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Biomedical subjects

W Greiner

Publications and source records attributed to W Greiner.

At least 19 recordsLinked to original sources
PubMed2000

[Using the excimer laser in refractive eye surgery. Results of a survey of German ophthalmologists].

BACKGROUND: Little information about the cost-effectiveness of excimer laser operations is available. As the number and structure of providers of these services in Germany are relatively unknown, only rough estimations can be made about the number of operations. PURPOSE: In this study the market for excimer laser operations is defined, structured from an economic view and examined according to medium-term demand and supply trends. The aim of the study is an applicable estimation of the current level of dissemination and of existing economic conditions for providers of excimer laser operations. METHODS: In a postal survey 219 ophthalmologists in Germany were asked to provide the number of excimer laser operations they had carried out and the organizational and financial details of these services. The questionnaire was answered anonymously. RESULTS: One can conclude that the annual number of interventions is increasing, although less significantly than in the United States. In most cases, providers of German health insurance have rejected inclusion of this service in their reimbursement catalogue. CONCLUSIONS: As of yet, excimer-laser-related turnover has frequently not met expectations. However, because of modifications of technological, health-economic and demand conditions an increase in the number of operations within this area is expected in the future.

Cost Control↗
PubMed2000

[Organ shortage in transplant centers--approaches to a solution from the economic viewpoint].

In the article the regulations of the German transplantation law, which came into force on 1 December 1997, are considered from an economic perspective. First, the essential regulations of the law are described and then analyzed with respect to economic aspects. The law regulates in particular the administration of the demand surplus for organs. This could be reduced by rationing the demand or by increasing the supply. Apart from the medical features economic attributes such as cost effectiveness are also applicable as criteria for rationing. In addition, the method of the quality-adjusted life-years (QALYs) is introduced and described on the basis of the results of a study about costs and benefits of liver transplantation. To increase the organ supply the authorities in Germany have so far established information campaigns and made appeals to the public. In contrast, an organ donation club the allocation of donors is made considering if and when the recipient declared his readiness to organ donation. In this way the willingness to donate his own organs could be sanctioned positively and an additional incentive for supply could be set.

Cost-Benefit Analysis↗
PubMed1999

[Quality of life of adult asthma patients].

BACKGROUND: Concepts of quality of life are gaining in increasing significance as measures of outcome, both in medicine as well as in economics. One of the relevant questionnaires is the FLA ("Fragebogen zur Lebensqualität bei Asthma"), a disease-specific instrument for measuring the quality of life of asthma patients. This questionnaire was supplemented with a generic instrument, the EuroQol. METHOD: Adult asthma patients treated in 23 pneumological ambulatory care units were randomly selected and asked to fill out both the FLA and the EuroQol questionnaires. Separate analyses of the results were carried out for each patient severity level, and covered the average values of the subscales, the correlation as well as the internal reliability of the questionnaires. RESULTS: The quality of life of asthma patients correlates strongly to the respective severity level of the illness. The patients of level 3 (serious asthma) in particular achieve values far below average when compared to the total population (42 out of 100 according to EuroQol). By contrast, the subjective quality of life of asthmatics in level 1 is only slightly reduced. The correlation of the FLA subscales as well as of the EuroQol values is high (0.74-0.97). CONCLUSIONS: The study points out that as progression of the illness is associated with high losses of quality of life for the patient. From a health-economic point of view this is important for the calculation of so-called intangible costs, which are often not quantified in studies on the cost of disease.

Adult↗
PubMed1998

[Compliance and asthma--a delphi survey on therapy compliance by by asthma patients in ambulatory care].

Compliance of asthma patients to a prescribed course of treatment is of both medical and economic importance, as the progression of the illness can be halted or at least slowed down by a consistent treatment with anti-inflammatory drugs. The use of fixed combination products which contain both an anti-inflammatory active ingredient (e.g. sodium cromoglycate) and a short-acting beta-2-agonist can lead to improve a compliance and thus slow down the progression. This was established with the help of a survey by experts carried out according to the Delphi Method, separating adult asthmatics from children with asthma.

Adult↗
PubMed1997

[Economic aspects in treatment of cystic fibrosis with chronic pulmonary pseudomonas infection. Ambulatory intravenous therapy in comparison with inpatient treatment].

BACKGROUND: Due to limited resources within the health service and the continuous discussion on cost containment, economic criteria should also be considered when assessing therapy concepts. Particular results in terms of economic efficiency reserves are to be expected from a transfer of care from the in-patient to the out-patient sector. METHODS: In a prospective, direct cost recording of all relevant uses of resources, the direct and indirect costs of the treatment of 14 patients with cystic fibrosis (CF) were included in the cross-over-design. The quality of life was recorded at least once for each patient using the EuroQol. In-patient intravenous antibiotic therapy carried out during the block of out-patient care served as one of the disqualification criteria when selecting patients. RESULT: Over an observation period of nine months, the average direct cost recorded were DM 35,706 for out-patient and DM 40,143 for in-patient treatment (+15%). As far as indirect costs are concerned, the losses of production in the national economy recorded for in-patient treatment were 80% higher. CONCLUSION: The direct and indirect costs for in-patient CF-therapy are in total higher than for out-patient care. Whether these cost advantages have to be "bought" with lower medical effectiveness needs to be demonstrated by further clinical studies. In the sense of the disease management approach, the results of this study should be used to help rationally weigh up the costs of out-patient care against alternative treatment concepts.

Adolescent↗
PubMed1996

[Cost of asthma therapy in relation to severity. An empirical study].

BACKGROUND: The aim of asthma therapy, i.e. the permanent elimination of the patient's symptoms, is as a rule, achievable over the long-term only with the aid of anti-inflammatory drugs. As well as medical, this approach also has considerable economic implications. The comparatively low compliance among asthmatics makes treatment in this context all the more difficult. An alternative that presents itself is the use of combination preparations, a mixture of a long-term prophylactic and a therapeutic agent. PATIENTS AND METHODS: With the aid of standardised questionnaires, data were acquired from 216 patients and assigned to subgroups in accordance with the degree of severity of the asthma. The patients were treated in the offices of a total of 23 GPs and internists selected at random from a complete list of all relevant practices in Germany. The use of resources, i.e. all diagnostic and therapeutic measures, was recorded retrospectively for a period of 1 year. In this way, all those resources of relevance to the health insurance carriers used during the observation period were identified. In addition to direct costs, so-called indirect costs were also estimated, i.e. in the present study the productivity loss to the economy due to illness-related absence from work. RESULTS: The annual cost of treating adult asthmatics was calculated to be DM 3,339 for level 1 severity, DM 5,260 for level 2 severity and DM 12,016 for level 3 severity. As the illness progresses in particular the direct cost of inpatient care and the indirect costs rise disproportionately. The yearly expenditure for women sufferers is about DM 800 more than for male sufferers. The direct cost of asthma treatment in children amounts to DM 2,950 for level 1, DM 3,225 for level 2, and DM 4,811 for level 3, severity. Here, drug-related costs in particular, rise significantly as the disease progresses. CONCLUSION: One of the results of the present study is the fact that for asthma sufferers in general, there is a positive correlation between average total costs and degree of severity. It may thus be postulated that preventive medical treatment of asthma that slows the progression of the illness, together with appropriate patient instruction, would have a positive effect on the total expenditure per patient. If, for example, the appropriate use of drugs in combination with patient instruction improved the compliance of asthmatics, lower treatment costs and a better quality of life for the patient could be expected.

Activities of Daily Living↗
PubMed1996

A multinational economic evaluation of rhDNase in the treatment of cystic fibrosis.

Economic evaluations of pharmaceuticals are increasingly being conducted in conjunction with randomized phase III clinical trials to meet the demand for pharmacoeconomic data when new products are launched. While the need for such data is often global, the trials in which relevant information may be collected are often conducted in only one or a limited number of countries. A critical issue is how data from pivotal clinical trials in one setting can serve as the basis for pharmacoeconomic evaluations in others. We address this issue and report on four economic evaluations that we undertook in conjunction with a recent U.S. phase III clinical trial of recombinant human deoxyribonuclease (rhDNase), which is used to improve pulmonary function in patients with cystic fibrosis (CF). The objective of these evaluations was to estimate the potential impact of rhDNase therapy in France, Germany, Italy, and the United Kingdom on the direct costs of medical care for the treatment of respiratory tract infections (RTIs) in patients with CF. Analyses of economic impact were undertaken both with and without adjustment for differences in practice patterns between the United States and the countries of interest. Our findings suggest that rhDNase therapy may reduce the cost of RTI-related care by between US$600 and US$1,100 over a 24-week period; the cost of rhDNase is not included in these figures, as a price was unavailable when our analyses were undertaken. Despite methodologic challenges, economic evaluations that meet the information needs of decision makers in diverse countries can nonetheless be undertaken in conjunction with phase III clinical trials.

Clinical Trials, Phase III as Topic↗
PubMed1995

[Socioeconomic evaluation of the effect of rhDNase on the cost of treating infections of the respiratory tract in patients with cystic fibrosis].

BACKGROUND: Data from a multicenter, placebo-controlled, double-blind, parallel clinical trial on the use of aerosolized recombinant human DNase (rhDNase), known as Pulmozyme produced by Genentech, about the treating of respiratory-tract infections among patients with cystic fibrosis (CF), has been used to evaluate possible economic effects by identifying the direct medical costs. To calculate the cost an intention-to-treat approach has been used. PATIENTS AND METHOD: The patients were randomly placed in one of three treatment groups. The first group was treated with a 2.5 mg dose of rhDNase and one dose of placebo daily, the second group with placebo twice a day. The third patient group (treated with a 2.5 mg dose of rhDNase twice a day) was not included in this study. RESULTS: The main measurements of resource utilization of services for treatment of respiratory-tract infections were the number of hospitalizations in the follow-up period of 24 weeks (0.41 rhDNase once daily, 0.56 placebo), the number of total days in hospital (4.9 rhDNase, 6.4 placebo), the number of total days of outpatient intravenous antibiotic therapy (2.9 rhDNase, 4.4 placebo), the number of total days of inpatient intravenous antibiotic therapy (4.8 rhDNase, 6.2 placebo), the number of total days of outpatient oral antibiotic therapy (23.5 rhDNase, 25.2 placebo) and the number of total days of inpatient oral antibiotic therapy (0.59 rhDNase, 0.55 placebo). From a health insurance perspective the total direct cost based on a weighted per diem for German CF-centres was 5,879 DM (rhDNase) vs 7,849 DM (placebo) per patient respectively. Costs of antibiotics were estimated using all available information on the consumption of antibiotic drugs revealing 2,954 DM per patient in the rhDNase-group and 4,213 DM in the placebo-group. The large cost differences remain also true in a sensitivity analysis introducing minima and maxima as key factors. CONCLUSION: As a result of this study we conclude that the use of rhDNase in treatment of respiratory-tract infections in patients with cystic fibrosis is cost saving and less burdened for the patients. However, all cost estimates do not include the cost of rhDNase itself, which are DM 9,094 for the period of follow-up.

Adolescent↗