Ansgar Lange - Academia.edu (original) (raw)
Papers by Ansgar Lange
Medicina
Background and Objectives: Appendiceal carcinoids are rare neuroendocrine tumors and mainly found... more Background and Objectives: Appendiceal carcinoids are rare neuroendocrine tumors and mainly found incidentally during histopathological examination following appendectomy. This observational cohort study was performed to determine the prevalence, treatment modalities and outcomes in children diagnosed with an appendiceal carcinoid tumor. Materials and Methods: Data from the largest German statutory health insurance “Techniker Krankenkasse” were analyzed within an 8-year period: January 2010 to December 2012 and January 2016 to December 2020. Patient characteristics, surgical technique, type of surgical department, diagnostic management, and postoperative morbidity were analyzed. Results: Out of 40.499 patients following appendectomy, appendiceal carcinoids were found in 44 children, resulting in a prevalence of 0.11%. Mean age at appendectomy was 14.7 (±2.6) years. Laparoscopic approach was performed in 40 (91%) cases. Right-sided hemicolectomy was performed in 8 (18%) patients. Add...
Fragestellung: Osteoporesebedingte Wirbelkörperkompressionsfrakturen (OVCF) stehen im Zusammenhan... more Fragestellung: Osteoporesebedingte Wirbelkörperkompressionsfrakturen (OVCF) stehen im Zusammenhang mit einer erhöhten Morbidität, Mortalität sowie verringerten Lebensqualität der Betroffenen. Analysen haben eine um 16% erhöhtes Mortalitätsrisiko ergeben (HR =[for full text, please go to the a.m. URL]
Value in Health, 2015
A223 and outcome of both surgical disciplines and the impact of numerous other factors. METHODS: ... more A223 and outcome of both surgical disciplines and the impact of numerous other factors. METHODS: Data were extracted from a major public health insurance claims database (~ 8 million clients) during a 3-year period (2010-2012). Patients aged 4-17 years with appendectomy were included. Logistic regression analysis for risk of a surgical complication within the first 180-postoperative days was performed. Complications were defined by ICD and OPS codes. RESULTS: 8,110 patients were analyzed (PedSurg: n= 1,937; GenSurg: n= 6,173). Laparoscopic appendectomy was performed significantly more frequently by GenSurg compared to PedSurg (79% vs. 61%). The complication rate during initial stay and the readmission rate for surgical complications were significantly higher in patients treated by PedSurg compared to those operated on by GenSurg (2.9% vs. 1.7% and 3.4% vs. 2.2% respectively, p< 0.01). Logistic regression analysis revealed no differences between the two surgical specialities for the risk of surgical complications during the initial hospital stay and no differences for the risk of readmission for a surgical complication in younger patients (4-11 years). In contrast, the risk of readmission for surgical complications in adolescents (12-17 years) was significantly higher if the patient was operated on by PedSurg (p< 0.01). The results showed that patients treated with laparoscopy had a significantly lower risk for developing surgical complications within the first 180 postoperative days than patients who underwent an open surgery (OR: 0.73, p< 0.1). No differences were found for the variables geographical region and working day vs. weekendsurgery. CONCLUSIONS: With overall low complication and readmission rates after appendectomy this study revealed an excellent quality of care for appendicitis in Germany. However, the increased risk of readmission for surgical complications in adolescent patients operated by PedSurg deserves future investigation.
The European journal of health economics : HEPAC : health economics in prevention and care, Jan 16, 2017
Although health technology assessment (HTA) systems base their decision making process either on ... more Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value. To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment. A systematic (peer review and grey) literature review was conducted using an analytical framework examining: (1) 'Responsibilities and structure of HTA agencies'; (2) 'Evidence and evaluation criteria considered in HTAs'; (3) 'Methods and techniques applied in HTAs'; and (4) 'Outcomes and implementation of HTAs'. Study countries were France, Germany, England, Sweden, Italy, Netherlan...
Prozessorientierter Leitfaden für die Analyse und Nutzung von Routinedaten der Gesetzlichen Krankenversicherung, 2017
Zeitschrift für Sozialreform, 2014
Modellrechnungen gehen in Zukunft von einer steigenden Zahl von Pflegebedürftigen und einem zuneh... more Modellrechnungen gehen in Zukunft von einer steigenden Zahl von Pflegebedürftigen und einem zunehmendem Finanzierungsbedarf der sozialen Pflegeversicherung aus. Die Methodik der bisherigen Berechnungen ist jedoch zumeist sehr undifferenziert, insbesondere mit Blick auf Unterschiede in der Inanspruchnahme von Pflegeleistungen zwischen Männern und Frauen. Hier setzt die vorliegende Untersuchung an und ermittelt auf Basis von Routinedaten alters- und geschlechtsspezifische Ausgabenprofile für Pflegeversicherungsleistungen. Die Ergebnisse zeigen, dass es vor allem in den hohen Altersgruppen zu Unterschiedenen in der Höhe der Pflegeausgaben zvischen Männern und Frauen kommt, die durch Abweichungen im Inanspruchnahmeverhalten erklärt werden können. Die Verwendung von differenzierten Ausgabenprofilen in Modellrechnungen kann dazu beitragen, die Effekte der Bevölkerungsentwicklung auf die Entwicklung der Pflegeausgaben realitätsorientierter abzuschätzen.
Health Policy, 2016
BACKGROUND The aim of this article is to evaluate the status, development, and perspectives of Ge... more BACKGROUND The aim of this article is to evaluate the status, development, and perspectives of German claims data analyses in the international and health political context. METHODS We conducted a comprehensive literature search in PubMed, Scopus, and DIMDI to identify empirical and methodological articles focusing on health insurance claims data studies published between 2000 and 2014. Inclusion criteria were (1) English/German full text articles or chapters in edited books that (2) focused on the claims data of statutory health insurance funds. FINDINGS In total, 435 articles were included. Over time, the number of claims data studies has increased strongly and the frequency of policy-relevant research types increased. Along with the historical improvement path of claims data in Germany, we observed a rising percentage of international publications and an increase in the average quality of publications. In contrast to the US or Canada where comprehensive databases have been established, the most common data source in this search was data from a single SHI fund, while databases were rarely used. CONCLUSIONS Claims data are an important source of information for healthcare stakeholders, and their use for research purposes has further increased during recent years in Germany. Despite its potential in optimising the health system, we found a lack of German comprehensive all-payer claims databases compared to the US and Canada.
Health Economics Review, 2015
Background: The regional availability of specialized physicians is an important aspect in healthc... more Background: The regional availability of specialized physicians is an important aspect in healthcare of patients with IBD. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?" Methods: We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated: regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed. Results: The study cohort was comprised of 21,771 individuals, including 9282 patients with Crohn disease and 12,489 patients with ulcerative colitis. Patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support. Conclusions: The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. No clear evidence of a general healthcare undersupply in rural areas was found.
Advances in Therapy, 2015
Introduction: Among patients with acute myeloid leukemia (AML), the DACO-016 randomized study sho... more Introduction: Among patients with acute myeloid leukemia (AML), the DACO-016 randomized study showed reduction in mortality for decitabine [Dacogen Ò (DAC), Eisai Inc., Woodcliff Lake, NJ, USA] compared with treatment choice (TC): at primary analysis the hazard ratio (HR) was 0.85 (95% confidence interval 0.69-1.04; stratified log-rank P = 0.108). With two interim analyses, two-sided alpha was adjusted to 0.0462. With 1-year additional follow-up the HR reached 0.82 (nominal P = 0.0373). These data resulted in approval of DAC in the European Union, though not in the United States. Though pre-specified, the log-rank test could be considered not optimal to assess the observed survival difference because of the non-proportional hazard nature of the survival curves. Methods: We applied the Wilcoxon test as a sensitivity analysis. Patients were randomized to DAC (N = 242) or TC (N = 243). One-hundred and eight (44.4%) patients in the TC arm and 91 (37.6%) patients in the DAC arm selectively crossed over to subsequent disease modifying therapies at progression, which might impact the survival beyond the median with resultant converging curves (and disproportional hazards). Results: The stratified Wilcoxon test showed a significant improvement in median (CI 95%) overall survival with DAC [7.7 (6.2; 9.2) months] versus TC [5.0 (4.3; 6.3) months; P = 0.0458]. Conclusion: Wilcoxon test indicated significant increase in survival for DAC versus TC compared to log-rank test.
The oncologist, 2014
Survival of patients with metastatic colorectal cancer (mCRC) has been significantly improved wit... more Survival of patients with metastatic colorectal cancer (mCRC) has been significantly improved with the introduction of the monoclonal antibodies targeting the vascular endothelial growth factor (VEGF) and the epidermal growth factor receptor (EGFR). Novel molecular-targeted agents such as aflibercept and regorafenib have recently been approved. The aim of this review is to summarize and assess the effects of molecular agents in mCRC based on the available phase II and III trials, pooled analyses, and meta-analyses/systematic reviews. A systematic literature search was conducted using the meta-database of the German Institute of Medical Documentation and Information. Criteria of the Scottish Intercollegiate Guidelines Network were used to assess the quality of the controlled trials and systematic reviews/meta-analyses. Of the 806 retrieved records, 40 publications were included. For bevacizumab, efficacy in combination with fluoropyrimidine-based chemotherapy in first- and subsequent...
BMC pulmonary medicine, Jan 4, 2014
Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems ... more Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion ...
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2014
The study aims to estimate the direct disease-related costs of osteoporotic vertebral compression... more The study aims to estimate the direct disease-related costs of osteoporotic vertebral compression fractures (OVCF) in patients with newly diagnosed fracture in the first year after index in Germany. Analyses reveal that OVCFs are associated with significant costs. In light of high and increasing incidence, the results emphasize importance of research in this field. OVCF are among the most common fractures related to osteoporosis. They have been shown to be associated with excess mortality and meaningful healthcare costs. Costs calculations have illustrated the significant financial burden to society and national social security systems. However, this information is not available for Germany. Therefore, aim of the study was to estimate the direct disease-related costs of OVCF in patients with newly diagnosed fracture in the first year after index in Germany. Data were obtained from a claims dataset of a large German health insurance fund. Subjects ≥ 60 years with a new vertebral frac...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2013
Claims data have proven useful for carrying out cost-of-illness studies. To avoid overestimating ... more Claims data have proven useful for carrying out cost-of-illness studies. To avoid overestimating disease-related costs, only those costs that are related to a specific disease should be considered. The present study demonstrates two basic approaches for identifying disease-related costs. Using the example of attention-deficit hyperactivity disorder (ADHD), the advantages and drawbacks of expert-based approaches and those based on control groups are compared. Anonymized data from the "Techniker Krankenkasse" for 2008 were available for the study. The study population encompassed all ADHD patients and a control group that was five times bigger. Additionally, a systematic literature review was carried out on 65 relevant studies. Compared with the control group, disease-related costs were EUR 2,902 per ADHD patient on average. However, using the expert-based approach, costs were established to be EUR 923 lower. This is mainly because a comparison with an appropriate control gr...
![Research paper thumbnail of [Economic aspects of integrated care]](https://attachments.academia-assets.com/102441632/thumbnails/1.jpg)
](Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2012
For more than 10 years integrated care has been an inherent part of the German healthcare system.... more For more than 10 years integrated care has been an inherent part of the German healthcare system. The aims of selective contracts are to minimize interface problems between outpatient and inpatient sectors, generalist und specialist care as well as to intensify competition. Despite repeated efforts by the legislator, comprehensive integrated healthcare is still limited to a few flagship projects. This is mainly due to low incentives on the part of both suppliers and customers. Therefore, this article focuses on the economic aspects of integrated care. From a theoretical perspective, integrated care improves efficiency in the healthcare sector by reducing interface problems and asymmetric information as well as by intensifying competition. In practice, however, there are a number of obstacles to implementation. Particularly noteworthy are the financial difficulties in addition to problems regarding sectoral budgeting and the long-term nature of investments. However, the political env...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2012
In recent years, claims data analyses have become of increasing importance in several scientific ... more In recent years, claims data analyses have become of increasing importance in several scientific disciplines in Germany. In specific research projects, it can be necessary to refine and to standardize the results by socioeconomic data. Information about graduation, social status, and occupation are provided by the German job role code for all people insured by statutory health insurance. During recent years, the working scheme has changed and new professions have appeared. Therefore, there has been a discussion about actualization and modification of the job role code. Since December 2011, an actualized job role code with an extensive set of new information is available. In addition, a new classification of professions is available in Germany which was considered in the design of the new job role code. The aim of this overview is to describe the structure of the new job role code as well as to discuss possible uses and limitations.
Gesundheitsökonomie & Qualitätsmanagement, 2012
Die vorliegende Arbeit diskutiert zunachst, unter welchen Umstanden eine gesundheitsokonomische E... more Die vorliegende Arbeit diskutiert zunachst, unter welchen Umstanden eine gesundheitsokonomische Evaluation aus der Perspektive der Privaten Krankenversicherung (PKV) sinnvoll erscheint. Im Anschluss folgt ein systematischer Uberblick uber die Kosten, welche aus Perspektive der PKV fur Arzneimittel sowie fur ambulante und stationare Leistungen anfallen und wie diese Kosten in Studien standardisiert bewertet werden sollten. Bei Arzneimitteln werden die gesetzlichen Grundlagen sowohl fur patentierte als auch fur patentfreie Arzneimittel strukturiert aufgearbeitet und die damit einhergehenden Rabatte fur die PKV berucksichtigt. Bei ambulanten Leistungen wird empfohlen, die entsprechenden Leistungen gemas der Gebuhrenordnung fur Arzte zu ermitteln. Zur Kalkulation des Erstattungsbetrages fur stationare Leistungen mussen sowohl die allgemeinen Krankenhausleistungen berucksichtigt werden als auch die Behandlung durch Chefarzte sowie die Unterbringung im Ein-/Zweibettzimmer. Die jeweilige Vorgehensweise wird anhand konkreter Beispiele verdeutlicht. Insgesamt liefert die vorgestellte Methodik erstmals fur Deutschland einen praktischen wie auch pragmatischen Ansatz zur Ermittlung der Kostendaten, die aus Perspektive der PKV innerhalb einer gesundheitsokonomischen Analyse genutzt werden sollten.
Value in Health, 2012
OBJECTIVES: Surgery is common after a hip fracture. Two surgical options are arthoplasty (AR) (i.... more OBJECTIVES: Surgery is common after a hip fracture. Two surgical options are arthoplasty (AR) (i.e., hip replacement) or internal fixation (IF) (i.e., fixing the patient's hip). Previous research suggests that AR is less costly than IF because IF failure rate is high. This retrospective cohort study compared medical costs between IF and AR in patients with hip fractures of the femoral neck in a large US population. METHODS: Patients Ն50 years with IF or AR performed within 7 days of a hip femoral neck fracture occurring between 7/1/2002 and 1/31/2010 were identified from the Marketscan database. Details on the specific location of the fracture line within the femoral neck were not available. All patients had continuous insurance coverage for 6 months prior to (pre-period) and 60 days following (post-period) the surgery date (index date). Patients were followed from surgery date up to 18 months or until death, end of continuous enrollment, or end of study period (3/31/ 2010), whichever came first. Generalized linear models on costs were used to adjust different patient demographic and clinical characteristics. RESULTS: A total of 41,789 patients (mean age 80 years) were identified (60% IF and 40% AR patients).
Value in Health, 2012
There is a lack of research regarding the subjective perception of financial security in the even... more There is a lack of research regarding the subjective perception of financial security in the event of illness of insured persons. Therefore, the aim of our study was to analyze the subjective perception of financial security in the event of illness in the German setting over time and to identify major determinants of that perception. Methods: We applied a probit-adapted ordinary least squares estimation procedure including fixed effects to a balanced data set from the German SocioEconomic Panel. After correcting our data set, we included approximately 23,500 observations in our analyses. Results: We show that higher income and the existence of private health insurance have a positive and significant impact on the perception of financial security. Furthermore, private supplementary health insurance has a positive and significant effect on this perception; however, this is solely true for policies that cover special features during hospital stays. Experience with the health care system is also positively related to the individual's perception. Finally, our regression results illustrate that the overall perception is declining over time. Conclusions: The results indicate that political decision makers are facing challenges regarding the declining subjective perception in the German health care system. Because of the positive correlation between experience and subjective perception, it can be assumed that the health care system and especially statutory health insurance are better than their presentation in the media. Hence, there is a problem of communication and information, and political decision makers face challenges in presenting the system objectively and handling the media in a proper way.
Spine, 2014
Study Design. Observational study. Objective. Examine the overall survival and treatment costs fr... more Study Design. Observational study. Objective. Examine the overall survival and treatment costs from a third-party-payer perspective for patients with osteoporotic vertebral compression fractures (OVCFs) treated by vertebral augmentation or conservative treatment in Germany. Summary of Background Data. OVCFs are associated with increased morbidity, mortality and thus reduced quality of life. Vertebral augmentation has been shown to be effective in these fractures. The association between treatment and survivorship as well as cost per life year gained for balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PVP) was analyzed in the Medicare population. Replication of these analyses is warranted for confidence in findings. Metliods. Claims data from a major health insurance fund were used. Mortality risk differences between operated (BKP, PVP) and nonoperated cohorts were assessed by Cox regression. Operated patient groups were established by propensity score matching adjusting for covariates. For the matched operated patients with OVCF, (2006-2010) survival was estimated by Kaplan-Meier method. Results. A total of 598 newly diagnosed patients with OVCF were operated of 3607 patients with OVCF. The operated cohort was 43% less likely to die than the nonoperated one in the 5-year study period (hazard ratio = 0.57; P < 0.001). Patients who received From the
Gesundheitsökonomie & Qualitätsmanagement, 2013
Medicina
Background and Objectives: Appendiceal carcinoids are rare neuroendocrine tumors and mainly found... more Background and Objectives: Appendiceal carcinoids are rare neuroendocrine tumors and mainly found incidentally during histopathological examination following appendectomy. This observational cohort study was performed to determine the prevalence, treatment modalities and outcomes in children diagnosed with an appendiceal carcinoid tumor. Materials and Methods: Data from the largest German statutory health insurance “Techniker Krankenkasse” were analyzed within an 8-year period: January 2010 to December 2012 and January 2016 to December 2020. Patient characteristics, surgical technique, type of surgical department, diagnostic management, and postoperative morbidity were analyzed. Results: Out of 40.499 patients following appendectomy, appendiceal carcinoids were found in 44 children, resulting in a prevalence of 0.11%. Mean age at appendectomy was 14.7 (±2.6) years. Laparoscopic approach was performed in 40 (91%) cases. Right-sided hemicolectomy was performed in 8 (18%) patients. Add...
Fragestellung: Osteoporesebedingte Wirbelkörperkompressionsfrakturen (OVCF) stehen im Zusammenhan... more Fragestellung: Osteoporesebedingte Wirbelkörperkompressionsfrakturen (OVCF) stehen im Zusammenhang mit einer erhöhten Morbidität, Mortalität sowie verringerten Lebensqualität der Betroffenen. Analysen haben eine um 16% erhöhtes Mortalitätsrisiko ergeben (HR =[for full text, please go to the a.m. URL]
Value in Health, 2015
A223 and outcome of both surgical disciplines and the impact of numerous other factors. METHODS: ... more A223 and outcome of both surgical disciplines and the impact of numerous other factors. METHODS: Data were extracted from a major public health insurance claims database (~ 8 million clients) during a 3-year period (2010-2012). Patients aged 4-17 years with appendectomy were included. Logistic regression analysis for risk of a surgical complication within the first 180-postoperative days was performed. Complications were defined by ICD and OPS codes. RESULTS: 8,110 patients were analyzed (PedSurg: n= 1,937; GenSurg: n= 6,173). Laparoscopic appendectomy was performed significantly more frequently by GenSurg compared to PedSurg (79% vs. 61%). The complication rate during initial stay and the readmission rate for surgical complications were significantly higher in patients treated by PedSurg compared to those operated on by GenSurg (2.9% vs. 1.7% and 3.4% vs. 2.2% respectively, p< 0.01). Logistic regression analysis revealed no differences between the two surgical specialities for the risk of surgical complications during the initial hospital stay and no differences for the risk of readmission for a surgical complication in younger patients (4-11 years). In contrast, the risk of readmission for surgical complications in adolescents (12-17 years) was significantly higher if the patient was operated on by PedSurg (p< 0.01). The results showed that patients treated with laparoscopy had a significantly lower risk for developing surgical complications within the first 180 postoperative days than patients who underwent an open surgery (OR: 0.73, p< 0.1). No differences were found for the variables geographical region and working day vs. weekendsurgery. CONCLUSIONS: With overall low complication and readmission rates after appendectomy this study revealed an excellent quality of care for appendicitis in Germany. However, the increased risk of readmission for surgical complications in adolescent patients operated by PedSurg deserves future investigation.
The European journal of health economics : HEPAC : health economics in prevention and care, Jan 16, 2017
Although health technology assessment (HTA) systems base their decision making process either on ... more Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value. To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment. A systematic (peer review and grey) literature review was conducted using an analytical framework examining: (1) 'Responsibilities and structure of HTA agencies'; (2) 'Evidence and evaluation criteria considered in HTAs'; (3) 'Methods and techniques applied in HTAs'; and (4) 'Outcomes and implementation of HTAs'. Study countries were France, Germany, England, Sweden, Italy, Netherlan...
Prozessorientierter Leitfaden für die Analyse und Nutzung von Routinedaten der Gesetzlichen Krankenversicherung, 2017
Zeitschrift für Sozialreform, 2014
Modellrechnungen gehen in Zukunft von einer steigenden Zahl von Pflegebedürftigen und einem zuneh... more Modellrechnungen gehen in Zukunft von einer steigenden Zahl von Pflegebedürftigen und einem zunehmendem Finanzierungsbedarf der sozialen Pflegeversicherung aus. Die Methodik der bisherigen Berechnungen ist jedoch zumeist sehr undifferenziert, insbesondere mit Blick auf Unterschiede in der Inanspruchnahme von Pflegeleistungen zwischen Männern und Frauen. Hier setzt die vorliegende Untersuchung an und ermittelt auf Basis von Routinedaten alters- und geschlechtsspezifische Ausgabenprofile für Pflegeversicherungsleistungen. Die Ergebnisse zeigen, dass es vor allem in den hohen Altersgruppen zu Unterschiedenen in der Höhe der Pflegeausgaben zvischen Männern und Frauen kommt, die durch Abweichungen im Inanspruchnahmeverhalten erklärt werden können. Die Verwendung von differenzierten Ausgabenprofilen in Modellrechnungen kann dazu beitragen, die Effekte der Bevölkerungsentwicklung auf die Entwicklung der Pflegeausgaben realitätsorientierter abzuschätzen.
Health Policy, 2016
BACKGROUND The aim of this article is to evaluate the status, development, and perspectives of Ge... more BACKGROUND The aim of this article is to evaluate the status, development, and perspectives of German claims data analyses in the international and health political context. METHODS We conducted a comprehensive literature search in PubMed, Scopus, and DIMDI to identify empirical and methodological articles focusing on health insurance claims data studies published between 2000 and 2014. Inclusion criteria were (1) English/German full text articles or chapters in edited books that (2) focused on the claims data of statutory health insurance funds. FINDINGS In total, 435 articles were included. Over time, the number of claims data studies has increased strongly and the frequency of policy-relevant research types increased. Along with the historical improvement path of claims data in Germany, we observed a rising percentage of international publications and an increase in the average quality of publications. In contrast to the US or Canada where comprehensive databases have been established, the most common data source in this search was data from a single SHI fund, while databases were rarely used. CONCLUSIONS Claims data are an important source of information for healthcare stakeholders, and their use for research purposes has further increased during recent years in Germany. Despite its potential in optimising the health system, we found a lack of German comprehensive all-payer claims databases compared to the US and Canada.
Health Economics Review, 2015
Background: The regional availability of specialized physicians is an important aspect in healthc... more Background: The regional availability of specialized physicians is an important aspect in healthcare of patients with IBD. The association between physician density and healthcare is not yet clear. Most studies did not consider district type, which reflects population density. Our research question was, "Do specialist density and district type influence the healthcare of IBD patients in Germany?" Methods: We combined a claims dataset from a German health insurance fund with population and physician data. Four main aspects were investigated: regular specialist visits, drug therapies, surveillance colonoscopy, and IBD-related hospitalizations. Various regression analyses were performed. Results: The study cohort was comprised of 21,771 individuals, including 9282 patients with Crohn disease and 12,489 patients with ulcerative colitis. Patients who were living in districts with higher specialist densities were more likely to attend specialist visits on a regular basis. No difference in the frequencies of TNF-alpha inhibitor therapies was found. However, individuals from urban areas were more likely to receive a permanent immunosuppressive therapy with continuous specialist support. Conclusions: The results revealed that some aspects had positive effects on the probability of implementing healthcare in accordance with pathways and guidelines. No clear evidence of a general healthcare undersupply in rural areas was found.
Advances in Therapy, 2015
Introduction: Among patients with acute myeloid leukemia (AML), the DACO-016 randomized study sho... more Introduction: Among patients with acute myeloid leukemia (AML), the DACO-016 randomized study showed reduction in mortality for decitabine [Dacogen Ò (DAC), Eisai Inc., Woodcliff Lake, NJ, USA] compared with treatment choice (TC): at primary analysis the hazard ratio (HR) was 0.85 (95% confidence interval 0.69-1.04; stratified log-rank P = 0.108). With two interim analyses, two-sided alpha was adjusted to 0.0462. With 1-year additional follow-up the HR reached 0.82 (nominal P = 0.0373). These data resulted in approval of DAC in the European Union, though not in the United States. Though pre-specified, the log-rank test could be considered not optimal to assess the observed survival difference because of the non-proportional hazard nature of the survival curves. Methods: We applied the Wilcoxon test as a sensitivity analysis. Patients were randomized to DAC (N = 242) or TC (N = 243). One-hundred and eight (44.4%) patients in the TC arm and 91 (37.6%) patients in the DAC arm selectively crossed over to subsequent disease modifying therapies at progression, which might impact the survival beyond the median with resultant converging curves (and disproportional hazards). Results: The stratified Wilcoxon test showed a significant improvement in median (CI 95%) overall survival with DAC [7.7 (6.2; 9.2) months] versus TC [5.0 (4.3; 6.3) months; P = 0.0458]. Conclusion: Wilcoxon test indicated significant increase in survival for DAC versus TC compared to log-rank test.
The oncologist, 2014
Survival of patients with metastatic colorectal cancer (mCRC) has been significantly improved wit... more Survival of patients with metastatic colorectal cancer (mCRC) has been significantly improved with the introduction of the monoclonal antibodies targeting the vascular endothelial growth factor (VEGF) and the epidermal growth factor receptor (EGFR). Novel molecular-targeted agents such as aflibercept and regorafenib have recently been approved. The aim of this review is to summarize and assess the effects of molecular agents in mCRC based on the available phase II and III trials, pooled analyses, and meta-analyses/systematic reviews. A systematic literature search was conducted using the meta-database of the German Institute of Medical Documentation and Information. Criteria of the Scottish Intercollegiate Guidelines Network were used to assess the quality of the controlled trials and systematic reviews/meta-analyses. Of the 806 retrieved records, 40 publications were included. For bevacizumab, efficacy in combination with fluoropyrimidine-based chemotherapy in first- and subsequent...
BMC pulmonary medicine, Jan 4, 2014
Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems ... more Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion ...
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2014
The study aims to estimate the direct disease-related costs of osteoporotic vertebral compression... more The study aims to estimate the direct disease-related costs of osteoporotic vertebral compression fractures (OVCF) in patients with newly diagnosed fracture in the first year after index in Germany. Analyses reveal that OVCFs are associated with significant costs. In light of high and increasing incidence, the results emphasize importance of research in this field. OVCF are among the most common fractures related to osteoporosis. They have been shown to be associated with excess mortality and meaningful healthcare costs. Costs calculations have illustrated the significant financial burden to society and national social security systems. However, this information is not available for Germany. Therefore, aim of the study was to estimate the direct disease-related costs of OVCF in patients with newly diagnosed fracture in the first year after index in Germany. Data were obtained from a claims dataset of a large German health insurance fund. Subjects ≥ 60 years with a new vertebral frac...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2013
Claims data have proven useful for carrying out cost-of-illness studies. To avoid overestimating ... more Claims data have proven useful for carrying out cost-of-illness studies. To avoid overestimating disease-related costs, only those costs that are related to a specific disease should be considered. The present study demonstrates two basic approaches for identifying disease-related costs. Using the example of attention-deficit hyperactivity disorder (ADHD), the advantages and drawbacks of expert-based approaches and those based on control groups are compared. Anonymized data from the "Techniker Krankenkasse" for 2008 were available for the study. The study population encompassed all ADHD patients and a control group that was five times bigger. Additionally, a systematic literature review was carried out on 65 relevant studies. Compared with the control group, disease-related costs were EUR 2,902 per ADHD patient on average. However, using the expert-based approach, costs were established to be EUR 923 lower. This is mainly because a comparison with an appropriate control gr...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2012
For more than 10 years integrated care has been an inherent part of the German healthcare system.... more For more than 10 years integrated care has been an inherent part of the German healthcare system. The aims of selective contracts are to minimize interface problems between outpatient and inpatient sectors, generalist und specialist care as well as to intensify competition. Despite repeated efforts by the legislator, comprehensive integrated healthcare is still limited to a few flagship projects. This is mainly due to low incentives on the part of both suppliers and customers. Therefore, this article focuses on the economic aspects of integrated care. From a theoretical perspective, integrated care improves efficiency in the healthcare sector by reducing interface problems and asymmetric information as well as by intensifying competition. In practice, however, there are a number of obstacles to implementation. Particularly noteworthy are the financial difficulties in addition to problems regarding sectoral budgeting and the long-term nature of investments. However, the political env...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz, 2012
In recent years, claims data analyses have become of increasing importance in several scientific ... more In recent years, claims data analyses have become of increasing importance in several scientific disciplines in Germany. In specific research projects, it can be necessary to refine and to standardize the results by socioeconomic data. Information about graduation, social status, and occupation are provided by the German job role code for all people insured by statutory health insurance. During recent years, the working scheme has changed and new professions have appeared. Therefore, there has been a discussion about actualization and modification of the job role code. Since December 2011, an actualized job role code with an extensive set of new information is available. In addition, a new classification of professions is available in Germany which was considered in the design of the new job role code. The aim of this overview is to describe the structure of the new job role code as well as to discuss possible uses and limitations.
Gesundheitsökonomie & Qualitätsmanagement, 2012
Die vorliegende Arbeit diskutiert zunachst, unter welchen Umstanden eine gesundheitsokonomische E... more Die vorliegende Arbeit diskutiert zunachst, unter welchen Umstanden eine gesundheitsokonomische Evaluation aus der Perspektive der Privaten Krankenversicherung (PKV) sinnvoll erscheint. Im Anschluss folgt ein systematischer Uberblick uber die Kosten, welche aus Perspektive der PKV fur Arzneimittel sowie fur ambulante und stationare Leistungen anfallen und wie diese Kosten in Studien standardisiert bewertet werden sollten. Bei Arzneimitteln werden die gesetzlichen Grundlagen sowohl fur patentierte als auch fur patentfreie Arzneimittel strukturiert aufgearbeitet und die damit einhergehenden Rabatte fur die PKV berucksichtigt. Bei ambulanten Leistungen wird empfohlen, die entsprechenden Leistungen gemas der Gebuhrenordnung fur Arzte zu ermitteln. Zur Kalkulation des Erstattungsbetrages fur stationare Leistungen mussen sowohl die allgemeinen Krankenhausleistungen berucksichtigt werden als auch die Behandlung durch Chefarzte sowie die Unterbringung im Ein-/Zweibettzimmer. Die jeweilige Vorgehensweise wird anhand konkreter Beispiele verdeutlicht. Insgesamt liefert die vorgestellte Methodik erstmals fur Deutschland einen praktischen wie auch pragmatischen Ansatz zur Ermittlung der Kostendaten, die aus Perspektive der PKV innerhalb einer gesundheitsokonomischen Analyse genutzt werden sollten.
Value in Health, 2012
OBJECTIVES: Surgery is common after a hip fracture. Two surgical options are arthoplasty (AR) (i.... more OBJECTIVES: Surgery is common after a hip fracture. Two surgical options are arthoplasty (AR) (i.e., hip replacement) or internal fixation (IF) (i.e., fixing the patient's hip). Previous research suggests that AR is less costly than IF because IF failure rate is high. This retrospective cohort study compared medical costs between IF and AR in patients with hip fractures of the femoral neck in a large US population. METHODS: Patients Ն50 years with IF or AR performed within 7 days of a hip femoral neck fracture occurring between 7/1/2002 and 1/31/2010 were identified from the Marketscan database. Details on the specific location of the fracture line within the femoral neck were not available. All patients had continuous insurance coverage for 6 months prior to (pre-period) and 60 days following (post-period) the surgery date (index date). Patients were followed from surgery date up to 18 months or until death, end of continuous enrollment, or end of study period (3/31/ 2010), whichever came first. Generalized linear models on costs were used to adjust different patient demographic and clinical characteristics. RESULTS: A total of 41,789 patients (mean age 80 years) were identified (60% IF and 40% AR patients).
Value in Health, 2012
There is a lack of research regarding the subjective perception of financial security in the even... more There is a lack of research regarding the subjective perception of financial security in the event of illness of insured persons. Therefore, the aim of our study was to analyze the subjective perception of financial security in the event of illness in the German setting over time and to identify major determinants of that perception. Methods: We applied a probit-adapted ordinary least squares estimation procedure including fixed effects to a balanced data set from the German SocioEconomic Panel. After correcting our data set, we included approximately 23,500 observations in our analyses. Results: We show that higher income and the existence of private health insurance have a positive and significant impact on the perception of financial security. Furthermore, private supplementary health insurance has a positive and significant effect on this perception; however, this is solely true for policies that cover special features during hospital stays. Experience with the health care system is also positively related to the individual's perception. Finally, our regression results illustrate that the overall perception is declining over time. Conclusions: The results indicate that political decision makers are facing challenges regarding the declining subjective perception in the German health care system. Because of the positive correlation between experience and subjective perception, it can be assumed that the health care system and especially statutory health insurance are better than their presentation in the media. Hence, there is a problem of communication and information, and political decision makers face challenges in presenting the system objectively and handling the media in a proper way.
Spine, 2014
Study Design. Observational study. Objective. Examine the overall survival and treatment costs fr... more Study Design. Observational study. Objective. Examine the overall survival and treatment costs from a third-party-payer perspective for patients with osteoporotic vertebral compression fractures (OVCFs) treated by vertebral augmentation or conservative treatment in Germany. Summary of Background Data. OVCFs are associated with increased morbidity, mortality and thus reduced quality of life. Vertebral augmentation has been shown to be effective in these fractures. The association between treatment and survivorship as well as cost per life year gained for balloon kyphoplasty (BKP) and percutaneous vertebroplasty (PVP) was analyzed in the Medicare population. Replication of these analyses is warranted for confidence in findings. Metliods. Claims data from a major health insurance fund were used. Mortality risk differences between operated (BKP, PVP) and nonoperated cohorts were assessed by Cox regression. Operated patient groups were established by propensity score matching adjusting for covariates. For the matched operated patients with OVCF, (2006-2010) survival was estimated by Kaplan-Meier method. Results. A total of 598 newly diagnosed patients with OVCF were operated of 3607 patients with OVCF. The operated cohort was 43% less likely to die than the nonoperated one in the 5-year study period (hazard ratio = 0.57; P < 0.001). Patients who received From the
Gesundheitsökonomie & Qualitätsmanagement, 2013