Comparison of one-year costs of type 2 diabetes treatment with insulin glargine or insulin detemir in a basal supported oral therapy (BOT) in Germany.

OBJECTIVE: A one-year cost analysis comparing basal insulin analogues glargine (IG, Lantus) versus detemir (ID, Levemir) in combination with oral antidiabetic drugs (basal supported oral therapy; BOT) in insulin naive Type 2 diabetes patients in Germany based on the results of a randomized controlled clinical trial (RCT). The trial demonstrated equivalent treatment efficacy. MATERIALS AND METHODS: Total direct diabetes treatment costs were estimated from the perspective of the German statutory health insurance (SHI) for the time horizon of one-year. Simulated resources included medication (insulin, oral antidiabetic drugs) and consumable items (needles, blood glucose test strips and lancets). Initial and final insulin doses per kg body weight and proportion of patients with once/twice daily insulin injection were taken from the above mentioned RCT. Unit costs were taken from official German price lists and sources. Deterministic-(DTA) and probabilistic sensitivity analyses (PSA) on resource use and unit costs were performed to test robustness of the results. RESULTS: Average annual treatment costs per patient (base case) were euro 849 for glargine and euro 1,334 for detemir resulting in cost savings of euro 486 per patient per year (36%). Costs of insulins were euro 469 (IG) and euro 746 (ID). Costs of consumable items amounted at euro 380 (IG) and euro 588 (ID) respectively. Sensitivity analyses confirmed the findings in favor of insulin glargine. PSA results found cost savings ranging from euro 429 to euro 608 (5th/95th percentiles). CONCLUSIONS: The current model estimated that insulin glargine was associated with lower annual treatment costs of euro 486 (36%) compared to the use of insulin detemir while the same glycemic control is expected to be achieved.

[Pharmacoeconomic studies - usability for reimbursement decisions]. / Pharmakoökonomische Studien - Nutzbarkeit für leistungsrechtliche Entscheidungen.

BACKGROUND AND OBJECTIVE: In Germany, cost-benefit-assessments are incorporated by law since April 2007. In this study it is examined whether published international pharmacoeconomic studies correspond to the methodological recommendations of the Institute for Quality and Efficiency in Health Care (IQWiG) and international guidelines, and whether they are usable for reimbursement decisions. METHODS: Pharmacoeconomic studies were identified by a systematic literature review and compared with the requirements of the IQWiG and 15 other international institutions. In hypothetical selection processes it was examined which and how many studies could be considered as basis for reimbursement decisions. RESULTS: 130 out of 1,982 pharmacoeconomic studies were identified as relevant and analyzed. Most frequently, the USA was mentioned as reference country (41 %) prior to UK (15 %), Canada (6 %) as well as Japan and Germany (each 4 %). In 63 % standard therapy was chosen as comparator. In 60 % of studies the payer's perspective was chosen primarily, in 22 % the societal perspective. Two thirds of the studies were modeled in most parts. Only two studies performed a comparison with standard therapy from the perspective of the statutory health insurance and could have been considered for reimbursement decisions of the G-BA. Only one German study examined the real-life effectiveness and compared it to standard therapy. CONCLUSIONS: The study revealed a congruence between the methods of iqwig and other similar international institutions. However, hitherto existing pharmacoeconomic studies do not follow international and German guidelines in many points. In consequence IQWiG will have to perform the analyses itself and the assessment process will be time-consuming and tedious so that in the short and medium term no relevant cost savings can be expected.

[Cost-of-illness Study for the Treatment of COPD in Germany]. / Krankheitskosten von COPD in Deutschland.

The present cost-of-illness study is focused on the costs of COPD in Germany. In a pre-study, data on 814 randomly selected patients were collected to achieve reliable figures for the distribution of COPD severity grades and the frequencies of exacerbations. The main study was performed on 321 randomly selected patients from the pre-study. Data on resource use were collected in a face-to-face interview with the respective physicians using the patient records as a basis. Costs associated with resource consumption were weighted with the frequencies of COPD severity grades as assessed in the pre-study to determine the costs of COPD. Annual COPD-related costs per patient were 3,027 from the societal perspective. Main cost components were hospitalisations (26 %), medication (23 %) and early retirement (17 %). Annual COPD-related costs from the perspective of the German health insurance system (GKV) were 1,944 euros per patient.

Nosocomial pneumonia: a cost-of-illness analysis.

BACKGROUND: We investigated incremental cost of nosocomial pneumonia (NP) from the perspective of a hospital and health insurance funds. PATIENTS AND METHODS: The incremental cost was determined by calculating total costs for pneumonia patients and controls using prospective and retrospective matched-pairs analysis with 29 and 37 matched pairs, respectively. RESULTS: Compared to controls, patients who developed pneumonia had to be on artificial ventilation 5 days longer, needed markedly more intensive care with 6.55 additional days in intensive care. Excess cost per pneumonia patient amounted to DM 14,606 (95% CI: DM 5,285-23,927) from the hospital's perspective and to DM 7,988 (95% CI: DM 5,281-10,894) according to statutory insurance charges. According to the retrospective anaLysis carried out on the neurosurgical and neurological intensive care wards, pneumonia patients were ventiLated 5 days longer than patients without pneumonia, needed more intensive care over 30 days and had an additional 14.03 days of intensive care and 10.14 more days in hospital. Excess cost per patient was DM 29,610 (95% CI: DM 23,054-36,174) from the hospitals perspective and DM 18,000 (95% CI: 14,885-21,020) according to the statutory insurance criteria. CONCLUSION: The study gives insight into the structure of incremental cost caused by NP and shows that based on a conservative cost calculation the incremental cost per NP patient is higher for the hospital than for health insurance funds which indicates a significant financial deficit for the hospital. Antibiotics and microbiology together only contribute 6.8% to incremental cost. Therefore in a cost saving initiative their close relationship to length of hospitalization must be considered.

Cost efficacy of tazobactam/piperacillin versus imipenem/cilastatin in the treatment of intra-abdominal infection.

OBJECTIVE: To compare the cost, efficacy and cost efficacy of tazobactam/piperacillin and imipenem/cilastatin in the treatment of intra-abdominal infection. DESIGN: The analysis was retrospective and based on a decision tree. Effectiveness data were obtained from 19 published clinical trials. Direct costs were quantified per patient from the time the decision was made to administer the antibacterial to the end of the first course of treatment or the end of a subsequent course of treatment, if required. The primary end-point was the cost per successfully treated patient. The cost per life saved was also analysed. Various follow-up times were taken into account. PERSPECTIVE: German National Health Insurance funds. STUDY POPULATION: 1744 patients with intra-abdominal infection. INTERVENTIONS: Tazobactam/piperacillin (total daily dosage of 13.5 g/day) and imipenem/cilastatin (total daily dosage of 1.5 to 4 g/day). The mean duration of treatment varied from 5.5 to 8.2 days for tazobactam/piperacillin and 5 to 9.4 days for imipenem/cilastatin. MAIN OUTCOME MEASURE AND RESULTS: Compared with imipenem/cilastatin, treatment with tazobactam/piperacillin was more effective and the overall treatment costs were lower. In the base-case analysis, the cost-efficacy ratio (cost per successfully treated patient) was 7881 German deutschmarks (DM) for tazobactam/piperacillin and DM11,390 for imipenem/cilastatin. The incremental cost-efficacy ratio (per life saved) varied between -DM72,567 and -DM350,738 for tazobactam/piperacillin. Sensitivity analyses revealed that the results were robust against various assumptions on cost parameters, clinical outcomes and length of treatment. All costs reflect 1998 values; $US1 = DM1.85. CONCLUSIONS: This study suggests that compared with imipenem/cilastatin, tazobactam/piperacillin is more cost efficacious in the treatment of intra-abdominal infections and that it offers a cost advantage through fewer relapses and lower daily therapeutic costs.

Cost-effectiveness of ceftriaxone 1 g vs second-generation cephalosporins in the treatment of pneumonia in general medical wards in Germany.

The cost-effectiveness of ceftriaxone 1 g in the treatment of pneumonia in general medical wards was compared with that of second-generation cephalosporins. A total of 1,706 patients were treated with either a second-generation cephalosporin (cefotiam, cefuroxime) or ceftriaxone (single daily dose of 1 g), and 604 in each group were included in a matched-pair analysis. Cure or improvement in response to monotherapy was observed in 81.4% of patients on cefuroxime/cefotiam vs 91% of those on ceftriaxone (P < 0.0001). Adverse events occurred with equal frequency in both groups (1.9%). In terms of mean hospital costs for antimicrobial medication, the staff required to administer it as well as laboratory and X-ray examinations, effective treatment with ceftriaxone is DM 193/$ 105 (25%) less expensive than effective treatment with a second-generation cephalosporin (P < 0.001). From the perspective of the health insurance, the costs for a patient treated with ceftriaxone are DM 3,910/$ 2,140 vs DM 4,392/$ 2,400 for a patient treated with a second-generation cephalosporin (March 1998: USD 1 = DM 1.83).

Cost-effectiveness of ceftazidime or imipenem/cilastatin versus ceftriaxone + aminoglycoside in the treatment of febrile episodes in neutropenic cancer patients in Germany.

A three-pronged cost-effectiveness analysis of the treatment of febrile episodes in neutropenic cancer patients was conducted. It included a review of 37 randomized, controlled studies in the MEDLINE and EMBASE databases (1980-1996). Clinical outcomes as well as costs of treatment with imipenem/cilastatin, ceftazidime and ceftriaxone + aminoglycoside were compared. Primary therapy and modification, respectively, were successful in 62 and 27% of patients treated with imipenem/cilastatin, in 56 and 31% with ceftazidime and in 41 and 13% with ceftriaxone + aminoglycoside. From the perspective of a 1,800-bed teaching hospital, the average overall cost per successfully treated patient was DM 7,475 with imipenem/cilastatin, DM 7,810 with ceftazidime and DM 8,963 with ceftriaxone + netilmicin (DM 1 = USD 0.56; 7/97). The costs for the German national economy were imipenem/cilastatin DM 23,828, ceftazidime DM 24,985 and ceftriaxone + netilmicin DM 29,838.