[Cost effectiveness of a health insurance based case management programme for patients with affective disorders]. / Kosteneffektivität eines krankenkassengestützten Case-Management-Programms für Patienten mit affektiven Störungen.

OBJECTIVE: Health economic evaluation of a health insurance based case management intervention for persons with mood to severe depressive disorders from payers' perspective. Intervention intended to raise utilization rates of outpatient health services. METHODS: Comparison of patients of one German health insurance company in two different regions/states. Cohort study consists of a control region offering treatment as usual. Patients in the experimental region were exposed to a case management programme guided by health insurance account manager who received trainings, quality circles and supervisions prior to intervention. Utilization rates of ambulatory psychiatrist and/or psychotherapist should be increased. Estimation of incremental cost effectiveness ratio (ICER) was intended. RESULTS: Intervention yielded benefits for patients at comparable costs. A conservative estimation of the ICER was 44,16 euro. Maximum willingness to pay was 378,82 euro per year. Sensitivity analyses showed that this amount of maximum willingness to pay can be reduced to 34,34 euro per year or 2,86 euro per month due to cost degression effects. CONCLUSIONS: The intervention gains increasing cost effectiveness by the number of included patients and case managers. Cooperation between health insurances is suggested in order to minimize intervention cost and to maximize patient benefits. Results should be confirmed by individual longitudinal data (bottom-up approach) first.

Valid comparisons and decisions based on clinical registers and population based cohort studies: assessing the accuracy, completeness and epidemiological relevance of a breast cancer query database.

BACKGROUND: Data accuracy and completeness are crucial for ensuring both the correctness and epidemiological relevance of a given data set. In this study we evaluated a clinical register in the administrative district of Marburg-Biedenkopf, Germany, for these criteria. METHODS: The register contained data gathered from a comprehensive integrated breast-cancer network from three hospitals that treated all included incident cases of malignant breast cancer in two distinct time periods from 1996-97 (N=389) and 2003-04 (N=488). To assess the accuracy of this data, we compared distributions of risk, prognostic, and predictive factors with distributions from established secondary databases to detect any deviations from these "true" population parameters. To evaluate data completeness, we calculated epidemiological standard measures as well as incidence-mortality-ratios (IMRs). RESULTS: In total, 12% (13 of 109) of the variables exhibited inaccuracies: 9% (5 out of 56) in 1996-97 and 15% (8 out of 53) in 2003-04. In contrast to raw, unstandardized incidence rates, (in-) directly age-standardized incidence rates showed no systematic deviations. Our final completeness estimates were IMR=36% (1996-97) and IMR=43% (2003-04). CONCLUSION: Overall, the register contained accurate, complete, and correct data. Regional differences accounted for detected inaccuracies. Demographic shifts occurred. Age-standardized measures indicate an acceptable degree of completeness. The IMR method of measuring completeness was inappropriate for incidence-based data registers. For the rising number of population-based health-care networks, further methodological advancements are necessary. Correct and epidemiologically relevant data are crucial for clinical and health-policy decision-making.