Comparison of 'anatomically designed' and 'point-by-point' catheter ablations for human atrial fibrillation in terms of procedure timing and costs in German hospitals.

AIMS: The purpose of the FAST-PVI study was to compare 'traditional' ablation tools based on 'point-by-point' technology with the new 'anatomically designed' technologies in terms of procedure times and related costs for the treatment of paroxysmal atrial fibrillation. METHODS AND RESULTS: Four hundred and fifty-two consecutive ablation procedures (222 'anatomically designed', 136 Arctic Front® and 86 PVAC®) and 230 'point-by-point' ablations (100 CARTO XP and 130 NavX navigation systems) performed by nine university centres across Germany from 2006 to 2010 were evaluated retrospectively. Staffing and resources times for each procedure were documented together with patient morbidities, complications, and pulmonary veins isolations. On the basis of DRG data from 2006 to 2010, human resources use and equipment maintenance costs were assigned to ablation procedure and calendar year. All procedural times were significantly higher in 'point-by-point' technologies compared with 'anatomically designed' ablations [average lab occupancy time 185.30 vs. 280.28 min; physician time 152.21 vs. 238.04 min; support time 183.43 vs. 278.34 min and fluoroscopy time 29.11 vs. 40.72 min; P < 0.001 (95% confidence interval, CI)]. For each ablation procedure human resource use per operating minute resulted in lower costs for 'anatomically designed' ablations [€744.24 per patient; P < 0.001 (95% CI)]. Savings due to reduced duration in 'anatomically designed' technologies accrued to 20% lower human resource costs. Sensitivity analyses did not lead to any significant variations on the outcomes parameter cost per minute. CONCLUSION: FAST-PVI showed reductions in ablation procedural time may lead to increased hospital capacity and non-device-related cost-savings, while maintaining quality.

Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany.

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is a common disorder with consequences for the patient's health-related quality of life (HRQoL). In Germany, few data are available on the impact of GERD on work-related productivity. AIM: To study the impact of GERD on work productivity despite proton pump inhibitor (PPI) therapy and the association between productivity and symptom duration, severity, and HRQoL. METHODS: Retrospective data from randomly selected patients with chronic GERD symptoms, treated by office-based general practitioners or general internists with routine clinical care, were analyzed together with information from self-administered instruments assessing work productivity (WPAI-GERD), symptoms (RDQ), and HRQoL (QOLRAD). RESULTS: Reduced productivity was reported by 152 of 249 patients (61.0%), although 89.5% of them were treated with PPI. The reduction in work productivity was 18.5% in all patients and 30.3% in those with reduced productivity. Patients with impaired productivity showed a significantly lower HRQoL and more-severe symptoms of reflux disease. In all patients, the mean sick leave attributable to reflux symptoms was 0.6 hours in the previous seven days and 1.4 work days in the previous three months. CONCLUSION: GERD has a substantial impact on work productivity in Germany, even in patients receiving routine clinical care and PPI therapy.

[Utilisation of medical resources of patients with pain undergoing an outpatient opioid therapy]. / Inanspruchnahme von medizinischen Leistungen bei Schmerzpatienten unter Opioid-Therapie in der ambulanten Versorgung.

In Germany, opioid therapy of patients with chronic musculoskeletal pain has not been sufficiently scrutinised. Furthermore, no observational resource utilisation study for these patients concerning the treatment with opioids is available. For the analysis of outpatient costs 6 months before and after the first prescription of different opioids (oxycodone HCI, fentanyl TD, morphine retard), data from the IMS disease analyser (mediplus) database were employed. Costs of the opioids differed significantly. Highest costs could be observed for the therapy with fentanyl (601.36 euro), followed by oxycodone (355.80 euro) and morphine (229.47 euro). Patients under treatment with oxycodene showed lower costs for other drugs compared with those under treatment with fentanyl and morphine during the opioid therapy, although there were no differences in the period before the first prescription of opioids. The number of consultations rose significantly after the first prescription of opioids. Patients with chronic pain, who are treated with long-lasting opioids for the first time, initially use considerably more healthcare resources. The type of opioid influences the amount of resource utilisation.

Improvement of the predictive value of CD4+ lymphocyte count by beta 2-microglobulin, immunoglobulin A and erythrocyte sedimentation rate. The Multicentre Cohort Study Group.

OBJECTIVE: To evaluate whether the use of immunological markers in addition to CD4+ lymphocyte count can improve the prediction of the probability of developing AIDS within a given period. DESIGN AND SETTING: Prospective multicentre cohort study of homosexual men. PATIENTS: A total of 447 HIV-positive homosexual men followed prospectively at 6-month intervals (median time of observation, 47 months). METHODS: Estimation of AIDS-free time using lifetable plots by Cutler and Ederer and Weibull parametric models. A stepwise multivariate regression analysis was used to calculate the optimal combination of the parameters studied. RESULTS: In general CD4+ lymphocyte counts are most important for the prediction of AIDS-free time. The use of serum levels of beta 2-microglobulin (beta 2M), immunoglobulin A (IgA) and erythrocyte sedimentation rate (ESR) can significantly improve the predictive value of CD4+ lymphocyte counts. However, the usefulness of these parameters depends on the stage of HIV disease. In patients with a CD4+ lymphocyte count > 500 x 10(6)/l, only IgA level had a significant predictive value; none of the other parameters significantly improved the model. In patients with a CD4+ lymphocyte count < 500 x 10(6)/l, the absolute number of CD4+ cells itself was the most important single predictive parameter, but the prediction of AIDS was significantly improved by the addition of the other parameters investigated. The most powerful combination of parameters in this group was CD4+ count, beta 2M and ESR. CONCLUSION: Determination of serum IgA, beta 2M and ESR in addition to CD4+ lymphocyte count may aid the choice of specific therapeutic regimens or systems of care for HIV-positive individuals.

[Effects of 2 reimbursement models on house calls by general practitioners]. / Auswirkungen zweier Vergütungsmodelle auf Hausbesuche von Allgemeinmedizinern.

This study compares the effects of the salary payment in the former GDR with the fee for service remuneration in Germany for outpatient service. The investigation focused on home visits 3 by family doctors in Magdeburg in the first two quarters of the years 1985 and 1992. The retrospective study based on existing documentations. Main questions were the modification of frequency resp. nature and matter of home visits. The frequency of home visits increased by about 134%. Distributed by age-groups, the home visits at patients up to the age of 55 showed only a small increase. However, the increase with patients between 60 and 79 years of age was 350%. In particular, diseases of the ICD Group VII (diseases of the vascular system) were affected by the increase. In contrast to this home visits of nurses were influenced to a lesser degree by the system changes. These are indications that the increase in the home visits is not due to an increased demand for them.