Costs of treating cardiovascular events in Germany: a systematic literature review
Tóm tắt
This study aims to systematically evaluate available evidence regarding direct medical costs of treating cardiovascular (CV) events in Germany after 2003 on an individual patient basis and from a payer perspective. The CV events of interest were myocardial infarction (MI), unstable angina, heart failure (HF), stroke, and peripheral artery disease (PAD). A systematic literature search was performed in the following databases according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines - Medline, Embase, Centre for Reviews and Dissemination, TIBORDER, and German dissertation database from January 2003 to October 2013. Both observational studies and randomized clinical trials were considered for the review. All values stated in € are inflation adjusted to 2014 € unless stated otherwise. This review included 13 articles. For newly occurred MI patients, the average hospitalization costs during the acute phase were reported to be between € 6790 and € 8918 per admission. In the first year after a MI event, direct medical costs were € 13,838–14,792 per patient. Direct medical costs of chronic HF patients were found to be between € 3417 and 5576 per patient per year. Treatment costs increase with disease progression. The average treatment costs for hospitalized PAD in the acute phase were reported to be € 4963 per admission, € 2535 per patient during month 1–6 after the initial hospitalization, € 1601 in month 7–12, and € 1390 in month 13–18. For stroke of all types, total direct medical costs in the 1st year after an event were reported to be € 13,273 per patient. Total direct medical costs during the 1st year after an ischemic stroke event were € 17,399–21,954 per patient, € 6260 in month 13–18, and € 6496 per year in the subsequent 4 years. MI, unstable angina, HF, stroke and PAD have a high financial impact on the German health care system. Treatment costs of these diseases are mostly incurred during the acute phase of events and tend to decrease over time. Hospitalization and rehabilitation costs were two major cost drivers. Medication costs was one of the smallest cost component reported.
Tài liệu tham khảo
World Health Organization. Cardiovascular diseases (CVDs). fact sheet. 2011. Available at: http://www.who.int/mediacentre/factsheets/fs317/en/index.html. Accessed May 21, 2012.
Statistisches Bundesamt Deutschland. Herz-/Kreislauf-Erkrankungen sind die häufigste Todesursache. 2009. Available at: https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Todesursachen/Todesursachen.html. Accessed May 5, 2014.
Gößwald A, Schienkiewitz A, Nowossadeck E, Busch MA. Prevalence of myocardial infarction and coronary heart disease in adults aged 40–47 years in Germany. Bundesgesundheitsbl. 2013;56:650–5.
Federal StatisticalOffice. Health in Germany. Berlin; 2008. Available at: http://www.gbe-bund.de/gbe10/owards.prc_show_pdf?p_id=9965&p_sprache=e&p_uid=gastd&p_aid=51065435&p_lfd_nr=1. Accessed April 2, 2014.
Statistisches Bundesamt Deutschland. Hospital patients. 2013. Available at: https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Krankenhaeuser/Tabellen/DiagnosenMaennlich.html. Accessed April 2, 2014.
Robert Koch Institut. Cardiovascular disease. 2013. Available at: http://www.rki.de/DE/Content/Gesundheitsmonitoring/Themen/Chronische_Erkrankungen/HKK/HKK_node.html;jsessionid=EA85A0F3849E069580E62C514785C57E.2_cid390. Accessed April 2, 2014.
Stausberg J, Kiefer E. Homogeneity of the German diagnosis-related groups. Heal Serv Manag Res. 2010;23(4):154–9. doi:10.1258/hsmr.2010.010002.
Bartkowski R. Length of hospital stay due to DRG reimbursement. Ther Umschau. 2012;69(1):15–21. doi:10.1024/0040-5930/a000245.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097.
Bäumler M, Stargardt T, Schreyögg J, Busse R. Cost effectiveness of drug-eluting stents in acute myocardial infarction patients in Germany: results from administrative data using a propensity score-matching approach. Appl Health Econ Health Policy. 2012;10(4):235–48. doi:10.2165/11597340-000000000-00000.
Stargardt T, Schreyögg J, Kondofersky I. Measuring the relationship between costs and outcomes: the example of acute myocardial infarction in german hospitals. Health Econ. 2013;Epub ahead. doi:10.1002/hec.2941.
Reinöhl J, Neubauer A, Ahrens I. Economic evaluation of anticoagulant strategies in interventional treatment of acute myocardial infarction. In: Value in Health. 2012. p. PCV38.
Reinhold T, Lindig C, Willich S, Brüggenjürgen B. The costs of myocardial infarction—a longitudinal analysis using data from a large German health insurance company. J Public Health (Bangkok). 2011;19:579–86. doi:10.1007/s10389-011-0420-8.
Schweikert B, Hahmann H, Steinacker JM, Imhof A, Muche R, Koenig W, et al. Intervention study shows outpatient cardiac rehabilitation to be economically at least as attractive as inpatient rehabilitation. Clin Res Cardiol. 2009;98:787–95. doi:10.1007/s00392-009-0081-6.
Tiemann O. Variations in hospitalisation costs for acute myocardial infarction–a comparison across Europe. Health Econ. 2008;17(S1):S33–45. doi:10.1002/hec.
Fuchs S, Klauss V, Dieterle C, Wasem J, Aidelsburger P. Treatment costs for myocardial infarction, stroke and diabetes mellitus type 2 under consideration of cardiovascular risk factors in the perspective of the public health insurance (Gesetzliche Krankenversicherung) in Germany. PharmacoEconomics - Ger Res Artic. 2008;6(1):3–18.
Brüggenjürgen B, Rupprecht H-J, Willich SN, Spannagl M, Ehlken B, Smala A, et al. Cost of atherothrombotic diseases—myocardial infarction, ischaemic stroke and peripheral arterial occlusive disease—in Germany. J Public Health (Bangkok). 2005;13:216–24. doi:10.1007/s10389-005-0112-3.
Brüggenjürgen B, Lippert B, Smala A. Inpatient treatment of unstable angina pectoris - Treatment courses and costs from the hospital’s perspective. Gesundh kon Qual Manag. 2006;11:97–104.
Biermann J, Neumann T, Angermann CE, Düngen HD, Erbel R, Herzog W, et al. Economic burden of patients with various etiologies of chronic systolic heart failure analyzed by resource use and costs. Int J Cardiol. 2012;156(3):323–5. doi:10.1016/j.ijcard.2012.01.099.
Peters-Klimm F, Halmer A, Flessa S, Szecsenyi J, Ose D. What drives the costs of heart failure care in Germany? A health services cost analysis. J Public Health (Bangkok). 2012;20(6):653–60. doi:10.1007/s10389-012-0501-3.
Abbas S, Ihle P, Hein R, Schubert I. Rehabilitation in geriatric patients after ischemic stroke - A comparison of 2 organisational systems in Germany using claims dta of a statutory health insurance fund. Rehabilitation. 2013;online pub.
Lindig C, Brüggenjürgen B, Willich S, Reinhold T. Die Kosten des Schlaganfalls - eine Längsschnittanalyse. PharmacoEconomics - Ger Res Artic. 2010;8(2):97–107.
Kolominsky-Rabas PL, Heuschmann PU, Marschall D, Emmert M, Baltzer N, Neundörfer B, et al. Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project. Stroke. 2006;37:1179–83. doi:10.1161/01.STR.0000217450.21310.90.
Abdul-Rahman S, Nammas W, Gamal A. Routine invasive versus ischemia-guided strategy in patients with acute inferior ST-elevation myocardial infarction who received fibrinolytic therapy: A prospective randomized controlled pilot trial. J Invasive Cardiol. 2011;23:316–21.
Stålhammar J, Stern L, Linder R, et al. Resource utilization and cost of heart failure associated with reduced ejection fraction in Swedish patients. J Med Econ. 2012;15(5):938–46. doi:10.3111/13696998.2012.686464.
Stepanova M, Venkatesan C, Altaweel L. Recent trends in inpatient mortality and resource utilization for patients with stroke in the United States: 2005–2009. J Stroke Cerebravascular Dis. 2013;22(4):491–9.
Fink E, Kokku PK, Nikiforou S, Hall LO, Goldgof DB, Krischer JP. Selection of patients for clinical trials: an interactive web-based system. Artif Intell Med. 2004;31(3):241–54. doi:10.1016/j.artmed.2004.01.017.