With the passing of the "Digital Care Act" by the German Bundestag at the end of 2019, it was made possible, among other things, for digital health applications to be reimbursed by statutory health ...insurance companies under certain conditions. The aim of this work is to identify digital health applications related to ear, nose, and throat medicine and to describe the underlying evidence.
The digital health applications register was analyzed to identify digital health applications with an indication area relating to an otorhinolaryngologic disease. Digital health applications were included that were either permanently or provisionally included, or currently deleted if further information was available. The underlying evidence was assessed according to the recommendations of the Oxford Center for Evidence-Based Medicine for therapeutic studies.
A total of six digital health applications with a direct or indirect connection to otorhinolaryngology were identified, three of which were permanently and two provisionally included in the directory. One digital health application has currently been withdrawn by the manufacturer. The permanently recorded digital health applications are based on evidence level 1b.
The introduction of digital health applications is sometimes also discussed critically, but they represent an innovative approach and various digital health applications with a high level of underlying evidence are already available, especially for the ear, nose, and throat area.
Background
A direct comparison of the cost–benefit analysis of retroperitoneoscopic adrenalectomy (RPA) versus the minimally invasive transperitoneal access (LTA) approach is currently lacking. We ...hypothesized that RPA is more cost effective than LTA; promising significant savings for the healthcare system in an era of ever more limited resources.
Methods
We performed a monocentric retrospective observational cohort study based on data from our Endocrine Surgery Registry. Patients who were operated upon between 2019 and 2022 were included. After pair-matching, both cohorts (RPA vs. LTA) were compared for perioperative variables and treatment costs (process cost calculation), revenue and profit.
Results
Two homogenous cohorts of 43 patients each (RPA vs. LTA) were identified following matching. Patient characteristics between the cohorts were comparable. In terms of both treatment-associated costs and profit, the RPA procedure was superior to LTA (costs: US$5789.99 for RPA vs. US$6617.75 for LTA,
P
= 0.043; profit: US$1235.59 for RPA vs. US$653.33 for LTA,
P
= 0.027). The duration of inpatient treatment and comorbidities significantly influenced the cost of treatment and the overall profit.
Conclusions
RPA appears not only to offer benefits over LTA in terms of perioperative morbidity and length of hospital stay, but also has a superior financial cost/benefit profile.
Graphical abstract
Stroke imposes a considerable economic burden on the individual and society. Recently, the concept of an integrated stroke unit has been established in several countries to improve the outcome of ...patients. This study evaluates the costs of acute care of the different cerebrovascular insults in a stroke unit.
The study population included 340 patients who were consecutively admitted to the Department of Neurology, Philipps University Marburg, with the diagnosis of stroke or transient ischemic attack (TIA) between January 1 and June 30, 2000. Clinical status and course were evaluated by using the Barthel index and the modified Rankin scale. Employing a “bottom-up” approach, we calculated the costs from the perspective of the hospital and the third-party payer using data from provider departments and other published sources.
Inpatient costs were €3020 (US$3290) for TIA, €3480 (US$3790) for ischemic stroke (IS), and €5080 (US-$5540) for intracerebral hemorrhage (ICH) and differed significantly among these subgroups (
P < .05). Patient subgroups ranked in the same order for average length of stay at 9.4 days for TIA, 10.2 days for IS, and 11.9 days for ICH (
P > .05). Approximately 30% of the hospital costs are due to physician charges and care. Imaging amounted to 10% and lab investigations to 14% of total costs, independent of the diagnosis. Postacute treatment, including inpatient rehabilitation, cost €9880 per patient. Across all diagnostic groups, a mean clinical improvement was observed at time of discharge.
Care of patients with cerebrovascular events in a stroke unit causes a high demand of resources and has a considerable impact on health-care expenditure. Therefore, investigations comparing the stroke unit concept with other strategies in stroke care are necessary to evaluate the stroke unit concept for a rational use of available resources in patients with cerebrovascular events.
Zusammenfassung
Hintergrund
Potenziell inadäquate Medikation (PIM) birgt für ältere Menschen das Risiko erhöhter Arzneimittelnebenwirkungen. Daten zur Prävalenz sind bekannt, jedoch gibt es bisher ...keine beschreibende Analyse der Verordnungen, die einen Ansatzpunkt zur Reduktion von PIM liefert.
Ziel der Arbeit
Ziel der Untersuchung ist es, die Verordnungen von PIM im ambulanten Sektor zu analysieren und Risikogruppen zu identifizieren, in denen eine verstärkte Sensibilisierung für das Thema notwendig ist.
Material und Methoden
Untersuchungsgrundlage ist ein Datensatz der AOK Bayern, der anonymisierte Verordnungsdaten eines Praxisnetzes an Patienten ab 65 Jahren von 2010 bis 2014 beinhaltet. Zur Identifikation der PIM wird die Priscus-Liste verwendet.
Ergebnisse
Für den Untersuchungszeitraum liegen 410.934 Verordnungen vor. Die Prävalenz von PIM-Verordnungen lag bei 5,60 %. Hausärzte verordneten 5,39 % PIM; Fachärzte für Neurologie/Psychiatrie/Psychotherapie (NPP) verordneten 16,36 % PIM. Arztgruppenübergreifend wurden am häufigsten PIM aus den Arzneimittelgruppen der Psycholeptika, Psychoanaleptika oder Antihypertonika verordnet. Bei Männern und Frauen entfielen in dem Zeitraum 4,50 % bzw. 6,31 % der Verordnungen auf PIM. Hinsichtlich der Altersgruppen erhielten hochbetagte Frauen am häufigsten PIM.
Diskussion
Bei Fachärzten für NPP ist zwar eine hohe Verordnungsprävalenz von PIM festzustellen, jedoch verordnen Hausärzte, absolut gesehen, insgesamt deutlich mehr PIM. Davon sind v. a. Frauen, v. a. zwischen 80 und 84 Jahren, betroffen. Zukünftig sollten Hausärzte stärker sensibilisiert werden, was ihre Verordnungen an ältere Frauen im Bereich Psychopharmaka und Antihypertonika betrifft.
Purpose
The calculation of aggregated composite measures is a widely used strategy to reduce the amount of data on hospital report cards. Therefore, this study aims to elicit and compare preferences ...of both patients as well as referring physicians regarding publicly available hospital quality information
Methods
Based on systematic literature reviews as well as qualitative analysis, two discrete choice experiments (DCEs) were applied to elicit patients’ and referring physicians’ preferences. The DCEs were conducted using a fractional factorial design. Statistical data analysis was performed using multinomial logit models
Results
Apart from five identical attributes, one specific attribute was identified for each study group, respectively. Overall, 322 patients (mean age 68.99) and 187 referring physicians (mean age 53.60) were included. Our models displayed significant coefficients for all attributes (
p
< 0.001 each). Among patients, “Postoperative complication rate” (20.6%; level range of 1.164) was rated highest, followed by “Mobility at hospital discharge” (19.9%; level range of 1.127), and ‘‘The number of cases treated” (18.5%; level range of 1.045). In contrast, referring physicians valued most the ‘‘One-year revision surgery rate’’ (30.4%; level range of 1.989), followed by “The number of cases treated” (21.0%; level range of 1.372), and “Postoperative complication rate” (17.2%; level range of 1.123)
Conclusion
We determined considerable differences between both study groups when calculating the relative value of publicly available hospital quality information. This may have an impact when calculating aggregated composite measures based on consumer-based weighting.
Purpose
This study aims to determine the intention to use hospital report cards (HRCs) for hospital referral purposes in the presence or absence of patient-reported outcomes (PROs) as well as to ...explore the relevance of publicly available hospital performance information from the perspective of referring physicians.
Methods
We identified the most relevant information for hospital referral purposes based on a literature review and qualitative research. Primary survey data were collected (May–June 2021) on a sample of 591 referring orthopedists in Germany and analyzed using structural equation modeling. Participating orthopedists were recruited using a sequential mixed-mode strategy and randomly allocated to work with HRCs in the presence (intervention) or absence (control) of PROs.
Results
Overall, 420 orthopedists (mean age 53.48, SD 8.04) were included in the analysis. The presence of PROs on HRCs was not associated with an increased intention to use HRCs (
p
= 0.316). Performance expectancy was shown to be the most important determinant for using HRCs (path coefficient: 0.387,
p
< .001). However, referring physicians have doubts as to whether HRCs can help them. We identified “complication rate” and “the number of cases treated” as most important for the hospital referral decision making; PROs were rated slightly less important.
Conclusions
This study underpins the purpose of HRCs, namely to support referring physicians in searching for a hospital. Nevertheless, only a minority would support the use of HRCs for the next hospital search in its current form. We showed that presenting relevant information on HRCs did not increase their use intention.
Zusammenfassung
Hintergrund
Das gefäßchirurgische Standardverfahren (SV) für die Versorgung distaler Aortenbogenpathologien ist ein Hybridengriff aus linksseitigem karotidosubklavialem Bypass und ...thorakaler endovaskulärer Aortenreparatur. Vor dem Hintergrund der Einführung einer thorakalen Seitenarmprothese (TBE) war das Ziel dieser Arbeit eine Analyse der Kosten-Erlös-Aspekte beider Verfahren.
Material und Methoden
Es erfolgte eine retrospektive Aufarbeitung von Fällen, die 2017 bis 2022 mittels SV operiert wurden. Um Rückschlüsse auf den Einsatz der TBE vornehmen zu können, wurden für die Erlösberechnungen Hauptdiagnosen und Prozeduren des SV anhand aktueller Klassifikationen (ICD/OPS 2023) rekodiert und nach aG-DRG 2023 neugruppiert. Für die Modellierung der TBE-Erlöse erfolgte eine OPS-Änderung und Neugruppierung.
Ergebnisse
Es konnten 13 Fälle identifiziert werden (mittleres Alter: 62,5 ± 13,8 Jahre; 10 Männer). Nach Neugruppierung lagen folgende DRGs vor: F42Z in
n
= 5, F51A in
n
= 4, F08B in
n
= 2 sowie F07A und F36B in je
n
= 1. Der Gesamterlös nach Neugruppierung betrug 666.514,13 €, inklusive Zusatzentgelt (ZE) von 132.729,14 €. Bei modellierter TBE-Anwendung wurde ein Gesamterlös von 659.212,19 € erzielt. Im Vergleich zum SV entspricht dies einem Erlösrückgang um 16.886,71 € (geänderte DRG), bei jedoch um 65.559,78 € steigenden ZE-Erlösen (unterschiedliche ZE). Bei TBE-Anwendung können 74 Belegungstage, davon 13,5 Intensivstationsbelegungstage, eingespart werden.
Schlussfolgerung
Eine Kostenüberdeckung erscheint bei Verfahrenswechsel wahrscheinlich – trotz noch nicht geklärter Bepreisung der TBE. Dies ist, bei sich jährlich ändernden DRG-Relativgewichten, in hohem Maße abhängig von der Kodierqualität und der zukünftigen Entwicklung der ZE. Für deren Festsetzung wird eine präzise und transparente Leistungs- und Kostenerfassung benötigt.
Potentially inappropriate medication (PIM) carries the risk of increased drug side effects for older people. The prevalence data are known but no descriptive analyses of prescription behavior as a ...starting point for reducing PIM have yet been conducted.
The aim of the study was to analyze PIM prescription in the outpatient sector and to identify risk groups where increased awareness of the issue is needed.
The basis for the investigation was the data set of the AOK Bavaria health insurance, which contains anonymized prescription data of a practice network for patients aged 65 years and older from 2010 to 2014. The Priscus list was used to identify the PIM.
There were 410,934 prescriptions during the investigation period. The prevalence of PIM was 5.60%. Family doctors prescribed 5.39% PIM and specialists for neurology, psychiatry and psychotherapy (NPP) prescribed 16.36% PIM. Regardless of the medical discipline, PIM from the drug groups psycholeptics, psychoanaleptics and antihypertensive drugs were most frequently prescribed. For men and women PIM accounted for 4.50% and 6.31%, respectively, of the prescriptions during the period. In terms of age groups older women received PIM most frequently.
In the case of specialists for NPP a high prevalence of prescriptions for PIM could be established; however, in absolute terms family doctors prescribed significantly more PIM overall. This mainly affected women and especially those between 80 and 84 years old. In the future family doctors should be made more aware with respect to the prescription of psychopharmaceuticals and antihypertensive drugs to older women.
Background and objectives
Motor Neuron Diseases (MND) are rare diseases but have a high impact on affected individuals and society. This study aims to perform an economic evaluation of MND in ...Germany.
Methods
Primary patient-reported data were collected including individual impairment, the use of medical and non-medical resources, and self-rated Health-Related Quality of Life (HRQoL). Annual socio-economic costs per year as well as Quality-Adjusted Life Years (QALYs) were calculated.
Results
404 patients with a diagnosis of Amyotrophic Lateral Sclerosis (ALS), Spinal Muscular Atrophy (SMA) or Hereditary Spastic Paraplegia (HSP) were enrolled. Total annual costs per patient were estimated at 83,060€ in ALS, 206,856€ in SMA and 27,074€ in HSP. The main cost drivers were informal care (all MND) and disease-modifying treatments (SMA). Self-reported HRQoL was best in patients with HSP (mean EuroQoL Five Dimension Five Level (EQ-5D-5L) index value 0.67) and lowest in SMA patients (mean EQ-5D-5L index value 0.39). QALYs for patients with ALS were estimated to be 1.89 QALYs, 23.08 for patients with HSP and 14.97 for patients with SMA, respectively. Cost-utilities were estimated as follows: 138,960€/QALY for ALS, 525,033€/QALY for SMA, and 49,573€/QALY for HSP. The main predictors of the high cost of illness and low HRQoL were disease progression and loss of individual autonomy.
Conclusion
As loss of individual autonomy was the main cost predictor, therapeutic and supportive measures to maintain this autonomy may contribute to reducing high personal burden and also long-term costs, e.g., care dependency and absenteeism from work.
The standard vascular surgical procedure (SV) for the treatment of distal aortic arch pathologies involves a hybrid approach using a left carotid-subclavian bypass and thoracic endovascular aortic ...repair. Considering the introduction of a thoracic side branch prosthesis (TBE), the aim of this study was to analyze the cost-revenue aspects of both procedures.
A retrospective analysis was conducted on cases treated by SV from 2017 to 2022. To draw conclusions regarding the use of TBE, the main diagnoses and procedures of SV were recoded based on current classifications (ICD/OPS 2023) for revenue calculations and regrouped according to aG-DRG 2023. An OPS modification and regrouping were performed for modeling TBE revenues.
A total of 13 cases were identified (mean age 62.5 ± 13.8 years; 10 males). After regrouping, the following DRGs were obtained: F42Z in N = 5, F51A in N = 4, F08B in N = 2, and F07A and F36B each in N = 1. The total revenue after regrouping was € 666,514.13, including an additional payment (ZE) of € 132,729.14. With the modeled application of TBE, a total revenue of € 659,212.19 was achieved. Compared to SV, this represents a revenue decrease of € 16,886.71 (changed DRG), but with an increase in ZE revenue by € 65,559.78 (different ZE). The use of TBE resulted in a saving of 74 occupancy days, including 13.5 days in intensive care.
A cost coverage seems probable with a change in the procedure, despite the yet to be determined pricing of TBE. This is highly dependent on the coding quality and the future development of ZE, given the annually changing DRG relative weights. Precise and transparent performance and cost documentation are essential for determining the pricing.
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