German Health Claims Data Research Articles

Vaccination rate and adherence of tick-borne encephalitis vaccination in Germany

BackgroundTick-borne encephalitis (TBE) is an arboviral infection of the central nervous system. As there is no causal treatment of TBE, disease prevention by vaccination is especially important. Immunization consists of a three-dose primary vaccination schedule, followed by regular booster doses. In Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute recommends TBE vaccination for all those at high risk of contracting TBE. This includes individuals living in, traveling to and/or working in risk areas, and being exposed to ticks. To our knowledge, there are currently no reliable data on TBE vaccination rates in Germany available. MethodsThis retrospective cohort study based on anonymized German health claims data was conducted to determine vaccination rates of TBE primary immunization in 2012 to 2015 by federal state, compliance with the vaccination schedule, and TBE vaccination uptake for the 2011 birth cohort. Vaccination protection rates for each federal state were simulated based on a compartmental model. ResultsVaccination rates of an initiated primary immunization ranged from about 3% in the southern federal states to <1% in the northern federal states. Across all federal states, compliance with the vaccination schedule decreased with each subsequent vaccination. Slightly higher TBE vaccination uptake was determined in the 2011 birth cohort, as compared to the German school entry health examination statistics in 2017. Simulated vaccination protection rates for each federal state ranged from 10% in Hamburg to 51% in Baden-Wuerttemberg. ConclusionsWhile there was an overall low vaccination uptake and a discrepancy between areas of high vs. low TBE risk, this study also indicates a concerning decline in vaccination compliance. Vaccinating physicians should address the importance of adherence upon initiation of TBE vaccination.

Time course of dementia following sepsis in German health claims data.

ObjectiveWe evaluated the short-, medium-, and long-term effects of sepsis on dementia incidence using German health claims data.MethodsA total of 161,567 patients (65 years or older) were followed from 2004 to 2015 at quarterly intervals. Time since sepsis was categorized into 0 (the effective quarter of sepsis diagnosis), 1–8, and ≥9 quarters since the latest diagnosis of sepsis, taking into account admission to intensive care unit and controlling for delirium, surgery, age, sex, and comorbidities. Incident dementia was defined for all persons who did not have a validated dementia diagnosis in 2004 and 2005 and who received a first-time, valid diagnosis between 2006 and 2015.ResultsDuring the quarter of sepsis diagnosis, patients not admitted to intensive care had a 3.14-fold (95% CI 2.83–3.49) increased risk, and those with intensive care stay had a 2.22-fold (95% CI: 1.83–2.70) increased risk of receiving an incident dementia diagnosis compared with patients without sepsis. The impact of sepsis on incident dementia remained in the following 2 years, remitting only thereafter.ConclusionsFor sepsis survivors, medium-term dementia risk remains elevated, whereas long-term risk may reach the level of those without sepsis, even after controlling for delirium. These findings encourage identifying modifiable components of hospital and rehabilitation care.

PMS32 LONG–TERM PAIN Management Pathways of Patients with Osteoarthritis of the HIP/Knee before Joint Replacement — a Retrospective Cohort Study Based on German Health Claims DATA

PMS32 LONG–TERM PAIN Management Pathways of Patients with Osteoarthritis of the HIP/Knee before Joint Replacement — a Retrospective Cohort Study Based on German Health Claims DATA

PSY16 Healthcare Resource Utilization and Associated Costs Among Patients with Atopic Dermatitis — a Retrospective Cohort Study Based on German Health Claims DATA

PSY16 Healthcare Resource Utilization and Associated Costs Among Patients with Atopic Dermatitis — a Retrospective Cohort Study Based on German Health Claims DATA

The Effect of Heat and Cold Waves on the Mortality of Persons with Dementia in Germany

We investigated whether persons with dementia (PwD) are at particular risk of mortality when exposed to extreme temperatures and whether the temperature effect depends on long-term care (LTC) need and residency. German health claims data provide information on inpatient and outpatient sectors. Data from the German Meteorological Service were merged, and measures of immediate and delayed heat, cold, and normal temperature (Heat Index, Wind Chill Temperature Index) were calculated. Cox models were applied to explore the interaction of temperature, dementia, and LTC, as well as residency. Immediate and delayed effects of heat and cold were tested as compared to normal temperatures. Models were adjusted for age, sex, comorbidities, urban/rural living, and summer/winter climate zones. The 182,384 persons aged ≥65 contributed 1,084,111 person-years and 49,040 deaths between 2004 and 2010. At normal temperatures, PwD had a 37% (p-value &lt; 0.001) increased mortality risk compared to persons without dementia (PwoD). Immediate heat effects further increased this effect by 11% (p = 0.031); no immediate heat effect existed for PwoD. The immediate heat effect was even greater for PwD suffering from severe or extreme physical impairment and for those living in private households and nursing homes. Immediate and delayed cold effects increased mortality independent of dementia. Care level and type of residency did not modify this effect among PwD. PwD revealed an increased vulnerability to immediate heat effects. Cold waves were risk factors for both groups. LTC need appeared to be an important intervening factor.

Prevalence and Mortality of Venous Leg Diseases of the Deep Veins: An Observational Cohort Study Based on German Health Claims Data.

This study estimates the prevalence and mortality of diseases of the deep veins of the legs such as deep vein thrombosis (DVT), postthrombotic syndrome (PTS), and venous leg ulceration (VLU). We used a random sample of 250 000 patients at age 50+ years of the register of the Allgemeine Ortskrankenkasse from 2004 to 2015. Selected manifestations of venous diseases assumed as risk factors for mortality were analyzed using Cox models while adjusting for various basic demographic and health characteristics. The prevalence in 2004 was 0.05% for DVT of the femoral veins, 0.50% for DVT of any deep veins, 0.86% for PTS, and 0.91% for VLU. The mortality rate in 2004 to 2015 was 20.40 deaths/100 person-years for DVT of the femoral veins, 10.69 for DVT of any deep veins, 4.34 for PTS, and 7.02 for VLU. The model revealed a 35% higher risk (p < .001) in patients with any DVT, an 88% higher mortality (p < .001) for femoral DVT, a 23% higher risk (p < .001) for VLU, and no health disadvantage in persons with PTS. Our study revealed an increased mortality for patients with VLU and DVT. Even after adjustment for embolic events and infections of the venous ulcers mortality remained significantly higher.

Differences in medical specialist utilization among older people in need of long-term care \u2013 results from German health claims data

BackgroundElderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.MethodsWe investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.ResultsWe found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.ConclusionThe findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.

P643Association of adherence and treatment intensity of lipid-lowering therapy with cardiovascular outcomes and all-cause mortality in very high-risk patients in Germany

Abstract Introduction Both intensity and adherence to lipid lowering therapies (LLT) play an important role in effectiveness of the therapies in patients at risk for cardiovascular events. Purpose To evaluate the association of adherence and treatment intensity with cardiovascular outcomes and all-cause mortality in very high-risk patients (as defined by the current ESC guidelines) treated with statin and/or ezetimibe. Methods Retrospective cohort study was based on German health claims data (2010–2015) obtained from German Institute for Health Research (InGef) database and included patients ≥18 years with an initial LLT treatment (statin and/or ezetimibe) in 2011–2013, and diagnoses of cardiovascular disease (CVD), stage 4 or 5 chronic kidney disease (CKD) or type 2 diabetes mellitus (DM). Patients must have had at least 2 LLT prescriptions in the first year to ensure intention of treatment. Follow-up period started 1 year after the second LLT prescription and continued until one of the events of the composite study endpoint (hospitalisation for myocardial infarction, unstable angina, ischemic stroke, heart failure, revascularization, or all-cause death) or 31.12.2015, whichever occurred earlier. Adherence was measured annually by the proportion of days covered (PDC) using prescription data. Treatment intensity was quantified based on expected LDL-C reduction as described in the American College of Cardiology and American Heart Association (ACC/AHA) 2018 guidelines. Adherence and treatment intensity were multiplied to create a combined measure of intensity after accounting for adherence. Results 73,257 patients of the CVD cohort were 68 (SD=12) years old, 59% men; the DM cohort (no CVD) had 13,584 patients, age 64 (10), 47% men; 472 patients in the CKD cohort (no CVD) were 65 (15) years old, 46% men. In a Cox proportional hazards model, each 10% increase in treatment intensity (LDL-C lowering) was associated with 18% lower risk of CV event in the CVD (HR 0.82, 95% CI 0.82–0.83), 21% - in the DM (HR 0.79, 95% CI 0.76–0.83), and 15% - in the CKD (HR 0.85, 95% CI 0.75–0.97) cohorts. Similarly, each 10% increase in adherence (PDC) was associated with 6% lower risk of CV event in the CVD (HR 0.94, 95% CI 0.93–0.94), 7% - in the DM (HR 0.93, 95% CI 0.91–0.94), and 7% - in the CKD (HR 0.93, 95% CI 0.89–0.97) cohorts. Each 10% increase in adherence-adjusted intensity was associated with 16% lower risk of CV event in the CVD (HR 0.84, 95% CI 0.83 - 0.85), 19% - in the DM (HR 0.81, 95% CI 0.78–0.85), and 17% - in the CKD (HR 0.83, 95% CI 0.72–0.96) cohorts. The models controlled for age, sex, Charlson comorbidity index and other cardiovascular risk factors at baseline. Conclusions A higher adherence and/or treatment intensity of LLT was associated with significantly lower risk of CV outcomes or all-cause death in German very high-risk patients. Strategies to tailor intensity to patient profile and improve adherence could further lower risk of CV events. Acknowledgement/Funding Amgen Europe GmbH

Different treatment forms of type II diabetes and the risk of dementia in German health claims data.

The association between type II diabetes (T2D) and increased all-cause dementia risk is well established. However, to date, there is no definite proof that a specific therapy for diabetes can halt a progress of cognitive decline. Therefore, we analyzed a large longitudinal random sample of German health claims data to focus on associations between T2D and dementia and to elucidate the role of different treatment forms of T2D on the risk for dementia. We used a longitudinal random sample (n = 250,000) of claims data of the largest public sickness fund in Germany, the Allgemeine Ortskrankenkasse (AOK). Dementia was defined as ICD-10 codes G31.0, G31.82, G23.1, F00, F01, F02, F03, and F05, and T2D was defined as E11-E14. We performed Cox proportional hazard models to explore the transition into dementia and to calculate the relative risk of dementia dependent on T2D and different T2D treatment forms. All models were adjusted for sex, age, and each patient's history of depression, renal insufficiency, and cardiovascular comorbidities. Non-pharmacologic-treated diabetics showed a 23% increased dementia risk (p < 0.001) and oral ADM-treated diabetics showed a 16% increased risk (p < 0.001). Insulin-dependent diabetics is still the highest dementia risk (40%; p < 0.001) and obesity additionally attenuated this risk (75%; p < 0.001) increased risk. We found that diabetes is an independent risk factor for all-cause dementia. An increased risk for dementia in insulin-dependent and obese subjects with diabetes was evident. Longitudinal studies on the effect of different forms of therapy and weight reduction are needed to verify the results of this study.

Burden of community-acquired pneumonia, predisposing factors and health-care related costs in patients with cancer

BackgroundData on the burden of community-acquired pneumonia (CAP) and health-care related costs in patients with cancer is scarce. We aimed to estimate the CAP incidence rate, mortality, and healthcare-related costs of CAP patients with different cancer subtypes in Germany.MethodsWe used German health claims data of a representative sample of 4 million subjects to conduct cohort studies in patients with a new diagnosis of lung, hematological, breast, gastro-intestinal tract and renal/urinary-tract cancer and a comparator cohort without cancer between 2011 and 2015. CAP cases were identified in both the hospital and ambulatory care setting. Crude and age- and sex-standardized incidence rates (sIR) of CAP and mortality after CAP were calculated. To compare the health care-related costs of cancer patients with and without a diagnosis of CAP, a propensity-score (PS) matched control group was created.ResultsThe study population comprised of 89,007 patients with cancer. In lung cancer patients, the sIR was increased 21-fold compared to the control cohort. For the other cancer subtypes, the sIR was increased 4.3-fold (hematological malignancies) to 1.7-fold (breast cancer) compared to the control cohort. The 30-day mortality in CAP cases was highest in lung cancer patients with 20.0% and ranged from 7.2 to 18.5% in CAP cases with other cancer subtypes. The highest costs were observed in CAP cases with hematological malignancies with 28,969 € (SD 37,142 €) and the lowest in patients with renal/urinary tract cancer with 17,432 € (SD 19,579 €). The absolute difference in the mean overall costs between CAP cases and controls without CAP ranged from 4,111€ to 9,826€, depending on the cancer type. CAP-related costs were predominantly triggered by substantially elevated hospital costs in CAP cases.ConclusionsThe incidence rate of CAP and related mortality is high in patients with cancer with strong variations by cancer subtype. Furthermore, CAP in cancer patients is associated with substantial direct excess costs.

Incidence and costs of cardiac device infections: retrospective analysis using German health claims data.

Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Patients had an implantable cardioverter defibrillator implanted over 2010-2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Risk of CDI 12months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence.

Economic and clinical benefits of endometrial radiofrequency ablation compared with other ablation techniques in women with menorrhagia: a retrospective analysis with German health claims data.

ObjectiveTo evaluate the economic and clinical benefits of endometrial radiofrequency ablation (RFA) compared with other ablation techniques for the treatment of menorrhagia.MethodsUsing German health claims data, women meeting defined inclusion criteria for the intervention group (RFA) were selected. A comparable control group (other endometrial ablations) was established using propensity score matching. These two groups were compared during the quarter of treatment (QoT) and a follow-up of 2 years for the following outcomes: costs during QoT and during follow-up, repeated menorrhagia diagnoses during follow-up and necessary retreatments during follow-up.ResultsAfter performing propensity score matching, 50 cases could be allocated to the intervention group, while 38 were identified as control cases. Patients in the RFA group had 5% fewer repeat menorrhagia diagnoses (40% vs 45%; not significant) and 5% fewer treatments associated with recurrent menorrhagia (6% vs 11%; not significant) than cases in the control group. During the QoT, the RFA group incurred €578 additional costs (€2,068 vs €1,490; ns). However, during follow-up, the control group incurred €1,254 additional costs (€4,561 vs €5,815; ns), with medication, outpatient physician consultations, and hospitals costs being the main cost drivers. However, none of the results were statistically significant.ConclusionAlthough RFA was more cost-intensive in the QoT compared with other endometrial ablation techniques, an average total savings of €676 was generated during the follow-up period. While having evidence that RFA is clinically equivalent to other endometrial ablation procedures, we generated indications that RFA is non-inferior and favorable with regard to economic outcomes.

Economic Benefits Of Endometrial Radiofrequency Ablation Compared With Other Endometrial Ablation Techniques In Women With Menorrhagia: A Retrospective Analysis With German Health Claims Data

Economic Benefits Of Endometrial Radiofrequency Ablation Compared With Other Endometrial Ablation Techniques In Women With Menorrhagia: A Retrospective Analysis With German Health Claims Data

Risk of Long-Term Care Dependence for Dementia Patients is Associated with Type of Physician: An Analysis of German Health Claims Data for the Years 2006 to 2010.

As the population ages, the numbers of people developing care- and cost-intensive forms of dementia are raising. We investigated the pathways of incident dementia patients to long-term care (LTC) dependence and death, and examined the effects of: (1) the type of the main treating physician, differentiated by neurologists/psychiatrists (NPs) and non-NPs; (2) the prescription of antidementive drugs on the risk of needing LTC, differentiated by the degree of care need. Longitudinal claims data of the largest German public sickness fund of 10,043 incident dementia cases aged 60 years and above were analyzed for the years 2006 to 2010. Cox proportional hazard models were performed to investigate the risk of LTC and death based on what type of physician was treating the patient, and whether the patient was prescribed antidementive drugs; adjusted for age, gender, cardiovascular comorbidities, and the previous LTC level. The patients who were primarily treated by NPs had a significantly lower risk of LTC than patients who were mainly treated by non-NPs (considerable LTC: RR = 0.72, p = 0.000, severe LTC: RR = 0.78, p = 0.000, extreme LTC: RR = 0.67, p = 0.001). They generally had a lower risk of death. Antidementive drug treatment was correlated with an increased risk of LTC (considerable LTC: RR = 1.66, p = 0.000, severe LTC: RR = 1.50, p = 0.000, extreme LTC: RR = 1.48, p = 0.000) but with a decreased risk of death. A higher rate of involvement of specialists in the treatment of dementia patients is associated with a reduced LTC dependence and increased survival of dementia patients. Antidementive drug treatments appear to extend live years with dementia.

Economic and clinical benefits of radiofrequency ablation versus hysterectomy in patients suffering from menorrhagia: a retrospective analysis with German health claims data

Objective: To assess clinical and economic benefits of radiofrequency ablation (RFA) compared to hysterectomy when treating patients suffering from menorrhagia. Methods: Based on German health claims data, a retrospective, longitudinal, observational analysis was performed. Patients having continuously statutory health insurance coverage during the study and being coded for menorrhagia and a relevant treatment option were included in the analysis. The control group was created using propensity score matching. Results: We discovered that using RFA generates cost savings of €1844 during the quarter of performance. As direct costs during a 2-year follow-up show similar levels in both groups, these initial savings can be preserved. This is partly because even if more patients in the RFA group were re-coded for menorrhagia after initial therapy, just a small proportion of these patients required another surgical intervention. Conclusion: RFA should more often be considered a relevant treatment option both from an economic and a medical point of view.

PHS51 Hospital Stays of Multiple Sclerosis Patients in Germany – Reasons, Frequencies, Duration and Impact on Drug Therapy

This study provides insights into hospital stays of German statutorily insured MS patients, compared to all insurants, not affected by the disease. Information was extracted from a large longitudinal database of German health claims data. Roughly 3.000 MS patients were identified by ICD-10 diagnoses and information on drug prescriptions. The observational period lasts from 2006 until 2010. All hospitalizations of MS patients were included in the analysis. In 2009, MS patients had 0,57 hospitalisations on average (SD 1,30) with a mean length of stay of 6,7 days (SD 8,0). Hospital stays of all insured patients were less frequent (0,20; SD 0,71) and had an average duration of 6,9 days (SD 11,9). Roughly 46,4% of the hospital stays of MS patients were due to MS. Among those, 78% were coded with the DRG B68D [treatment of MS and cerebral ataxia without complications or comorbidities (CCs)], while 19% were coded as treatment of MS with CCs (DRG B68A). The following diagnostic procedures were observed quite often visual evoked potential (12%), somatosensory evoked potential (11,6%), and MRT (8%), as were procedures such as 6-003.f0 [Natalizumab, parental 300 – 600 mg] related to escalating drug therapy (6%). Many hospital admissions were observed shortly before changes in drug therapy: 41% of patients with a transition from basic to escalating treatment regime were hospitalized within 6 months preceding the therapy change. 11% of those patients were admitted in the month of treatment transition. Changes of medication within the basic therapy seem to be similarly affected by admissions (28% and 10% respectively). MS patients are hospitalized on average more than twice as often as all insurants. Almost half of all hospital stays among MS patients are related to the treatment of MS, which frequently leads to a change in drug therapy.