (pre-, post-market), and safely speed patient access while promoting increased collaboration among Member States on coverage decisions.
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Affiliation(s)
| | - Helen Banks
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS), Milano, taly
| | - Oriana Ciani
- SDA Bocconi School of Management, Government, Health & Not-for-profit Division Health Economics & HTA, Milano, Italy
| | - Werner Brouwer
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management (ESHPM), Rotterdam, Netherlands
| | - Michael F Drummond
- Centre for Health Economics, University of York, York, United Kingdom of Great Britain and Northern Ireland
| | - Reiner Leidl
- Ludwig-Maximilians-Universitat Munchen, Munich School of Management, Munchen, Germany
| | - Nicolas Martelli
- Assistance Publique Hopitaux de Paris, Pharmacy Department, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Rod S Taylor
- University of Glasgow, Institute of Health and Wellbeing, Glasgow, United Kingdom of Great Britain and Northern Ireland
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Kuck KH, Leidl R, Frankenstein L, Wahlers T, Sarmah A, Candolfi P, Shore J, Green M. Cost-Effectiveness of SAPIEN 3 Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in German Severe Aortic Stenosis Patients at Low Surgical Mortality Risk. Adv Ther 2023; 40:1031-1046. [PMID: 36622552 PMCID: PMC9988804 DOI: 10.1007/s12325-022-02392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/28/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In the randomized PARTNER 3 trial, transcatheter aortic valve implantation (TAVI) with the SAPIEN 3 device significantly reduced a composite of all-cause death, stroke, and rehospitalization, compared with surgical aortic valve replacement (SAVR), in patients with severe symptomatic aortic stenosis and low risk of surgical mortality. Furthermore, TAVI has been shown to be cost-effective in low-risk patients, compared with SAVR, in a number of countries. This study aimed to determine the cost-effectiveness of TAVI with SAPIEN 3 versus SAVR in Germany. METHODS A previously published two-stage Markov-based model that captured clinical outcomes from the PARTNER 3 trial was adapted for the German context using the German Statutory Health Insurance perspective. The model had a lifetime horizon. The cost-utility analysis estimated changes in direct healthcare costs as well as survival and health-related quality of life using TAVI with SAPIEN 3 compared with SAVR. RESULTS TAVI with SAPIEN 3 increased quality-adjusted life years (QALYs) by + 0.72 at an increased cost of €8664 per patient. The incremental cost-effectiveness/QALY ratio was €12,037, which fell below that of other cardiovascular interventions in use in Germany. The cost-effectiveness of TAVI over SAVR remained robust across multiple challenging scenarios and was driven by lower longer-term management costs compared with SAVR. CONCLUSIONS TAVI with SAPIEN 3 appears to be a clinically meaningful, cost-effective treatment option over SAVR for patients with severe symptomatic aortic stenosis and low risk for surgical mortality in Germany. CLINICAL TRIAL REGISTRATION NUMBER www. CLINICALTRIALS gov identifier: NCT02675114.
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Affiliation(s)
- Karl H Kuck
- Department of Cardiology, University Heart Center, Lübeck, Germany.,LANS Cardio, Hamburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich School of Management, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | | | | | - Judith Shore
- York Health Economics Consortium, University of York, York, UK
| | - Michelle Green
- York Health Economics Consortium, University of York, York, UK
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Maqhuzu PN, Schwarzkopf L, Markart P, Behr J, Holle R, Leidl R, Kreuter M. Costs of Pharmacological and Non-Pharmacological Interventions in Interstitial Lung Disease Management in Germany. Respiration 2022; 101:1015-1023. [DOI: 10.1159/000526575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Interstitial lung diseases (ILDs) are associated with a high economic burden, yet prospective data of the German healthcare system are sparse. <b><i>Objective:</i></b> We assessed average ILD-related costs of pharmacological and non-pharmacological (hospitalizations, outpatient, rehabilitation, physiotherapy, and medical aids) interventions in ILD. <b><i>Methods:</i></b> We used data from the multicenter, observational, prospective Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases registry to evaluate adjusted per capita costs and cost drivers for ILD-related healthcare costs over 4 years, using generalized estimating equation regression models. <b><i>Results:</i></b> Idiopathic pulmonary fibrosis (IPF) had the highest annual pharmacological costs >EUR 21,000, followed by connective tissue disease-associated ILD (CTD-ILD) averaging EUR 6,000. Other idiopathic interstitial pneumonias and hypersensitivity pneumonitis averaged below EUR 2,400 and sarcoidosis below EUR 400. There were no significant differences in pharmacological costs over time. Trends in non-pharmacological costs were statistically significant. At year 1, CTD-ILD had the highest costs (EUR 7,700), while sarcoidosis had the lowest (EUR 2,547). By year 4, these declined to EUR 3,218 and EUR 232, respectively. Regarding cost drivers, the ILD subtype had the greatest impact with 75 times higher pharmacological costs in IPF and 4 times higher non-pharmacological costs in CTD-ILD, compared to the reference. Pulmonary hypertension (PH) and gastroesophageal reflux disease (GERD) triggered higher pharmacological costs, and higher values of forced vital capacity % predicted were associated with lower pharmacological and non-pharmacological costs. <b><i>Conclusion:</i></b> Stabilizing lung function and reducing the impact of PH and GERD are crucial in reducing the economic burden of ILD. There is an urgent need for effective treatment options, especially in CTD-ILD.
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Hodiamont F, Schatz C, Gesell D, Leidl R, Boulesteix AL, Nauck F, Wikert J, Jansky M, Kranz S, Bausewein C. COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use - a protocol for a cross-sectional multi-centre study. BMC Palliat Care 2022; 21:18. [PMID: 35120502 PMCID: PMC8814797 DOI: 10.1186/s12904-021-00897-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ needs in palliative care. Therefore, the study aims to develop a patient-oriented, nationally applicable complexity and casemix classification for adult palliative care patients in Germany. Methods COMPANION is a mixed-methods study with data derived from three subprojects. Subproject 1: Prospective, cross-sectional multi-centre study collecting data on patients’ needs which reflect the complexity of the respective patient situation, as well as data on resources that are required to meet these needs in specialist palliative care units, palliative care advisory teams, and specialist palliative home care. Subproject 2: Qualitative study including the development of a literature-based preliminary list of characteristics, expert interviews, and a focus group to develop a taxonomy for specialist palliative care models. Subproject 3: Multi-centre costing study based on resource data from subproject 1 and data of study centres. Data and results from the three subprojects will inform each other and form the basis for the development of the casemix classification. Ultimately, the casemix classification will be developed by applying Classification and Regression Tree (CART) analyses using patient and complexity data from subproject 1 and patient-related cost data from subproject 3. Discussion This is the first multi-centre costing study that integrates the structure and process characteristics of different palliative care settings in Germany with individual patient care. The mixed methods design and variety of included data allow for the development of a casemix classification that reflect on the complexity of the research subject. The consecutive inclusion of all patients cared for in participating study centres within the time of data collection allows for a comprehensive description of palliative care patients and their needs. A limiting factor is that data will be collected at least partly during the COVID-19 pandemic and potential impact of the pandemic on health care and the research topic cannot be excluded. Trial registration German Register for Clinical Studies trial registration number: DRKS00020517.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Daniela Gesell
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Anne-Laure Boulesteix
- Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Julia Wikert
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Steven Kranz
- German Association for Palliative Medicine, Berlin, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
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Puchinger K, Castelletti N, Rubio-Acero R, Geldmacher C, Eser TM, Deák F, Paunovic I, Bakuli A, Saathoff E, von Meyer A, Markgraf A, Falk P, Reich J, Riess F, Girl P, Müller K, Radon K, Guggenbuehl Noller JM, Wölfel R, Hoelscher M, Kroidl I, Wieser A, Olbrich L, Alamoudi E, Anderson J, Baumann M, Behlen M, Beyerl J, Böhnlein R, Brauer A, Britz V, Bruger J, Caroli F, Contento L, Diekmannshemke J, Do A, Dobler G, Eberle U, Eckstein J, Frese J, Forster F, Frahnow T, Fröschl G, Geisenberger O, Gillig K, Heiber A, Hinske C, Hoefflin J, Hofberger T, Höfinger M, Hofmann L, Horn S, Huber K, Janke C, Kappl U, Kiani C, Kroidl A, Laxy M, Leidl R, Lindner F, Mayrhofer R, Mekota AM, Müller H, Metaxa D, Pattard L, Pletschette M, Prückner S, Pusl K, Raimúndez E, Rothe C, Schäfer N, Schandelmaier P, Schneider L, Schultz S, Schunk M, Schwettmann L, Seibold H, Sothmann P, Stapor P, Theis F, Thiel V, Thiesbrummel S, Thur N, Waibel J, Wallrauch C, Winter S, Wolff J, Wullinger P, Yaqine H, Zange S, Zeggini E, Zimmermann T, Zielke A, Ibraheem M, Ahmed M, Becker M, Diepers P, Schälte Y, Garí M, Pütz P, Pritsch M, Fingerle V, Le Gleut R, Gilberg L, Brand I, Diefenbach M, Eser T, Weinauer F, Martin S, Quenzel EM, Durner J, Girl P, Müller K, Radon K, Fuchs C, Hasenauer J. The interplay of viral loads, clinical presentation, and serological responses in SARS-CoV-2 – Results from a prospective cohort of outpatient COVID-19 cases. Virology 2022; 569:37-43. [PMID: 35245784 PMCID: PMC8855229 DOI: 10.1016/j.virol.2022.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Risk factors for disease progression and severity of SARS-CoV-2 infections require an understanding of acute and long-term virological and immunological dynamics. Fifty-one RT-PCR positive COVID-19 outpatients were recruited between May and December 2020 in Munich, Germany, and followed up at multiple defined timepoints for up to one year. RT-PCR and viral culture were performed and seroresponses measured. Participants were classified applying the WHO clinical progression scale. Short symptom to test time (median 5.0 days; p = 0.0016) and high viral loads (VL; median maximum VL: 3∙108 copies/mL; p = 0.0015) were indicative for viral culture positivity. Participants with WHO grade 3 at baseline had significantly higher VLs compared to those with WHO 1 and 2 (p = 0.01). VLs dropped fast within 1 week of symptom onset. Maximum VLs were positively correlated with the magnitude of Ro-N-Ig seroresponse (p = 0.022). Our results describe the dynamics of VLs and antibodies to SARS-CoV-2 in mild to moderate cases that can support public health measures during the ongoing global pandemic.
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Schatz C, Leidl R, Plötz W, Bredow K, Buschner P. Preoperative patients' health decrease moderately, while hospital costs increase for hip and knee replacement due to the first COVID-19 lockdown in Germany. Knee Surg Sports Traumatol Arthrosc 2022; 30:3304-3310. [PMID: 35211774 PMCID: PMC8868037 DOI: 10.1007/s00167-022-06904-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was a comparison between osteoarthritis patients with primary hip and knee replacements before, during and after the first COVID-19 lockdown in Germany. Patients' preoperative health status is assumed to decrease, owing to delayed surgeries. Costs for patients with osteoarthritis were assumed to increase, for example, due to higher prices for protective equipment. Hence, a comparison of patients treated before, during and after the first lockdown is conducted. METHODS In total, 852 patients with primary hip or knee replacement were included from one hospital in Germany. Preoperative health status was measured with the WOMAC Score and the EQ-5D-5L. Hospital unit costs were calculated using a standardised cost calculation. Kruskal-Wallis tests and Chi-squared tests were applied for the statistical analyses. RESULTS The mean of the preoperative WOMAC Score was slightly higher (p < 0.01) for patients before the first lockdown, compared with patients afterwards. Means of the EQ-5D-5L were not significantly different regarding the lockdown status (NS). Length of stay was significantly reduced by approximately 1 day (p < 0.001). Total inpatient hospital unit costs per patient and per day were significantly higher for patients during and after the first lockdown (p < 0.001). CONCLUSION Preoperative health, measured with the WOMAC Score, worsened slightly for patients after the first lockdown compared with patients undergoing surgery before COVID-19. Preoperative health, measured using the EQ-5D-5L, was unaffected. Inpatient hospital unit costs increased significantly with the COVID-19 pandemic. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- LMU Munich School of Management, Institute of Health Economics and Health Care Management, Ludwig-Maximilians-Universität München, Munich, Germany. .,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany.
| | - Reiner Leidl
- LMU Munich School of Management, Institute of Health Economics and Health Care Management, Ludwig-Maximilians-Universität München, Munich, Germany ,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany ,Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Katharina Bredow
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Sidelnikov E, Dornstauder E, Jacob C, Maas C, Pinto L, Leidl R, Ahrens I. Healthcare resource utilization and costs of cardiovascular events in patients with atherosclerotic cardiovascular disease in Germany - results of a claims database study. J Med Econ 2022; 25:1199-1206. [PMID: 36330899 DOI: 10.1080/13696998.2022.2141964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We assessed healthcare resource utilization (HCRU) and costs of cardiovascular (CV) events in patients with a history of atherosclerotic cardiovascular disease (ASCVD) in Germany. METHODS We conducted a retrospective matched case-control study based on German claims data from 1 January 2012 to 31 December 2017 using the "Institute for Applied Health Research Berlin" (InGef) Research Database. Cases who had a myocardial infarction (MI), stroke and angina pectoris identified by ICD-10-GM codes between 1 January 2014 and 31 December 2016 were matched to event-free controls by an exact matching approach without replacement at a ratio of 1:2. Costs and HCRU were assessed in individual 1-year follow-up periods after the index event for the overall cohort and subgroups of MI cases and stroke cases. RESULTS The overall cohort consisted of a total of 14,169 cases with a CV index event matched to 28,338 controls. The mean age of the overall cohort was 73.3 years, 34.1% of the patients were female, 3,717 (26.2%) had an MI, and 3,752 (26.5%) had stroke. Following the index events, 12.2% of cases in the overall cohort, 12.6% of MI cases, and 8.7% of stroke cases experienced a recurrent CV event. CV cases had on average 1.7 more all-cause hospitalizations (p <0.001) and 6.1 more outpatient visits (p <0.001) during the 1-year follow-up period than did controls. In the MI and stroke subgroups, cases had on average 1.8 and 1.6 more all-cause hospitalizations and 7.0 and 4.0 more outpatient visits, respectively (differences were statistically significant). Compared to controls, cases incurred on average higher total healthcare costs: by €11,898 for overall cases, by €16,349 for MI, and by €14,360 in stroke cases (overall: p <0.001; MI: p <0.001; stroke: p <0.001). CONCLUSION CV events in ASCVD patients pose a considerable clinical burden on patients and cause significant costs for the German statutory healthcare system.
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Affiliation(s)
| | - Eugen Dornstauder
- Health Economics and Outcomes Research, AMGEN GmbH (Germany), München, Germany
| | | | | | - Lionel Pinto
- Global Health Economics, Amgen Inc, Thousand Oaks, CA, USA
| | - Reiner Leidl
- Institute for Health Economics and Healthcare Management, Ludwig-Maximilians-Universität München, München, Germany
| | - Ingo Ahrens
- Klinik für Kardiologie und internistische Intensivmedizin, Krankenhaus der Augustinerinnen - Severinsklösterchen, Köln, Germany
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14
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Teni FS, Gerdtham UG, Leidl R, Henriksson M, Åström M, Sun S, Burström K. Inequality and heterogeneity in health-related quality of life: findings based on a large sample of cross-sectional EQ-5D-5L data from the Swedish general population. Qual Life Res 2021; 31:697-712. [PMID: 34628587 PMCID: PMC8921093 DOI: 10.1007/s11136-021-02982-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Accepted: 08/22/2021] [Indexed: 11/24/2022]
Abstract
Purpose This study aimed to investigate inequality and heterogeneity in health-related quality of life (HRQoL) and to provide EQ-5D-5L population reference data for Sweden. Methods Based on a large Swedish population-based survey, 25,867 respondents aged 30‒104 years, HRQoL is described by sex, age, education, income, economic activity, health-related behaviours, self-reported diseases and conditions. Results are presented by EQ-5D-5L dimensions, respondents rating of their overall health on the EQ visual analogue scale (EQ VAS), VAS index value and TTO (time trade-off) index value allowing for calculation of quality-adjusted life years (QALYs). Ordinary Least Squares and multivariable logistic regression analyses were used to study inequalities in observed EQ VAS score between socioeconomic groups and the likelihood to report problems on the dimensions, respectively, adjusted for confounders. Results In total, 896 different health states were reported; 24.1% did not report any problems. Most problems were reported with pain/discomfort. Women reported worse HRQoL than men, and health deteriorated with age. The strongest association between diseases and conditions and EQ VAS score was seen for depression and mental health problems. There was a socioeconomic gradient in HRQoL; adjusting for health-related behaviours, diseases and conditions slightly reduced the differences between educational groups and income groups, but socioeconomic inequalities largely remained. Conclusion EQ-5D-5L population reference (norms) data are now available for Sweden, including socioeconomic differentials. Results may be used for comparisons with disease-specific populations and in health economic evaluations. The observed socioeconomic inequality in HRQoL should be of great importance for policy makers concerned with equity aspects. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02982-3.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
| | - Ulf-G Gerdtham
- Department of Economics, Lund University, Lund, Sweden.,Health Economics Unit, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Reiner Leidl
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany
| | - Martin Henriksson
- Center for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mimmi Åström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.,Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sun Sun
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden. .,Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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15
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Stöber A, Lutter JI, Schwarzkopf L, Kirsch F, Schramm A, Vogelmeier CF, Leidl R. Impact of Lung Function and Exacerbations on Health-Related Quality of Life in COPD Patients Within One Year: Real-World Analysis Based on Claims Data. Int J Chron Obstruct Pulmon Dis 2021; 16:2637-2651. [PMID: 34588773 PMCID: PMC8473986 DOI: 10.2147/copd.s313711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Real-world evidence on the impact of forced expiratory volume in one second (FEV1) and exacerbations on health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) is sparse especially with regard to GOLD ABCD groups. This study investigates how changes in FEV1 and exacerbations affect generic and disease-specific HRQoL in COPD patients over one year. METHODS Using German claims data and survey data, we classified 3016 COPD patients and analyzed their health status by GOLD groups AB and CD. HRQoL was measured with the disease-specific COPD assessment test (CAT) and the visual analog scale (VAS) from the generic Euro-Qol 5D-5L. We applied change score models to assess associations between changes in FEV1 (≥100 mL decrease/no change/≥100 mL increase) or the development of severe exacerbations with change in HRQoL. RESULTS FEV1 decrease was associated with a significant but not minimal important difference (MID) deterioration in disease-specific HRQoL (mean change [95% CI]: CAT +0.74 [0.15 to 1.33]), while no significant change was observed in the generic VAS. Experiencing at least one severe exacerbation also had a significant impact on CAT deterioration (+1.58 [0.52 to 2.64]), but again not on VAS. Here, GOLD groups AB showed not only a statistically but also a clinically relevant MID deterioration in CAT (+2.1 [0.88 to 3.32]). These particular patient groups were further characterized by a higher probability of being male, having a higher mMRC and Charlson index, and a lower probability of having higher FEV1 or BMI values. CONCLUSION FEV1 decline and the occurrence of ≥1 severe exacerbation are significantly associated with overall deterioration in disease-specific HRQoL. Preventing severe exacerbations particularly in patients without previous severe exacerbations (ABCD groups A and B) may help to stabilize the key patient-reported outcome HRQoL.
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Affiliation(s)
- Alisa Stöber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institute fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
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Huber MB, Schneider N, Kirsch F, Schwarzkopf L, Schramm A, Leidl R. Long-term weight gain in obese COPD patients participating in a disease management program: a risk factor for reduced health-related quality of life. Respir Res 2021; 22:226. [PMID: 34391434 PMCID: PMC8364095 DOI: 10.1186/s12931-021-01787-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/28/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about how long-term weight gain affects the health perception of COPD patients. OBJECTIVES The aim is to evaluate the long-term association of BMI change and health-related quality of life (HRQoL) in obese COPD patients. METHODS Claims and survey data from a COPD disease management program were used to match two groups of COPD patients with BMI ≥ 30 who have differing weight trajectories over a 5-year timespan via propensity score and genetic matching. EQ-5D-5L, including visual analog scale (VAS) and COPD Assessment Test (CAT), were used as outcomes of interest. Sociodemographic and disease-based variables were matched. RESULTS Out of 1202 obese COPD patients, 126 with a weight increase of four or more BMI points were matched separately with 252 (propensity score matching) and 197 (genetic matching) control subjects who had relatively stable BMI. For the EQ-5D-5L, patients with BMI increase reported significantly worse health perception for VAS and all descriptive dimensions except pain/discomfort. For the CAT, especially the perception of ability to complete daily activities and overall energy results were significantly worse. VAS differences reach the range of minimal important differences. Stopping smoking and already being in obesity class II were the most influential risk factors for BMI increase. CONCLUSION Obese COPD patients who gain four or more BMI points over 5 years report significantly lower results in different dimensions of generic and disease-specific HRQoL than their peers with stable BMI. To improve real-world outcomes, tracking and preventing specific BMI trajectories could constitute a clinically relevant aspect of managing COPD patients.
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Affiliation(s)
- Manuel B Huber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nelli Schneider
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany. .,Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University, Munich, Germany.
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany.,IFT - Institute fuer Therapieforschung, Working Group Therapy and Health Services Research, Leopoldstrasse 175, 80804, Munich, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany
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17
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Huber MB, Kurz C, Kirsch F, Schwarzkopf L, Schramm A, Leidl R. The relationship between body mass index and health-related quality of life in COPD: real-world evidence based on claims and survey data. Respir Res 2020; 21:291. [PMID: 33143706 PMCID: PMC7607880 DOI: 10.1186/s12931-020-01556-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Body mass index (BMI) is an important parameter associated with mortality and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD). However, informed guidance on stratified weight recommendations for COPD is still lacking. This study aims to determine the association between BMI and HRQoL across different severity grades of COPD to support patient management. METHODS We use conjunct analysis of claims and survey data based on a German COPD disease management program from 2016 to 2017. The EQ-5D-5L visual analog scale (VAS) and COPD Assessment Test (CAT) are used to measure generic and disease-specific HRQoL. Generalized additive models with smooth functions are implemented to evaluate the relationship between BMI and HRQoL, stratified by COPD severity. RESULTS 11,577 patients were included in this study. Mean age was 69.4 years and 59% of patients were male. In GOLD grades 1-3, patients with BMI of around 25 had the best generic and disease-specific HRQoL, whereas in GOLD grade 4, obese patients had the best HRQoL using both instruments when controlled for several variables including smoking status, income, COPD severity, comorbidities, emphysema, corticosteroid use, and days spent in hospital. CONCLUSION This real-world analysis shows the non-linear relationship between BMI and HRQoL in COPD. HRQoL of obese patients with mild to severe COPD might improve following weight reduction. For very severe COPD, a negative association of obesity and HRQoL could not be confirmed. The results hint at the need to stratify COPD patients by disease stage for optimal BMI management.
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Affiliation(s)
- Manuel B Huber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Christoph Kurz
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany
- IFT-Institute Fuer Therapieforschung, Working Group Therapy and Health Services Research, Munich, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany
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Tarricone R, Ciani O, Torbica A, Brouwer W, Chaloutsos G, Drummond MF, Martelli N, Persson U, Leidl R, Levin L, Sampietro-Colom L, Taylor RS. Lifecycle evidence requirements for high-risk implantable medical devices: a European perspective. Expert Rev Med Devices 2020; 17:993-1006. [PMID: 32975149 DOI: 10.1080/17434440.2020.1825074] [Citation(s) in RCA: 8] [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] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The new European Union (EU) Regulations on medical devices and on in vitro diagnostics provide manufacturers and Notified Bodies with new tools to improve pre-market and post-market clinical evidence generation especially for high-risk products but fail to indicate what type of clinical evidence is appropriate at each stage of the whole lifecycle of medical devices. In this paper we address: i) the appropriate level and timing of clinical evidence throughout the lifecycle of high-risk implantable medical devices; and ii) how the clinical evidence generation ecosystem could be adapted to optimize patient access. AREAS COVERED The European regulatory and health technology assessment (HTA) contexts are reviewed, in relation to the lifecycle of high-risk medical devices and clinical evidence generation recommended by international network or endorsed by regulatory and HTA agencies in different jurisdictions. EXPERT OPINION Four stages are relevant for clinical evidence generation: i) pre-clinical, pre-market; ii) clinical, pre-market; iii) diffusion, post-market; and iv) obsolescence & replacement, post-market. Each stage has its own evaluation needs and specific studies are recommended to generate the appropriate evidence. Effective lifecycle planning requires anticipation of what evidence will be needed at each stage.
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Affiliation(s)
- Rosanna Tarricone
- Department of Social and Political Science, Bocconi University , Milan, Italy.,SDA Bocconi School of Management , Milan, Italy.,SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS) , Milan, Italy
| | - Oriana Ciani
- SDA Bocconi School of Management, Centre for Research on Health and Social Care Management (CERGAS) , Milan, Italy.,Institute of College and Medicine, University of Exeter, South Cloisters, St Luke's Campus , Exeter, UK
| | - Aleksandra Torbica
- Department of Social and Political Science, Bocconi University , Milan, Italy.,SDA Bocconi School of Management , Milan, Italy
| | - Werner Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam , Rotterdam, PA, The Netherlands
| | - Georges Chaloutsos
- Biomedical Engineering Department, Onassis Cardiac Surgery Centre & Director , Athens, Greece
| | - Michael F Drummond
- Professor of Health Economics, Centre for Health Economics, University of York , York, UK
| | - Nicolas Martelli
- Associate Clinical Professor, Hôpital Européen Georges Pompidou , Paris, France
| | - Ulf Persson
- IHE, Swedish Institute for Health Economics , Lund, Sweden
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh) , Neuherberg, Germany
| | - Les Levin
- Chief Executive Officer & Scientific Officer, EXCITE International , Canada
| | - Laura Sampietro-Colom
- Deputy Director of Innovation, Head of Health Technology Assessment Unit at Hospital Clinic Barcelona , Spain
| | - Rod S Taylor
- Institute of Health and Wellbeing, University of Glasgow , Glasgow, UK
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19
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Kähm K, Stark R, Laxy M, Schneider U, Leidl R. Assessment of excess medical costs for persons with type 2 diabetes according to age groups: an analysis of German health insurance claims data. Diabet Med 2020; 37:1752-1758. [PMID: 31834643 DOI: 10.1111/dme.14213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 01/22/2023]
Abstract
AIM This cross-sectional study used a large nationwide claims data set to assess the excess medical costs of people with type 2 diabetes according to age group in 2015. METHODS Data from 291 709 people with diabetes and 291 709 age- and sex-matched controls were analysed. Total costs (expressed as 2015 euros) of outpatient and inpatient services, medication, rehabilitation, and the provision of aids and appliances were examined. Overall and age-stratified excess costs of people with diabetes were estimated using gamma regression with a log-link. RESULTS Overall, the estimated total direct costs of a person with type 2 diabetes are approximately double those of a person without diabetes: €4727 vs. €2196, respectively. Absolute excess costs were approximately the same in all age groups (around €2500), however, relative excess costs of persons with diabetes were much higher in younger (~ 334% for < 50 years) than in older age groups (~ 156% for ≥ 80 years). Regional costs, both absolute and excess, partly differed from the national level. CONCLUSIONS This study complements and updates previous studies on the excess medical costs of people with diabetes in Germany. The results indicate the importance of preventing the development of type 2 diabetes, especially in younger age groups. Longitudinal and regional studies examining changes in prevalence and the development of excess costs in groups with different types of diabetes, and according to age, would be of interest to validate our findings and better understand the avoidable burden of having diabetes.
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Affiliation(s)
- K Kähm
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
| | - R Stark
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
| | - M Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
| | - U Schneider
- Health Care Management, Techniker Krankenkasse, Hamburg, Germany
| | - R Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Diabetes Research, München-Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany
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20
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Burström K, Teni FS, Gerdtham UG, Leidl R, Helgesson G, Rolfson O, Henriksson M. Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States. Pharmacoeconomics 2020; 38:839-856. [PMID: 32307663 DOI: 10.1007/s40273-020-00905-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. METHODS In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondent's current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). RESULTS A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. CONCLUSIONS Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.
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Affiliation(s)
- Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden.
- Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
| | - Ulf-G Gerdtham
- Department of Economics, Lund University, Lund, Sweden
- Health Economics Unit, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - Reiner Leidl
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany
| | - Gert Helgesson
- Medical Ethics Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Stockholm, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Swedish Hip Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Martin Henriksson
- Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Olm M, Stark RG, Beck N, Röger C, Leidl R. Impact of interventions to reduce overnutrition on healthcare costs related to obesity and type 2 diabetes: a systematic review. Nutr Rev 2020; 78:412-435. [PMID: 31769843 DOI: 10.1093/nutrit/nuz070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/26/2023] Open
Abstract
CONTEXT In recent decades, obesity and type 2 diabetes mellitus (T2DM) have both become global epidemics associated with substantial healthcare needs and costs. OBJECTIVE The aim of this review was to critically assess nutritional interventions for their impact on healthcare costs to community-dwelling individuals regarding T2DM or obesity or both, specifically using CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria to assess the economic components of the evidence. DATA SOURCES Searches were executed in Embase, EconLit, AgEcon, PubMed, and Web of Science databases. STUDY SELECTION Studies were included if they had a nutritional perspective, reported an economic evaluation that included healthcare costs, and focused on obesity or T2DM or both. Studies were excluded if they examined clinical nutritional preparations, dietary supplements, industrially modified dietary components, micronutrient deficiencies, or undernutrition; if they did not report the isolated impact of nutrition in complex or lifestyle interventions; or if they were conducted in animals or attempted to transfer findings from animals to humans. DATA EXTRACTION A systematic review was performed according to PRISMA guidelines. Using predefined search terms, 21 studies evaluating food habit interventions or taxation of unhealthy foods and beverages were extracted and evaluated using CHEERS criteria. RESULTS Overall, these studies showed that nutrition interventions and taxation approaches could lead to cost savings and improved health outcomes when compared with current practice. All of the included studies used external sources and economic modeling or risk estimations with population-attributable risks to calculate economic outcomes. CONCLUSIONS Most evidence supported taxation approaches. The effect of nutritional interventions has not been adequately assessed. Controlled studies to directly measure economic impacts are warranted.
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Affiliation(s)
- Michaela Olm
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of General Practice and Health Services Research, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Renée G Stark
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nathanael Beck
- Munich Center of Health Sciences, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany
| | - Christina Röger
- Competence Center for Nutrition and the Institute of the Bavarian State Ministry of Food, Agriculture and Forestry, Freising, Bavaria, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians University Munich, Munich, Bavaria, Germany
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Teni FS, Burström K, Berg J, Leidl R, Rolfson O. Predictive ability of the American Society of Anaesthesiologists physical status classification system on health-related quality of life of patients after total hip replacement: comparisons across eight EQ-5D-3L value sets. BMC Musculoskelet Disord 2020; 21:441. [PMID: 32631419 PMCID: PMC7339530 DOI: 10.1186/s12891-020-03399-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/03/2020] [Indexed: 03/11/2023] Open
Abstract
Background American Society of Anaesthesiologists (ASA) physical status classification system and its association with postoperative outcomes has been studied in different diseases. However, there is a paucity of studies on the relationship between ASA class and postoperative health-related quality of life (HRQoL) outcomes following total hip replacement (THR). The aim of this study was to assess the discriminative abilities of EQ-5D-3L value sets from Sweden, Germany, Denmark and the United Kingdom in relation to ASA classes and these value sets’ abilities to show the predictive performance of ASA classes on HRQoL among THR patients in Sweden. Methods A longitudinal study was conducted using data of patients in the Swedish Hip Arthroplasty Register who underwent THR between 2008 and 2016. We included 69,290 pre- and 1-year postoperative records and 21,305 6-year postoperative records. The study examined three experience-based EQ-5D-3L value sets (the Swedish VAS and TTO and the German VAS) and five hypothetical value sets (TTO from Germany and VAS and TTO value sets from Denmark and the UK each). Using linear models, the abilities of the value sets to discriminate among ASA classes and to show the predictive performance of ASA classes on HRQoL score were assessed. Results All value sets differentiated among ASA classes and showed the predictive effect of ASA classes on HRQoL. ASA classes were found to predict HRQoL consistently for all value sets investigated, with small variations in prediction error among the models. Conclusion ASA classes of patients undergoing THR predicted HRQoL scores significantly and consistently, indicating their importance in tailoring care for patients.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.
| | - Kristina Burström
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Jenny Berg
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Reiner Leidl
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany
| | - Ola Rolfson
- Health Outcomes and Economic Evaluation Research Group, Stockholm Centre for Healthcare Ethics, Department of Learning Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Swedish Hip Arthroplasty Register, Gothenburg, Sweden
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23
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Kirsch F, Becker C, Schramm A, Maier W, Leidl R. Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival. Eur J Health Econ 2020; 21:607-619. [PMID: 32006188 PMCID: PMC7214389 DOI: 10.1007/s10198-020-01158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 01/06/2020] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. METHODS The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. RESULTS The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). CONCLUSION Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.
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Affiliation(s)
- Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Christian Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Werner Maier
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
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24
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Hindelang M, Kirsch F, Leidl R. Effectiveness of non-pharmacological COPD management on health-related quality of life - a systematic review. Expert Rev Pharmacoecon Outcomes Res 2020; 20:79-91. [PMID: 32098530 DOI: 10.1080/14737167.2020.1734455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. The chronic progressive disease is accompanied by a high loss of health-related quality of life (HRQoL). The available drugs usually only have symptomatic effects; therefore, non-pharmacological therapies are essential too.Areas covered: This systematic review examines non-pharmacological interventions consisting of pulmonary rehabilitation, physical activity, and training versus usual care or no intervention in COPD using at least one of the following HRQoL measuring instruments: St. George's Respiratory Questionnaire, Clinical COPD Questionnaire, COPD Assessment Test, and EuroQol-5D. Of 1532 identified records from CENTRAL, MEDLINE, and EMBASE, 15 randomized controlled trials met the inclusion criteria. Pulmonary rehabilitation programs were investigated in nine studies, education and counseling-based training programs in three studies, and breathing exercises in three studies. Ten studies were found that investigated non-pharmacological treatment programs that led to a significant and clinically relevant improvement in HRQoL compared with usual care or no treatment.Expert opinion: Non-pharmacological interventions consisting of pulmonary rehabilitation, education and counseling-based training programs, and breathing exercises can improve the HRQoL of COPD patients.
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Affiliation(s)
- Michael Hindelang
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology - IBE, Ludwig-Maximilians-Universität München, Munich, Germany.,Pettenkofer School of Public Health. Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Florian Kirsch
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München - German Research Center for Environmental Health (Gmbh), Institute of Health Economics and Health Care Management, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Neuherberg, Germany
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25
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Felix J, Becker C, Vogl M, Buschner P, Plötz W, Leidl R. Patient characteristics and valuation changes impact quality of life and satisfaction in total knee arthroplasty - results from a German prospective cohort study. Health Qual Life Outcomes 2019; 17:180. [PMID: 31815627 PMCID: PMC6902559 DOI: 10.1186/s12955-019-1237-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/24/2019] [Indexed: 01/16/2023] Open
Abstract
Background Evaluation of variations in pre- and postoperative patient reported outcomes (PRO) and the association between preoperative patient characteristics and health and satisfaction outcomes after total knee arthroplasty (TKA) may support shared decision-making in Germany. Since previous research on TKA health outcomes indicated valuation differences in longitudinal data, experienced-based population weights were used for the first time as an external valuation system to measure discrepancies between patient and average population valuation of HRQoL. Methods Baseline data (n = 203) included sociodemographic and clinical characteristics and PROs, measured by the EQ-5D-3 L and WOMAC. Six-month follow-up data (n = 161) included medical changes since hospital discharge, PROs and satisfaction. A multivariate linear regression analysis was performed to evaluate the relationship between preoperative patient characteristics and PRO scores. Patient acceptable symptom state (PASS) was calculated to provide a satisfaction threshold. Patient-reported health-related quality of life (HRQoL) valuations were compared with average experienced-based population values to detect changes in valuation. Results One hundred thirty-seven subjects met inclusion criteria. All PRO measures improved significantly. Preoperative WOMAC and EQ-5D VAS, housing situation, marital status, age and asthma were found to be predictors of postoperative outcomes. 73% of study participants valued their preoperative HRQoL higher than the general population valuation, indicating response shift. Preoperatively, patient-reported EQ-5D VAS was substantially higher than average experienced-based population values. Postoperatively, this difference declined sharply. Approximately 61% of the patients reported satisfactory postoperative health, being mainly satisfied with results if postoperative WOMAC was ≥82.49 (change ≥20.25) and postoperative EQ-5D VAS was ≥75 (change ≥6). Conclusion On average, patients benefited from TKA. Preoperative WOMAC and EQ-5D VAS were predictors of postoperative outcomes after TKA. Particularly patients with high absolute preoperative PRO scores were more likely to remain unsatisfied. Therefore, outcome prediction can contribute to shared-decision making. Using general population valuations as a reference, this study underlined a discrepancy between population and patient valuation of HRQoL before, but not after surgery, thus indicating a potential temporary response shift before surgery.
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Affiliation(s)
- Julia Felix
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany.
| | - Christian Becker
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany
| | - Matthias Vogl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, 80639, Munich, Germany
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Romanstraße 93, 80639, Munich, Germany.,Klinikum rechts der Isar, Technical University Munich, 81675, Munich, Germany
| | - Reiner Leidl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758, Neuherberg, Germany.,Institute for Health Economics and Health Care Management and Munich Center of Health Sciences, Ludwig-Maximilians-University, Ludwigstr. 28 RG, 80539, Munich, Germany
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26
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Kirsch F, Schramm A, Schwarzkopf L, Lutter JI, Szentes B, Huber M, Leidl R. Direct and indirect costs of COPD progression and its comorbidities in a structured disease management program: results from the LQ-DMP study. Respir Res 2019; 20:215. [PMID: 31601216 PMCID: PMC6785905 DOI: 10.1186/s12931-019-1179-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/17/2019] [Accepted: 09/03/2019] [Indexed: 01/06/2023] Open
Abstract
Background Evidence on the economic impact of chronic obstructive pulmonary disease (COPD) for third-party payers and society based on large real world datasets are still scarce. Therefore, the aim of this study was to estimate the economic impact of COPD severity and its comorbidities, stratified by GOLD grade, on direct and indirect costs for an unselected population enrolled in the structured German Disease Management Program (DMP) for COPD. Methods All individuals enrolled in the DMP COPD were included in the analysis. Patients were only excluded if they were not insured or not enrolled in the DMP COPD the complete year before the last DMP documentation (at physician visit), had a missing forced expiratory volume in 1 s (FEV1) measurement or other missing values in covariates. The final dataset included 39,307 patients in GOLD grade 1 to 4. We used multiple generalized linear models to analyze the association of COPD severity with direct and indirect costs, while adjusting for sex, age, income, smoking status, body mass index, and comorbidities. Results More severe COPD was significantly associated with higher healthcare utilization, work absence, and premature retirement. Adjusted annual costs for GOLD grade 1 to 4 amounted to €3809 [€3691–€3935], €4284 [€4176–€4394], €5548 [€5328–€5774], and €8309 [€7583-9065] for direct costs, and €11,784 [€11,257–€12,318], €12,985 [€12,531-13,443], €15,805 [€15,034–€16,584], and €19,402 [€17,853–€21,017] for indirect costs. Comorbidities had significant additional effects on direct and indirect costs with factors ranging from 1.19 (arthritis) to 1.51 (myocardial infarction) in direct and from 1.16 (myocardial infarction) to 1.27 (cancer) in indirect costs. Conclusion The findings indicate that more severe GOLD grades in an unselected COPD population enrolled in a structured DMP are associated with tremendous additional direct and indirect costs, with comorbidities significantly increase costs. In direct cost category hospitalization and in indirect cost category premature retirement were the main cost driver. From a societal perspective prevention and interventions focusing on disease control, and slowing down disease progression and strengthening the ability to work would be beneficial in order to realize cost savings in COPD.
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Affiliation(s)
- Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany. .,Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, München, Germany.
| | - Anja Schramm
- AOK Bayern, Service Center of Health Care Management, Regensburg, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,German Center for Lung Research (DZL), Coprehensive Pneumology Center Munich (CPC-M), Hannover, Germany
| | - Johanna I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,German Center for Lung Research (DZL), Coprehensive Pneumology Center Munich (CPC-M), Hannover, Germany
| | - Boglárka Szentes
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,German Center for Lung Research (DZL), Coprehensive Pneumology Center Munich (CPC-M), Hannover, Germany
| | - Manuel Huber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany.,Munich School of Management and Munich Center of Health Sciences, Ludwig-Maximilians-Universität, München, Germany
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Szentes BL, Schwarzkopf L, Kirsch F, Schramm A, Leidl R. Measuring quality of life in COPD patients: comparing disease-specific supplements to the EQ-5D-5L. Expert Rev Pharmacoecon Outcomes Res 2019; 20:523-529. [PMID: 31512524 DOI: 10.1080/14737167.2019.1662302] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Patients with chronic obstructive pulmonary disease (COPD) show impairments in health-related quality of life (HRQL). We aimed to find a disease-specific questionnaire for routine application in large cohorts and to assess its additional explanatory power to generic HRQL tool (EQ-5D-5L). Methods: 1,350 participants of the disease management program COPD received the EQ-5D-5L combined with one of the three disease-specific tools: COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) or St. George's Respiratory Disease Questionnaire (SGRQ) (450 participants each). We compared metric properties and evaluated the Germany-specific experience-based values (EBVS) and utilities in comparison to the Visual Analogue Scale (VAS). We calculated the additional explanatory power of the identified disease-specific tool on VAS through regression analysis. Results: 344 patients returned the questionnaire. CAT, CCQ, and SGRQ group did not differ regarding baseline characteristics. The questionnaire specific response rates were 33.7% for CAT, 30.5% for CCQ, and 34.6% SGRQ, thereof 94.0%, 94.3%, and 65.6% valid answers, respectively. EBVS was better suited to reflect VAS than utilities. CAT increased the explanatory power by 10%. Conclusion: CAT outperformed CCQ and SGRQ, and it increased the explanatory power of VAS. EBV combined with CAT seems superior to only generic or disease-specific approaches.
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Affiliation(s)
- Boglárka Lilla Szentes
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL) , 85764 Neuherberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL) , 85764 Neuherberg, Germany
| | - Florian Kirsch
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL) , 85764 Neuherberg, Germany
| | - Anja Schramm
- Versorgungsmanagement, AOK Bayern, Service center of healthcare management , Regensburg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL) , 85764 Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-Universität München , 80539 Munich, Germany
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Lutter JI, Szentes B, Wacker ME, Winter J, Wichert S, Peters A, Holle R, Leidl R. Are health risk attitude and general risk attitude associated with healthcare utilization, costs and working ability? Results from the German KORA FF4 cohort study. Health Econ Rev 2019; 9:26. [PMID: 31471778 PMCID: PMC6734302 DOI: 10.1186/s13561-019-0243-9] [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] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/21/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Risk attitudes influence decisions made under uncertainty. This paper investigates the association of risk attitudes with the utilization of preventive and general healthcare services, work absence and resulting costs to explore their contribution to the heterogeneity in utilization. METHODS Data of 1823 individuals (56.5 ± 9.5 years), participating in the German KORA FF4 population-based cohort study (2013/2014) were analyzed. Individuals' general and health risk attitude were measured as willingness to take risk (WTTR) on 11-point scales. Utilization of preventive and medical services and work absence was assessed and annual costs were calculated from a societal perspective. Generalized linear models with log-link function (logistic, negative-binomial and gamma regression) adjusted for age, sex, and height were used to analyze the association of WTTR with the utilizations and costs. RESULTS Higher WTTR was significantly associated with lower healthcare utilization (physician visits, physical therapy, and medication intake), work absence days and indirect costs. Regarding preventive services, an overall negative correlation between WTTR and utilization was examined but this observation remained non-significant except for the outcome medical check-up. Here, higher WTTR was significantly associated with a lower probability of participation. For all associations mentioned, Odds Ratios ranged between 0.90 and 0.79, with p < 0.05. Comparing the two risk attitudes (general and regarding health) we obtained similar results regarding the directions of associations. CONCLUSIONS We conclude that variations in risk attitudes contribute to the heterogeneity of healthcare utilization. Thus, knowledge of their associations with utilization might help to better understand individual decision-making - especially in case of participation in preventive services.
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Affiliation(s)
- Johanna I. Lutter
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Institute for Medical Informatics, Biometry and Epidemiology, Marchioninistr 15, 81377 Munich, Germany
| | - Boglárka Szentes
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Margarethe E. Wacker
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Joachim Winter
- Department of Economics, Ludwig-Maximilians-Universität München, Ludwigstr 33, 80539 Munich, Germany
| | - Sebastian Wichert
- ifo Institute – Leibniz Institute for Economic Research at the University of Munich, Poschingerstr 5, 81679 Munich, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Ingolstaedter Landstr 1, 85764 Neuherberg, Germany
- Ludwig-Maximilians-Universität München, Munich Center of Health Sciences, Ludwigstr 28 RG, 80539 Munich, Germany
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Affiliation(s)
- Reiner Leidl
- Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians University, Munich, Germany
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Schildmann E, Hodiamont F, Leidl R, Maier BO, Bausewein C. Which Reimbursement System Fits Inpatient Palliative Care? A Qualitative Interview Study on Clinicians' and Financing Experts' Experiences and Views. J Palliat Med 2019; 22:1378-1385. [PMID: 31210558 DOI: 10.1089/jpm.2019.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Context: Internationally, a variety of reimbursement systems exists for palliative care (PC). In Germany, PC units (PCUs) may choose between per-diem rates and diagnosis-related groups (DRGs). Both systems are controversially discussed. Objectives: To explore the experiences and views of German PCU clinicians and experts for PCU financing regarding per-diem rates and DRGs as reimbursement systems with a focus on (1) cost coverage, (2) strengths and weaknesses of both financing systems, and (3) options for further development of funding PCUs. Design: Qualitative semistructured interviews with PCU clinicians and experts for PCU financing, analyzed by thematic analysis using the Framework approach. Setting/Subjects/Measurements: Ten clinicians and 13 experts for financing were interviewed June-October 2015 on both reimbursement systems for PCU. Results: Interviewees had divergent experiences with both reimbursement systems regarding cost coverage. A described strength of per-diem rates was the perceived possibility of individual care without direct financial pressure. The nationwide variation of per-diem rates and the lack of quality standards were named as weaknesses. DRGs were criticized for incentives perceived as perverse and inadequate representation of PC-specific procedures. However, the quality standards for PCUs required within the German DRG system were described as important strength. Suggestions for improvement of the funding system pointed toward a combination of per-diem rates with a grading according to disease severity/complexity of care. Conclusions: Expert opinions suggest that neither current DRGs nor per-diem rates are ideal for funding of PCUs. Suggested improvements regarding adequate funding of PCUs resemble and supplement international developments.
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Affiliation(s)
- Eva Schildmann
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum Munich-German Research Center for Environmental Health, Munich, Germany.,Munich School of Management, Institute of Health Economics and Health Care Management, Munich Center of Health Sciences, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
| | - Bernd Oliver Maier
- Department for Palliative Medicine and Interdisciplinary Oncology, St. Josef-Hospital, Wiesbaden, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universitaet (LMU) Munich, Munich, Germany
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31
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Hodiamont F, Jünger S, Leidl R, Maier BO, Schildmann E, Bausewein C. Understanding complexity - the palliative care situation as a complex adaptive system. BMC Health Serv Res 2019; 19:157. [PMID: 30866912 PMCID: PMC6417077 DOI: 10.1186/s12913-019-3961-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 04/15/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background The concept of complexity is used in palliative care (PC) to describe the nature of patients’ situations and the extent of resulting needs and care demands. However, the term or concept is not clearly defined and operationalised with respect to its particular application in PC. As a complex problem, a care situation in PC is characterized by reciprocal, nonlinear relations and uncertainties. Dealing with complex problems necessitates problem-solving methods tailored to specific situations. The theory of complex adaptive systems (CAS) provides a framework for locating problems and solutions. This study aims to describe criteria contributing to complexity of PC situations from the professionals’ view and to develop a conceptual framework to improve understanding of the concept of “complexity” and related elements of a PC situation by locating the complex problem “PC situation” in a CAS. Methods Qualitative interview study with 42 semi-structured expert (clinical/economical/political) interviews. Data was analysed using the framework method. The thematic framework was developed inductively. Categories were reviewed, subsumed and connected considering CAS theory. Results The CAS of a PC situation consists of three subsystems: patient, social system, and team. Agents in the "system patient" are allocated to further subsystems on patient level: physical, psycho-spiritual, and socio-cultural. The "social system" and the "system team" are composed of social agents, who affect the CAS as carriers of characteristics, roles, and relationships. Environmental factors interact with the care situation from outside the system. Agents within subsystems and subsystems themselves interact on all hierarchical system levels and shape the system behaviour of a PC situation. Conclusions This paper provides a conceptual framework and comprehensive understanding of complexity in PC. The systemic view can help to understand and shape situations and dynamics of individual care situations; on higher hierarchical level, it can support an understanding and framework for the development of care structures and concepts. The framework provides a foundation for the development of a model to differentiate PC situations by complexity of patients and care needs. To enable an operationalisation and classification of complexity, relevant outcome measures mirroring the identified system elements should be identified and implemented in clinical practice. Electronic supplementary material The online version of this article (10.1186/s12913-019-3961-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Saskia Jünger
- Research Unit Ethics, University Hospital Cologne, Cologne, Germany.,Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, University of Cologne, Cologne, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Bernd Oliver Maier
- St. Josephs-Hospital, Department of Palliative Medicine and Interdisciplinary Oncology, Wiesbaden, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Witt S, Krauss E, Barbero MAN, Müller V, Bonniaud P, Vancheri C, Wells AU, Vasakova M, Pesci A, Klepetko W, Seeger W, Crestani B, Leidl R, Holle R, Schwarzkopf L, Guenther A. Psychometric properties and minimal important differences of SF-36 in Idiopathic Pulmonary Fibrosis. Respir Res 2019; 20:47. [PMID: 30823880 PMCID: PMC6397447 DOI: 10.1186/s12931-019-1010-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/20/2019] [Indexed: 01/06/2023] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a rare disease with a median survival of 3–5 years after diagnosis with limited treatment options. The aim of this study is to assess the psychometric characteristics of the Short Form 36 Health Status Questionnaire (SF-36) in IPF and to provide disease specific minimally important differences (MID). Methods Data source was the European IPF Registry (eurIPFreg). The psychometric properties of the SF-36 version 2 were evaluated based on objective clinical measures as well as subjective perception. We analysed acceptance, feasibility, discrimination ability, construct and criterion validity, responsiveness and test-retest-reliability. MIDs were estimated via distribution and anchor-based approaches. Results The study population included 258 individuals (73.3% male; mean age 67.3 years, SD 10.7). Of them 75.2% (194 individuals) had no missing item. The distribution of several items was skewed, although floor effect was acceptable. Physical component score (PCS) correlated significantly and moderately with several anchors, whereas the correlations of mental component score (MCS) and anchors were only small. The tests showed mainly significant lower HRQL in individuals with long-term oxygen therapy. Analyses in stable individuals did not show significant changes of HRQL except for one dimension and anchor. Individuals with relevant changes of the health status based on the anchors had significant changes in all SF-36 dimensions and summary scales except for the dimension PAIN. PCS and MCS had mean MIDs of five and six, respectively. Mean MIDs of the dimensions ranged from seven to 21. Conclusion It seems that the SF-36 is a valid instrument to measure HRQL in IPF and so can be used in RCTs or individual monitoring of disease. Nevertheless, the additional evaluation of longitudinal aspects and MIDs can be recommended to further analyse these factors. Our findings have a great potential impact on the evaluation of IPF patients. Trial registration The eurIPFreg and eurIPFbank are listed in https://clinicaltrials.gov (NCT02951416). Electronic supplementary material The online version of this article (10.1186/s12931-019-1010-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine Witt
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany.
| | - Ekaterina Krauss
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Marburg, Germany
| | | | - Veronika Müller
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Philippe Bonniaud
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Reference Center for Rare Pulmonary Diseases, Centre Hospitalier Universitaire Dijon-Bourgogne, INSERMU1231, Université Bourgogne/Franche-Comté, Dijon, France
| | - Carlo Vancheri
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Department of Clinical and Molecular Biomedicine, Università degli Studi di Catania, Catania, Italy
| | - Athol U Wells
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Martina Vasakova
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,First Faculty of Medicine, Thomayer University Hospital Prague, Prague, Czech Republic
| | - Alberto Pesci
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Ospedale San Gerardo, Monza, Italy
| | - Walter Klepetko
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Department of Thoracic Surgery, Vienna University Hospital, Vienna, Austria
| | - Werner Seeger
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Marburg, Germany.,Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Justus-Liebig University Giessen , Giessen, Germany
| | - Bruno Crestani
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Institut National de la Santé et de la Recherche Médicale (INSERM 700), Hôpital Bichat, Service de Pneumologie, Paris, France
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany.,Ludwig-Maximilians-University, Munich Center of Health Sciences, Munich, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany
| | - Andreas Guenther
- European IPF Registry & Biobank (eurIPFreg/bank), Giessen, Germany.,Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Giessen, Marburg, Germany.,Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Justus-Liebig University Giessen , Giessen, Germany.,AGAPLESION Lung Clinic Waldhof-Elgershausen, Greifenstein, Germany
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Huber M, Kurz C, Leidl R. Predicting patient-reported outcomes following hip and knee replacement surgery using supervised machine learning. BMC Med Inform Decis Mak 2019; 19:3. [PMID: 30621670 PMCID: PMC6325823 DOI: 10.1186/s12911-018-0731-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/27/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Machine-learning classifiers mostly offer good predictive performance and are increasingly used to support shared decision-making in clinical practice. Focusing on performance and practicability, this study evaluates prediction of patient-reported outcomes (PROs) by eight supervised classifiers including a linear model, following hip and knee replacement surgery. METHODS NHS PRO data (130,945 observations) from April 2015 to April 2017 were used to train and test eight classifiers to predict binary postoperative improvement based on minimal important differences. Area under the receiver operating characteristic, J-statistic and several other metrics were calculated. The dependent outcomes were generic and disease-specific improvement based on the EQ-5D-3L visual analogue scale (VAS) as well as the Oxford Hip and Knee Score (Q score). RESULTS The area under the receiver operating characteristic of the best training models was around 0.87 (VAS) and 0.78 (Q score) for hip replacement, while it was around 0.86 (VAS) and 0.70 (Q score) for knee replacement surgery. Extreme gradient boosting, random forests, multistep elastic net and linear model provided the highest overall J-statistics. Based on variable importance, the most important predictors for post-operative outcomes were preoperative VAS, Q score and single Q score dimensions. Sensitivity analysis for hip replacement VAS evaluated the influence of minimal important difference, patient selection criteria as well as additional data years. Together with a small benchmark of the NHS prediction model, robustness of our results was confirmed. CONCLUSIONS Supervised machine-learning implementations, like extreme gradient boosting, can provide better performance than linear models and should be considered, when high predictive performance is needed. Preoperative VAS, Q score and specific dimensions like limping are the most important predictors for postoperative hip and knee PROMs.
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Affiliation(s)
- Manuel Huber
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
| | - Christoph Kurz
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
| | - Reiner Leidl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-University, Ludwigstr. 28, 80539 Munich, RG Germany
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Becker C, Leidl R, Schildmann E, Hodiamont F, Bausewein C. A pilot study on patient-related costs and factors associated with the cost of specialist palliative care in the hospital: first steps towards a patient classification system in Germany. Cost Eff Resour Alloc 2018; 16:35. [PMID: 30349423 PMCID: PMC6192371 DOI: 10.1186/s12962-018-0154-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background Specialist palliative care in the hospital addresses a heterogeneous patient population with complex care needs. In Germany, palliative care patients are classified based on their primary diagnosis to determine reimbursement despite findings that other factors describe patient needs better. To facilitate adequate resource allocation in this setting, in Australia and in the UK important steps have been undertaken towards identifying drivers of palliative care resource use and classifying patients accordingly. We aimed to pioneer patient classification based on determinants of resource use relevant to specialist palliative care in Germany first, by calculating the patient-level cost of specialist palliative care from the hospital’s perspective, based on the recorded resource use and, subsequently, by analysing influencing factors. Methods Cross-sectional study of consecutive patients who had an episode of specialist palliative care in Munich University Hospital between 20 June and 4 August, 2016. To accurately reflect personnel intensity of specialist palliative care, aside from administrative data, we recorded actual use of all involved health professionals’ labour time at patient level. Factors influencing episode costs were assessed using generalized linear regression and LASSO variable selection. Results The study included 144 patients. Mean costs of specialist palliative care per palliative care unit episode were 6542€ (median: 5789€, SE: 715€) and 823€ (median: 702€, SE: 31€) per consultation episode. Based on multivariate models that considered both variables recorded at beginning and at the end of episode, we identified factors explaining episode cost including phase of illness, Karnofsky performance score, and type of discharge. Conclusions This study is an important step towards patient classification in specialist palliative care in Germany as it provides a feasible patient-level costing method and identifies possible starting points for classification. Application to a larger sample will allow for meaningful classification of palliative patients.
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Affiliation(s)
- Christian Becker
- 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85758 Neuherberg, Germany.,2Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Reiner Leidl
- 1Institute of Health Economics and Health Care Management, Helmholtz Zentrum München-German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85758 Neuherberg, Germany.,2Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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Huber M, Vogelmann M, Leidl R. Valuing health-related quality of life: systematic variation in health perception. Health Qual Life Outcomes 2018; 16:156. [PMID: 30068349 PMCID: PMC6090681 DOI: 10.1186/s12955-018-0986-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population-based value sets are widely used to transform health states into utilities, but may deviate from actual patient experience. Whether this occurs in a systematic way can be analyzed, in a first step, for respondents who do not report problems on the five domains of the EQ-5D-5L instrument in population studies. METHODS EQ-5D-5L results from three annual cross-sectional surveys (2012, 2013, and 2014) were filtered for participants who reported being problem-free. Continuous visual analog scale (VAS) scores, ranging from 0 (worst imaginable health) to 100 (best imaginable health) were then used to measure their actual health perception and to compare results with the proposed EQ-5D-5L value. A multiple linear regression model was used to identify possible risk factors for low VAS scores. RESULTS Some 3739 (61.5%) participants reported being problem-free. Their mean age was 41.1 years and mean VAS score was 91.9. Age and BMI were significantly associated with lower VAS scores. Age groups from 50 years onwards reported VAS means of 90.0 and below. Female gender and low education also had small but significant negative effects on patient experience. The presence of BMI class III as well as diabetes had the greatest negative effect on VAS results (- 9.0 and - 8.4) and reached the range of minimally important differences. Heart disease (- 6.2) and musculoskeletal disease (- 3.4) also had strong negative effects. The 25th percentile of VAS scores in our sample was 90.0, and the 50th percentile was 95.0. CONCLUSIONS For some groups in population studies, especially older people with high BMI and those affected by specific diseases, no problems on all five domains of the EQ-5D-5L fails to reflect the respondents' health perception as measured by the VAS.
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Affiliation(s)
- Manuel Huber
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
| | - Martin Vogelmann
- Wort & Bild Verlag Konradshöhe GmbH & Co. KG, 82065 Baierbrunn, Germany
| | - Reiner Leidl
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-University, Ludwigstr. 28 RG, 80539 Munich, Germany
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Trapero-Bertran M, Muñoz C, Coyle K, Coyle D, Lester-George A, Leidl R, Bertalan N, Cheung KL, Pokhrel S, Lopez-Nicolás A. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90419] [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: 11/24/2022]
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Trapero-Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak-Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S, EQUIPT Study Group OBOT. Estimating costs for modelling return on investment from smoking cessation interventions. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90429] [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: 11/24/2022]
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Trapero‐Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak‐Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S. Estimates of costs for modelling return on investment from smoking cessation interventions. Addiction 2018; 113 Suppl 1:32-41. [PMID: 29532538 PMCID: PMC6033022 DOI: 10.1111/add.14091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/20/2017] [Accepted: 11/02/2017] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIMS Modelling return on investment (ROI) from smoking cessation interventions requires estimates of their costs and benefits. This paper describes a standardized method developed to source both economic costs of tobacco smoking and costs of implementing cessation interventions for a Europe-wide ROI model [European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD)]. DESIGN Focused search of administrative and published data. A standardized checklist was developed in order to ensure consistency in methods of data collection. SETTING AND PARTICIPANTS Adult population (15+ years) in Hungary, Netherlands, Germany, Spain and England. For passive smoking-related costs, child population (0-15 years) was also included. MEASUREMENTS Costs of treating smoking-attributable diseases; productivity losses due to smoking-attributable absenteeism; and costs of implementing smoking cessation interventions. FINDINGS Annual costs (per case) of treating smoking attributable lung cancer were between €5074 (Hungary) and €52 106 (Germany); coronary heart disease between €1521 (Spain) and €3955 (Netherlands); chronic obstructive pulmonary disease between €1280 (England) and €4199 (Spain); stroke between €1829 (Hungary) and €14 880 (Netherlands). Costs (per recipient) of smoking cessation medications were estimated to be: for standard duration of varenicline between €225 (England) and €465 (Hungary); for bupropion between €25 (Hungary) and €220 (Germany). Costs (per recipient) of providing behavioural support were also wide-ranging: one-to-one behavioural support between €34 (Hungary) and €474 (Netherlands); and group-based behavioural support between €12 (Hungary) and €257 (Germany). The costs (per recipient) of delivering brief physician advice were: €24 (England); €9 (Germany); €4 (Hungary); €33 (Netherlands); and €27 (Spain). CONCLUSIONS Costs of treating smoking-attributable diseases as well as the costs of implementing smoking cessation interventions vary substantially across Hungary, Netherlands, Germany, Spain and England. Estimates for the costs of these diseases and interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Puttarin Kulchaitanaroaj
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
| | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
- Department of Epidemiology and Community Medicine, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Maximilian Präger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
| | - Judit Józwiak‐Hagymásy
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei Long Cheung
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Mickael Hiligsmann
- CAPHRI Care and Public Health Research Institute, Department of Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonUxbridgeUK
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Coyle K, Coyle D, Lester‐George A, West R, Nemeth B, Hiligsmann M, Trapero‐Bertran M, Leidl R, Pokhrel S. Development and application of an economic model (EQUIPTMOD) to assess the impact of smoking cessation. Addiction 2018; 113 Suppl 1:7-18. [PMID: 28833765 PMCID: PMC6033161 DOI: 10.1111/add.14001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/27/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Although clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision-makers need tools to assess the Return on Investment (ROI)/cost-effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking. METHODS EQUIPTMOD uses a Markov model to estimate life-time costs, quality-adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country-specific rates. RESULTS For illustration, over a life-time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease-related health care costs than if the smoker ceased smoking in the next 12 months. For all age-sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued. CONCLUSIONS EQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.
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Affiliation(s)
- Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonLondonUK
| | - Doug Coyle
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonLondonUK
- School of Epidemiology, Public Health and Preventative MedicineUniversity of OttawaOttawaONCanada
| | | | - Robert West
- Department of Epidemiology and Public HealthUniversity College LondonLondonUK
| | | | - Mickael Hiligsmann
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI)Maastricht UniversityMaastrichtthe Netherlands
| | - Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF)University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M)Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and SocietiesBrunel University LondonLondonUK
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Huber MB, Präger M, Coyle K, Coyle D, Lester‐George A, Trapero‐Bertran M, Nemeth B, Cheung KL, Stark R, Vogl M, Pokhrel S, Leidl R. Cost-effectiveness of increasing the reach of smoking cessation interventions in Germany: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:52-64. [PMID: 29243347 PMCID: PMC6033002 DOI: 10.1111/add.14062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/07/2017] [Accepted: 10/03/2017] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate costs, effects and cost-effectiveness of increased reach of specific smoking cessation interventions in Germany. DESIGN A Markov-based state transition return on investment model (EQUIPTMOD) was used to evaluate current smoking cessation interventions as well as two prospective investment scenarios. A health-care perspective (extended to include out-of-pocket payments) with life-time horizon was considered. A probabilistic analysis was used to assess uncertainty concerning predicted estimates. SETTING Germany. PARTICIPANTS Cohort of current smoking population (18+ years) in Germany. INTERVENTIONS Interventions included group-based behavioural support, financial incentive programmes and varenicline. For prospective scenario 1 the reach of group-based behavioral support, financial incentive programme and varenicline was increased by 1% of yearly quit attempts (= 57 915 quit attempts), while prospective scenario 2 represented a higher reach, mirroring the levels observed in England. MEASUREMENTS EQUIPTMOD considered reach, intervention cost, number of quitters, quality-of-life years (QALYs) gained, cost-effectiveness and return on investment. FINDINGS The highest returns through reduction in smoking-related health-care costs were seen for the financial incentive programme (€2.71 per €1 invested), followed by that of group-based behavioural support (€1.63 per €1 invested), compared with no interventions. Varenicline had lower returns (€1.02 per €1 invested) than the other two interventions. At the population level, prospective scenario 1 led to 15 034 QALYs gained and €27 million cost-savings, compared with current investment. Intervention effects and reach contributed most to the uncertainty around the return-on-investment estimates. At a hypothetical willingness-to-pay threshold of only €5000, the probability of being cost-effective is approximately 75% for prospective scenario 1. CONCLUSIONS Increasing the reach of group-based behavioural support, financial incentives and varenicline for smoking cessation by just 1% of current annual quit attempts provides a strategy to German policymakers that improves the population's health outcomes and that may be considered cost-effective.
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Affiliation(s)
- Manuel B. Huber
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Maximilian Präger
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Doug Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
- School of Epidemiology, Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Marta Trapero‐Bertran
- Centre for Research on Economics an Health (CRES) Universitat Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | | | - Kei Long Cheung
- Caphri School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Renee Stark
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Matthias Vogl
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
| | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonLondonUK
| | - Reiner Leidl
- Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)Institute of Health Economics and Health Care ManagementNeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
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Trapero‐Bertran M, Muñoz C, Coyle K, Coyle D, Lester‐George A, Leidl R, Németh B, Cheung K, Pokhrel S, Lopez‐Nicolás Á. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Addiction 2018; 113 Suppl 1:65-75. [PMID: 29532966 PMCID: PMC6032934 DOI: 10.1111/add.14090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 12/02/2022]
Abstract
AIMS To assess the cost-effectiveness of alternative smoking cessation scenarios from the perspective of the Spanish National Health Service (NHS). DESIGN We used the European study on Quantifying Utility of Investment in Protection from Tobacco model (EQUIPTMOD), a Markov-based state transition economic model, to estimate the return on investment (ROI) of: (a) the current provision of smoking cessation services (brief physician advice and printed self-helped material + smoking ban and tobacco duty at current levels); and (b) four alternative scenarios to complement the current provision: coverage of proactive telephone calls; nicotine replacement therapy (mono and combo) [prescription nicotine replacement therapy (Rx NRT)]; varenicline (standard duration); or bupropion. A rate of 3% was used to discount life-time costs and benefits. SETTING Spain. PARTICIPANTS Adult smoking population (16+ years). MEASUREMENTS Health-care costs associated with treatment of smoking attributable diseases (lung cancer, coronary heart disease, chronic obstructive pulmonary infection and stroke); intervention costs; quality-adjusted life years (QALYs). Costs and outcomes were summarized using various ROI estimates. FINDINGS The cost of implementing the current provision of smoking cessation services is approximately €61 million in the current year. This translates to 18 quitters per 1000 smokers and a life-time benefit-cost ratio of 5, compared with no such provision. All alternative scenarios were dominant (cost-saving: less expensive to run and generated more QALYs) from the life-time perspective, compared with the current provision. The life-time benefit-cost ratios were: 1.87 (proactive telephone calls); 1.17 (Rx NRT); 2.40 (varenicline-standard duration); and bupropion (2.18). The results remained robust in the sensitivity analysis. CONCLUSIONS According to the EQUIPTMOD modelling tool it would be cost-effective for the Spanish authorities to expand the reach of existing GP brief interventions for smoking cessation, provide pro-active telephone support, and reimburse smoking cessation medication to smokers trying to stop. Such policies would more than pay for themselves in the long run.
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Affiliation(s)
- Marta Trapero‐Bertran
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Faculty of Economics and Social SciencesUniversitat Internacional de Catalunya (UIC)BarcelonaSpain
| | - Celia Muñoz
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
| | - Kathryn Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
| | - Doug Coyle
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) ‐ German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL)NeuherbergGermany
- Munich Center of Health SciencesLudwig‐Maximilians‐UniversityMunichGermany
| | - Bertalan Németh
- Faculty of Social Sciences, Department of Health Policy and Health EconomicsEötvös Loránd University, and Syreon Research InstituteBudapestHungary
| | - Kei‐Long Cheung
- Caphri School of Public Health and Primary Care, Health Services ResearchMaastricht UniversityMaastrichtthe Netherlands
| | - Subhash Pokhrel
- Health Economics Research GroupInstitute of Environment, Health and Societies, Brunel University LondonUxbridgeUK
| | - Ángel Lopez‐Nicolás
- Centre of Research in Economics and Health (CRES‐UPF) University Pompeu FabraBarcelonaSpain
- Department of Economics, Faculty of Business ScienceUniversidad Politécnica de Cartagena
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Präger M, Kiechle M, Stollenwerk B, Hinzen C, Glatz J, Vogl M, Leidl R. Costs and effects of intra-operative fluorescence molecular imaging - A model-based, early assessment. PLoS One 2018; 13:e0198137. [PMID: 29856875 PMCID: PMC5983425 DOI: 10.1371/journal.pone.0198137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/14/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Successful breast conserving cancer surgeries come along with tumor free resection margins and account for cosmetic outcome. Positive margins increase the likelihood of tumor recurrence. Intra-operative fluorescence molecular imaging (IFMI) aims to focus surgery on malignant tissue thus substantially lowering the presence of positive margins as compared with standard techniques of breast conservation (ST). A goal of this paper is to assess the incremental number of surgeries and costs of IFMI vs. ST. Methods We developed a decision analytical model and applied it for an early evaluation approach. Given uncertainty we considered that IFMI might reduce the proportion of positive margins found by ST from all to none and this proportion is assumed to be reduced to 10% for the base case. Inputs included data from the literature and a range of effect estimates. For the costs of IFMI, respective cost components were added to those of ST. Results The base case reduction lowered number of surgeries (mean [95% confidence interval]) by 0.22 [0.15; 0.30] and changed costs (mean [95% confidence interval]) by €-663 [€-1,584; €50]. A tornado diagram identified the Diagnosis Related Group (DRG) costs, the proportion of positive margins of ST, the staff time saving factor and the duration of frozen section analysis (FSA) as important determinants of this cost. Conclusions These early results indicate that IFMI may be more effective than ST and through the reduction of positive margins it is possible to save follow-up surgeries–indicating further health risk–and to save costs through this margin reduction and the avoidance of FSA.
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Affiliation(s)
- Maximilian Präger
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- * E-mail:
| | - Marion Kiechle
- Center for Hereditary Breast and Ovarian Cancer, Department of Gynecology, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
- Comprehensive Cancer Center Munich (CCCM), Munich, Germany
| | - Björn Stollenwerk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
| | - Christoph Hinzen
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- Chair for Biological Imaging, Technical University Munich, Munich, Germany
| | - Jürgen Glatz
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- Chair for Biological Imaging, Technical University Munich, Munich, Germany
| | - Matthias Vogl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)—German Research Center for Environmental Health, Neuherberg, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
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Szentes BL, Kreuter M, Bahmer T, Birring SS, Claussen M, Waelscher J, Leidl R, Schwarzkopf L. Quality of life assessment in interstitial lung diseases:a comparison of the disease-specific K-BILD with the generic EQ-5D-5L. Respir Res 2018; 19:101. [PMID: 29801506 PMCID: PMC5970441 DOI: 10.1186/s12931-018-0808-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022] Open
Abstract
Background Patients with interstitial lung diseases (ILD) have impaired health-related quality of life (HRQL). Little is known about the applicability of the disease-specific King’s Brief Interstitial Lung Disease questionnaire (K-BILD) and the generic EQ-5D-5L in a German setting. Methods We assessed disease-specific (K-BILD) and generic HRQL (EQ-5D experience based value set (EBVS) and Visual Analog Scale (VAS)) in 229 patients with different ILD subtypes in a longitudinal observational study (HILDA). Additionally, we assessed the correlation of the HRQL measures with lung function and comorbidities. In a linear regression model, we investigated predictors (including age, sex, ILD subtype, FVC percentage of predicted value (FVC%pred), DLCO percentage of predicted value, and comorbidities). Results Among the 229 patients mean age was 63.2 (Standard deviation (SD): 12.9), 67.3% male, 24.0% had idiopathic pulmonary fibrosis, and 22.3% sarcoidosis. Means scores were as follows for EQ-5D EBVS 0.66(SD 0.17), VAS 61.4 (SD 19.1) and K-BILD Total 53.6 (SD 13.8). K-BILD had good construct validity (high correlation with EQ-5D EBVS (0.71)) and good internal consistency (Cronbach’s alpha 0.89). Moreover, all HRQL measures were highly accepted by patients including low missing items and there were no ceiling or floor effects. A higher FVC % pred was associated with higher HRQL in all measures meanwhile comorbidities had a negative influence on HRQL. Conclusions K-BILD and EQ-5D had similar HRQL trends and were associated similarly to the same disease-related factors in Germany. Our data supports the use of K-BILD in clinical practice in Germany, since it captures disease specific effects of ILD. Additionally, the use of the EQ-5D-5L could provide comparison to different disease areas and give an overview about the position of ILD patients in comparison to general population. Electronic supplementary material The online version of this article (10.1186/s12931-018-0808-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Boglárka Lilla Szentes
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases Pneumology and Respiratory Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse, 169126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm, 80 22927, Großhansdorf, Germany
| | - Surinder S Birring
- Centre of Human & Aerospace Physiological Sciences, School of Basic & Medical Biosciences Faculty of Life Sciences & Medicine, King's College London, London, WC2R 2LS, UK.,Department of Respiratory Medicine, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the Airway Research Center North (ARCN), German Center for Lung Research (DZL), Wöhrendamm, 80 22927, Großhansdorf, Germany
| | - Julia Waelscher
- Center for Interstitial and Rare Lung Diseases Pneumology and Respiratory Critical Care Medicine, Thoraxklinik University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Roentgenstrasse, 169126, Heidelberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.,Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Ludwigstr. 28, 80539, Munich, RG, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
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Kisch R, Bergmann A, Koller D, Leidl R, Mansmann U, Mueller M, Sanftenberg L, Schelling J, Sundmacher L, Voigt K, Grill E. Patient trajectories and their impact on mobility, social participation and quality of life in patients with vertigo/dizziness/balance disorders and osteoarthritis (MobilE-TRA): study protocol of an observational, practice-based cohort study. BMJ Open 2018; 8:e022970. [PMID: 29680815 PMCID: PMC5914901 DOI: 10.1136/bmjopen-2018-022970] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients' needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing. OBJECTIVE The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) . METHODS Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals. ETHICS AND DISSEMINATION The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
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Affiliation(s)
- Rebecca Kisch
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Antje Bergmann
- Department of General Practice/Medical Clinic III, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Reiner Leidl
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Mueller
- Faculty of Applied Health and Social Sciences, Hochschule Rosenheim, Rosenheim, Germany
| | - Linda Sanftenberg
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joerg Schelling
- Institute of General Practice and Family Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leonie Sundmacher
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karen Voigt
- Department of General Practice/Medical Clinic III, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians Universität München, Munich, Germany
- German Centre for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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Vogl M, Schildmann E, Leidl R, Hodiamont F, Kalies H, Maier BO, Schlemmer M, Roller S, Bausewein C. Redefining diagnosis-related groups (DRGs) for palliative care - a cross-sectional study in two German centres. BMC Palliat Care 2018; 17:58. [PMID: 29622004 PMCID: PMC5887171 DOI: 10.1186/s12904-018-0307-3] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. METHODS Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. RESULTS Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. CONCLUSIONS Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not reproduce the costs adequately, but causes a financing gap for inpatient palliative care.
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Affiliation(s)
- Matthias Vogl
- Helmholtz Zentrum Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Eva Schildmann
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum Munich, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universitaet Munich, Munich School of Management, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Munich, Germany
| | - Farina Hodiamont
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Helen Kalies
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Bernd Oliver Maier
- St. Josephs-Hospital, Department of Palliative Medicine and Interdisciplinary Oncology, Wiesbaden, Germany
| | - Marcus Schlemmer
- Krankenhaus Barmherzige Brüder Munich, Department of Palliative Medicine, Munich, Germany
| | - Susanne Roller
- Krankenhaus Barmherzige Brüder Munich, Department of Palliative Medicine, Munich, Germany
| | - Claudia Bausewein
- Munich University Hospital, Department of Palliative Medicine, Ludwig-Maiximilians-Universitaet Munich, Marchioninistr. 15, 81377 Munich, Germany
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Lutter J, Wacker M, Jörres RA, Schulz H, Karrasch S, Karch A, Leidl R, Watz H, Vogelmeier C, Holle R. Welche Faktoren prädizieren eine Verschlechterung der gesundheitsbezogenen Lebensqualität bei COPD? Erste längsschnittliche Ergebnisse der COSYCONET COPD-Kohorte. Pneumologie 2018. [DOI: 10.1055/s-0037-1619341] [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: 10/28/2022]
Affiliation(s)
- J Lutter
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - M Wacker
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - RA Jörres
- Institut für Arbeits-, Sozial- und Umweltmedizin, Ludwigs-Maximilians-Universität München
| | - H Schulz
- Institut für Epidemiologie, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - S Karrasch
- Institut für Epidemiologie, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - A Karch
- Institut für Biometrie, Medizinische Hochschule Hannover
| | - R Leidl
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - H Watz
- Pneumologisches Forschungsinstitut an der Lungenclinic Grosshansdorf GmbH, ARCN, Mitglied im Deutschen Zentrum für Lungenforschung (DZL)
| | - C Vogelmeier
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, UGMLC, Philipps-Universität Marburg, Mitglied im Deutschen Zentrum für Lungenforschung (DZL)
| | - R Holle
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
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Kreuter M, Herth FJF, Wacker M, Witt S, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederholf C, Skowasch D, Stolpe C, Joest M, Veitshans S, Leidl R, Hellmann A, Pfeifer M, Behr J, Kauschka D, Mall M, Günther A, Markart P. Diagnostik und Therapie von Patienten mit interstitiellen Lungenerkrankungen in Deutschland – das EXCITING ILD Register. Pneumologie 2018. [DOI: 10.1055/s-0037-1619191] [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: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg
| | - M Wacker
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - S Witt
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | | | - L Hagmeyer
- Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen
| | | | - A Esselmann
- Outpatient Center for Pulmonology, Warendorf
| | | | - D Skowasch
- Medical Clinic II, University Hospital Bonn
| | - C Stolpe
- Outpatient Center for Pulmonology, Ibbenbüren
| | - M Joest
- Malteser Center for Pulmonology and Allergology, Bonn
| | - S Veitshans
- Outpatient Center for Pulmonology, Böblingen
| | - R Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - A Hellmann
- Outpatient Center for Pulmonology, Augsburg
| | - M Pfeifer
- Klinik Donaustauf und Universitätsklinikum Regensburg
| | | | | | - M Mall
- Translational Pulmonology, University of Heidelberg, Germany, Member of the German Center for Lung Research (TLRC)
| | - A Günther
- Universitätsklinikum Gießen und Marburg
| | - P Markart
- Medical Clinic II, University Hospital Gießen, Universities of Gießen and Marburg Lung Centre (Ugmlc), Member and Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg
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Kulchaitanaroaj P, Kaló Z, West R, Cheung KL, Evers S, Vokó Z, Hiligsmann M, de Vries H, Owen L, Trapero-Bertran M, Leidl R, Pokhrel S. Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic model: a cross-sectional study. BMC Health Serv Res 2018; 18:115. [PMID: 29444679 PMCID: PMC5813331 DOI: 10.1186/s12913-018-2923-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders' views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data. METHODS An interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team's contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders' views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review. RESULTS Ninety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [- 0.09, 0.89]). CONCLUSIONS The intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.
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Affiliation(s)
- Puttarin Kulchaitanaroaj
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Robert West
- Health Behaviour Research Centre, University College London, London, UK
- National Centre for Smoking Cessation and Training, Birmingham, UK
| | - Kei Long Cheung
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Mickael Hiligsmann
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Lesley Owen
- National Institute for Health and Care Excellence, London, UK
| | - Marta Trapero-Bertran
- Centre for Research in Economics and Health, University Pompeu Fabra, Barcelona, Spain
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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Walter J, Tufman A, Leidl R, Holle R, Schwarzkopf L. Rural versus urban differences in end-of-life care for lung cancer patients in Germany. Support Care Cancer 2018; 26:2275-2283. [DOI: 10.1007/s00520-018-4063-y] [Citation(s) in RCA: 8] [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: 08/04/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
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Knoll A, Mewes HW, Schwaiger M, Bode A, Broy M, Daniel H, Feussner H, Gradinger R, Hauner H, Höfler H, Holzmann B, Horsch A, Kemper A, Krcmar H, Kochs EF, Lange R, Leidl R, Mansmann U, Mayr EW, Meitinger T, Molls M, Navab N, Nüsslin F, Peschel C, Reiser M, Ring J, Rummeny EJ, Schlichter J, Schmid R, Wichmann HE, Ziegler S, Kuhn KA. Informatics and Medicine. Methods Inf Med 2018. [DOI: 10.3414/me9117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: To clarify challenges and research topics for informatics in health and to describe new approaches for interdisciplinary collaboration and education. Methods: Research challenges and possible solutions were elaborated by scientists of two universities using an interdisciplinary approach, in a series of meetings over several months. Results and Conclusion: In order to translate scientific results from bench to bedside and further into an evidence-based and efficient health system, intensive collaboration is needed between experts from medicine, biology, informatics, engineering, public health, as well as social and economic sciences. Research challenges can be attributed to four areas: bioinformatics and systems biology, biomedical engineering and informatics, health informatics and individual healthcare, and public health informatics. In order to bridge existing gaps between different disciplines and cultures, we suggest focusing on interdisciplinary education, taking an integrative approach and starting interdisciplinary practice at early stages of education.* See more detailed authors´ affiliations at the end of the article.
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