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Biomedical subjects

J Wasem

Publications and source records attributed to J Wasem.

15 recordsLinked to original sources
PubMed2006

[Health economics of chronic infectious diseases: the example of hepatitis C].

Based on the German Hepatitis C Model (GEHMO) we developed a Hepatitis C Policy Model and applied it to the heterogeneous German hepatitis C population within the German health care context. We used Markov cohort simulation to predict absolute clinical and economic outcomes for a 20-year time horizon. For the cost-effectiveness analysis, a lifelong time horizon was used. Four different strategies were compared: (1) no antiviral treatment, (2) interferon monotherapy, (3) combination therapy with interferon plus ribavirin, and (4) combination therapy with pegylated interferon plus ribavirin. Based on our model, antiviral therapy with pegylated interferon and ribavirin could prevent about 17,000 cases of cirrhosis, 580 liver transplants, and 7,600 HCV-related deaths and is expected to save about 53,000 life years at total costs of 1.3 billion Euros within the next 20 years. Pegylated interferon plus ribavirin was the most effective treatment with an incremental cost-utility ratio of 23,000 Euros per quality-adjusted life year saved.

Chronic Disease↗
PubMed2005

[Empirical standard costs for health economic evaluation in Germany -- a proposal by the working group methods in health economic evaluation].

Measurement of health care costs is a crucial task in health economic evaluation. Various guidelines with different amount of details have been set up for costing methods in economic evaluation which, however, do not precisely stipulate how to value resource consumption. In this article we present a proposal for the standardisation of the monetary valuation of health care utilisation occurring in the follow up period after the actual intervention to be evaluated. From a societal perspective the primary direct and indirect cost components are considered, such as outpatient medical care, pharmaceuticals, non-physician health services, inpatient care, days of sick leave and early retirement due to sickness. The standard costs are based on administrative charges and rates or on official statistics. They are based on the most current data sources which are mainly from 2002 and 2003. This system of standard costs aims at an average valuation of resource consumption. This makes for the comparability of different health economic studies. Most standard costs are not based on market prices but on administratively specified charges and rates. This implies that institutional changes which are quite common in the health care system, may also affect the valuation rates, for example the introduction of DRGs. This should be taken into account when updating the system of standard costs.

Ambulatory Care↗
PubMed2005

[Health economic evaluation of rehabilitation programmes in the "rehabilitation sciences" research funding programme in Germany].

A main problem of the German rehabilitation sector is to meet the increasing demand for rehabilitation treatment while available resources are scarce. Thus, health economic evaluation is gaining more importance for decision making in the rehab system. In the "Rehabilitation Sciences" research funding programme the relevance of health economic analyses was recognised from the outset. In nearly all regional networks health economic analyses were conducted - though with different scope. In the first funding period the main focus of health economic evaluation was on (1) patient education programmes and (2) the comparison of inpatient versus outpatient rehabilitation. The projects of the research funding programme have initialised health economic evaluation of rehabilitation in Germany. It was shown that health economics can contribute relevant results for designing rehabilitation concepts. The article concludes with an outlook on the main future questions of rehab economic evaluation.

Biomedical Research↗
PubMed2004

[The National Institute for Clinical Excellence (NICE)].

In discussions on the development of the institutional framework for decisions on the benefit package of social health insurance in Germany, the English National Institute for Clinical Excellence (NICE) is considered as either a good or a bad example for reform. According to this study, the procedures and criteria applied by NICE for making health care coverage decisions are legitimate. Procedures are transparent and interest groups are broadly represented. Decision criteria include cost effectiveness of services - albeit only if information on cost effectiveness is available and highly evident. Furthermore, cost effectiveness is not the only criteria for coverage decisions. NICE very rarely induces strong direct rationing, but rather leaves room for discretion. However, the trade-off between maximising allocative efficiency and avoiding distributional consequences becomes apparent.

Cost-Benefit Analysis↗
PubMed2004

[Smoking-attributable productivity loss in Germany--a partial sickness cost study based on the human capital potential method].

PURPOSE: Costs of productivity loss for the Federal Republic of Germany attributable to smoking in 1999 was to be determined. METHODS: Mortality and morbidity attributable to smoking is determined by a 0.5 % sample of the smoking behaviour of the German population (microcensus 1999) and the relative mortality risks of smokers (US-American cancer prevention study II). Tobacco smoke-associated cancer illnesses, cardiovascular diseases, respiratory tract diseases and illnesses of children under one year are considered. Calculation of the productivity-relevant consequences of smoking due to morbidity and mortality is effected according to the so-called human potential capital method. RESULTS: In Germany total of 607,393 working years were lost because of smoking in the year 1999. The costs of productivity loss are estimated at 14,480 billion euro. From this 4,525 billion euro are allotted to premature mortality, 5.759 billion euro to permanent disablement and 4.196 billion euro to temporary incapacitation for work. If the costs of productivity loss by smoking are referred to the gross national product (BSP) in the year 1999, an economical damage at a value of 0.74 % of BSPs results. This corresponds to a productivity loss of 379 euro per present or former smoker. The sensitivity analysis manifests that the inclusion of "non-marketable production" results in an immense rise productivity losses attributable to smoking. However, it should be noted that in times of mass unemployment the human capital method which is based on full employment does not measure the actual, but only the potential productivity loss cost. CONCLUSIONS: This partial disease cost study shows that immense economic productivity losses are associated with smoking. This loss of resources can justify a purposeful promotion of studies regarding cost effectiveness of anti-smoking therapeutic measures or preventive measures against smoking. But it should be considered that the use of the human potential capital method results in an overestimation of the actual productivity losses by smoking. In future the costs of productivity losses attributable to smoking should be determined by the friction cost method. With this procedure a more realistic estimation of productivity-relevant costs of smoking is possible.

Adult↗
PubMed2003

Cost effectiveness of peginterferon alpha-2b plus ribavirin versus interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C.

BACKGROUND: Peginterferon alpha-2b plus ribavirin therapy in previously untreated patients with chronic hepatitis C yields the highest sustained virological response rates of any treatment strategy but is expensive. AIMS: To estimate the cost effectiveness of treatment with peginterferon alpha-2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of patients with chronic hepatitis C. METHODS: Individual patient level data from a randomised clinical trial with peginterferon plus ribavirin were applied to a previously published and validated Markov model to project lifelong clinical outcomes. Quality of life and economic estimates were based on German patient data. We used a societal perspective and applied a 3% annual discount rate. RESULTS: Compared with no antiviral therapy, peginterferon plus fixed or weight based dosing of ribavirin increased life expectancy by 4.2 and 4.7 years, respectively. Compared with standard interferon alpha-2b plus ribavirin, peginterferon plus fixed or weight based dosing of ribavirin increased life expectancy by 0.5 and by 1.0 years with incremental cost effectiveness ratios of 11,800 euros and 6600 euros per quality adjusted life year (QALY), respectively. Subgroup analyses by genotype, viral load, sex, and histology showed that peginterferon plus weight based ribavirin remained cost effective compared with other well accepted medical treatments. CONCLUSIONS: Peginterferon alpha-2b plus ribavirin should reduce the incidence of liver complications, prolong life, improve quality of life, and be cost effective for the initial treatment of chronic hepatitis C.

Adult↗
PubMed2002

[Impact of hospital diagnostic related groups on geriatric rehabilitation facilities].

The introduction of the DRGs (diagnosis related groups) for paying hospitals in Germany in 2003 will result in changes in quality, quantity and financial flows foremost for the hospital sector but also for the important sector of the geriatric rehabilitation. This geriatric sector will experience a growth in total patient numbers, an enhanced and altered service range and a change in the market relationship towards the hospitals. The introduction of case-related payments also for the geriatric rehabilitation could, on the one hand, reduce the negative spillover effects from the hospital sector and, on the other hand, guaranty an efficient service provision. Furthermore, there would be a good comparability among the geriatric rehabilitation facilities and between costs in institutions of geriatric rehabilitation and hospitals. If hospital and geriatric rehabilitation services were payed by case-related payments, efficiency of health care services could be further improved by a broad definition of cases (complex case-based reimbursement), including care in the hospital as well as the care in the rehabilitation clinic afterwards. If rehabilitation would be financed by case-based reimbursement as well as by of a complex case-based reimbursement, a quality assurance program would be necessary.

Aged↗
PubMed2002

[Promoting competition and improving quality. Accepting the intergenerational contract by stabilizing health care reform].

The challenge of demographic transition requires a health care reform which strengthens competition and quality in health care. With this, important contributions in stabilizing intergenerational relations, especially intergenerational solidarity in the public health care system, can be achieved. The reform proposal by an expert group, invited by the Friedrich-Ebert-Foundation to develop a concept of health care reform, takes these considerations into account.

Aged↗
PubMed2001

[Methods of comparative economic evaluations of therapies and for rational allocation of resources across sectors of health care systems - introduction, advantages, risks].

Because of scarcity of resources, diagnostic and therapeutic procedures in medicine increasingly have to be examined not only with regard to effectiveness but also with regard to cost-effectiveness, which means with regard to the relation between resources used and resulting outcome (however this outcome is measured). Primarily, this is true for treatment methods for one and the same medical condition. However, economists also consider to evaluate medical interventions across heterogeneous medical conditions, in order to rank them with regard to their cost-effectiveness. Using quality-adjusted life-years (QALYs) as outcome variable, all medical interventions examined can be ranked in QALY-League-Tables, which could serve as a basis for resource allocation decisions by health policy makers or other payers. However, there are methodological as well as ethical objections with such an approach.

Cost-Benefit Analysis↗
PubMed2000

[Methods for the costing process in the field of economic evaluation of a rehabilitation program for patients with chronic obstructive lung diseases].

Studies in health economics especially economic evaluations of health care technologies and programmes are getting more and more important. However, in Germany there are no established, validated and commonly used instruments for the costing process. For the economic evaluation of a rehabilitation programme for patients with chronic lung diseases such as asthma and chronic bronchitis we developed methods for identification, measurement and validation of resource use during the inpatient rehabilitation programme and during the outpatient follow-up period. These methods are based on methodological considerations as well as on practical experience from conducting a pilot study. With regard to the inpatient setting all relevant diagnostic and therapeutic resource uses could be measured basing on routine clinical documentation and validated by using the cost accounting of the clinic. For measuring the use of resources during the follow-up period in an outpatient setting no reliable administrative data are accessible. Hence, we compared a standardised retrospective patient questionnaire used in a 20-minute interview (n = 50) and a cost diary for the continuing documentation by the patient over a period of 4 weeks (n = 50). Both tools were useful for measuring all relevant resource uses in sufficient detail, but because of higher participation rates and lower dropouts the structured interview appears to be more suitable. Average total costs per month were 1591 DM (interview), respectively 1867 DM (cost diary). Besides productivity loss, costs for medication and GP visits caused the relatively highest resource uses. Practicable instruments were developed for the costing process as part of an economic evaluation in a German rehabilitation setting for pulmonary diseases. After individual modification, these could also be used for different indications and in other institutional settings.

Adolescent↗
PubMed1999

[Parameter of evidence-based medicine in health care economics].

In the view of scarcity of resources, economic evaluations in health care, in which not only effects but also costs related to a medical intervention are examined and a incremental cost-outcome-ratio is build, are an important supplement to the program of evidence based medicine. Outcomes of a medical intervention can be measured by clinical effectiveness, quality-adjusted life years, and monetary evaluation of benefits. As far as costs are concerned, direct medical costs, direct non-medical costs and indirect costs have to be considered in an economic evaluation. Data can be used from primary studies or secondary analysis; metaanalysis for synthesizing of data may be adequate. For calculation of incremental cost-benefit-ratios, models of decision analysis (decision tree models, Markov-models) often are necessary. Methodological and ethical limits for application of the results of economic evaluation in resource allocation decision in health care have to be regarded: Economic evaluations and the calculation of cost-outcome-rations should only support decision making but cannot replace it.

Costs and Cost Analysis↗
PubMed1997

A study on decentralizing from acute care to home care settings in Germany.

Although it is generally accepted in Germany that decentralizing towards home care settings can improve the efficiency and effectiveness of health care, a coherent policy toward decentralization has not been developed yet. A variety of elements of the traditional German health care system have limited the opportunities for decentralizing. Separation between health care and social services, separation between acute care and medical rehabilitation and separation between ambulatory care and hospital care were rather strict, prohibiting development of a comprehensive infrastructure of professional support for home care as well as the hospital financing scheme. Recent reform measures in Germany in the field of health care policy and social policy partly have tackled these problems. The introduction of long-term care insurance might provide the chance for a better infrastructure and more comprehensive usage of professional support for home care, although it is not without risks, and integration of long-term care insurance in the health policy sector lacks coherence. While reforms of the hospital financing scheme and an entitlement of hospitals to provide one-day-surgery and post-discharge treatment will decrease the likelihood that hospitals keep patients in order to fill their beds, the extent to which hospitals will make use of these new instruments remains doubtful at present. Increased competition between sickness funds could open opportunities for prudent 'managed care' as part of 'managed competition', and strengthening of home care might be part of managed care programs. At present it is not clear, however, whether sickness funds will be entitled to compete through usage of managed care mechanisms. Other elements of recent health care reforms were counterproductive as far as decentralizing towards home care is concerned. Especially global budgets on honorariums for office-based doctors and on volumes of prescribed drugs might create incentives for inefficient and ineffective referrals to hospitals.

Cost Control↗
PubMed1995

[Realization and financing of different models of home care].

In the long term perspectives for home care are characterized by four challenges: First, home care services can be rationalized only below average. If professionals in the home care services shall take part nevertheless in the general development of wages in the economy, it is necessary that a rising part of domestic income will be spent for these services. Second, in the families tensions between the desire for self-realization of the middle generations and expectations of home care patients that the next generation shall take over caring responsibilities, will increase, which will lead to a rising demand for professional home care services. Third, the rising proportion of single households will also lead to a rising demand for professional services, because people living alone need more services than people living within families. Fourth, the future demographic development will not only lead to a rising number of people in need of home care but also to declining number of younger people. This will cause not only problems for financing of welfare state programs for people in need of home care but will also lead to a scarcity of nursing professionals. Against this background the new "Social Long Term Care Insurance," which will come into effect in Germany by 1995 has to be examined for its economic justifiability, for its distributional justice and for the effectiveness of its benefits. The new insurance program can strengthen home care; however in terms of economic justifiability and distributional justice it is not without risks.

Aged↗
PubMed1984

Caring for the infirm: a task for the individual or for a social insurance programme?

In West Germany, seventy per cent of all nursing home patients receive only a pocket-money, for social health insurances are responsible only for the care of "sick" people, but not of those needing only "care". The infirm individual, however, rarely can pay for the costs of nursing homes out of his own revenue. Despite general agreement that guarding against the financial risks of becoming dependent on nursing is insufficient there is little consensus on what a new concept should look like. Some proposals are more concerned with avoiding cost-expansion than with effective health care. On the one hand, the implementation of a new branch in the social insurance system, called "nursing insurance", is demanded, which would pay for the stay in nursing homes. On the other hand, it is emphasized that the capacity for voluntary individual provision should be strengthened as well as the families' means to care for their bedridden members. This paper presents the discussion and outlines implications for health care of the various proposals.

Aged↗