Original article
Mit dem Inkrafttreten des ersten hausarztzentrierten Versorgungsvertrags nach dem neuen §73b SGB V am 1. Juli 2008 begann der Aufbau der eHealth-Infrastruktur in Baden-Württemberg. Über 1.200 Hausärzte sind über die hoch sichere Infrastruktur bereits online vernetzt. >> Der hausarztzentrierte Versorgungsvertrag (HZV) zwischen AOK Baden-Württemberg, Hausärztlicher Vertragsgemeinschaft (HÄVG) und MEDI Verbund sichert teilnehmenden Ärzten nicht nur […]
01.04.2009
With the Statutory Health Insurance Competition Strengthening Act (GKV-WSG), the Institute for Quality and Efficiency in Health Care (IQWiG) has been given the additional task of carrying out the economic evaluation of medicines in the form of cost-benefit assessments. In their last article for this magazine (MVF 1/2009: 32-37), the head of IQWiG, Prof. Dr. med. Peter Sawicki and two of his employees briefly presented the methodology newly developed by IQWiG and its motivation. Against the background of many years of research in health economics, the conclusion is disappointing. Neither the internationally applied standards of scientific research were taken into account, nor were the long-standing experiences of other comparable assessment agencies such as the National Institute for Health and Clinical Excellence (NICE) taken into account in the specific design of the cost-benefit assessment. The hope remains that with the presentation and discussion of the recently commissioned pilot studies, the influence of health economics experts will increase again in order to move the German special approach in cost-benefit assessment more towards the standards accepted in health economics.
01.04.2009
In Germany, health economic instruments for drug evaluation were introduced for the first time through the GKV Modernization Act. The basis for this economic evaluation of medicines is the international standards of health economics, which are explicitly required by law. The draft methods presented by IQWiG have so far been inadequate and have been subject to widespread criticism. The efficiency frontier concept proposed by IQWiG is subject to many methodological shortcomings. In addition, the QALY is strictly rejected as a cross-indication benefit measure. The chosen perspective of the insured community and the close integration of the benefit parameters also do not correspond to the international standard. The IQWiG proposal is therefore not suitable for creating the necessary instructions for carrying out cost-benefit assessments of new medical technologies. A look at the international methods that have been established in many other countries for some time shows all the necessary solutions. This solution will also have an impact on the healthcare research landscape.
01.04.2009
Diabetes mellitus has become a widespread disease in Germany. There are at least 7 million people with diagnosed diabetes mellitus in Germany and, taking into account the undiagnosed cases and the increasing prevalence of the disease worldwide, especially among younger people, the German health system will face major challenges, including economic ones. Under certain conditions, self-monitoring of blood sugar can be a very useful and cost-effective therapeutic element in the treatment of the disease. Although this benefit in insulin-dependent diabetics is largely undisputed, there is still no consensus in Germany about the benefit in non-insulin-dependent type 2 diabetics. However, what is often overlooked in the benefit assessment is that self-measurement of blood glucose is a diagnostic procedure which – unlike medicines – cannot have an intrinsic effect. Applying drug evaluation methods to a diagnostic procedure can subsequently lead to misleading results. If blood glucose measurement is used correctly by patients and appropriate assessment methods are used, self-assessment of blood glucose in type 2 patients even proves to be cost-saving for health insurance companies.
01.04.2009
Prof. Dr. Wolf-Dieter Ludwig, Vorsitzender der Arzneimittelkommission der deutschen Ärzteschaft, im MVF-Titelinterview
01.03.2009
Since 2002, the market for narcotic analgesics has more than doubled
01.03.2009
Das von dem Burscheider Institut für empirische Gesundheitsökonomie (Ifeg) erarbeitete Gutachten belegt eine erhebliche Unterversorgung bei der Behandlung der rheumatoiden Arthritis (RA). Eine Unterversorgungsquote von 69 % wurde konstatiert. Dabei wurde von einer Prävalenzrate von 0,5 % ausgegangen. Diese Unterversorgung ist eng verknüpft mit dem Mangel an internistischen Rheumatologen in der ambulanten Versorgung, der auch […]
01.03.2009
Health management services are knowledge-based services. They can be used in different care settings and in different phases of the indication-specific disease progression. A distinction is made between selective, periodic to sequential and continuous HMS interventions. The instruments start with simple reminder or e-mail educational services (Infocept), lead through more data- and technology-driven call centers or risk assessments to personnel-intensive offers such as case or disease management programs. In the future, personal health coaching and behavior modification will become more important if you really want to achieve sustainability. The costs for HMS instruments and programs range between 5 euros and 2,000 euros per intervention or year. The benefit lies in improved medical outcomes. Financing can be provided by cost bearers, service providers, product providers, additional insurance or personal contributions.
01.03.2009
With the most recent health care reform (GKV-WSG), the tasks of the Institute for Quality and Efficiency in Health Care (IQWiG) were expanded: Previously, it could only evaluate drugs with regard to their medical benefits. In the future, the institute should also put the costs of the medication in relation to the previously determined benefits. According to the law, these cost-benefit assessments are intended, on the one hand, to set maximum amounts for certain medications. On the other hand, they can support the Federal Joint Committee (G-BA) in assessing the cost-effectiveness of medical procedures. The proposed concept favors “efficient frontier analysis” as a method. The second element is a “budget impact analysis” to estimate how decisions affect healthcare spending.
01.03.2009
Cost-effectiveness analysis has experienced enormous growth in recent years as an aid to decision-making. Their legal anchoring in the performance audit means that the reliability of the statements must be checked. Political and methodological skepticism is particularly directed against a simple decision based on the monetary costs per QALY of a therapy. The discussion is also growing as to whether subjective assessments of benefits by individuals should take precedence over objective assessments of a group. It is still unclear which controls will ultimately be chosen in the healthcare system. However, both approaches require methodological refinement before they can offer helpful support to health policy.