Veröffentlichungen des IGES Instituts

Zur Diskussion über starke und abrupte Beitragserhöhungen in der privaten Krankenversicherung (PKV) vor allem bei älteren Versicherten liefert eine Studie erstmals fundierte Daten. Danach müssen langfristig privat Krankenversicherte im Alter nicht zwangsläufig höhere Prämien als Jüngere zahlen. Die Studie basiert auf Langzeitdaten der vergangenen 20 Jahre von Versicherten des größten privaten Krankenversicherers in Deutschland.

Der Arzneimittel-Atlas - für einen realistischen Blick auf den Arzneimittelmarkt Valide Informationen über den Verbrauch von Arzneimitteln sind für gesundheits- und wirtschaftspolitische Entscheidungen unabdingbar. Der Arzneimittel-Atlas liefert für den Arzneimittelmarkt seit mehr als 10 Jahren transparente und strukturierte Informationen über die Entwicklung der Verordnungen zulasten der Gesetzlichen Krankenversicherung (GKV). Das Standardwerk untersucht dafür den gesamten ambulanten Arzneimittelmarkt, setzt dabei Akzente und zeigt in diesem Buch die Ergebnisse besonders dynamischer Indikationsgruppen.

BACKGROUND: Follow-up care after kidney transplantation is performed in transplant centers as well as in local nephrologist's practices in Germany. However, organized integrated care of these different sectors of the German health care system is missing. This organizational deficit as well as non-adherence of kidney recipients and longterm cardiovascular complications are major reasons for an impaired patient and graft survival. METHODS: The KTx360 degrees study is supported by a grant from the Federal Joint Committee of the Federal Republic of Germany. The study will include 448 (39 children) incident patients of all ages with KTx after study start in May 2017 and 963 (83 children) prevalent patients with KTx between 2010 and 2016. The collaboration between transplant centers and nephrologists in private local practices will be supported by internet-based case-files and scheduled virtual visits (patient consultation via video conferencing). At specified points of the care process patients will receive cardiovascular and adherence assessments and respective interventions. Care will be coordinated by an additional case management. The goals of the study will be evaluated by an independent institute using claims data from the statutory health insurances and data collected from patients and their caregivers during study participation. To model longitudinal changes after transplantation and differences in changes and levels of immunosuppresive therapy after transplantation between study participants and historical data as well as data from control patients who do not participate in KTx360 degrees , adjusted regression analyses, such as mixed models with repeated measures, will be used. Relevant confounders will be controlled in all analyses. DISCUSSION: The study aims to prolong patient and graft survival, to reduce avoidable hospitalizations, co-morbidities and health care costs, and to enhance quality of life of patients after kidney transplantation. TRIAL REGISTRATION: ISRCTN29416382 (retrospectively registered on 05.05.2017).

Aus der Welt der Arzneimittel ist die sog. ,,frühe Nutzenbewertung" bereits seit 2004 (GKV-Modernisierungsgesetz) mit dem § 35a SGB V bekannt. Seit März 2016 regelt nun der eingeführte § 137h SGB V die Nutzenbewertung für Neue Untersuchungs- und Behandlungsmethoden, die maßgeblich auf dem Einsatz eines Medizinprodukts einer hohen Risikoklasse beruhen. In 2016 wurden die ersten acht Methoden bewertet. Die Bewertungsverfahren für 2017 stehen kurz bevor. Eine Bilanz zu den bisherigen Ergebnissen und deren Folgen für den Versorgungsalltag.

BACKGROUND: Studies assessing the routine outpatient dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in Germany are scarce. The aim of this study was (i) to investigate the initiation and duration of DAPT after inpatient PCI with stent implantation in Germany, and (ii) to identify factors associated with DAPT discontinuation during the recommended treatment period. METHODS: This retrospective cohort study was based on data from a large German electronic healthcare database of the years 2004 to 2009. The study population comprised four groups of patients with acute coronary syndrome (ACS) or stable angina pectoris undergoing inpatient PCI with either bare metal stent (BMS) or drug eluting stent (DES) implantation between 2005 and 2008. Initiation of outpatient DAPT within a period from 100 days before the PCI to 60 days after the PCI was ascertained. Time until end of treatment was analysed using the Kaplan-Meier method. Factors potentially associated with DAPT discontinuation, like sex, age, cardiovascular comorbidity, contraindications, and other antithrombotic drugs were analysed in a Cox proportional hazard model. RESULTS: The cohort comprised 37,001 patients. Depending on the type of stent and the indication for the PCI, DAPT was initiated in 85 % (ACS/BMS) and 95 % (AP/DES) of all patients. Of those, 12 % (AP/DES) and 64 % (ACS/BMS) discontinued DAPT during the recommended treatment duration. An age of over 80 years (OR 1.2-1.5 compared to patients aged 0-49 years) and the use of phenprocoumon (OR 2.7-5.0 compared to no phenprocoumon) were associated with an increased risk of DAPT discontinuation. CONCLUSIONS: A high proportion of patients with coronary artery disease undergoing inpatient PCI with stent implantation received DAPT. However, DAPT discontinuation during the recommended time span was frequent, particularly in patients suffering from ACS. On the other hand, especially patients with AP and DES were often treated longer than recommended.