[Skin cancer screening and treatment costs : Utilisation of the skin cancer screening and skin cancer treatment costs in organ transplant recipients]. / Hautkrebsscreening und Behandlungskosten : Inanspruchnahme des Hautkrebsscreenings und Kosten der Hautkrebsbehandlung bei organtransplantierten Patienten.

BACKGROUND: Organ transplant recipients have an up to 250-times higher risk to develop skin cancer. This article evaluated the utilisation of skin cancer screening and the treatment costs for skin cancer in organ transplant recipients. Patients of the health insurance AOK Bremen/Bremerhaven had been identified and the need for skin cancer prevention trainings was derived. METHODS: The number of organ transplant recipients (ICD code Z94.0-4) with and without any history of skin cancer (ICD code C43/C44), the utilisation of dermatologic health care services, and the costs for treatments with the diagnosis Z94.0-4 with and without C43/C44 were evaluated. The analyses were carried out for the period from 2009-2014 by using the accounting systems of the AOK. RESULTS: Between 2009 and 2014, 231 organ transplant recipients had been recorded. By mid-2014, 20% of these insured persons developed skin cancer and the mean incidence was 2.76% per year. On average, 43% of these patients were seen by a dermatologist at least once a year, whereby only 15% of the organ transplant recipients participated in the annual skin cancer screening. In 29% of the patients without any history of skin cancer, a skin examination was never performed by a dermatologist or a general practitioner. In all, 17 inpatient cases of organ transplant recipients with the primary diagnosis C43/C44 were analyzed. This resulted in total costs of 54,707 € (on average about 3200 € per case). CONCLUSIONS: The increased incidence of skin cancer and the associated treatment costs indicate the need for skin cancer prevention training.

The contribution of comorbidities to mortality in hospitalized patients with heart failure.

BACKGROUND: Heart failure (HF) with reduced ejection fraction (HFrEF) has a worse prognosis than HF with preserved EF (HFpEF). The study aimed to evaluate whether different comorbidity profiles of HFrEF- and HFpEF-patients or HF-specific mechanisms contribute to a greater extent to this difference. METHODS: We linked data from two health insurances to data from a cardiology clinic hospital information system. Patients with a hospitalization with HF in 2005-2011, categorized as HFrEF (EF < 45%) or HFpEF (EF ≥ 45%), were propensity score (PS) matched to controls without HF on comorbidites and medication to assure similar comorbidity profiles of patients and their respective controls. The balance of the covariates in patients and controls was compared via the standardized difference (SDiff). Age-standardized 1-year mortality rates (MR) with 95% confidence intervals (CI) were calculated. RESULTS: 777 HFrEF-patients (1135 HFpEF-patients) were PS-matched to 3446 (4832) controls. Balance between patients and controls was largely achieved with a SDiff < 0.1 on most variables considered. The age-standardized 1-year MRs per 1000 persons in HFrEF-patients and controls were 267.8 (95% CI 175.9-359.8) and 86.1 (95% CI 70.0-102.3). MRs in HFpEF-patients and controls were 166.2 (95% CI 101.5-230.9) and 61.5 (95% CI 52.9-70.1). Thus, differences in MRs between patients and their controls were higher for HFrEF (181.7) than for HFpEF (104.7). CONCLUSIONS: Given the similar comorbidity profiles between HF-patients and controls, the higher difference in mortality rates between HFrEF-patients and controls points more to HF-specific mechanisms for these patients, whereas for HFpEF-patients a higher contribution of comorbidity is suggested by our results.

[Return to Work After Shoulder Arthroscopy as an Index of Cost Effectiveness]. / Nutzenbewertung der minimal-invasiven Schulterchirurgie aus Sicht der Kostenträger.

Cost-effectiveness of shoulder arthroscopy was analyzed and assessed by the days off work as part of the indirect costs. We retrospectively evaluated a group of 266 inpatients on sick leave after arthroscopic shoulder surgery. Mean duration till return to full duty was 9.5 days, the mean sick leave benefit was € 485. There was a statistically significant difference in the mean time to return to work between the older (age >50) and the younger group (age under 50). Secondary data analysis of sick leave and sickness benefits as indirect costs of medical treatment seems to be well suited to provide essentiell information to health care policy makers and those charged with distributing disability funds.