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Background The aim of this article is to evaluate the status, development, and perspectives of German claims data analyses in the international and health political context. Methods We conducted a comprehensive literature search in PubMed, Scopus, and DIMDI to identify empirical and methodological articles focusing on health insurance claims data studies published between 2000 and 2014. Inclusion criteria were (1) English/German full text articles or chapters in edited books that (2) focused on the claims data of statutory health insurance funds. Findings In total, 435 articles were included. Over time, the number of claims data studies has increased strongly and the frequency of policy-relevant research types increased. Along with the historical improvement path of claims data in Germany, we observed a rising percentage of international publications and an increase in the average quality of publications. In contrast to the US or Canada where comprehensive databases have been established, the most common data source in this search was data from a single SHI fund, while databases were rarely used. Conclusions Claims data are an important source of information for healthcare stakeholders, and their use for research purposes has further increased during recent years in Germany. Despite its potential in optimising the health system, we found a lack of German comprehensive all-payer claims databases compared to the US and Canada.

Background and objectives: The costs and treatment patterns of attention deficit hyperactivity disorder (ADHD) are subjects of health services research in Germany and worldwide. Previous publications focused mainly on prevalent patients and thus research gaps were identified regarding costs and treatment patterns of incident patients before and after the first diagnosis. Methods: Analyses were conducted using claims data obtained from a large German sickness fund (Techniker Krankenkasse). Inclusion criteria consisted of patients with at least two secured outpatient or one inpatient ADHD diagnosis in 2007. Incidence was ensured by defining a baseline period without ADHD-diagnosis in 2006. In addition to diseaserelated cost analyses compared to a control group including age group comparisons, comorbidities, the proportion of multimodal treatment and medication treatment patterns were described. Results: In total, 9083 newly diagnosed ADHD patients were identified (73 % male; mean age: 12.9 years (SD: 10.3)). The mean total cost of ADHD patients during the year after the first diagnosis exceeded the mean total cost of the year before by 976 € (Differencein-Difference-estimator: 1006 €). Our analyses have shown that 10 % of ADHD patients have been treated with multimodal therapy. In addition, 11 % of the investigated ADHD population have received methylphenidate or atomoxetine preceeding the date of diagnosis in the relevant observation period. Discussion: This study provides important insights into the costs as well as the treatment patterns of incident ADHD patients. ADHD-related costs and medications can be identified prior to the date of the first ADHD diagnosis. Although, multimodal therapy is presented as an optimal treatment option by many international guidelines and experts, its proportion for treatment is low (10 %). Further research is necessary to identify reasons for the low proportion of multimodal therapy and (cost-)effectiveness has to be evaluated in comparison to other treatment options. In addition, ADHD-related costs could be identified before the first diagnosis is documented. The reasons for medication prior to diagnosis have to be further investigated. BMBF

The financial burden for EU health systems associated with cardiovascular disease (CV) has been estimated to be nearly €110 billion in 2006, corresponding to 10 % of total healthcare expenditure across EU or a mean €223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in five European countries (Italy, Germany, France, Spain and England). A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of CV related to hypertension (CV defined as: stroke, heart attack, heart failure) in five European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure (BP) control (BP < 140/90 mmHg). Relative risk of CV, based on controlled or uncontrolled BP group, was estimated from the Framingham Heart Study and national review data. Prevalence and cost data were estimated from national literature reviews. A national payer (NP) perspective for 10 years was considered. Probabilistic sensitivity analysis was performed in order to evaluate uncertainty around the results (given as 95 % confidence intervals). The model estimated a total of 8.6 million (1.4 in Italy, 3.3 in Germany, 1.2 in Spain, 1.8 in France and 0.9 in England) CV events related to hypertension over the 10-year time horizon. Increasing the adherence rate to anti-hypertensive therapy to 70 % (baseline value is different for each country) would lead to 82,235 fewer CV events (24,058 in Italy, 7,870 in Germany, 18,870 in Spain, 24,855 in France and 6,553 in England). From the NP perspective, the direct cost associated with hypertension was estimated to be €51.3 billion (8.1 in Italy, 17.1 in Germany, 12.2 in Spain, 8.8 in France and 5.0 in England). Increasing adherence to anti-hypertensive therapy to 70 % would save a total of €332 million (CI 95 %: €319–346 million) from the NPs perspective. This study is the first attempt to estimate the economic impact of non-adherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England).

Treatment with antipsychotic medication is an important element of relapse prevention in the management of schizophrenia, and can reduce inpatient stays. Recently, the long-acting atypical antipsychotic paliperidone long-acting injectable (PLAI), a once-monthly LAI antipsychotic, was approved for treatment of schizophrenia in Germany. To estimate, based on a previously published model, the cost effectiveness of PLAI compared with other common antipsychotic treatment strategies in patients diagnosed with schizophrenia in Germany. A Markov decision analytic model was adapted to the German healthcare system. The model considers the cost effectiveness for PLAI as a maintenance treatment for patients with schizophrenia from the payer perspective. The patients transition between eight health states on a monthly basis over a 5-year time horizon. As therapeutic strategies, PLAI, quetiapine, risperidone long-acting injections (RLAI), oral olanzapine, oral risperidone, zuclopenthixol decanoate, olanzapine long-acting injections (OLAI), oral typical and oral atypical were compared. Probability of relapse, level of adherence, side effects and treatment discontinuation were derived from the Swedish original model. Input factors regarding resource use and costs were estimated and adjusted for the German healthcare system. A probabilistic sensitivity analyses (PSA) using cost-effectiveness scatter plots was performed to visualize the robustness of the results. In base-case scenario, PLAI is superior to RLAI in gained quality-adjusted life-years (QALYs) and avoided relapses. Relative to all other treatment strategies, PLAI is more effective with regard to gained QALYs and avoided relapses but results in higher treatment costs over a 5-year horizon in base-case scenario. The results were tested in PSA. If a cost-effectiveness threshold of €30,000 is assumed, for example, PLAI can be considered to be cost effective compared with RLAI in about 92.5 % of cases regarding gained QALYs, and in 78.6 % of cases regarding avoided relapse. Compared with OLAI, in about 94.4 % of cases regarding gained QALYs and in 99.9 % of cases regarding avoided relapse, cost effectiveness can be considered. Comparing PLAI and zuclopenthixol decanoate, cost effectiveness can be assumed in about 90.4 % of cases regarding gained QALYs, and in all cases regarding avoided relapse. PLAI dominates RLAI and compared with the other treatment strategies PLAI has shown to be more effective but results in higher costs in base-case scenario.

Background: The financial burden for EU health systems associated with cardiovascular disease has been estimated to be nearly € 110 billion in 2006, corresponding to 10% of total healthcare expenditure across EU or a mean € 223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in 5 European countries (Italy, Germany, France, Spain and England).Methods: A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of cardiovascular disease related to hypertension (CV defined as: stroke, heart attack, kidney disease, heart failure) in 5 European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure control (BP Results: The model estimated a total of 8.6 million (1.4 in Italy, 3.3 in Germany, 1.2 in Spain, 1.8 in France and 0.9 in England) CV events related to hypertension over the 10 year time horizon. Increasing the adherence rate to anti-hypertensive therapy to 70% (baseline value is different for each country) would lead to 82,235 fewer CV events (24,058 in Italy, 7,870 in Germany, 18,870 in Spain, 24,855 in France and 6,553 in England). From the NHS perspective, the direct cost associated with hypertension was estimated to be € 51.1 billion (8.1 in Italy, 17.8 in Germany, 12.2 in Spain, 8.8 in France and 4.1 in England). Increasing adherence to anti-hypertensive therapy to 70% would save a total of € 323.7 million (CI 95%: € 304.2 - € 342.2 million) from the NHSs perspective.Conclusion: This study is the first attempt to estimate the economic impact of nonadherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England).

Background: The aim of the study was to determine the costs of treating schizophrenia from the perspective of the statutory health insurance, as well as the identification of predictors of hospitalisation of formerly stable schizophrenia patients. Methods: Claims data for the years 2004-2006 were analysed. Patients who did not have to be treated in a hospital as a result of an ICD diagnosis F20 both in the year 2005 as well as also in 2006 were defined as stable patients. In contrast, those patients who had to be treated in a hospital in 2006 because of a diagnosis of schizophrenia were defined as unstable. In addition to the overall healthcare costs, the costs specific to schizophrenia were also analysed. Also, based on binary logistic regression analysis, predictors for hospital treatment were determined. Results: 8497 stable and 1449 unstable patients were identified. The schizophrenia specific costs for stable patients were € 1605 and the overall costs were € 4029 in 2006, respectively. Unstable patients had indication-specific costs amounting to € 12864 and overall health care costs of € 16824. For unstable patients, the costs of hospital treatment were identified as being a substantial cost area. Predictors for a higher probability of hospital treatment were: female patients, at least one rehabilitation measure, at least one stay in hospital in 2004, and being co-morbid with substance abuse. In contrast, older patients, who were treated with concomitant medications, and if they received a continuous drug therapy in all quarters of a year had a lower probability of hospitalisation. In addition, an increased number of visits to a doctor reduced the probability of hospitalisation. The variable 'depot medication' were close to significance and the variable 'inability to work lasting more than six weeks' had, in contrast, no significant influence. Conclusions: The schizophrenia specific and overall health care costs of unstable patients were clearly higher than was the case with stable patients and mainly determined by inpatient hospital treatment. A range of potential predicting factors which can be extracted from routine claims data have a positive or negative influence on the probability of treatment in hospital. Keywords: Schizophrenia, Claims data, Hospitalisation, Costs, Predictors, Germany

Background: To obtain detailed real-life data on costs and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in patients treated in Switzerland. Methods: Administrative claims processed by a major Swiss health insurer between 2005 and 2008 were analysed. Patients with inflammatory rheumatic diseases (IRDs) with at least one prescription for adalimumab, etanercept, or infliximab were identified. All-cause and disease-specific costs, as well as daily costs of treatment, were calculated. Dosing patterns and discontinuation rates were analysed. Results: A total of 555 IRD patients were identified. All-cause costs during the 12 months after the index event were 20,555CHF in the etanercept group, 24,152CHF in the adalimumab group, and 27,614CHF in the infliximab group. The most important cost driver was mean TNF inhibitor drug cost, which was 15,613CHF in the etanercept group, 19,166CHF in the adalimumab group, and 21,313CHF in the infliximab group. Discontinuation rates during the first year after the index event were 46.8% in etanercept, 41.3% in adalimumab, and 51.2% in the infliximab group. Rates of dosage increase were 13.3% in the etanercept group, 13.0% in the adalimumab group, and 14.1% in the infliximab group. When time on treatment was considered, daily costs of treatment were similar for etanercept and adalimumab, but were higher for infliximab. Conclusions: Marked differences in costs between subcutaneous and intravenous therapies were observed. Among the three groups of patients defined by TNF inhibitor treatment, costs for the infliximab group were highest during the year after the index event. Helsana Versicherungen AG

Da hier die Pravalenz nicht zu einem bestimmten Zeitpunkt, sondern innerhalb eines Zeitraums zu ermitteln ist, muss die Periodenpravalenz errechnet werden. Die Formel lautet

To examine costs of inpatient and outpatient rehabilitation for cardiac disorders from the perspective of a major statutory health insurance fund in Germany.: A nationwide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analyzed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of in- and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented.: Mean costs were 2,006 Euros for inpatient rehabilitation and 1,502 Euros for outpatient rehabilitation. No systematic differences were identified between in- and outpatient rehabilitation in costs for drugs and physical therapy in the year preceding and the year directly following the rehabilitation. The costs for hospital treatment in the year before rehabilitation were higher in inpatient rehabilitation, whereas in the year after rehabilitation no differences between in- and outpatient rehabilitation were seen.: Assuming comparable medical outcome, outpatient rehabilitation seems to pose a superior alternative compared to inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health-care resources.

OBJECTIVES To examine the costs of inpatient and outpatient rehabilitation for musculoskeletal disorders from the perspective of a major statutory health insurance fund in Germany. METHODS A nation-wide database from a major health insurance fund in Germany was used to evaluate all rehabilitation cases in 2005. In addition, to all direct cost domains of the rehabilitation itself, costs incurred in the preceding and the following year for hospital treatment, drugs and physical therapy were analysed. A cost-cost analysis in different institutional settings was chosen for the cost comparison of inpatient and outpatient rehabilitation. To minimize the influence of possible confounders, a statistical control system was implemented. RESULTS After a preceding hospital stay, inpatient and outpatient rehabilitation results in mean costs of euro2047 and euro1111, respectively. If the rehabilitation was not preceded by a directly related hospital treatment, mean costs for inpatient (outpatient) rehabilitation were euro2067 (euro1310). No systematic differences could be found between inpatient and outpatient rehabilitation evaluating costs for hospital treatment, drugs or physical therapy in the year preceding and the year directly following the rehabilitation. CONCLUSIONS Assuming comparable medical outcomes, outpatient rehabilitation seems to be a superior alternative compared with inpatient rehabilitation from an economic perspective. Hence, from the perspective of the statutory health insurance, fostering a higher market share of outpatient rehabilitation may add to a better allocation of overall health care resources. For this, regional differences in rehabilitation infrastructure have to be taken into account.

Einleitung Das Center for Health Economics Research Hannover (CHERH) ist eines von vier geförderten Zentren der gesundheitsökonomischen Forschung in Deutschland. Die Forschungsschwerpunkte der Kooperation aus Leibniz Universität Hannover und der Medizinischen Hochschule Hannover liegen auf der Analyse von Routinedaten der Gesetzlichen Krankenversicherung, gesundheitsökonomischen Evaluationen, Verteilungsgerechtigkeit sowie der Messung von Patient Reported Outcomes. Das übergreifende Ziel des CHERH ist die gesundheitsökonomische Analyse und Optimierung von Versorgungsstrukturen.

Objective: To obtain detailed real-world data on persistence and dosing patterns in the utilisation of the TNF inhibitors adalimumab, etanercept, and infliximab in rheumatoid arthritis (RA) patients treated in Germany. Methods: In this retrospective observational study claims data of a major German health insurance fund between 2005 and 2008 were analysed. Patients receiving at least one prescription of adalimumab, etanercept or infliximab were identified and categorised as "TNF inhibitor naive" or "TNF inhibitor continuing". For the calculation of TNF inhibitor persistence a survival analysis with the Kaplan-Meier estimator was used. A Cox regression was used to analyse, if any relevant factors were influencing persistence. Dosage increase rates were analysed for adalimumab, etanercept and infliximab. Sensitivity analyses based on variations in gap length were conducted. Results: A total of 2,201 RA patients were identified. 1,468 of these patients were TNF inhibitor naive patients and 733 were defined as TNF inhibitor continuing patients. There were no significant differences in the treatment persistence rates between adalimumab, etanercept and infliximab for TNF inhibitor naive and continuing patients. The persistence rate after three years was 22.47% for adalimumab, 24.27% for etanercept and 21.49% for infliximab naive patients. For continuing patients, the persistence rate after three years was 32.88% for adalimumab, 30.95% for etanercept, and 33.90% for infliximab, respectively. Gender, medication and Charlson Comorbidities Index did not influence the persistence significantly. Dosage increase occurred in 7.3% adalimumab, 1.4% etanercept, and 17.2% infliximab naive patients and 5.8%, 1.1% and 11.9% respectively in the continuing patients. Conclusions: In this study, there were no significant differences in persistence among adalimumab, etanercept and infliximab treated patients. Consistent with previous research, there was a higher dose escalation for infliximab than for the two subcutaneous treatments, adalimumab or etanercept.