[Current Potential for Outpatient Care in Urology: What the IGES Report Means if Applied to Real Data]. / Aktuelle Ambulantisierungspotenziale in der Urologie - was bedeutet das IGES Gutachten auf Echtdaten angewendet.

BACKGROUND: The hospital reform initiated through an expert opinion of the German research institute IGES places great emphasis on the aspect of outpatient care. In this context, the current IGES guidelines extend further than has previously been the case. There are only very isolated instances where this theoretical potential has been translated into practical application in urology. This study aims to reflect the theoretical potential calculated using real data from urology with a view to practical application. MATERIAL AND METHODS: Using the algorithm of the "Hospital Structure Navigator" of DKTIG (Deutsche Krankenhaus TrustCenter und Informationsverarbeitung GmbH), focused on the extension of the AOP (Ambulatory Operations and Procedures) catalogue, section-21 data of the year 2022 from the Clinic for Urology at the University Hospital Schleswig-Holstein was analysed. The inclusion and exclusion criteria provided by IGES were applied, along with a limitation of the length of stay to two days and a minimum case number of 30 cases per year. Since this resulted in a very low potential for target DRGs (Diagnosis-Related Groups), the criteria were further modified. With this approach, a plausibility check for the outpatient treatment capability of identified cases was conducted. RESULTS: After applying the inclusion and exclusion criteria, only one applicable DRG (L18B) emerged, but with the expanded criteria, eight DRGs were identified. From the case flat rates determined, three appropriate OPS codes were identified:1.) Ureterorenoscopic removal of stones from the kidney with lithotripsy (5-550.31)2.) Transurethral resection of a bladder tumour, not fluorescence-supported (5-573.40)3.) Bougienage of a ureter, transurethral (5-560.2) CONCLUSION: With the current set of criteria defined by IGES for urology, no significant outpatient potential can be achieved. However, the expansion of criteria has uncovered areas that could be well implemented with a broader set of criteria and are currently seen more systematically in the realm of measures replacing inpatient procedures or hybrid DRGs. In addition to the need to clarify the fundamental outpatient feasibility of the methods on an individual case basis, there are limitations here, especially for multimorbid populations. Therefore, in expanding the catalogue, the legislator must take into account the higher risk and monitoring effort required for these patients.

Epidemiology and treatment of pain associated with osteoarthritis of the knee in Germany: A retrospective health claims data analysis.

Objective: Osteoarthritis of the knee (knee OA) is a serious joint disease leading to pain and reduced quality of life. Pharmacological treatments include anti-inflammatories, analgesics, intraarticular hyaluronic acid, and intraarticular corticosteroids while for severe knee OA, knee replacement is an option. This study examined the incidence, prevalence, patient characteristics, and uptake of medical and surgical treatments in knee OA patients in Germany. Design: A non-interventional, retrospective health claims data analysis with anonymized data from the InGef database was performed. Patients ≥18 years were analyzed cross-sectionally for each year 2015-2020. Newly diagnosed patients in 2015 were also longitudinally analyzed until end of 2020. Results: Annual knee OA prevalence increased from 7.07 â€‹% in 2015 to 7.39 â€‹% in 2020. Annual incidence proportions ranged from 1.71 â€‹% in 2015 to 1.46 â€‹% in 2020. Knee replacement was the most common surgery, with rising patient numbers (e.g., 7918 patients in 2015 and 8975 patients in 2019). Approximately 62 â€‹% of patients newly diagnosed in 2015 received prescription pharmacological pain treatment during follow-up. Most (96.95 â€‹%) received non-opioid analgesics, followed by weak opioids (8.14 â€‹%) and strong opioids (3.00 â€‹%) as first-line treatment (combinations possible). Knee surgery was performed in 16.6 â€‹% of patients during follow-up. Median time from first diagnosis until surgery was 346 days for any knee surgery and 564 days for knee replacement. Conclusions: The number of patients with knee OA in Germany is steadily rising, along with an increasing number of surgical interventions, especially knee replacement. Time until first surgery and knee replacement is relatively short, even for newly diagnosed patients.

Early risk markers for severe clinical course and fatal outcome in German patients with COVID-19.

BACKGROUND: Some patients with Corona Virus Disease 2019 (COVID-19) develop a severe clinical course with acute respiratory distress syndrome (ARDS) and fatal outcome. Clinical manifestations and biomarkers in early stages of disease with relevant predictive impact for outcomes remain largely unexplored. We aimed to identify parameters which are significantly different between subgroups. DESIGN: 125 patients with COVID-19 were analysed. Patients with ARDS (N = 59) or non-ARDS (N = 66) were compared, as well as fatal outcome versus survival in the two groups. KEY RESULTS: ARDS and non-ARDS patients did not differ with respect to comorbidities or medication on developing a fatal outcome versus survival. Body mass index was higher in patients with ARDS versus non-ARDS (p = 0.01), but not different within the groups in survivors versus non-survivors. Interleukin-6 levels on admission were higher in patients with ARDS compared to non-ARDS as well as in patients with fatal outcome versus survivors, whereas lymphocyte levels were lower in the different subgroups (all p<0.05). There was a highly significant 3.5-fold difference in fever load in non-survivors compared to survivors (p<0.0001). Extrapulmonary viral spread was detected more often in patients with fatal outcome compared to survivors (P = 0.01). Further the detection of SARS-CoV-2 in serum showed a significantly more severe course and an increased risk of death (both p<0.05). CONCLUSIONS: We have identified early risk markers for a severe clinical course, like ARDS or fatal outcome. This data might help develop a strategy to address new therapeutic options early in patients with COVID-19 and at high risk for fatal outcome.

Economic impact of disease prevention in a morbidity-based financing system: does prevention pay off for a statutory health insurance fund in Germany?

Preventable chronic diseases account for the greatest burden in the German health system and statutory health insurance (SHI) funds play a crucial role in implementing and financing prevention strategies. On the contrary, the morbidity-based scheme to distribute financial resources from the Central Reallocation Pool among the different sickness funds may counteract efforts of effective prevention from an economic perspective. We assessed financial impacts of prevention from a sickness funds perspective in a retrospective controlled study. Claims data of 6,247,275 persons were analyzed and outcomes between two propensity-matched groups (n = 852,048) of prevention users and non-users were compared in a 4-year follow-up. Using a difference-in-differences approach, we analyzed healthcare expenditures, the development of morbidity, financial transfers from the Central Reallocation Pool, and contribution margins. The group of prevention users develops less morbidity (incidences and disease aggravations) compared to the control group. Healthcare expenditures increase in both groups within 4 years, whereas the increase is lower for prevention users compared to non-users (€568.04 vs. €640.60, p < 0.0001). Taking morbidity-based financial transfers into account, the decrease in contribution margins is stronger for prevention users (- €188.44 vs. - €138.73, p < 0.0001). This study demonstrates an economic disincentive from a sickness funds' perspective. In the semi-competitive SHI market, sickness funds will be discouraged from effective prevention strategies if investments are not worth it financially. Their efforts and knowledge are, however, crucial for joint action to foster prevention over cure in the health system.

Burden of community-acquired pneumonia, predisposing factors and health-care related costs in patients with cancer.

BACKGROUND: Data on the burden of community-acquired pneumonia (CAP) and health-care related costs in patients with cancer is scarce. We aimed to estimate the CAP incidence rate, mortality, and healthcare-related costs of CAP patients with different cancer subtypes in Germany. METHODS: We used German health claims data of a representative sample of 4 million subjects to conduct cohort studies in patients with a new diagnosis of lung, hematological, breast, gastro-intestinal tract and renal/urinary-tract cancer and a comparator cohort without cancer between 2011 and 2015. CAP cases were identified in both the hospital and ambulatory care setting. Crude and age- and sex-standardized incidence rates (sIR) of CAP and mortality after CAP were calculated. To compare the health care-related costs of cancer patients with and without a diagnosis of CAP, a propensity-score (PS) matched control group was created. RESULTS: The study population comprised of 89,007 patients with cancer. In lung cancer patients, the sIR was increased 21-fold compared to the control cohort. For the other cancer subtypes, the sIR was increased 4.3-fold (hematological malignancies) to 1.7-fold (breast cancer) compared to the control cohort. The 30-day mortality in CAP cases was highest in lung cancer patients with 20.0% and ranged from 7.2 to 18.5% in CAP cases with other cancer subtypes. The highest costs were observed in CAP cases with hematological malignancies with 28,969 € (SD 37,142 €) and the lowest in patients with renal/urinary tract cancer with 17,432 € (SD 19,579 €). The absolute difference in the mean overall costs between CAP cases and controls without CAP ranged from 4,111€ to 9,826€, depending on the cancer type. CAP-related costs were predominantly triggered by substantially elevated hospital costs in CAP cases. CONCLUSIONS: The incidence rate of CAP and related mortality is high in patients with cancer with strong variations by cancer subtype. Furthermore, CAP in cancer patients is associated with substantial direct excess costs.

German claims data analysis to assess impact of different intraocular lenses on posterior capsule opacification and related healthcare costs.

AIM: Cataract extraction is one of the most frequent surgeries in Germany. In most cases, the clouded natural lens is replaced by a hydrophobic or hydrophilic acrylic intraocular lens (IOL) implant. The most common long-term complication after cataract surgery is the development of a posterior capsule opacification (PCO). Although no precise real world data are available, published evidence suggests a lower risk for PCO development for hydrophobic acrylic IOLs compared to hydrophilic acrylic IOLs. Therefore, in the present study we assessed real world data on the impact of different IOL material types on the incidence of post-operative PCO treatment. SUBJECT AND METHODS: In this retrospective study, we included 3,025 patients who underwent cataract extraction and implantation of either an acrylic hydrophobic or hydrophilic IOL in 2010. We assessed clinical outcomes and direct costs in a 4-year follow-up period after cataract surgery from a statutory health insurance (SHI) perspective in Germany. RESULTS: PCO that required capsulotomies occurred significantly (p < 0.0001) less frequent in patients who had received a hydrophobic IOL (31.57% of 2,078 patients) compared to the group with hydrophilic IOL implants (56.6% of 947 patients) and costs per patient for postoperative treatment in a 4-year follow-up were 50.03 € vs. 87.81 € (i.e. 75% higher in the latter group, p < 0.0001). CONCLUSION: Considering the high prevalence of cataract, the economic burden associated with adverse effects of cataract extraction is of great relevance for the German SHI. Hydrophobic lenses seem to be superior regarding both medical and economic results.

[Utility Analysis of Oncological Centre Building in the Field of Colorectal Cancer]. / Nutzenanalyse onkologischer Zentrenbildung im Bereich der Behandlung des kolorektalen Karzinoms.

BACKGROUND: In the field of colorectal cancer and other cancer entities, there is an ongoing trend to establish multidisciplinary treatment in specialised cancer centres. Little is known by now about the outcomes of this centralised and quality-driven treatment approach. In light of the increasing cost-benefit discussions, assessments of their impact seem to be necessary. This paper discusses positive effects of cancer centres with a particular focus on the multidisciplinary approach and its potential impact on survival outcomes of colorectal cancer patients. The study applies a Markov approach to assess the epidemiological impact of the cancer centre establishment and associated life years gained, both at a regional level and over time. MATERIALS AND METHODS: We conducted a systematic literature review to evaluate effects of multidisciplinary treatment in specialised cancer centres in the field of colorectal cancer. Applying the PRISMA scheme, 602 articles were assessed by title, abstract and full text. Finally, 10 publications met the inclusion criteria and were included in a meta-analysis. Using the example of the "Krebszentrum Nord" at the University Hospital in the federal state of Schleswig-Holstein, we assessed the impact of changes in survival rates at the regional level by simulating expected incidence, mortality and prevalence rates in a Markov model including detailed population data of Schleswig-Holstein. RESULTS: The meta-analysis revealed that multidisciplinary treatment in a cancer centre was associated with a 4.5 % reduction of mortality rates in colorectal cancer patients. The greatest benefits were found for patients in advanced disease stages. At the regional level, 106 life years could be gained through the centre for colorectal cancer until 2020, according to the assumptions of the simulation. CONCLUSION: The establishment of colorectal cancer centres is associated with positive outcomes for patients. However, the scarce evidence base underpins the need for additional studies to further examine the impact of centre building in colorectal cancer care. Cancer registries are a solid foundation for further research. Future requirements for oncological care can be derived from the predicted epidemiological development.

Cost-effectiveness comparison of prophylactic octreotide and pasireotide for prevention of fistula after pancreatic surgery.

PURPOSE: Postoperative pancreatic fistula (POPF) is a major determinant of pancreatic surgery outcome, and prevention of POPF is a relevant clinical challenge. The aim of the present study is to compare the cost-effectiveness of octreotide and pasireotide for POPF prophylaxis. METHODS: A systematic literature review and meta-analysis and a retrospective patient cohort provided the data. Cost-effectiveness was calculated by the incremental cost-effectiveness ratio (ICER) and by decision tree modelling of hospital stay duration. RESULTS: Six randomised trials on octreotide (1255 patients) and one trial on pasireotide (300 patients) were included. The median POPF incidence without prophylaxis was 19.6 %. The relative risks for POPF after octreotide or pasireotide prophylaxis were 0.54 or 0.45. Octreotide prophylaxis (21 × 0.1 mg) costs were 249.69 Euro, compared with 728.84 Euro for pasireotide (14 × 0.9 mg) resulting in an ICER of 266.19 Euro for an additional 1.8 % risk reduction with pasireotide. Decision tree modelling revealed no significant reduction of median hospital stay duration if pasireotide was used instead of octreotide. CONCLUSION: Prophylactic octreotide is almost as effective as pasireotide but incurs significantly fewer drug costs per case. However, the data quality is limited, because the effect of octreotide on clinically relevant POPF is unclear. Together with the lack of multicentric data on pasireotide and its effectiveness, a current off-label use of pasireotide does not appear to be justified.