health economics and health care management

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Projects

 

Current Projects: 

 

 

 

Building a Tool to Evaluate and Improve Health Investments in Health Investments in Screening and Diagnosis of Disease (HIScreenDiag)
Work Package 3: Existing procedures and criteria of health investment decision making
Head/Team:Prof. R. Leidl, Dr. W. Rogowski, Dipl.-Vw. K. Fischer
Funding:European Union, 7th framework programme, Grant No. 233533
Project partners:Institute of Prospective Technological Studies (IPTS) (Sevilla, Spanien), University of La Rioja (Spain), University of Gent (Belgium), principal investigator
University of Groningen (The Netherlands), University of Manchester (United Kingdom)
Duration:May 1st, 2009 - August 31st, 2010
Objectives:Over recent decades, the possibilities for the prevention, diagnosis and treatment of disease have expanded throughout the European Union. As a result, health policy decision makers and public funders are faced with the challenge of making choices for health investments to improve the healthy life expectancy of Europeans within the context of constrained resources. Health investments include any new technology for the diagnosis, prevention or treatment of disease. It is, however, not clear to which extent recent decisions on such health investments have been optimal. Public funders sometimes evaluate the impact of health investments, but there is a lack of standardised procedures and criteria. This is even more the case for investments related to screening and diagnosis of disease, and in particular for genetic testing.

Aim of this work package is to receive a structured overview of current procedures and criteria applied in decision making on coverage/ reimbursement of new technologies in the area of screening and diagnosis. A recently published framework is applied to describe the steps of decision processes: Entering scope of health care payer, trigger of the process, assessment, appraisal, reimbursement, setting rules for service provision, participation, publication of decision and supplementary information.
Methods:A methodology is developed for structured analysis of decision processes according to the steps of the applied framework. A web-based question design is applied where respondents are supported by telephone.

Current decision making of third party payers and related experts in selected member states is then analyzed covering at least 50% of the population of the European Union and at least 50% of the population of the new accession countries. Decisions are selected examples from the area of genetic testing with a first focus on neonatal screening technologies.
Identified decision processes are analyzed qualitatively as well as quantitatively to identify criteria that are relevant of decision making.

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German COPD and systemic consequences-comorbidities network (COSYCONET) Subproject 6: Economics and Health Care Research in COPD with specific focus on comorbidities
Team:Prof. R. Holle, P. Menn
Funding:BMBF
Duration:3 years
Objectives:

Main objectives are to investigate

  1. health care utilisation and costs of COPD,
  2. health-related quality of life in individuals with different stages of COPD and population-based controls in cross-sectional and longitudinal analyses,
  3. the use of these data to build a Markov model for long-term course and costs of COPD in Germany.
As their specific focus all analyses address the impact of comorbidities and the interaction between disease entities in COPD.
Methods:In view of limited health care resources, decision makers are in need of representative and valid data concerning costs and outcomes of COPD. Such questions are particularly relevant in chronic diseases such as COPD which are associated with comorbidities that result in multiple treatments and interactions between treatments. This subproject will collect such data for Germany by using a large patient cohort, and compare it with data from a population-based study.

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Diabetes-Collaborative Research of Epidemiologic Studies (DIAB-CORE) Subproject 2 (Economics and Health Care Research): Health-Related Quality of Life (HRQoL) in Type 2 Diabetes Mellitus
Investigators:Prof. R. Holle (PI), Dr. M. Schunk, Dr. P. Reitmeir
Funded by:BMBF (German Federal Ministry for Education and Research)
Duration:12/2008 - 11/2011
Description:The project belongs – as part of subproject 2 - to the research consortium „Diabetes-Collaborative Research of Epidemiologic Studies“(DIAB-CORE), one of seven research groups affiliated to the “Competence Network Diabetes” funded by the BMBF. Main goal of the DIAB-CORE consortium is to establish a large pooled sample from six population-based German survey studies comprising more than 30.000 subjects (est. 1800 subjects with prevalent T2DM) for economic evaluation and health care research in type 2 diabetes mellitus (T2DM).
Objectives:Within subproject 2, this project is in charge of the following research question:
 
  • Health-Related Quality of Life (HRQoL) in T2DM
Patient-reported outcomes such as HRQoL are essential for the evaluation of cost-effectiveness of innovative drugs or treatment interventions as well as for model based cost-utility analysis. With the pooled data of several population- based studies across Germany, it is aimed to provide a reference set of German HRQoL values for T2DM in different stages of the disease and in patient subgroups.
Methods:The pooled data set contains variables on health care utilisation, HRQoL, medication, co-morbidities as well as a range of disease-specific information and basic variables age, sex and socioeconomic position. Quality of life was assessed by the Health Survey Short Form (SF12, SF36), a generic index instrument for HRQoL. In all six studies, the same or similar instruments were used. Based on a comprehensive analysis of the pooled data, HRQoL utility values of T2DM patients will be calculated and compared with those of non-diabetic subjects.  The association of HRQoL with other factors will be analysed using multiple regression models.

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Diabetes-Collaborative Research of Epidemiologic Studies (DIAB-CORE) Subproject 1: 'Regional and Social Differences in the Prevalence and Incidence of Type 2 Diabetes Mellitus'
Investigators:Dr. A. Mielck, W. Maier
Funded by:BMBF  (German Federal Ministry of Education and Research)
Duration:January 2009 - December 2011
Description:The project belongs to the research consortium 'Diabetes-Collaborative Research of Epidemiologic Studies' (DIAB-CORE), one of seven research groups cooperating in the 'Competence Network Diabetes' funded by the BMBF. The main goal of the DIAB-CORE consortium is to establish a large pooled sample from six population-based German survey studies comprising more than 30.000 subjects (including about 1,800 subject with prevalent T2DM) for economic evaluation and health care research in type diabetes mellitus (T2DM). Subproject 1 is conducted together with Dr. Klaus Berger (University of Muenster) and Dr. Henry Völzke (University of Greifswald).
Objectives:In this subproject, working group 1 of the IGM is focusing on the following research topic:
 
  • 'Regional differences and social disparities in the prevalence and incidence of type 2 diabetes mellitus on the community level'
The joint analyses of several large regional and national studies will provide important reference values for Germany. The results will be important for the planning of diabetes-related health care.
Methods:The combination of five population-based studies from different regions in Germany and the German National Health Survey enables, for the first time, the detailed description and quantification of social and regional disparities in the prevalence and incidence of type 2 diabetes mellitus. Concerning the regional disparities, two levels are distinguished: communities, and (in selected cities) city districts. Socio-demographic and socio-economic factors will be examined concerning their role in explaining the observed regional disparities in diabetes prevalence and incidence. Individual social factors (e.g. educational level) and regional factors (e.g. proportion of welfare recipients) will be integrated by a deprivation index on the community level.

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Evaluation of the „Munich Programme for Early Screening and Intervention”
Team:Dr. M. Schunk, Dr. A. Mielck
Funded by:Landeshauptstadt München
Duration:01.06.2009 - 31.07.2010
Objectives:The “Munich Programme for Early Screening and Intervention” was established in 2008 by the City of Munich to help families exposed to a high number of risk factors. The Programme is building upon the long-standing post-natal home-visiting programme within the Department of Health and Environment to identify families in need of support services. The services are provided locally by approved organisations. It is aimed to promote integrated and tailored service delivery. The evaluation examines the access to the programme, the quality of case management and cooperation between the health and social service sector as well as the parents’ satisfaction with the programme. The project is undertaken jointly with a team from Ulm University Hospital and is jointly funded by the Social Services Department and the Department of Health and Environment of the City of Munich
Methods:The team at IGM is responsible for establishing a health sector data base with information from the programmes’ screening instruments and analysing the data. Furthermore, structured questionnaires are being developed to assess parents’ views about the programme and determinants of their acceptance of the programme as well as the views of  key partners of the programme in the health services (home visiting nurses, nurses at participating birth clinics) about their experiences with screening and enrolment of families and the cooperation with programme partners. The report will be brought before the City Council.

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KORINNA - A case management intervention for aged patients with myocardial infarction
Head:Prof. Dr. R. Holle
Team:Dipl.-Volksw.  S. Kunz, Volkswirtin/BA H. Seidl
Funding:Federal Ministry of Education and Health
Duration:3 years
Description:The randomized study compares case management for elderly people with acute myocardial infarction admitted to hospital with standard care. Our institute is responsible for the economic evaluation of the study, data management and statistical analysis.
Objective:The main research hypothesis is that for patients aged 70 years and older with a myocardial infarction a case management can reduce the rehospitalization rate. The intervention will be accompanied by a cost-utility analysis.
Method:The intervention group will be compared with a control group with regard to several outcome measures. Patients in the intervention group will be offered a case management program. Case management includes telephone calls and home visits by a trained nurse. Patients in the control group receive standard care. Patients will be randomized at study entry (balanced by age, sex and comorbidities).

A number of 300 patients is planned to be recruited. Data will be collected at study entry during hospital stay and after one year in the hospital by a practitioner. Additionally, patients will be interviewed within a computer-aided telephone interview (CATI) every three months.

Patient recruitment will start in summer 2008.

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MEMORI: Multidisciplinary Early Modification of Obesity Risk
(Excellence Network Obesity)
Subproject 1: Economic assessment of obesity in children and adolescents and its prevention

Principle investigator and co-investigators:Dr. Jürgen John, Dipl.-Kffr. S. Wolfenstetter, Prof. R. Leidl, Dipl.-Kffr. Christina Wenig, Dr. A. Breitfelder
Funding:Federal Ministry of Education and Research
Duration:3 years in phase 1 (8/2008 - 7/2011)
Objective(s):

Objective 1: to analyze the economic burden of overweight and obesity in children and adolescents. This includes analyses of resource utilization and health care costs linked to obesity in children and adolescents.

Objective 2: to assess the cost-effectiveness of interventions and programmes to prevent overweight and obesity in this target population.

Summary:

Obesity-associated healthcare utilization and costs will be assessed in three population-based samples of children (KiGGS, GINI and LISA) by using an excess cost approach. The economic impact of obesity as well as overweight in children will be evaluated.

Preparatory research will be undertaken to economically assess overweight intervention programmes for children and adolescents by a decision-analytical model. The feasibility of this approach is investigated in two steps:

1) Data on the effectiveness of prevention strategies will be derived from the literature using systematic review techniques. This review will be complemented by an in-depth analysis on whether and how the findings can be appropriately adapted to the context of preventing juvenile obesity in Germany to screen for the most suitable interventions.
2) The epidemiological and cost data collected and generated in the first part of the project will be used to further parameterize the model. In future research phases, it is intended to develop and use this model tool to economically assess prevention strategies for which appropriate medical evidence is available, including strategies that are pursued within this network.

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Economic analysis of Type 2 Diabetes Mellitus and Disease-Management-Programmes (DMP) in longitudinal and cross-sectional perspective
Team:Dr. R. Stark, Dr. M. Schunk, Prof. R. Holle
Funded by:AOK Bundesverband
Programme duration:2006-2009
Objectives:

This project examines health care costs, provision of services and health outcomes of people with type 2 diabetes. Key topics of this research are:

  • Changes in costs, provision of services and health outcomes of diabetic patients over time and since the introduction of Disease-Management-Programmes 
  • Differences in costs, provision of services and health outcomes of diabetic patients who are enrolled in Disease-Management-Programmes compared to those who have not been enrolled
  • Enrolment in Disease-Management-Programmes as determinant for the development of costs, provision of services and health outcomes between 1999/2001 and 2006/2008
Methods:

The study is based on survey data from two studies conducted previously in 1999/2001 (S4) and in 2004/2005 (F3), as well as from an ongoing survey 2006-2008 (F4). Data collection is carried out through the KORA research platform, with samples drawn from the resident population in the region of Augsburg. The region includes the city of Augsburg and two neighbouring counties, Augsburg and Aichach-Friedberg with a population of over 600.000 people.
Clinical outcome measurements (e.g. HbA1c values) are obtained through laboratory tests of study participants’ blood samples. Information on the provision of health care services (e.g. foot exams) is provided in a personal interview or in a self-administered questionnaire. Costs of health care services are extrapolated to one year on the basis of the information on the provision of health care services.

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IDA - Dementia Care Initiative in Primary Practice
Head:Prof. R. Leidl, Prof. R. Holle
Team:Dipl.-Volksw. S. Kunz, Volkswirtin/BA S. Seidl, H. Hänsch, Dr. P. Reitmeir, P. Menn
Funding:
AOK Bavaria (sickness fund), Federal Association of the AOK, Eisai GmbH, Pfizer Deutschland GmbH
Duration:5 years
Description:
The study compares two complex interventions for demented patients, their caregivers and doctors with usual care. The IDA project is designed as a three-armed cluster-randomized study. Our institute is responsible for the economic evaluation of the study, data management and statistical analysis.
Objective:
The main research hypothesis is that for dementia patients still living at home a complex intervention consisting of an initial training of general practitioners (GPs) in evidence-based treatment, of the provision of caregiver support groups, and of actively approaching family counseling, can prolong time to nursing home placement in comparison to usual care. Further outcomes are health, psychological and other consequences for the informal caregivers and the costs of the different interventions. The economic evaluation is performed as a cost-effectiveness analysis.
Method:
In comparison to usual care (study arm A), one intervention group receives additional training of GPs and is offered to participate in caregiver support groups (study arm B), whereas in the second intervention group actively approaching family counseling is implemented (study arm C). The caregivers in study arm B will be offered the actively approaching family counseling after one year of study participation.
The IDA project is a cluster-randomized study where the GPs are the clusters and thus the units of randomization. 220 GPs in the study region of Middle Franconia participated in the study of which 129 GPs recruited 390 patients with their primary informal caregiver. The measurements in the IDA project occur at the following time points: baseline measurement at entry into study, at twelve months, after 24 months, and when the patient is permanently moving into a nursing home. The informal caregivers will be interviewed within a computer-aided telephone interview (CATI) while the GPs’ documentation is in written form. Claim data for health services were provided by Bavarian Organization of the AOK and the Bavarian Association of Statutory Health Insurance Physicians. The 2-year follow-up will be completed at the end of 2008. The data analysis will be performed in 2009.

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