TY  - JOUR
AB  - BACKGROUND: Insufficient physical activity (PA) is a leading risk factor for non-communicable diseases posing a significant economic burden to healthcare systems and societies. The study aimed to examine the differences in healthcare and indirect costs between sufficient and insufficient PA and the cost differences between PA intensity groups. METHODS: The cross-sectional analysis was based on data from 157,648 participants in the baseline examination of the German National Cohort (NAKO) study. Healthcare and indirect costs were calculated based on self-reported information on health-related resource use and productivity losses. PA in the domains leisure, transport, and work was assessed by the Global Physical Activity Questionnaire and categorized into sufficient/insufficient and intensity levels (very low/low/medium/high) based on PA recommendations of the World Health Organization. Two-part models adjusted for relevant covariates were used to estimate mean costs for PA groups. RESULTS AND CONCLUSION: Insufficiently active people had higher average annual healthcare costs (Δ €188, 95% CI [64, 311]) and healthcare plus indirect costs (Δ €482, 95% CI [262, 702]) compared to sufficiently active people. The difference was especially evident in the population aged 60 + years and when considering only leisure PA. An inverse association was observed between leisure PA and costs, whereas a direct association was found between PA at work and costs. Adjusting for the number of comorbidities reduced the differences between activity groups, but the trend persisted. The association between PA and costs differed in direction between PA domains. Future research may provide further insight into the temporal relationship between PA and costs.
AU  - Gottschalk, S.*
AU  - König, H.H.*
AU  - Weber, A.*
AU  - Leitzmann, M.F.*
AU  - Stein, M.J.*
AU  - Peters, A.
AU  - Flexeder, C.
AU  - Krist, L.*
AU  - Willich, S.N.*
AU  - Nimptsch, K.*
AU  - Pischon, T.*
AU  - Gastell, S.*
AU  - Steindorf, K.*
AU  - Herbolsheimer, F.*
AU  - Ebert, N.*
AU  - Michels, K.B.*
AU  - Dorrn, A.*
AU  - Harth, V.*
AU  - Obi, N.*
AU  - Karch, A.*
AU  - Teismann, H.*
AU  - Völzke, H.*
AU  - Meinke-Franze, C.*
AU  - Klimeck, L.*
AU  - Seum, T.L.*
AU  - Dams, J.*
C1  - 70654
C2  - 55806
CY  - One New York Plaza, Suite 4600, New York, Ny, United States
SP  - 117-128
TI  - Costs associated with insufficient physical activity in Germany: Cross-sectional results from the baseline examination of the German national cohort (NAKO).
JO  - Eur. J. Health Econ.
VL  - 26
IS  - 1
PB  - Springer
PY  - 2024
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Sugar-sweetened beverages (SSBs) are associated with increased body weight and obesity, which induce a wide array of health impairments such as diabetes or cardiovascular disorders. Excise taxes have been introduced to counteract SSB consumption. We investigated the effect of sugar taxes on SSB sales in Hungary and France using a synthetic control approach. For France, we found a slight decrease in SSB sales after tax implementation while overall soft drink sales increased. For Hungary, there was only a short-term decrease in SSB sales which disappeared after 2 years, leading to an overall increase in SSB sales. However, both effects are characterized by great uncertainty.
AU  - Kurz, C.F.
AU  - König, A.
C1  - 61752
C2  - 50445
SP  - 905-915
TI  - The causal impact of sugar taxes on soft drink sales: Evidence from France and Hungary.
JO  - Eur. J. Health Econ.
VL  - 22
IS  - 6
PY  - 2021
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Objective: Acute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years. Methods: The study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models. Results: The propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757). Conclusion: Previous and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.
AU  - Kirsch, F.
AU  - Becker, C.
AU  - Schramm, A.*
AU  - Maier, W.
AU  - Leidl, R.
C1  - 57997
C2  - 48080
SP  - 607–619
TI  - Patients with coronary artery disease after acute myocardial infarction: Effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival.
JO  - Eur. J. Health Econ.
VL  - 21
PY  - 2020
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Background: Cognitive impairment in older adults causes a high economic and societal burden. This study assesses the cost-effectiveness of the multicomponent, non-pharmacological MAKS treatment vs. “care as usual” in German day care centers (DCCs) for community-dwelling people with mild cognitive impairment (MCI) or mild to moderate dementia over 6 months. Methods: The analysis was conducted from the societal perspective alongside the cluster-randomized controlled, multicenter, prospective DeTaMAKS-trial with waitlist group design. Outcomes were Mini-Mental Status Examination (MMSE) and Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) of 433 individuals in 32 DCCs. Incremental differences in MMSE and ETAM were calculated via a Gaussian-distributed and incremental cost difference via a Gamma-distributed Generalized Linear Model. Cost-effectiveness was assessed via cost-effectiveness planes and cost-effectiveness acceptability curves (CEAC). Results: At 6 months, MMSE (adjusted mean difference = 0.92; 95% confidence interval (CI): 0.17 to 1.67; p = 0.02) and ETAM (adjusted mean difference = 1.00; CI: 0.14 to 1.85; p = 0.02) were significantly better in the intervention group. The adjusted cost difference was − €938.50 (CI: − 2733.65 to 763.13; p = 0.31). Given the CEAC, MAKS was cost-effective for 78.0% of MMSE and 77.4% for ETAM without a need for additional costs to payers. Conclusions: MAKS is a cost-effective treatment to stabilize the ability to perform activities of daily living and cognitive abilities of people with MCI or mild to moderate dementia in German DCCs. Thus, MAKS should be implemented in DCCs.
AU  - Steinbeisser, K.
AU  - Schwarzkopf, L.
AU  - Graessel, E.*
AU  - Seidl, H.
C1  - 58721
C2  - 48273
SP  - 825–844
TI  - Cost-effectiveness of a non-pharmacological treatment vs. “care as usual” in day care centers for community-dwelling older people with cognitive impairment: Results from the German randomized controlled DeTaMAKS-trial.
JO  - Eur. J. Health Econ.
VL  - 21
PY  - 2020
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Value-based health insurance designs (VBIDs) are one approach to increase adherence to highly effective medications and simultaneously contain rising health care costs. The objective of this systematic review was to identify VBID effects on adherence and incentive designs within these programs that were associated with higher effects. Eight economic and medical databases were searched for literature. Random effects meta-analyses and mixed effects meta-regressions were used to synthesize VBID effects on adherence. Thirteen references with evaluation studies, including 12 patient populations with 79 outcomes, were used for primary meta-analyses. For qualitative review and sensitivity analyses, up to 19 references including 20 populations with 119 outcomes were used. Evidence of synthesized effects was good, because references with high risk of bias were excluded. VBIDs significantly increased adherence in all indication areas. Highest effects were found in medications indicated in heart diseases (4.05%-points, p < 0.0001). Each additional year increased effects by 0.15%-points (p < 0.01). VBIDs with education were more effective than without education, but the difference was not significant. Effects of VBIDs with full coverage were more than twice as high as effects of VBID without that option (4.52 vs 1.81%-points, p < 0.05). These findings were robust in most sensitivity analyses. It is concluded that VBID implementation should be encouraged, especially for patients with heart diseases, and that full coverage was associated with higher effects. This review may provide insight for policy-makers into how to make VBIDs more effective.
AU  - Krack, G.
C1  - 55869
C2  - 46647
SP  - 841-856
TI  - How to make value-based health insurance designs more effective? A systematic review and meta-analysis.
JO  - Eur. J. Health Econ.
VL  - 20
IS  - 6
PY  - 2019
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - BACKGROUND: The 'German Consortium for Hereditary Breast and Ovarian Cancer' (GC-HBOC) offers women with a family history of breast and ovarian cancer genetic counseling. The aim of this modeling study was to evaluate the cost-effectiveness of genetic testing for BRCA 1/2 in women with a high familial risk followed by different preventive interventions (intensified surveillance, risk-reducing bilateral mastectomy, risk-reducing bilateral salpingo-oophorectomy, or both mastectomy and salpingo-oophorectomy) compared to no genetic test. METHODS: A Markov model with a lifelong time horizon was developed for a cohort of 35-year-old women with a BRCA 1/2 mutation probability of ≥ 10%. The perspective of the German statutory health insurance (SHI) was adopted. The model included the health states 'well' (women with increased risk), 'breast cancer without metastases', 'breast cancer with metastases', 'ovarian cancer', 'death', and two post (non-metastatic) breast or ovarian cancer states. Outcomes were costs, quality of life years gained (QALYs) and life years gained (LYG). Important data used for the model were obtained from 4380 women enrolled in the GC-HBOC. RESULTS: Compared with the no test strategy, genetic testing with subsequent surgical and non-surgical treatment options provided to women with deleterious BRCA 1 or 2 mutations resulted in additional costs of €7256 and additional QALYs of 0,43 (incremental cost-effectiveness ratio of €17,027 per QALY; cost per LYG: €22,318). The results were robust in deterministic and probabilistic sensitivity analyses. CONCLUSION: The provision of genetic testing to high-risk women with a BRCA1 and two mutation probability of ≥ 10% based on the individual family cancer history appears to be a cost-effective option for the SHI.
AU  - Müller, D.*
AU  - Danner, M.*
AU  - Schmutzler, R.*
AU  - Engel, C.*
AU  - Wassermann, K.*
AU  - Stollenwerk, B.
AU  - Stock, S.*
AU  - Rhiem, K.*
C1  - 55561
C2  - 46229
SP  - 739-750
TI  - Economic modeling of risk-adapted screen-and-treat strategies in women at high risk for breast or ovarian cancer.
JO  - Eur. J. Health Econ.
VL  - 20
IS  - 5
PY  - 2019
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - BACKGROUND: Women with a BRCA1 or BRCA2 mutation are at increased risk of developing breast and/or ovarian cancer. This economic modeling study evaluated different preventive interventions for 30-year-old women with a confirmed BRCA (1 or 2) mutation. METHODS: A Markov model was developed to estimate the costs and benefits [i.e., quality-adjusted life years (QALYs), and life years gained (LYG)] associated with prophylactic bilateral mastectomy (BM), prophylactic bilateral salpingo-oophorectomy (BSO), BM plus BSO, BM plus BSO at age 40, and intensified surveillance. Relevant input data was obtained from a large German database including 5902 women with BRCA 1 or 2, and from the literature. The analysis was performed from the German Statutory Health Insurance (SHI) perspective. In order to assess the robustness of the results, deterministic and probabilistic sensitivity analyses were performed. RESULTS: With costs of €29,434 and a gain in QALYs of 17.7 (LYG 19.9), BM plus BSO at age 30 was less expensive and more effective than the other strategies, followed by BM plus BSO at age 40. Women who were offered the surveillance strategy had the highest costs at the lowest gain in QALYs/LYS. In the probabilistic sensitivity analysis, the probability of cost-saving was 57% for BM plus BSO. At a WTP of 10,000 € per QALY, the probability of the intervention being cost-effective was 80%. CONCLUSIONS: From the SHI perspective, undergoing BM plus immediate BSO should be recommended to BRCA 1 or 2 mutation carriers due to its favorable comparative cost-effectiveness.
AU  - Müller, D.*
AU  - Danner, M.*
AU  - Rhiem, K.*
AU  - Stollenwerk, B.
AU  - Engel, C.*
AU  - Rasche, L.*
AU  - Borsi, L.*
AU  - Schmutzler, R.K.*
AU  - Stock, S.*
C1  - 50902
C2  - 42675
SP  - 341–353
TI  - Cost-effectiveness of different strategies to prevent breast and ovarian cancer in German women with a BRCA 1 or 2 mutation.
JO  - Eur. J. Health Econ.
VL  - 19
PY  - 2017
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Despite the increasing availability of routine data, no analysis method has yet been presented for cost-of-illness (COI) studies based on massive data. We aim, first, to present such a method and, second, to assess the relevance of the associated gain in numerical efficiency. We propose a prevalence-based, top-down regression approach consisting of five steps: aggregating the data; fitting a generalized additive model (GAM); predicting costs via the fitted GAM; comparing predicted costs between prevalent and non-prevalent subjects; and quantifying the stochastic uncertainty via error propagation. To demonstrate the method, it was applied to aggregated data in the context of chronic lung disease to German sickness funds data (from 1999), covering over 7.3 million insured. To assess the gain in numerical efficiency, the computational time of the innovative approach has been compared with corresponding GAMs applied to simulated individual-level data. Furthermore, the probability of model failure was modeled via logistic regression. Applying the innovative method was reasonably fast (19 min). In contrast, regarding patient-level data, computational time increased disproportionately by sample size. Furthermore, using patient-level data was accompanied by a substantial risk of model failure (about 80 % for 6 million subjects). The gain in computational efficiency of the innovative COI method seems to be of practical relevance. Furthermore, it may yield more precise cost estimates.
AU  - Stollenwerk, B.
AU  - Welchowski, T.
AU  - Vogl, M.
AU  - Stock, S.*
C1  - 43230
C2  - 36285
SP  - 235-244
TI  - Cost-of-illness studies based on massive data: A prevalence-based, top-down regression approach.
JO  - Eur. J. Health Econ.
VL  - 17
PY  - 2016
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Background Fractures are one of the most costly consequences of falls in elderly patients in nursing homes. Objectives To compare the cost-effectiveness of a 'multifactorial fracture prevention program' provided by a multidisciplinary team with 'no prevention' in newly admitted nursing home residents. Methods We performed a cost-utility analysis using a Markov-based simulation model to establish the effectiveness of a multifaceted fall prevention program from the perspective of statutory health insurance (SHI) and long-term care insurance (LCI). The rate of falls was used to estimate the clinical and economic consequences resulting from hip and upper limb fractures. Robustness of the results was assessed using deterministic and probabilistic sensitivity analyses. Results Compared to no prevention a multifactorial prevention program for nursing home residents resulted in a cost-effectiveness ratio of €21,353 per quality-adjusted life-year. The total costs for SHI/LCI would result in €1.7 million per year. Results proved to be robust following deterministic and probabilistic sensitivity analyses. Conclusion Multifactorial fracture prevention appears to be cost-effective in preventing fractures in nursing home residents. Since the results were based on the number of falls further research is required to confirm the results.
AU  - Müller, D.J.*
AU  - Stock, S.*
AU  - Stollenwerk, B.
C1  - 31583
C2  - 34578
SP  - 517-527
TI  - Cost-effectiveness of a multifactorial fracture prevention program for elderly people admitted to nursing homes.
JO  - Eur. J. Health Econ.
VL  - 16
IS  - 5
PY  - 2015
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Objectives We assessed the cost-effectiveness of a case management intervention by trained nurses in elderly (≥65 years) patients with myocardial infarction from a societal perspective. Methods The intervention and observation period spanned 1 year and 329 participants were enrolled. The intervention consisted of at least one home visit and quarterly telephone calls. Data on resource use and quality of life were collected quarterly. The primary measurements of effect were quality-adjusted life years (QALYs), based on the EuroQol five-dimensional questionnaire (EQ-5D-3L) health utilities from the German time trade-off. The secondary measurements were EQ-5D-3L utility values and patients' self-rated health states according to the visual analogue scale (VAS) among survivors. To estimate mean differences, a linear regression model was used for QALYs and a gamma model for costs. Health states among the survivors were analysed using linear mixed models. To assess the impact of different health state valuation methods, VAS-adjusted life years were constructed. Results The mean difference in QALYs was small and not significant (-0.0163; CI -0.0681-0.0354, p value: 0.536, n = 297). Among survivors, EQ-5D-3L utilities showed significant improvements within 6 months in the intervention group (0.051; CI 0.0028-0.0989; p value: 0.0379, n = 280) but returned towards baseline levels by month 12. The mean improvement in self-rated health (VAS) within 1 year was significantly larger in the intervention group (+9.2, CI 4.665-13.766, p value: <0.0001, n = 266). The overall cost difference was -€17.61 (CI - €2,601-€2,615; p value: 0.9856, n = 297). The difference in VAS-adjusted life years was 0.0378 (CI -0.0040-0.0796, p value: 0.0759, n = 297). Conclusions This study could not provide evidence to conclude that the case management intervention was an effective and cost-effective alternative to usual care within a time horizon of 1 year.
AU  - Seidl, H.
AU  - Hunger, M.
AU  - Leidl, R.
AU  - Meisinger, C.
AU  - Wende, R.*
AU  - Kuch, B.*
AU  - Holle, R.
C1  - 31904
C2  - 34874
SP  - 671-681
TI  - Cost-effectiveness of nurse-based case management versus usual care for elderly patients with myocardial infarction: Results from the KORINNA study.
JO  - Eur. J. Health Econ.
VL  - 16
IS  - 6
PY  - 2015
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - OBJECTIVE: The planning of health care management benefits from understanding future trends in demand and costs. In the case of lung diseases in the national German hospital market, we therefore analyze the current structure of care, and forecast future trends in key process indicators. METHODS: We use standardized, patient-level, activity-based costing from a national cost calculation data set of respiratory cases, representing 11.9-14.1 % of all cases in the major diagnostic category "respiratory system" from 2006 to 2012. To forecast hospital admissions, length of stay (LOS), and costs, the best adjusted models out of possible autoregressive integrated moving average models and exponential smoothing models are used. RESULTS: The number of cases is predicted to increase substantially, from 1.1 million in 2006 to 1.5 million in 2018 (+2.7 % each year). LOS is expected to decrease from 7.9 to 6.1 days, and overall costs to increase from 2.7 to 4.5 billion euros (+4.3 % each year). Except for lung cancer (-2.3 % each year), costs for all respiratory disease areas increase: surgical interventions +9.2 % each year, COPD +3.9 %, bronchitis and asthma +1.7 %, infections +2.0 %, respiratory failure +2.6 %, and other diagnoses +8.5 % each year. The share of costs of surgical interventions in all costs of respiratory cases increases from 17.8 % in 2006 to 30.8 % in 2018. CONCLUSIONS: Overall costs are expected to increase particularly because of an increasing share of expensive surgical interventions and rare diseases, and because of higher intensive care, operating room, and diagnostics and therapy costs.
AU  - Vogl, M.
AU  - Leidl, R.
C1  - 45099
C2  - 37237
TI  - Informing management on the future structure of hospital care: An extrapolation of trends in demand and costs in lung diseases.
JO  - Eur. J. Health Econ.
PY  - 2015
SN  - 1618-7598
ER  - 

TY  - JOUR
AU  - Fischer, K.E.
AU  - Leidl, R.
C1  - 30575
C2  - 33714
SP  - 899-906
TI  - Analysing coverage decision-making: Opening Pandora's box?
JO  - Eur. J. Health Econ.
VL  - 15
IS  - 9
PY  - 2014
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - BACKGROUND: Positive screening results are often associated not only with target-disease-specific but also with non-target-disease-specific mortality. In general, this association is due to joint risk factors. Cost-effectiveness estimates based on decision-analytic models may be biased if this association is not reflected appropriately. OBJECTIVE: To develop a procedure for quantifying the degree of bias when an increase in non-target-disease-specific mortality is not considered. METHODS: We developed a family of parametric functions that generate hazard ratios (HRs) of non-target-disease-specific mortality between subjects screened positive and negative, with the HR of target-disease-specific mortality serving as the input variable. To demonstrate the efficacy of this procedure, we fitted a function within the context of coronary artery disease (CAD) risk screening, based on HRs related to different risk factors extracted from published studies. Estimates were embedded into a decision-analytic model, and the impact of 'modelling increased non-target-disease-specific mortality' was assessed. RESULTS: In 55-year-old German men, based on a risk screening with 5 % positively screened subjects, and a CAD risk ratio of 6 within the first year after screening, incremental quality-adjusted life-years were 19 % higher and incremental costs were 8 % lower if no adjustment was made. The effect varied depending on age, gender, the explanatory power of the screening test and other factors. CONCLUSION: Some bias can occur when an increase in non-target-disease-specific mortality is not considered when modelling the outcomes of screening tests.
AU  - Stollenwerk, B.
AU  - Gandjour, A.*
AU  - Lüngen, M.*
AU  - Siebert, U.*
C1  - 22827
C2  - 30946
SP  - 1035-1048
TI  - Accounting for increased non-target-disease-specific mortality in decision-analytic screening models for economic evaluation.
JO  - Eur. J. Health Econ.
VL  - 14
IS  - 6
PB  - Springer
PY  - 2013
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - OBJECTIVE: To compare postoperative complications and cost of treatment of laparoscopic (LA) versus open appendectomy (OA) and to identify the most cost-effective treatment method METHODS: Patients treated for appendectomy in US veterans health administration (VHA) hospitals in 2005 were included into our study. Direct medical cost and postoperative complications during hospitalization were used as outcomes. Propensity score matching was employed to adjust for baseline imbalances between treatment groups. It was adjusted for the severity of appendicitis, comorbidities according to Charlson Comorbidity Index, and demographic variables. 1:1 optimal matching with replacement was performed. Based on the matched samples, we estimated generalized linear mixed regression models for costs (gamma model) and postoperative complications (logit model). Besides patients' covariates, predictors of hospital resource use and quality of care at the hospital level were considered as explanatory variables. RESULTS: The total study population comprised of 1,128 patients (370 LA, 758 OA) from 95 VHA hospitals. Type of appendectomy had a significant influence on total costs (P = 0.005), with predicted costs for LA being 17.1% lower in comparison to OA (OA: 10,851 US$ [95%CI: 9,707 US$; 12,131 US$] vs. LA: 8,995 US$ [95%CI: 8,073 US$; 10,022 US$]). Differences in the predicted overall postoperative complication were not significant between LA and OA (P = 0.6311). Severity of appendicitis had a significant impact on costs and postoperative complications. CONCLUSION: Predicted costs for LA were 1,856 US$ lower than for OA while the postoperative complication rate did not differ significantly. Thus, LA is the treatment of choice from a provider's perspective.
AU  - Haas, L.
AU  - Stargardt, T.
AU  - Schreyögg, J.
C1  - 6366
C2  - 29255
SP  - 549-560
TI  - Cost-effectiveness of open versus laparoscopic appendectomy: A multilevel approach with propensity score matching.
JO  - Eur. J. Health Econ.
VL  - 13
IS  - 5
PB  - Springer
PY  - 2012
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Over the last decades, methods for the economic evaluation of health care technologies were increasingly used to inform reimbursement decisions. For a short time, the German Statutory Health Insurance makes use of these methods to support reimbursement decisions on patented drugs. In this context, the discounting procedure emerges as a critical component of these methods, as discount rates can strongly affect the resulting incremental cost-effectiveness ratios. The aim of this paper is to identify the appropriate value of a social discount rate to be used by the German Statutory Health Insurance for the economic evaluation of health technologies. On theoretical grounds, we build on the widespread view of contemporary economists that the social rate of time preference (SRTP) is the adequate social discount rate. For quantifying the SRTP, we first apply the market behaviour approach, which assumes that the SRTP is reflected in observable market interest rates. As a second approach, we derive the SRTP from optimal growth theory by using the Ramsey equation. A major part of the paper is devoted to specify the parameters of this equation. Depending on various assumptions, our empirical findings result in the range of 1.75-4.2% for the SRTP. A reasonable base case discount rate for Germany, thus, would be about 3%. Furthermore, we deal with the much debated question whether a common discount rate for costs and health benefits or a lower rate for health should be applied in health economic evaluations. In the German social health insurance system, no exogenously fixed budget constraint does exist. When evaluating a new health technology, the health care decision maker is obliged to conduct an economic evaluation in order to examine whether there is an economically appropriate relation between the value of the health gains and the additional costs which are given by the value of the consumption losses due to the additional health care expenditures. Therefore, a discount rate lower than the SRTP for consumption should be applied if an increase in the consumption value of health is expected. However, given the limited empirical evidence on the relationship between consumption and the value of health, it is hardly possible to make reliable forecasts of this value. Regarding the practice of the German evaluation authority, it is not recommended to use differential discounting in the base case. Instead, the issue of differential discounting should be addressed in sensitivity analyses. Reducing the discount rate for health compared to the rate for costs by a figure in the range between near 0% and 3% may be considered to be appropriate for Germany.
AU  - Schad, M.
AU  - John, J.
C1  - 6530
C2  - 28913
SP  - 127-144
TI  - Towards a social discount rate for the economic evaluation of health technologies in Germany: An exploratory analysis.
JO  - Eur. J. Health Econ.
VL  - 13
IS  - 2
PB  - Springer
PY  - 2012
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - To understand Latina mothers’ definitions of health and obesity in their children and perceptions of physician weight assessments. 24 low-income Spanish speaking Mexican mothers of children ages 2–5 years were recruited to participate in 4 focus groups. Half of the mothers had overweight or obese children and half had healthy weight children. Focus group comments were transcribed and analyzed using grounded theory. Themes and supporting comments were identified independently by 3 reviewers for triangulation. A fourth reader independently confirmed common themes. Mothers define health as a function of their child’s ability to play and engage in all aspects of life. Obesity was defined with declining physical abilities. Mothers state health care provider assessments help determine a child’s overweight status. Causative factors of obesity included family role-modeling and psycho-social stress, physical inactivity, and high-fat foods consumed outside the home. Controlling food intake was the primary approach to preventing and managing obesity but mothers described family conflict related to children’s eating habits. These findings held constant with mothers regardless of whether their children were overweight, obese, or at a healthy weight. Mothers utilize physical limitations and health care professional’s assessment of their child’s weight as indicators of an overweight status. These results highlight the importance of calculating and communicating body mass indices (BMI) for Latino children. Eliminating non-nutritive foods from the home, increasing physical activity, and involving family members in the discussion of health and weight maintenance are important strategies for the prevention and management of childhood obesity.
AU  - Wenig, C.M.
C1  - 5759
C2  - 27821
SP  - 39-50
TI  - The impact of BMI on direct costs in children and adolescents: Empirical findings for the German Healthcare System based on the KiGGS-study.
JO  - Eur. J. Health Econ.
VL  - 13
IS  - 1
PB  - Springer
PY  - 2012
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Reference pricing and health technology assessment are policies commonly applied in order to obtain more value for money from pharmaceuticals. This study focussed on decisions about the initial price and reimbursement status of innovative drugs and discussed the consequences for market access and cost. Four countries were studied: Germany, The Netherlands, Sweden and the United Kingdom. These countries have operated one, or both, of the two policies at certain points in time, sometimes in parallel. Drugs in four groups were considered: cholesterol-lowering agents, insulin analogues, biologic drugs for rheumatoid arthritis and "atypical" drugs for schizophrenia. Compared with HTA, reference pricing is a relatively blunt instrument for obtaining value for money from pharmaceuticals. Thus, its role in making reimbursement decisions should be limited to drugs which are therapeutically equivalent. HTA is a superior strategy for obtaining value for money because it addresses not only price but also the appropriate indications for the use of the drug and the relation between additional value and additional costs. However, given the relatively higher costs of conducting HTAs, the most efficient approach might be a combination of both policies.
AU  - Drummond, M.*
AU  - Jönsson, B.*
AU  - Rutten, F.*
AU  - Stargardt, T.
C1  - 5760
C2  - 27823
SP  - 263-271
TI  - Reimbursement of pharmaceuticals: Reference pricing versus health technology assessment.
JO  - Eur. J. Health Econ.
VL  - 12
IS  - 3
PB  - Springer
PY  - 2011
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health-care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.
AU  - Schreyögg, J.
AU  - Grabka, M.M.
C1  - 1240
C2  - 26676
CY  - New York
SP  - 331-341
TI  - Copayments for ambulatory care in Germany: A natural experiment using a difference-in-difference approach.
JO  - Eur. J. Health Econ.
VL  - 11
IS  - 3
PB  - Springer
PY  - 2010
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - This paper analyses (1) the impact of the inclusion of statins in the German reference pricing scheme in 2005 on the statin market, and (2) the effect of switching behaviour subsequent to the policy change on healthcare utilisation and costs. Patients with prescriptions for statins in 2004 were observed for 1 year before and 1 year after the policy change, which went into effect on 1 January 2005. Data on outpatient and inpatient visits, pharmaceutical consumption, and cost to the sickness fund were collected from a sickness fund with more than 5.8 million insured members in 2005. Compared to patients who were not affected by the policy change, patients treated previously with atorvastatin experienced higher non-adherence and increased discontinuation of treatment (P < 0.0001). Compared to patients who continued treatment with atorvastatin (non-switchers), patients who switched to another statin were hospitalised more often (P = 0.0439). However, difference-in-differences in hospitalisation due to coronary heart disease (P = 0.8751) and emergency visits (P = 0.5624) did not differ significantly between the two groups. Patients who switched more than once experienced a significant increase in hospital visits (P = 0.0061) and hospital visits due to cardiovascular disease (P = 0.0096) compared to non-switchers. Difference-in-differences in outpatient healthcare utilisation did not differ between non-switchers and switchers. Total savings resulting from the policy change ranged from  94.4 million to  108.7 million. Although manufacturers usually comply with reference pricing by reducing their retail prices to the reference price, regulators have to be aware of the consequences in cases where manufacturers react as in this situation.
AU  - Stargardt, T.
C1  - 6227
C2  - 28394
SP  - 267-277
TI  - The impact of reference pricing on switching behaviour and healthcare utilisation: The case of statins in Germany.
JO  - Eur. J. Health Econ.
VL  - 11
IS  - 3
PB  - Springer
PY  - 2010
SN  - 1618-7598
ER  - 

TY  - JOUR
AB  - Five models of risk adjusters were tested as a (proxy) measure for health status with data from a large German sickness fund. The first two models use standard demographic and socio-demographic variables. One model incorporates a simple binary indicator for hospitalization and the last two are based on the hierarchical coexisting conditions (HCCs: DxCG® Risk Adjustment Software Release 6.1) using in-patient diagnoses. Special investigations were done on the subgroups of insurees who left, joined or stayed with the fund over the observation period. Age and gender grouping accounted for 3.2% of the variation in total expenditure for concurrent as well as prospective models. The current German risk adjusters age, sex, and invalidity status account for 5.1 and 4.5% of the variance in the concurrent and prospective models, respectively. Age, gender, invalidity status and in-patient HCC covariates explain about 37% of the variations of the total expenditures in a concurrent model and roughly 12% of the variations of total expenditures in a prospective model. Only modest improvement can be achieved with the long-term-care (LTC) indicator. For high-risk (cost) groups, substantial under-prediction remains; conversely, for the low-risk group, represented by enrolees who did not show any health care expense in the base year, all of the models over-predict expenditure. Special investigations were done on the subgroups of insurees who left, joined or stayed with the fund over the observation period.
AU  - Behrend, C.
AU  - Buchner, F.*
AU  - Happich, M.
AU  - Holle, R.
AU  - Reitmeir, P.
AU  - Wasem, J.*
C1  - 5869
C2  - 24486
SP  - 31-39
TI  - Risk-adjusted capitation payments: How well do principal inpatient diagnosis-based models work in the German situation? Results from a large data set.
JO  - Eur. J. Health Econ.
VL  - 8
IS  - 1
PB  - Springer
PY  - 2007
SN  - 1618-7598
ER  -