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Chronic coronary heart disease (CHD) contributes significantly to mortality, morbidity and loss of quality of life in Germany. Improved therapies and secondary and tertiary drug prevention have contributed to a significant decrease in CHD-related mortality in recent years. The improved survival with CHD and the growing proportion of the older population lead to an increase in the prevalence of the disease and its complications. The present publication is intended to present the morbidity, mortality and prevalence of chronic CHD in Germany and to identify the population groups that are particularly frequently affected by the disease. In addition, aspects of the burden of disease (quality of life, premature mortality and medical costs) are taken into account. Furthermore, gaps in care and potential for optimizing secondary and tertiary prevention for patients with chronic CHD should be identified.
24.01.2013
Integrated supply models are legally and politically supported in Germany. The aim of such models is to contribute to optimizing high-quality and economical patient care by promoting collaboration between service providers within and between the outpatient, acute inpatient, rehabilitation and nursing sectors. Due to the ongoing cost pressure in the German healthcare system, redundancies and frictional losses between the players should be reduced and the burden on social security funds should be relieved. An essential feature of integrated care models is that providers, consumers and cost bearers conclude an individual contract on the basis of selective contracts and on a voluntary basis (see §§140a and b SGB V). In doing so, the legislature has moved away from the collective bargaining system in order to promote greater competition and efficiency in the healthcare system. This opens up the possibility for health insurance companies in particular to select service providers according to their own criteria, negotiate remuneration systems and thus standardize service financing and service delivery under one roof (cf. Amelung 2009, p.6f.). The result is a change in the roles in the traditional triangular structure of insurance company - service provider - patient. The benefit for service providers is to distinguish themselves and professionalize themselves in the competition by offering special treatment programs. Proof of good quality and reputation thus becomes the focus of interest for service providers. Patients benefit from coordinated treatment and quality through, for example, integrated treatment paths (Waehlert/Wagner/Czap 2010) as well as possible bonuses/discounts or other improved conditions from the payers through participation in integrated care models. In return, the patients usually give up their free choice of doctor and undertake to recognize the performance control in the specified contract.
24.01.2013
The expenditure of statutory health insurance on medicines for the treatment of cancer is always the focus of discussion (Neller 2013). A report prepared on behalf of the Federal Ministry of Health on the question of ensuring efficient drug supply in oncology shows that an increase in costs for statutory health insurance is to be expected in this area (Glaeske et al. 2010). The prognosis of future medical costs in the oncological field is also important internationally. Mariotto et al. (2010) considers in particular the demographically related additional costs of cancer treatment in the USA. Yabroff et al. (2011) point to the additional consideration of indirect costs as a result of cancer therapy. These are described by Featherstone et al. (2010) for a consideration of costs in the United Kingdom (UK). The demographically-related annual cost increases between 2008/2010 and 2020 are estimated in these publications at 1.0 % to 2.5 %. Global observations with a focus on the pharmaceutical market and taking new launches into account assume higher annual increases (6.9 % between 2010 and 2016) (Business Insight (2011)), which are also expected in Germany (Höer et al. 2010). The aim of the analysis currently presented is to create a current forecast for the expected development of sales and consumption of statutory health insurance (GKV) for oncological drugs dispensed on an outpatient basis until 2016.
24.01.2013
The scandal surrounding breast implants that ruptured far too easily and were also filled with industrial silicone drew attention in Europe to the safety of high-risk medical products, so that the subsequent scandals were also taken up in public discourse. Now it remains to be seen whether Europe can defend itself against lobby pressure and actually improve safety for patients with the new medical device regulation.
24.01.2013
The so-called multi-criteria decision analysis (MCEA) can be used to support complex technology assessments. Multi-criteria decision analysis procedures have their origins in decision theory or operations research and are used there to make decisions under uncertainty. They assist decision makers in evaluating a finite number of alternative health interventions using a finite number of performance criteria. In addition to conjoint analysis, the elimination and choice translating reality method (ELECTRE) and the multiattribute utility theory (MAUT) (Lootsma/Schujit 1997), the most widely used multi-criteria decision analysis tools include the Analytic Hierarchy Process (AHP).
24.01.2013
Most decision makers, including IQWiG, consider various patient-relevant endpoints to demonstrate the superiority of a therapy over a placebo or a comparator. The question arises: How can contradictory results in different endpoints be interpreted? The problem in benefit assessments with more than one endpoint is the weighting and the subsequent calculation of a key figure for the overall benefit. Without the aggregation of several endpoints into a score/index, the derivation of recommendations or regulatory decisions could be questionable.
24.01.2013
In Germany, medical care is largely financed by contributions from insured persons. This results in the normative and ethical obligation of statutory health insurance to provide the optimum level of health services with maximum benefit for the insured. It is important to reduce waste, use resources efficiently, and all results must be meaningful, especially for patients. The health insurance companies, together with the service providers and the patients, are responsible for achieving these goals and a primarily scientifically based approach (SGB V §§ 2, 12, 35b, 70). The question of what is useful is described, for example, in SGB V § 35b as “improving the state of health, shortening the duration of the illness, extending the lifespan, reducing side effects and improving the quality of life”. This maxim can be found in an identical form in the G-BA's Rules of Procedure, in the Drug Benefit Assessment Ordinance or in the IQWiG method paper for benefit assessment. The statement that the benefit assessment has to be based on “patient-relevant target values” is of particular importance. “In this context, “patient-relevant” should be understood as how a patient feels, can perceive their functions and activities or whether they survive.” (IQWiG 2011, p. 30f)
24.01.2013
The federal government's drug commissioner, Ms. Mechthild Dyckmans (FDP), recently called for nicotine replacement therapy for smoking cessation to be reimbursed by statutory health insurance in an interview with the "Berliner Zeitung" at the turn of the year 2013. In her justification, she referred not least to a health economic effect: the savings made by the statutory health insurance through reduced treatment costs for ex-smokers who have successfully given up. In Germany, smoking is the most important preventable health risk for a variety of serious diseases and is also the leading cause of premature mortality. According to the federal government's drug report, the economic damage amounts to around 21 billion euros annually. Among the approaches to avoiding illness and thus the costs of illness, in addition to preventing people from starting to smoke, reducing the smoking rate - both medically and economically - is important. One of the most effective aids in quitting smoking is medical support using nicotine replacement therapy (NET). However, the current framework conditions in the context of the GKV system do not currently allow NET to reimburse costs. This should be critically questioned, taking into account all the criteria used in social law and health policy practice to determine whether medicines can be reimbursed by statutory health insurance.
24.01.2013
Given the challenges of demographic change, the healthcare system is faced with the question of how to allocate resources efficiently and fairly. Only 20% of the insured are responsible for 81.2% of the hospital, medication and doctor expenses of the statutory health insurance (GKV) (1). Approximately 5% of patients account for 50% of utilization (Fig. 1). Almost half of these expenses relate to hospital treatment. In many cases, these are unavoidable and serve to ensure the safety and good quality of treatment for patients. A common reason for claiming benefits is the presence of a chronic illness. The top 10 reasons for hospitalization include diagnoses such as heart failure, angina, hypertension, and type 2 diabetes (1). The acute deterioration of chronic diseases such as diabetes or heart failure often leads to hospitalization. The risk of hospitalization increases significantly if a person has several chronic illnesses at the same time. In order to be able to assess a person's risk, risk prediction models are developed (predictive modeling). The aim of risk models is to avoid (re-)admissions to hospital, to prevent the incurrence of hospital costs and to achieve better health outcomes for the patient with intensive, cheaper medical intervention (2). Risk models can take a lot of information from the service sectors and master data into account in parallel and can be used to predict hospital stays for any reason as well as for specific diseases.
24.01.2013
The current special report from the Expert Council for the Assessment of Developments in the Health Care System (SVR 2012) comprehensively discusses the problems at the interfaces between the outpatient and inpatient sectors. In particular, discharge from hospital is an unprepared admission for vulnerable patients (older age, chronic illness, multimorbidity and/or functional limitations) with numerous risks such as post-hospital health complications, failure to heal, increased psychosocial stress for the patient and their relatives nursing home or readmission to a hospital. The SVR also emphasizes that it has repeatedly pointed out the interface problems as well as implementation and coordination deficits in, among other things, the reports from 2003 and 2007. The fact that “efforts to improve hospital discharge have become even more important” (SVR 2012: 138) is made clear by the current SVR survey. According to this, 78.2% of the hospitals surveyed with more than 50 beds carry out systematic discharge or transfer management and 44.8% have implemented the expert standard discharge management in nursing care (DNQP), with hospitals with a larger number of beds stating significantly more often that they provide these services ( SVR 2012: Tables A-1 and A-2). The SVR also emphasizes that despite this information on the provision of discharge and transition management, “it is not known how successfully this is implemented in practice” (ibid.: 139).