Veröffentlichungen des IGES Instituts

The optimal treatment choice for preserving quality of life (QoL) of the about 64,000 men diagnosed with prostate cancer each year in Germany still remains unclear. The objectives therefore were to estimate cost utility under day-to-day conditions of caring for men in Germany with newly diagnosed LCLRPC using hormonal therapy (HT), active surveillance (AS), radiotherapy (RT), operation (OP), or watchful waiting (WW) – HAROW.

Objective: Literature on the economic burden of anal cancer in Germany is scarce. About 84% of these cancers are associated with human papillomavirus infection. This study, therefore, aimed to assess the annual costs of human papillomavirus-related anal cancer incurred by hospitalization, inpatient rehabilitation, and sick leave in 2008 in Germany. Methods: A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to anal cancer in 2008 were analyzed. Associated numbers of anal cancer hospitalizations, healthcare resource use, and costs were identified and extracted using the ICD-10 code C21 as the main diagnosis. The annual cost of human papillomavirus-related anal cancer was estimated based on the percentage of anal cancer likely to be attributable to human papillomavirus. Results: In 2008, there were 5774 hospitalizations (39% males, 61% females), 517 inpatient rehabilitations, and 897 sick leaves due to anal cancer representing costs of E34.11 million. The estimated annual costs associated with human apillomavirus-related anal cancer were E28.72 million, mainly attributed to females (62%). Direct costs accounted for 90% (86% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 10% of human papillomavirus-related costs. Conclusions: The economic burden of human papillomavirus-related anal cancer in 2008 in Germany is under-estimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and remature death were not included. However, this study is the first analysis to investigate the economic burden of anal cancer in Germany. The estimated annual costs of human papillomavirus-related anal cancer contribute to a ignificant economic burden in Germany and should be considered when assessing health and economic benefits of human papillomavirus vaccination in both genders.

Betriebe müssen mit immer älteren Belegschaften ihre Produktivität sicherstellen. Dies ist dann ein Problem, wenn Arbeitsplätze nicht altersgerecht sind. Hier setzt die Anforderungsorientierte Tätigkeitsanalyse (AorTa) an: Sie ist eine Methode, um Arbeitsplätze altersgerechter zu machen und zur Demografiefestigkeit von Betrieben beizutragen. 2008 vom IGES Institut und der BASF SE entwickelt und pilotiert, befindet sie sich seit 2011 in der Roll-Out Phase. Dieser Beitrag stellt die Methode vor und illustriert sie anhand der Erfahrungen aus 17 bisher durchgeführten AorTen.

Diseases are considered as 'rare', if they - referring to Germany - affect no more than approximately 41,000 people. A single 'rare disease' affects currently 2,000 or 6,000 people, depending on whether it is based on the median or mean value. In total, 4.2 million people in Germany suffer from one of the 732 diseases, of which the number of incidents is known or estimated. The 'rare diseases' are often characterized by inhered or acquired genetic or epigenetic defects. They are predominantly metabolic and cancer diseases. A funding programme for 'rare diseases' exists in Europe since the year 2000 to develop therapies, in particular medicine. A main point of the programme is the 10 year market protection ofthe manufacturer before the market access of analogue active agents as 'orphan drugs' will be allowed. This is in addition to already existing protective rights from patents and 'supplementary protection certificates'. There are 62 orphan drugs currently permitted in Europe. The programme is considered successful with regard to the funding of the development of therapies. The published prevalence does not provide a sufficient basis for the prognosis ofthe economical success of orphan drugs. Prevalence and market volume can increase, when an active agent is capable of preventing deaths over a longer period of time. The increase could be several times the amount of the original prevalence. At the same time the market volume may be limited through the fact, that 'rare diseases' are diagnosed hesitantly and the access to orphan drugs may provide difficult hurdles. It is estimated that on average only a quarter of the accounted prevalence is available as market potential in the first ten years after admission to the market. Due to the admission hurdles, to which the majority of the world's population is exposed, the German market comprises approximately ten percent of the world market- much more than the German's percentage of the world population. For the pricing of orphan drugs, 'sunken costs' in the sense of R&D (Research and Development) advance payments and their required interests have to be considered. These determine the price even more, if the market volume is smaller. In a defined price model the annual therapy costs of common and very rare diseases differs between approximately five to 500,000 Euros. Rare diseases are not to be equated with personalised medicine, but they are an important step in the development of medicine. A consequence rich change has to be expected from the disease-centred to the systematic approach.

Zusammenfassung: Gerechtigkeitsdefizite und Reformbedarf werden in der Bevölkerung stärker auf der Leistungsseite als bei der Finanzierung der Krankenversicherung wahrgenommen. Entsprechend stößt die leistungsseitige Begründung einer Integrierten Krankenversicherung – gleiche Arzthonorierung und Wartezeiten für alle Patienten – auf vergleichsweise größere Zustimmung in der Bevölkerung. Finanzierungsseitig werden Reformansätze bevorzugt, mit denen die Mehrheit vermutlich für sich selbst wenig konkrete Belastungen verbindet. Jüngere Menschen zeigen sich deutlich skeptischer gegenüber den Solidaritätsprinzipien in der Finanzierung der Krankenversicherung. Hintergrund und Fragestellung: Unter Experten wird die Debatte um einen integrierten Krankenversicherungsmarkt rege und zumindest in entsprechenden Fachmedien durchaus öffentlich geführt. Über die Einschätzung der breiten Bevölkerung ist hingegen wenig bekannt, obwohl größere Veränderungen gänzlich ohne Rückhalt in der Bevölkerung kaum realisierbar erscheinen. In dem vorliegenden Artikel werden daher Gerechtigkeitsaspekte, Solidaritätsprinzipien in der Krankenversicherung und zentrale Ansatzpunkte für Reformen des Krankenversicherungssystems aus Bevölkerungsperspektive analysiert. Darüber hinaus wird die Frage gestellt, welche gesundheitspolitischen Implikationen sich aus den Einschätzungen der Bevölkerung für zukünftige Reformen ergeben und wie die Bevölkerungspräferenzen zu bewerten sind, wenn man sie den zu erwartenden Finanzierungseffekten konkreter Reform-Szenarien gegenüberstellt. Methode: Datenbasis ist eine repräsentative Stichprobe der Erwachsenenbevölkerung im Alter von 18 bis 79 Jahren, die im Nov/Dez 2012 schriftlich-postalische befragt wurde. Die Ergebnisse werden für die Häufigkeitsauszählungen mit gewichteten Daten errechnet und anhand der Variablen Einkommen und Bildung gewichtet, multivariate Verfahren (nominale Regression) erfolgen auf Basis ungewichteter Daten. Die Bewertung und Diskussion der ermittelten Bevölkerungspräferenzen erfolgt unter Berücksichtigung von Ergebnissen einer Studie, mit der die Finanzierungseffekte konkreter Reformszenarien auf Basis von mikrodatenbasierten Simulationen berechnet wurden. Ergebnisse: Eine hohe Zustimmung gab es in der Bevölkerung insbesondere für Reformansätze auf der Leistungsseite. Dort sahen die Befragten auch mehrheitlich Gerechtigkeitsdefizite mit höherem Reformbedarf (Unterschiede bei Ärztehonorierung und Terminvergabe zwischen GKV und PKV) als bei der Finanzierung. Finanzierungsseitig gab es die höchste Zustimmung zu Reformansätzen, mit denen die Mehrheit der Befragten vermutlich für sich selbst wenig konkrete Belastungen verbindet (Einbeziehung der bislang privat Versicherten in die GKV, Erhöhung staatlicher Zuschüsse). Jüngere Menschen stimmten vielen Reformansätzen weniger zu und zeigten sich zurückhaltender bei grundsätzlichen Fragen einer solidarischen Finanzierung im Gesundheitsbereich. Schlussfolgerungen: Die leistungsseitige Begründung einer Integrierten Krankenversicherung – gleiche Arzthonorierung und Wartezeiten für alle Patienten – stößt auf größere Zustimmung in der Bevölkerung, dagegen stellt sich die finanzierungsseitige Begründung einer Ausweitung des Versichertenkreises schwieriger dar, denn spürbare Entlastungen großer Bevölkerungsteile sind nicht zu erwarten. In der Bevölkerung ist mit weniger Ablehnung zu rechnen, wenn Mehrbelastungen nur mittelbar wirken oder nicht explizit erkennbar sind, etwa in Form einer Ausweitung der paritätischen Finanzierung oder einer Erhöhung von Steuerzuschüssen aus dem allgemeinen Steueraufkommen ohne spezifische „Gegenfinanzierung“. Die Frage, ob und wie die intergenerative Umverteilung in der Krankenversicherung verändert wird, sollte bei Gestaltung und Kommunikation einer künftigen Finanzierungsreform mehr Aufmerksamkeit erfahren.

Urban transport is strategically important for the economic competitiveness, social cohesion, and sustainable growth of Europe. Thus, combating traffic congestion and associated air pollution and traffic accidents are challenges for governments and transport authorities in all EU Member States. The EU is providing guidelines for cities and towns to move towards sustainable and integrated urban transport and is promoting research and demonstration of innovative and green solutions to meet the societal and environmental challenges of tomorrow. This Policy Brochure produced by the Transport Research and Innovation Portal (TRIP) highlights the contribution of research in delivering innovative solutions for sustainable and integrated urban transport.

Background: The aim of this study was to determine the health care utilization of patients with acute coronary syndrome (ACS) of one German statutory health insurance. The utilization of ambulatory services as well as of inpatient rehabilitation should be regarded. Moreover, the study should reveal the prescription of drugs for secondary prevention. Here, patients showing guideline corresponding prescriptions should be compared with patients without such prescriptions. Methods: A retrospective claims data analysis of one German statutory health insurance was conducted. Health care utilization was considered in the first year after an index hospitalization due to ACS. Beneficiaries for whom an ICD-10 discharge diagnosis of ACS was reported between January 1st 2007 and December 31st 2009 were included. In order to reveal differences in health care utilization depending on the type of ACS (STEMI versus NSTEMI/ UA) stratified analyses were performed. Another stratification was done for patients with and without defined drug prescriptions. Results: From 45,188 patients with ACS almost three quarters were assigned to the group of NSTEMI/UA. For 8.9% of all ACS patients (18.74% STEMI, 8.89% NSTEMI/UA), inpatient posthospital rehabilitation related to ACS was recorded. Ambulatory care related to CHD diagnosis was utilized by 77.6% of patients, more often by STEMI than by NSTEMI/UA patients. For 36.7% and 45.7% of ACS patients, a prescription of aspirin or clopidogrel was recorded, respectively, 79.4% of STEMI patients received at least one prescription for antiplatelet drugs, the corresponding proportion of NSTEMI/UA was 59.8%. A considerable part of patients without prescription dropped out within the first 90 days after the index event. Conclusions: A claims data analysis of one German statutory health insurance fund showed that health care utilization of ACS patients varied depending on the ACS type. It is necessary to distinguish between STEMI and NSTEMI/UA patients when discussing the ambulatory drug utilization.

Objective: Data on fracture frequency and medical care of patients with osteoporosis are still insufficient. We aimed to analyze frequency of osteoporosis-related fractures and multiple fractures, re-fracture rates, treatment prevalence, and persistence to osteoporosis-related medication in Germany. Methods and Materials: Using claims data of a state health insurer (2006 - 2009), we performed a retrospective "real world" analysis. Inclusion criteria were age of 50 years or older and an osteoporosis diagnosis or a prescription for defined osteoporosis-related medication. We assessed fractures, frequencies, and the number of multiple fractures per patient as well as time to follow-up fracture and drug persistence using Kaplan-Meier analysis. Results: Within the observation period, 27% of the osteoporosis patients sustained fractures; of those with fractures, 69% had multiple fractures. For patients with multiple fractures, re-fracture rate after 360 days was between 69% for patients who received parathyroid hormone and 85% for patients who received no anti-osteoporotic medication 360 days before follow-up fracture. In the patient population, persistence rates after 1 year were between 58% for parathyroid hormone and 2% for other osteoporosis-specific drugs (alfacalcidol, fluorides, nandrolone, calcitonin). Conclusions: In Germany, the number of patients with osteoporosis-attributable fractures is high. There are still deficits in proper treatment as well as in drug persistence. Low persistence lead to a relatively high proportion of patients with follow-up fractures.