TY  - JOUR
AB  - OBJECTIVES: This study aimed to develop a microsimulation model to estimate the health effects, costs, and cost-effectiveness of public health and clinical interventions for preventing/managing type 2 diabetes. METHODS: We combined newly developed equations for complications, mortality, risk factor progression, patient utility, and cost-all based on US studies-in a microsimulation model. We performed internal and external validation of the model. To demonstrate the model's utility, we predicted remaining life-years, quality-adjusted life-years (QALYs), and lifetime medical cost for a representative cohort of 10 000 US adults with type 2 diabetes. We then estimated the cost-effectiveness of reducing hemoglobin A1c from 9% to 7% among adults with type 2 diabetes, using low-cost, generic, oral medications. RESULTS: The model performed well in internal validation; the average absolute difference between simulated and observed incidence for 17 complications was < 8%. In external validation, the model was better at predicting outcomes in clinical trials than in observational studies. The cohort of US adults with type 2 diabetes was projected to have an average of 19.95 remaining life-years (from mean age 61), incur $187 729 in discounted medical costs, and accrue 8.79 discounted QALYs. The intervention to reduce hemoglobin A1c increased medical costs by $1256 and QALYs by 0.39, yielding an incremental cost-effectiveness ratio of $9103 per QALY. CONCLUSIONS: Using equations exclusively derived from US studies, this new microsimulation model achieves good prediction accuracy in US populations. The model can be used to estimate the long-term health impact, costs, and cost-effectiveness of interventions for type 2 diabetes in the United States.
AU  - Hoerger, T.J.*
AU  - Hilscher, R.*
AU  - Neuwahl, S.*
AU  - Kaufmann, M.B.*
AU  - Shao, H.*
AU  - Laxy, M.
AU  - Cheng, Y.J.*
AU  - Benoit, S.*
AU  - Chen, H.*
AU  - Anderson, A.*
AU  - Craven, T.*
AU  - Yang, W.*
AU  - Cintina, I.*
AU  - Staimez, L.*
AU  - Zhang, P.*
C1  - 67885
C2  - 54363
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - 1372-1380
TI  - A new type 2 diabetes microsimulation model to estimate long-term health outcomes, costs, and cost-effectiveness.
JO  - Value Health
VL  - 26
IS  - 9
PB  - Elsevier Science Inc
PY  - 2023
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - OBJECTIVES: The Munich Breathlessness Service (MBS) significantly improved control of breathlessness measured by the Chronic Respiratory Questionnaire (CRQ) Mastery in a randomized controlled fast track trial with waitlist group design spanning 8 weeks in Germany. This study aimed to assess the within-trial cost-effectiveness of MBS from a societal perspective. METHODS: Data included generic (5-level version of EQ-5D) health-related quality of life and disease-specific CRQ Mastery. Quality-adjusted life years (QALYs) were calculated based on 5-level version of EQ-5D utilities valued with German time trade-off. Direct medical costs and productivity loss were calculated based on standardized unit costs. Incremental cost-effectiveness ratios (ICER) and cost-effectiveness-acceptance curves were calculated using adjusted mean differences (AMD) in costs (gamma-distributed model) and both effect parameters (Gaussian-distributed model) and performing 1000 simultaneous bootstrap replications. Potential gender differences were investigated in stratified analyses. RESULTS: Between March 2014 and April 2019, 183 eligible patients were enrolled. MBS intervention demonstrated significantly better effects regarding generic (AMD of QALY gains of 0.004, 95% confidence interval [CI] 0.0003 to 0.008) and disease-specific health-related quality of life at nonsignificantly higher costs (AMD of €605 [95% CI -1109 to 2550]). At the end of the intervention, the ICER was €152 433/QALY (95% CI -453 545 to 1 625 903) and €1548/CRQ Mastery point (95% CI -3093 to 10 168). Intervention costs were on average €357 (SD = 132). Gender-specific analyses displayed dominance for MBS in males and higher effects coupled with significantly higher costs in females. CONCLUSIONS: Our results show a high ICER for MBS. Considering dominance for MBS in males, implementing MBS on approval within the German health care system should be considered.
AU  - Seidl, H.
AU  - Schunk, M.*
AU  - Le, L.*
AU  - Syunyaeva, Z.*
AU  - Streitwieser, S.*
AU  - Berger, U.*
AU  - Mansmann, U.*
AU  - Szentes, B.L.
AU  - Bausewein, C.*
AU  - Schwarzkopf, L.
C1  - 66367
C2  - 53153
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - 81-90
TI  - Cost-effectiveness of a specialized breathlessness service versus usual care for patients with advanced diseases.
JO  - Value Health
VL  - 26
IS  - 1
PB  - Elsevier Science Inc
PY  - 2023
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives: At 3 months after the intervention, this study evaluates the cost-effectiveness of a 3-week inpatient pulmonary rehabilitation (PR) in patients with asthma compared with usual care alongside the single-center randomized controlled trial—Effectiveness of Pulmonary Rehabilitation in Patients With Asthma. Methods: Adopting a societal perspective, direct medical costs and productivity loss were assessed using the Questionnaire for Health-Related Resource Use-Lung, a modification of the FIM in an Elderly Population. The effect side was operationalized as minimal important differences (MIDs) of the Asthma Control Test (ACT) and the Asthma Quality of Life Questionnaire (AQLQ) and through quality-adjusted life-years (QALYs) gained. Adjusted mean differences in costs (gamma-distributed model) and each effect parameter (Gaussian-distributed model) were simultaneously calculated within 1000 bootstrap replications to determine incremental cost-effectiveness ratios (ICERs) and to subsequently delineate cost-effectiveness acceptability curves. Results: PR caused mean costs per capita of €3544. Three months after PR, we observed higher mean costs (Δ€3673; 95% confidence interval (CI) €2854-€4783) and improved mean effects (ACT Δ1.59 MIDs, 95% CI 1.37-1.81; AQLQ Δ1.76 MIDs, 95% CI 1.46-2.08; QALYs gained Δ0.01, 95% CI 0.01-0.02) in the intervention group. The ICER was €2278 (95% CI €1653-€3181) per ACT-MID, €1983 (95% CI €1430-€2830) per AQLQ-MID, and €312 401 (95% CI €209 206-€504 562) per QALY gained. Conclusions: Contrasting of PR expenditures with ICERs suggests that the intervention, which achieves clinically relevant changes in asthma-relevant parameters, has a high probability to be already cost-effective in the short term. However, in terms of QALYs, extended follow-up periods are likely required to comprehensively judge the added value of a one-time initial investment in PR.
AU  - Böckmann, D.
AU  - Szentes, B.L.
AU  - Schultz, K.*
AU  - Nowak, D.*
AU  - Schuler, M.*
AU  - Schwarzkopf, L.
C1  - 61925
C2  - 50516
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - 1254-1262
TI  - Cost-effectiveness of pulmonary rehabilitation in patients with bronchial asthma: An analysis of the EPRA randomized controlled trial.
JO  - Value Health
VL  - 24
IS  - 9
PB  - Elsevier Science Inc
PY  - 2021
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - ISPOR–The Professional Society for Health Economics and Outcomes Research Objectives: Health utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. Thisstudy estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a cross-sectional population-based German study. Methods: Data were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Region of Augsburg) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with an interaction term between type 2 diabetes and cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. Results: Type 2 diabetes (β = −0.028, standard error [SE] = 0.014), stroke (β = −0.070, SE = 0.010), cardiac arrhythmia (β = −0.031, SE = 0.006), heart failure (β = −0.073, SE = 0.009), coronary heart disease (β = −0.028, SE = 0.010), myocardial infarction (β = −0.020, SE = 0.011, estimates of main effec), and neuropathy (β = −0.067, SE = 0.020), diabetic foot (β = −0.042, SE = 0.030), nephropathy (β = −0.032, SE = 0.025), and blindness (β = −0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (β = −0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. Conclusions: Diabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of diabetes in Germany.
AU  - Laxy, M.
AU  - Becker, J.
AU  - Kähm, K.
AU  - Holle, R.
AU  - Peters, A.
AU  - Thorand, B.
AU  - Schwettmann, L.
AU  - Karl, F.
C1  - 61014
C2  - 49845
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - 274-280
TI  - Utility decrements associated with diabetes and related complications: Estimates from a population-based study in Germany.
JO  - Value Health
VL  - 24
IS  - 2
PB  - Elsevier Science Inc
PY  - 2021
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives: This study aims to estimate the national impact and cost-effectiveness of the 2018 American College of Physicians (ACP) guidance statements compared to the status quo. Methods: Survey data from the 2011-2016 National Health and Nutrition Examination were used to generate a national representative sample of individuals with diagnosed type 2 diabetes in the United States. Individuals with A1c <6.5% on antidiabetic medications are recommended to deintensify their A1c level to 7.0% to 8.0% (group 1); individuals with A1c 6.5% to 8.0% and a life expectancy of <10 years are recommended to deintensify their A1c level >8.0% (group 2); and individuals with A1c >8.0% and a life expectancy of >10 years are recommended to intensify their A1c level to 7.0% to 8.0% (group 3). We used a Markov-based simulation model to evaluate the lifetime cost-effectiveness of following the ACP recommended A1c level. Results: 14.41 million (58.1%) persons with diagnosed type 2 diabetes would be affected by the new guidance statements. Treatment deintensification would lead to a saving of $363 600 per quality-adjusted life-year (QALY) lost for group 1 and a saving of $118 300 per QALY lost for group 2. Intensifying treatment for group 3 would lead to an additional cost of $44 600 per QALY gain. Nationally, the implementation of the guidance would add 3.2 million life-years and 1.1 million QALYs and reduce healthcare costs by $47.7 billion compared to the status quo. Conclusions: Implementing the new ACP guidance statements would affect a large number of persons with type 2 diabetes nationally. The new guidance is cost-effective.
AU  - Shao, H.*
AU  - Laxy, M.
AU  - Gregg, E.W.*
AU  - Albright, A.*
AU  - Zhang, P.*
C1  - 60497
C2  - 49488
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - 227-235
TI  - Cost-effectiveness of the new 2018 American college of physicians glycemic control guidance statements among US adults with type 2 diabetes.
JO  - Value Health
VL  - 24
IS  - 2
PB  - Elsevier Science Inc
PY  - 2021
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Maqhuzu, P.N.
AU  - Szentes, B.L.
AU  - Kreuter, M.*
AU  - Bahmer, T.*
AU  - Kahn, N.C.*
AU  - Claussen, M.*
AU  - Holle, R.
AU  - Schwarzkopf, L.
C1  - 59406
C2  - 48786
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - S360-S360
TI  - Predictors of health-related quality of life decline in intersitial lung disease using the K-bild questionnaire.
JO  - Value Health
VL  - 23
PB  - Elsevier Science Inc
PY  - 2020
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Kirsch, F.
AU  - Schramm, A.*
AU  - Schwarzkopf, L.
AU  - Szentes, B.L.
AU  - Lutter, J.
AU  - Huber, M.B.
AU  - Leidl, R.
C1  - 57751
C2  - 47894
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - S876-S876
TI  - Influence of COPD severity and its comorbidities on direct and indirect costs: Results from the LQ-DMP study.
JO  - Value Health
VL  - 22
PB  - Elsevier Science Inc
PY  - 2019
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Maqhuzu, P.N.
AU  - Kreuter, M.*
AU  - Schwarzkopf, L.
C1  - 57752
C2  - 47895
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - S845-S845
TI  - Cost of healthcare resource utilization in interstitial lung diseases in Germany in 2017.
JO  - Value Health
VL  - 22
PB  - Elsevier Science Inc
PY  - 2019
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Szentes, B.L.
AU  - Schwarzkopf, L.
AU  - Schüler, M.*
AU  - Lehbert, N.*
AU  - Nowak, D.*
AU  - Wittmann, M.*
AU  - Faller, H.*
AU  - Schultz, K.*
C1  - 57753
C2  - 47896
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - S882-S882
TI  - The suitablility of the EQ-5D-5L in asthma patients.
JO  - Value Health
VL  - 22
PB  - Elsevier Science Inc
PY  - 2019
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objective: Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies. Methods: Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies. Results: First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000. Conclusions: Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.
AU  - Arnold, M.
AU  - Quante, A.S.
C1  - 53050
C2  - 44760
CY  - 360 Park Ave South, New York, Ny 10010-1710 Usa
SP  - 799-808
TI  - Personalized mammography screening and screening adherence-A simulation and economic evaluation.
JO  - Value Health
VL  - 21
IS  - 7
PB  - Elsevier Science Inc
PY  - 2018
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Szentes, B.L.
AU  - Kirsch, F.
AU  - Schramm, A.*
AU  - Schwarzkopf, L.
AU  - Leidl, R.
C1  - 55672
C2  - 46431
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - S419-S419
TI  - Association between severe, moderate and mild exacerbations with generic health-related quality of life in COPD patients.
JO  - Value Health
VL  - 21
PB  - Elsevier Science Inc
PY  - 2018
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Walter, J.
AU  - Schwarzkopf, L.
C1  - 55673
C2  - 46432
CY  - Ste 800, 230 Park Ave, New York, Ny 10169 Usa
SP  - S35-S35
TI  - First insights into comparing expenditures for targeted therapy and survival in NSCLC.
JO  - Value Health
VL  - 21
PB  - Elsevier Science Inc
PY  - 2018
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Arnold, M.*
AU  - Quante, A.S.
C1  - 52538
C2  - 44035
CY  - New York
SP  - A442-A442
TI  - Risk-stratified breast cancer screening and non-adherence in Germany.
JO  - Value Health
VL  - 20
IS  - 9
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives: To validate outcomes of presently available chronic obstructive pulmonary disease (COPD) cost-effectiveness models against results of two large COPD trials-the 3-year TOwards a Revolution in COPD Health (TORCH) trial and the 4-year Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial. Methods: Participating COPD modeling groups simulated the outcomes for the placebo-treated groups of the TORCH and UPLIFT trials using baseline characteristics of the trial populations as input. Groups then simulated treatment effectiveness by using relative reductions in annual decline in lung function and exacerbation frequency observed in the most intensively treated group compared with placebo as input for the models. Main outcomes were (change in) total/severe exacerbations and mortality. Furthermore, the absolute differences in total exacerbations and quality-adjusted life-years (QALYs) were used to approximate the cost per exacerbation avoided and the cost per QALY gained. Result: Of the six participating models, three models reported higher total exacerbation rates than observed in the TORCH trial (1.13/patient-year) (models: 1.22-1.48). Four models reported higher rates than observed in the UPLIFT trial (0.85/patient-year) (models: 1.13-1.52). Two models reported higher mortality rates than in the TORCH trial (15.2%) (models: 20.0% and 30.6%) and the UPLIFT trial (16.3%) (models: 24.8% and 36.0%), whereas one model reported lower rates (9.8% and 12.1%, respectively). Simulation of treatment effectiveness showed that the absolute reduction in total exacerbations, the gain in QALYs, and the cost-effectiveness ratios did not differ from the trials, except for one model. Conclusions: Although most of the participating COPD cost-effectiveness models reported higher total exacerbation rates than observed in the trials, estimates of the absolute treatment effect and cost-effectiveness ratios do not seem different from the trials in most models.
AU  - Hoogendoorn, M.*
AU  - Feenstra, T.L.*
AU  - Asukai, Y.*
AU  - Briggs, A.H.*
AU  - Hansen, R.N.*
AU  - Leidl, R.
AU  - Risebrough, N.*
AU  - Samyshkin, Y.*
AU  - Wacker, M.*
AU  - Rutten-van Mölken, M.P.*
C1  - 50283
C2  - 42100
CY  - New York
SP  - 397-403
TI  - External validation of health economic decision models for chronic obstructive pulmonary disease (COPD): Report of the third COPD modeling meeting.
JO  - Value Health
VL  - 20
IS  - 3
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Kirsch, F.*
AU  - Becker, C.
AU  - Maier, W.
AU  - Schramm, A.*
C1  - 52536
C2  - 44037
CY  - New York
SP  - A609-A609
TI  - Effects of adherence to pharmacological secondary prevention after myocardial infarction on healthcare expenditures.
JO  - Value Health
VL  - 20
IS  - 9
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Background: There is uncertainty about the cost-effectiveness of early intensive treatment versus routine care in individuals with type 2 diabetes detected by screening. Objectives: To derive a trial-informed estimate of the incremental costs of intensive treatment as delivered in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Europe (ADDITION) trial and to revisit the long-term cost-effectiveness analysis from the perspective of the UK National Health Service. Methods: We analyzed the electronic primary care records of a subsample of the ADDITION-Cambridge trial cohort (n = 173). Unit costs of used primary care services were taken from the published literature. Incremental annual costs of intensive treatment versus routine care in years 1 to 5 after diagnosis were calculated using multilevel generalized linear models. We revisited the long-term cost-utility analyses for the ADDITION-UK trial cohort and reported results for ADDITION-Cambridge using the UK Prospective Diabetes Study Outcomes Model and the trial-informed cost estimates according to a previously developed evaluation framework. Results: Incremental annual costs of intensive treatment over years 1 to 5 averaged £29.10 (standard error = £33.00) for consultations with general practitioners and nurses and £54.60 (standard error = £28.50) for metabolic and cardioprotective medication. For ADDITION-UK, over the 10-, 20-, and 30-year time horizon, adjusted incremental quality-adjusted life-years (QALYs) were 0.014, 0.043, and 0.048, and adjusted incremental costs were £1,021, £1,217, and £1,311, resulting in incremental cost-effectiveness ratios of £71,232/QALY, £28,444/QALY, and £27,549/QALY, respectively. Respective incremental cost-effectiveness ratios for ADDITION-Cambridge were slightly higher. Conclusions: The incremental costs of intensive treatment as delivered in the ADDITION-Cambridge trial were lower than expected. Given UK willingness-to-pay thresholds in patients with screen-detected diabetes, intensive treatment is of borderline cost-effectiveness over a time horizon of 20 years and more.
AU  - Laxy, M.
AU  - Wilson, E.C.F.*
AU  - Boothby, C.E.*
AU  - Griffin, S.J.*
C1  - 51540
C2  - 43299
CY  - New York
SP  - 1288-1298
TI  - Incremental costs and cost-effectiveness of intensive treatment in individuals with type 2 diabetes detected by screening in the ADDITION-UK trial: An update with empirical trial-based cost data.
JO  - Value Health
VL  - 20
IS  - 10
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objective: Valuation of health states provides a summary measure useful to health care decision makers. Results may depend on whether the currently experienced health state or a hypothetical health state is being evaluated. This study derives a value set for the EuroQoL Five-Dimensional Five-Level Questionnaire (EQ-5D-5L) by focusing on the individual's current experience. Data and Methods: Data include four pooled population surveys of the general German population in 2012-2015 (N = 8114). For valuation, a visual analogue scale (VAS) was used. Six specifications of a generalized linear model with binomial error distribution and constraint parameter estimation were analyzed. In each 1000 simulation runs, models were cross-validated after splitting the sample into an estimation part and a validation part. Predictive accuracy was measured by mean absolute error and sum of squared errors. Results: The models rendered a consistent set of parameters. With regard to predictive accuracy, the model considering all problem levels within the five dimensions and the highest problem level reached performed best overall. Discussion: Estimation proved to be feasible. Predictive accuracy exceeded that of a similar, experience-based value set for the EQ-5D-3L. Compared with a Dutch value set for the EQ-5D-5L derived for hypothetical health states, experienced values tended to be slightly lower for mild health states and substantially higher for severe health states. Clinical relevance and usefulness of the value set remain to be determined in future studies. Conclusions: For decision makers who prioritize patient-relevant benefit, the experience-based value set provides a novel option to summarize health states, reflecting how health states experienced are valued in a population.
AU  - Leidl, R.
AU  - Reitmeir, P.
C1  - 51500
C2  - 43096
CY  - New York
SP  - 1150-1156
TI  - An experience-based value set for the EQ-5D-5L in Germany.
JO  - Value Health
VL  - 20
IS  - 8
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives: To assess the 3-year cost-effectiveness of a nurse-based case management intervention in elderly patients with myocardial infarction from a societal perspective. Methods: The intervention consisted of one home visit and quarterly telephone calls in the first year, and semi-annual calls in the following 2 years. The primary effect measures were quality-adjusted life-years (QALYs), on the basis of the EuroQol five-dimensional questionnaire (EQ-5D-3L) and adjusted life-years from patients' self-rated health states according to the visual analogue scale (VAS-ALs). A linear regression model was used for adjusted life-years and a gamma model for costs. Estimation uncertainty was addressed by cost-effectiveness acceptability curves, which indicate the likelihood of cost-effectiveness for a given value of willingness to pay. The secondary objective was to examine EQ-5D-3L utility scores and VAS scores among survivors using linear mixed models. Results: Primary outcomes regarding QALY gains (+0.0295; . P = 0.76) and VAS-AL gains (+0.1332; . P = 0.09) in the intervention group were not significant. The overall cost difference was -€2575 (P = 0.30). The probability of cost-effectiveness of the case management at a willingness-to-pay value of €0 per QALY was 84% in the case of QALYs and 81% in the case of VAS-ALs. Secondary outcomes concerning survivors' quality of life were significantly better in the intervention group (EQ-5D-3L utilities: +0.104, . P = 0.005; VAS: +8.15, . P = 0.001) after 3 years. Conclusions: The case management was cost-neutral and led to an important and significant improvement in health status among survivors. It was associated with higher QALYs and lower costs but the differences in costs and QALYs were not statistically significant.
AU  - Seidl, H.
AU  - Hunger, M.
AU  - Meisinger, C.
AU  - Kirchberger, I.
AU  - Kuch, B.*
AU  - Leidl, R.
AU  - Holle, R.
C1  - 50255
C2  - 41618
CY  - New York
SP  - 441-450
TI  - The 3-year cost-effectiveness of a nurse-based case management versus usual care for elderly patients with myocardial infarction: Results from the KORINNA follow-up study.
JO  - Value Health
VL  - 20
IS  - 3
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Szentes, B.L.
AU  - Kreuter, M.*
AU  - Bahmer, T.*
AU  - Birring, S.*
AU  - Claussen, M.*
AU  - Waelscher, J.*
AU  - Schwarzkopf, L.
C1  - 52535
C2  - 44039
CY  - New York
SP  - A649-A649
TI  - Quality of life assessment in ILD - a comparison of  EQ-5D with the disease-specific K-bild.
JO  - Value Health
VL  - 20
IS  - 9
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Walter, J.
AU  - Tufman, A.*
AU  - Holle, R.
AU  - Schwarzkopf, L.
C1  - 52537
C2  - 44036
CY  - New York
SP  - A511-A511
TI  - Comparison of costs and care of lung cancer patient at the end-of-life in Germany depending on the tome of survival after diagnosis.
JO  - Value Health
VL  - 20
IS  - 9
PB  - Elsevier Science Inc
PY  - 2017
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Arnold, M.*
AU  - Quante, A.S.
C1  - 50998
C2  - 42616
CY  - New York
SP  - A738-A738
TI  - Personalized mammography screening and screening adherence - a simulation of cost-effectiveness.
JO  - Value Health
VL  - 19
IS  - 7
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Danner, M.*
AU  - Müller, D.*
AU  - Schmutzler, R.K.*
AU  - Rhiem, K.*
AU  - Engel, C.*
AU  - Stollenwerk, B.
AU  - Stock, S.*
AU  - Wassermann, K.*
C1  - 50999
C2  - 42617
CY  - New York
SP  - A737-A738
TI  - Economic modeling of risk-adapted screen-and-treat strategies in women at high-risk for breast or ovarian cancer.
JO  - Value Health
VL  - 19
IS  - 7
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives To assess how suitable current chronic obstructive pulmonary disease (COPD) cost-effectiveness models are to evaluate personalized treatment options for COPD by exploring the type of heterogeneity included in current models and by validating outcomes for subgroups of patients. Methods A consortium of COPD modeling groups completed three tasks. First, they reported all patient characteristics included in the model and provided the level of detail in which the input parameters were specified. Second, groups simulated disease progression, mortality, quality-adjusted life-years (QALYs), and costs for hypothetical subgroups of patients that differed in terms of sex, age, smoking status, and lung function (forced expiratory volume in 1 second [FEV1] % predicted). Finally, model outcomes for exacerbations and mortality for subgroups of patients were validated against published subgroup results of two large COPD trials. Results Nine COPD modeling groups participated. Most models included sex (seven), age (nine), smoking status (six), and FEV1% predicted (nine), mainly to specify disease progression and mortality. Trial results showed higher exacerbation rates for women (found in one model), higher mortality rates for men (two models), lower mortality for younger patients (four models), and higher exacerbation and mortality rates in patients with severe COPD (four models). Conclusions Most currently available COPD cost-effectiveness models are able to evaluate the cost-effectiveness of personalized treatment on the basis of sex, age, smoking, and FEV1% predicted. Treatment in COPD is, however, more likely to be personalized on the basis of clinical parameters. Two models include several clinical patient characteristics and are therefore most suitable to evaluate personalized treatment, although some important clinical parameters are still missing.
AU  - Hoogendoorn, M.*
AU  - Feenstra, T.*
AU  - Asukai, Y.*
AU  - Briggs, A.*
AU  - Borg, S.*
AU  - dal Negro, R.*
AU  - Hansen, R.N.*
AU  - Jansson, S.A.*
AU  - Leidl, R.
AU  - Risebrough, N.*
AU  - Samyshkin, Y.*
AU  - Wacker, M.
AU  - Rutten van-Mölken, M.*
C1  - 48664
C2  - 41247
CY  - New York
SP  - 800-810
TI  - Patient heterogeneity in health economic decision models for Chronic Obstructive Pulmonary Disease: Are current models suitable to evaluate personalized medicine?.
JO  - Value Health
VL  - 19
IS  - 6
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Abstract Background Disease management programs (DMPs) for chronic diseases are being increasingly implemented worldwide. Objectives To present a systematic overview of the economic effects of DMPs with Markov models. The quality of the models is assessed, the method by which the DMP intervention is incorporated into the model is examined, and the differences in the structure and data used in the models are considered. Methods A literature search was conducted; the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed to ensure systematic selection of the articles. Study characteristics e.g. results, the intensity of the DMP and usual care, model design, time horizon, discount rates, utility measures, and cost-of-illness were extracted from the reviewed studies. Model quality was assessed by two researchers with two different appraisals: one proposed by Philips et al. (Good practice guidelines for decision-analytic modelling in health technology assessment: a review and consolidation of quality asessment. Pharmacoeconomics 2006;24:355-71) and the other proposed by Caro et al. (Questionnaire to assess relevance and credibility of modeling studies for informing health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report. Value Health 2014;17:174-82). Results A total of 16 studies (9 on chronic heart disease, 2 on asthma, and 5 on diabetes) met the inclusion criteria. Five studies reported cost savings and 11 studies reported additional costs. In the quality, the overall score of the models ranged from 39% to 65%, it ranged from 34% to 52%. Eleven models integrated effectiveness derived from a clinical trial or a meta-analysis of complete DMPs and only five models combined intervention effects from different sources into a DMP. The main limitations of the models are bad reporting practice and the variation in the selection of input parameters. Conclusions Eleven of the 14 studies reported cost-effectiveness results of less than $30,000 per quality-adjusted life-year and the remaining two studies less than $30,000 per life-year gained. Nevertheless, if the reporting and selection of data problems are addressed, then Markov models should provide more reliable information for decision makers, because understanding under what circumstances a DMP is cost-effective is an important determinant of efficient resource allocation.  
AU  - Kirsch, F.
C1  - 49727
C2  - 40884
CY  - New York
SP  - 1039-1054
TI  - Economic evaluations of multicomponent disease management programs with Markov models: A systematic review.
JO  - Value Health
VL  - 19
IS  - 8
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Leidl, R.
AU  - Reitmeir, P.
C1  - 51001
C2  - 42618
CY  - New York
SP  - A386-A386
TI  - Analyzing a German index for the EQ-5D-5L based on experienced health.
JO  - Value Health
VL  - 19
IS  - 7
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Szentes, B.L.
AU  - Witt, S.
AU  - Bush, A.*
AU  - Cunningham, S.*
AU  - Emiraliouglu, N.*
AU  - Goldbeck, L.*
AU  - Griese, M.*
AU  - Hengst, M.*
AU  - Kiper, N.*
AU  - Krenke, K.*
AU  - Lange, J.*
AU  - Leidl, R.
AU  - Schwerk, N.*
AU  - Schwarzkopf, L.
C1  - 51000
C2  - 42619
CY  - New York
SP  - A558-A558
TI  - Current practice of drug treatment in children with ILD: First insights from the child-EU registry.
JO  - Value Health
VL  - 19
IS  - 7
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives: To compare complication rates, length of hospital stay, and resulting costs between the use of manual compression and a vascular closing device (VCD) in both diagnostic and interventional catheterization in a German university hospital setting. Methods: A stratified analysis according to risk profiles was used to compare the risk of complications in a retrospective cross-sectional single-center study. Differences in costs and length of hospital stay were calculated using the recycled predictions method, based on regression coefficients from generalized linear models with gamma distribution. All models were adjusted for propensity score and possible confounders, such as age, sex, and comorbidities. The analysis was performed separately for diagnostic and interventional catheterization. Results: The unadjusted relative risk (RR) of complications was not significantly different in diagnostic catheterization when a VCD was used (RR = 0.70; 95% confidence interval [CI] 0.22-2.16) but significantly lower in interventional catheterization (RR = 0.44; 95% CI 0.21-0.93). Costs were on average €275 lower in the diagnostic group (95% CI -€478.0 to -€64.9; P = 0.006) and around €373 lower in the interventional group (95% CI -€630.0 to -€104.2; P = 0.014) when a VCD was used. The adjusted estimated average length of stay did not differ significantly between the use of a VCD and manual compression in both types of catheterization. Conclusions: In interventional catheterization, VCDs significantly reduced unadjusted complication rates, as well as costs. A significant reduction in costs also supports their usage in diagnostic catheterization on a larger scale.
AU  - Walter, J.
AU  - Vogl, M.
AU  - Holderried, M.*
AU  - Becker, C.
AU  - Brandes, A.
AU  - Sinner, M.F.*
AU  - Rogowski, W.H.
AU  - Maschmann, J.*
C1  - 49103
C2  - 41663
CY  - New York
SP  - 769-776
TI  - Manual compression versus vascular closing device for closing access puncture site in femoral left-heart catheterization and percutaneous coronary interventions: A retrospective cross-sectional comparison of costs and effects in inpatient care.
JO  - Value Health
VL  - 20
IS  - 6
PB  - Elsevier Science Inc
PY  - 2016
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Hoogendoorn, M.*
AU  - Feenstra, T.*
AU  - Asukai, Y.*
AU  - Briggs, A.*
AU  - Borg, S.*
AU  - dal Negro, R.*
AU  - Hansen, R.N.*
AU  - Jansson, S.A.*
AU  - Wacker, M.
AU  - Risebrough, N.*
AU  - Samyshkin, Y.*
AU  - Leidl, R.
AU  - Rutten van-Mölken, M.*
C1  - 47205
C2  - 39156
TI  - Patient heterogeneity in cost-effectiveness models for Chronic Obstructive Pulmonary Disease (COPD): Are current models suitable to evaluate personalized medicine.
JO  - Value Health
VL  - 18
IS  - 7
PY  - 2015
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Background: Reliable burden of disease (BOD) estimates are needed to support decision making in health care. Objectives: The objective of this study was to introduce an analysis approach based on individual-level longitudinal survey data that estimates the burden of diabetes in patients with coronary heart disease in terms of quality-adjusted life-years (QALYs) lost. Methods: Data from two postal surveys (2006, N = 1022; 2010-2011, N = 716) of survivors from the KORA Myocardial Infarction Registry in Southern Germany were analyzed. Accumulated QALYs were calculated for each participant over a mean observation time of 4.1 years, considering the noninformative censoring structure of the follow-up study. Linear regression models were used to estimate the loss in (quality-unadjusted) life-years and QALYs between patients with and without diabetes, and generalized additive models were used to analyze the nonlinear association with age. The cross-sectional and longitudinal association with quality of life (QOL) and QOL change and the impact on mortality were analyzed to enhance the understanding of the observed results. Results: Diabetes was associated with a reduced QOL at baseline (cross-sectional: β = -0.069; P < 0.001), but not with a significant longitudinal QOL change. Mortality in patients with diabetes was increased (hazard ratio = 1.68; P < 0.005). This resulted in a loss of 0.14 life-years (P = 0.003) and 0.37 QALYs (P < 0.001). Results from generalized additive models indicated that the burden of diabetes is less pronounced in older subjects. Conclusions: The application of the proposed approach provides confounder-adjusted BOD estimates for the studied time horizon and can be used to compare the BOD across different chronic conditions. Curative efforts are needed to diminish the substantial diabetes-related QALY gap.
AU  - Laxy, M.
AU  - Hunger, M.
AU  - Stark, R.G.
AU  - Meisinger, C.
AU  - Kirchberger, I.
AU  - Heier, M.
AU  - von Scheidt, W.*
AU  - Holle, R.
C1  - 46873
C2  - 39006
CY  - New York
SP  - 969-976
TI  - The burden of diabetes mellitus in patients with coronary heart disease: A methodological approach to assess quality-adjusted life-years based on individual-level longitudinal survey data.
JO  - Value Health
VL  - 18
IS  - 8
PB  - Elsevier Science Inc
PY  - 2015
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Brandes, A.
AU  - Koerber, F.
AU  - Schwarzkopf, L.
AU  - Hunger, M.
AU  - Waidelich, R.*
AU  - Rogowski, W.H.
C1  - 43668
C2  - 36719
CY  - New York
SP  - A636-A637
TI  - Cost-effectiveness of radical prostatectomy, radiation therapy and active surveillance for the treatment of localized prostate cancer - a claims data analysis.
JO  - Value Health
VL  - 17
IS  - 7
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Butzke, B.
AU  - Oduncu, F.*
AU  - Heinemann, V.*
AU  - Pfeufer, A.
AU  - Giessen, C.*
AU  - Stollenwerk, B.
AU  - Rogowski, W.H.
C1  - 43667
C2  - 36720
CY  - New York
SP  - A643
TI  - Cost-effectiveness analysis of ugt1a1 genotyping before colorectal cancer treatment with irinotecan.
JO  - Value Health
VL  - 17
IS  - 7
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - OBJECTIVES: To compare different chronic obstructive pulmonary disease (COPD) cost-effectiveness models with respect to structure and input parameters and to cross-validate the models by running the same hypothetical treatment scenarios. METHODS: COPD modeling groups simulated four hypothetical interventions with their model and compared the results with a reference scenario of no intervention. The four interventions modeled assumed 1) 20% reduction in decline in lung function, 2) 25% reduction in exacerbation frequency, 3) 10% reduction in all-cause mortality, and 4) all these effects combined. The interventions were simulated for a 5-year and lifetime horizon with standardization, if possible, for sex, age, COPD severity, smoking status, exacerbation frequencies, mortality due to other causes, utilities, costs, and discount rates. Furthermore, uncertainty around the outcomes of intervention four was compared. RESULTS: Seven out of nine contacted COPD modeling groups agreed to participate. The 5-year incremental cost-effectiveness ratios (ICERs) for the most comprehensive intervention, intervention four, was €17,000/quality-adjusted life-year (QALY) for two models, €25,000 to €28,000/QALY for three models, and €47,000/QALY for the remaining two models. Differences in the ICERs could mainly be explained by differences in input values for disease progression, exacerbation-related mortality, and all-cause mortality, with high input values resulting in low ICERs and vice versa. Lifetime results were mainly affected by the input values for mortality. The probability of intervention four to be cost-effective at a willingness-to-pay value of €50,000/QALY was 90% to 100% for five models and about 70% and 50% for the other two models, respectively. CONCLUSIONS: Mortality was the most important factor determining the differences in cost-effectiveness outcomes between models.
AU  - Hoogendoorn, M.*
AU  - Feenstra, T.L.*
AU  - Asukai, Y.*
AU  - Borg, S.*
AU  - Hansen, R.N.*
AU  - Jansson, S.A.*
AU  - Samyshkin, Y.*
AU  - Wacker, M.
AU  - Briggs, A.H.*
AU  - Lloyd, A.*
AU  - Sullivan, S.D.*
AU  - Rutten-van Mölken, M.P.*
C1  - 31948
C2  - 34883
CY  - New York
SP  - 525-536
TI  - Cost-effectiveness models for chronic obstructive pulmonary disease: Cross-model comparison of hypothetical treatment scenarios.
JO  - Value Health
VL  - 17
IS  - 5
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Hoogendoorn, M.*
AU  - Feenstra, T.*
AU  - Asukai, Y.*
AU  - Borg, S.*
AU  - Hansen, R.N.*
AU  - Jansson, S.A.*
AU  - Samyshkin, Y.*
AU  - Wacker, M.
AU  - Briggs, A.*
AU  - Lloyd, A.*
AU  - Sullivan, S.D.*
AU  - Rutten-van Moelken, M.P.*
C1  - 43664
C2  - 36786
CY  - New York
SP  - A557-A558
TI  - Cost-effectiveness models for Chronic Obstructive Pulmonary Disease (COPD): Cross-model comparison of hypothetical treatment scenarios.
JO  - Value Health
VL  - 17
IS  - 7
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Laxy, M.
AU  - Hunger, M.
AU  - Thorand, B.
AU  - Meisinger, C.
AU  - Kirchberger, I.*
AU  - Holle, R.
C1  - 43665
C2  - 36721
CY  - New York
SP  - A494
TI  - The intermediate burden of diabetes mellitus in patients with cardiovascular disease (CVD): A quality adjusted life year (QALY) - analysis based on primary longitudinal data.
JO  - Value Health
VL  - 17
IS  - 7
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Background: Health states can be valued by those who currently experience a health state (experienced health states [EHS]) or by the general public, who value a set of given health states (GHS) described to them. There has been debate over which method is more appropriate when making resource allocation decisions. Objective: This article informs this debate by assessing whether differences between these methods have an effect on the mean EQ-5D-3L tariff scores of different patient groups. Methods: The European tariff based on GHS valuations was compared with a German EHS tariff. Comparison was made in the context of EQ-5D-3L health states describing a number of diagnosed chronic diseases (stroke, diabetes, myocardial infarction, and cancer) taken from the Cooperative Health Research in the Augsburg Region population surveys. Comparison was made of both the difference in weighting of the dimensions of the EQ-5D-3L and differences in mean tariff scores for patient groups. Results: Weighting of the dimensions of the EQ-5D-3L were found to be systematically different. The EHS tariff gave significantly lower mean scores for most, but not all, patient groups despite tariff scores being lower for 213 of 243 EQ-5D-3L health states using the GHS tariff. Differences were found to vary between groups, with the largest change in difference being 5.45 in the multiple stoke group. Conclusions: The two tariffs have systematic differences that in certain patient groups could drive the results of an economic evaluation. Therefore, the choice as to which is used may be critical when making resource allocation decisions.
AU  - Little, M.H.R.
AU  - Reitmeir, P.
AU  - Peters, A.
AU  - Leidl, R.
C1  - 31220
C2  - 34210
CY  - New York
SP  - 364-371
TI  - The impact of differences between patient and general population EQ-5D-3L values on the mean tariff scores of different patient groups.
JO  - Value Health
VL  - 17
IS  - 4
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Rochau, U.*
AU  - Kuhner, F.*
AU  - Jahn, B.*
AU  - Kurzthaler, C.*
AU  - Ramos, C.*
AU  - Chhatwal, J.*
AU  - Stollenwerk, B.
AU  - Goldhaber-Fiebert, J.D.*
AU  - Siebert, U.*
C1  - 43666
C2  - 36785
CY  - New York
SP  - A639
TI  - Prioritization of future outcomes research studies in chronic myeloid leukemia: Value of information analysis.
JO  - Value Health
VL  - 17
IS  - 7
PB  - Elsevier Science Inc
PY  - 2014
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objectives: To compare in patients with inflammatory bowel disease the performance of a value set for the EQ-5D based on experienced health states (EHSs) with value sets based on given health states (GHSs). Methods: A value set based on EHSs and valuation by the visual analogue scale (VAS) in the German general population was compared with a German and a UK value set, both based on GHSs and time-trade off valuation. Accuracy in the prediction of actual VAS ratings by patients was assessed using correlation and mean absolute error. Construct validity was tested by correlation with established disease activity indices and test-retest reliability by intraclass correlation between two measurements. Data originated from a survey of 270 patients with Crohn's disease and 232 patients with ulcerative colitis. Results: EHS-VAS correlates best with actual VAS ratings for all patients but not for all subgroups. EHS-VAS has the lowest mean absolute error for almost all analyzed groups except for measured differences between two time points. Regarding test-retest reliability in all patients, EHS-VAS correlations were closest to those of actual VAS ratings. Conclusion: EHS-VAS renders experience-based valuations but not decision utilities. GHS-based approaches cover severe health states more extensively, but study patients reported health states similar to those of a general population. Compared to GHS time-trade off value sets, the EHS-VAS value set predicted EQ-5D VAS valuations by patients with inflammatory bowel disease equally well and partly better. It performed partly better with respect to test-retest reliability and the same with respect to construct validity.
AU  - Leidl, R.
AU  - Reitmeir, P.
AU  - König, H.-H.*
AU  - Stark, R.G.
C1  - 6705
C2  - 29142
SP  - 151-157
TI  - The performance of a value set for the EQ-5D based on experienced health states in patients with inflammatory bowel disease.
JO  - Value Health
VL  - 15
IS  - 1
PB  - Elsevier
PY  - 2012
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - OBJECTIVE: To compare a complex nondrug intervention including actively approaching counseling and caregiver support groups with differing intensity against usual care with respect to time to institutionalization in patients with dementia. METHODS: Within this three-armed cluster-randomized controlled trial, 390 community-dwelling patients aged 65 years or older with physician-diagnosed mild to moderate dementia and their caregivers were enrolled via 129 general practitioners in Middle Franconia, Germany. The intervention included general practitioners' training in dementia care and their recommendation of support groups and actively approaching caregiver counseling. Primary study end point was time to institutionalization over 2 years. In addition, long-term intervention effects were assessed over a time horizon of 4 years. Secondary end points included cognitive functioning, (instrumental) activities of daily living, burden of caregiving, and health-related quality of life after 2 years. Frailty models with strict intention-to-treat approach and mixed linear models were applied to account for cluster randomization. Health care costs were assessed from the societal perspective. RESULTS: After 2 (4) years, 12% (24%) of the patients were institutionalized and another 21% (35%) died before institutionalization. No significant differences between study groups were observed with respect to time to institutionalization after 2 and 4 years (P 0.25 and 0.71, respectively). Secondary end points deteriorated, but differences were not significant between study groups. Almost 80% of the health care costs were due to informal care. Total annual costs amounted to more than €47,000 per patient and did not differ between study arms. CONCLUSION: The intervention showed no effects on time to institutionalization and secondary outcomes.
AU  - Menn, P.
AU  - Holle, R.
AU  - Kunz, S.
AU  - Donath, C.*
AU  - Lauterberg, J.*
AU  - Leidl, R.
AU  - Marx, P.*
AU  - Mehlig, H.*
AU  - Ruckdäschel, S.*
AU  - Vollmar, H.C.*
AU  - Wunder, S.*
AU  - Gräßel, E.*
C1  - 10563
C2  - 30303
SP  - 851-859
TI  - Dementia care in the general practice setting: A cluster randomized trial on the effectiveness and cost impact of three management strategies.
JO  - Value Health
VL  - 15
IS  - 6
PB  - Elsevier
PY  - 2012
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Objective: In Germany, only limited data are available to quantify the attributable resource utilization associated with adverse drug events (ADEs). The aim of this study was twofold: first, to calculate the direct treatment costs associated with ADEs leading to hospitalization and, second, to derive the excess costs and extra hospital days attributable to ADEs of inpatient treatments in selected German hospitals. Methods: This was a retrospective and medical record-based study performed from the hospitals' perspective based on administrative accounting data from three hospitals (49,462 patients) in Germany. Total treatment costs ("analysis 1") and excess costs (i.e., incremental resource utilization) between patients suffering from an ADE and those without ADEs were calculated by means of a propensity score-based matching algorithm ("analysis 2"). Results: Mean treatment costs ("analysis 1") of ADEs leading to hospitalization (n = 564) were (sic)1,978 +/- 2,036 (range (sic)191-18,147; median (sic)1,446; (sic)843-2,480 [Q1-Q3]). In analysis 2, the mean costs of inpatients suffering from an ADE (n = 1,891) as a concomitant disease or complication ((sic)5,113 +/- 10,059; range (sic)179-246,288; median (sic)2,701; (sic)1,636-5,111 [Q1-Q3]) were significantly higher ((sic)970; P < 0.0001) than those of non-ADE inpatients ((sic)4,143 +/- 6,968; range (sic)154-148,479; median (sic)2,387; (sic)1,432-4,701 [Q1-Q3]). Mean inpatient length of stay of ADE patients (12.7 +/- 17.2 days) and non-ADE patients (9.8 +/- 11.6 days) differed by 2.9 days (P < 0.0001). A nationwide extrapolation resulted in annual total treatment costs of (sic)1.058 billion. Conclusions: This is one of the first administrative data-based analyses calculating the economic consequences of ADEs in Germany. Further efforts are necessary to improve pharmacotherapy and relieve health care payers of preventable treatment costs.
AU  - Rottenkolber, D.
AU  - Hasford, J.*
AU  - Stausberg, J.*
C1  - 10632
C2  - 30447
SP  - 868-875
TI  - Costs of adverse drug events in German hospitals - a microcosting study.
JO  - Value Health
VL  - 15
IS  - 6
PB  - Elsevier
PY  - 2012
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - BACKGROUND: Preference-weighted index scores of health-related quality of life are commonly skewed to the left and bounded at one. Beta regression is used in various disciplines to address the specific features of bounded outcome variables such as heteroscedasticity, but has rarely been used in the context of health-related quality of life measures. We aimed to examine if beta regression is appropriate for analyzing the relationship between subject characteristics and SF-6D index scores. METHODS: We used data from the population-based German KORA F4 study. Besides classical beta regression, we also fitted extended beta regression models by allowing a regression structure on the precision parameter. Regression coefficients and predictive accuracy of the models were compared to those from a linear regression model with model-based and robust standard errors. RESULTS: The beta distribution fitted the empirical distribution of the SF-6D index better than the normal distribution. Extended beta regression performed best in terms of predictive accuracy but confidence intervals of the fit measures suggested that no model was superior to the others. Age had a significant negative effect on the precision parameter indicating higher variation of health utilities in older age groups. The observations reporting perfect health had a high influence on model results. CONCLUSIONS: Beta regression, especially with precision covariates is a possible supplement to the methods currently used in the analysis of health utility data. In particular, it accounted for the boundedness and heteroscedasticity of the SF-6D index. A pitfall of the beta regression is that it does not work well in handling one-valued observations.
AU  - Hunger, M.
AU  - Baumert, J.J.
AU  - Holle, R.
C1  - 6524
C2  - 28907
SP  - 759-767
TI  - Analysis of SF-6D index data: Is beta regression appropriate?
JO  - Value Health
VL  - 14
IS  - 5
PB  - Elsevier
PY  - 2011
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - OBJECTIVE: Rising life expectancy is associated with higher prevalence rates of dementia disorders. When disease progresses the patients' call on formal health care services and on social support grows which imposes increasing costs of care. The aim of this study was to investigate the costs for patients with mild and moderate dementia in community setting in Germany. METHODS: We assessed total costs of care and individual cost components for 383 community-living dementia patients alongside a cluster-randomized trial from societal and health insurance perspective. Utilization of formal health care services was based on insurance claims data and time dedicated to informal care was assessed within caregiver interviews. We estimated costs using a two-part regression model adjusting for age, gender and cluster-effects. RESULTS: Costs of care equal €47,747 (Euros) from societal perspective which is almost the 4.7-fold of health insurance expenditures. Valued informal care covers 80.2% of societal costs and increases disproportionally when disease progresses. In moderate dementia the corresponding amount exceeds the one in mild dementia by 69.9%, whereas costs for formal health care services differ by 14.3%. CONCLUSION: Due to valued informal care, costs of care for community-living patients with moderate dementia are significantly higher than for patients with mild dementia. Informal care is a non-cash item saving expenditures for professional care. To relieve social security system and family caregivers as well as to allow dementia patients to stay at home as long as possible, concepts fostering community-based dementia care and support to family caregivers need to be further developed.
AU  - Schwarzkopf, L.
AU  - Menn, P.
AU  - Kunz, S.
AU  - Holle, R.
AU  - Lauterberg, J.*
AU  - Marx, P.*
AU  - Mehlig, H.*
AU  - Wunder, S.*
AU  - Leidl, R.
AU  - Donath, C.*
AU  - Graessel, E.*
C1  - 6583
C2  - 28937
SP  - 827-835
TI  - Costs of care for dementia patients in community setting: An analysis for mild and moderate disease stage.
JO  - Value Health
VL  - 14
IS  - 6
PB  - Elsevier
PY  - 2011
SN  - 1098-3015
ER  - 

TY  - JOUR
AU  - Schweikert, B.*
AU  - John, J.
AU  - Ringborg, A.*
AU  - Erhardt, W.*
AU  - Bleckmann, A.*
AU  - Neubauer, A.S.*
C1  - 4738
C2  - 28199
SP  - A300-A300
TI  - Standards for the assessment of antidiabetic drugs-the IQWIG perspectice.
JO  - Value Health
VL  - 13
IS  - 7
PB  - Wiley-Blackwell
PY  - 2010
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - Many studies support the finding that patients, compared to the general public, valuate a given health condition differently. Based on Prospect Theory, this difference can be explained by adaptation processes resulting in differences in individual reference points. Using tinnitus as a case in point, our objective is to analyze empirically to what extent differences in risk attitudes (as a proxy to reference points) mediate differences in health valuations. Two hundred ten tinnitus patients and a similar number of unaffected persons indicated their willingness to undergo, hypothetically, an intervention (surgery or treatment) that would either improve or worsen the condition, thus revealing their risk attitudes. Utilities were elicited using three different methods: visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG). Repeated measure analysis of variance was used to test for mediation of utility differences by reference points. Health status (affected-unaffected) has a significant effect on tinnitus utilities and risk attitude; at the same time, the latter is significantly associated with utilities. Adjusting for risk attitude, differences by health status disappear for SG and TTO, and are alleviated for VAS. Reference points in terms of risk attitudes are a potential confounder in the valuation of health states. Taking into account theoretical predictions and issues in measuring SG, TTO, and risk attitudes, these results cast doubt on the construct validity of SG and TTO, and point to the need to recognize and further clarify the role of reference points in health valuation research.
AU  - Happich, M.
AU  - Moock, J.*
AU  - von Lengerke, T.
C1  - 1326
C2  - 26155
SP  - 88-95
TI  - Health state valuation methods and reference points: The case of tinnitus.
JO  - Value Health
VL  - 12
IS  - 1
PB  - Wiley-Blackwell
PY  - 2009
SN  - 1098-3015
ER  - 

TY  - JOUR
AB  - no Abstract
AU  - Graf von der Schulenburg, J.M.*
AU  - Greiner, W.*
AU  - Jost, F.*
AU  - Klusen, N.*
AU  - Kubin, M.*
AU  - Leidl, R.
AU  - Mittendorf, T.*
AU  - Rebscher, H.*
AU  - Schoeffski, O.*
AU  - Vauth, C.*
AU  - Volmer, T.*
AU  - Wahler, S.*
AU  - Wasem, J.*
AU  - Weber, C.*
AU  - Hanover Consensus Group (*)
C1  - 3652
C2  - 25864
SP  - 539-544
TI  - German recommendations on health economic evaluation: Third and updated version of the Hanover Consensus.
JO  - Value Health
VL  - 11
IS  - 4
PB  - Wiley-Blackwell
PY  - 2008
SN  - 1098-3015
ER  -