German Health Insurance Data Research Articles

Increase in the incidence of severe hypoglycaemia in people with Type 2 diabetes in spite of new drugs: analysis based on health insurance data from Germany.

To evaluate the use of new anti-hyperglycaemic agents that offer effective glycaemic control while reducing risk of hypoglycaemia, by analysing the incidence rates of severe hypoglycaemia in 2006 vs 2011 in relation to the medication. This cross-sectional, population-based study used German health insurance data. All adults diagnosed with Type 2 diabetes mellitus (extrapolated to the German population: 6.35 million in 2006 and 7.52 million in 2011) were screened for severe hypoglycaemia. Anti-hyperglycaemic agents were identified by their Anatomical Therapeutic Chemical code, and defined daily doses of each medication were calculated. The severe hypoglycaemic event rate was 460 per 100,000 people/year in 2006 and 490 per 100,000 people/year in 2011. In 2006 and 2011, 10.9% and 7.3%, respectively, of all people with severe hypoglycaemia were on sulfonylureas, while 12.7% and 9.3%, respectively, were on a combination therapy of metformin and sulfonylureas. Among those with severe hypoglycaemia, there were no prescriptions of dipeptidyl peptidase-4 inhibitors or glucagon-like peptide-1 receptor agonists in 2006, but in 2011, 1.55% and 0.17%, of those with severe hypoglycaemia were receiving the respective treatments. In 2006 vs 2011, human insulin was prescribed for 11.3% vs 10.3% of people with severe hypoglycaemia, while insulin analogues were prescribed for 5.4% vs 8.1%, and mixed human insulins for 19.7% vs 14.0% of patients with severe hypoglycaemia. People receiving insulin analogue therapy had a higher risk of severe hypoglycaemia than those receiving metformin, after adjusting for age, gender, nephropathy diagnosis and year of survey (odds ratio 14.6; CI 13.3-15.9). The incidence of severe hypoglycaemic events in Germany increased between 2006 and 2011, despite increased use of newer anti-hyperglycaemic agents and decreased use of insulins.

Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data

PurposeTo examine the implementation of the clinical practice guideline ⿿first epileptic seizure and epilepsy in adulthood⿿ published in 2008 to patients with newly diagnosed epilepsy between 2008 and 2014. MethodThis retrospective, population-based analysis was performed on patient data of 4.1 million insurants from the German statutory health insurance. Prevalent and incident cases in adults were identified based on ICD-10 codes, using a hierarchical diagnosis selection algorithm. The first anticonvulsive agent in a newly diagnosed epilepsy patient was validated against the clinical practice guideline. ResultsWe determined an annual crude prevalence rate in adults between 0.946% and 1.090% and incidence rates of at least 156 per 100,000. A significant increase in guideline compliant monotherapy was found in patients with a focal epilepsy syndrome, while, among patients with idiopathic generalised epilepsies, the share of guideline noncompliant monotherapy increased. Both changes are likely due to the overall increase in prescription of levetiracetam from 19.6% in 2008 to 58.9% in 2014 in all newly treated patients. Overall, the proportion of enzyme-inducing anticonvulsants fell significantly from 20.7% in 2008 to 4.3% in 2014 (p<0.001). The likelihood to receive non-enzyme-inducing antiepileptic drugs was 5.82 (95% CI 4.62⿿7.33) higher in 2014 than in 2008. ConclusionInitial monotherapy for focal epilepsy is in line with current clinical practice guidelines and mainly implemented by prescription of levetiracetam. Further evaluations should address the question of whether patients treated in line with the guidelines have a favorable outcome, compared to patients not treated in line with current guidelines.

Addison's disease with polyglandular autoimmunity carries a more than 2·5-fold risk for adrenal crises: German Health insurance data 2010-2013.

Adrenal crises are potentially life-threatening complications in patients with adrenal insufficiency (AI). Our objective was to investigate the frequency of adrenal crises in different forms of AI. The Statutory Health Insurance (SHI) database of the Techniker Krankenkasse - covering more than 12% of the German population - was analysed for diagnostic codes from 1 January 2010 to 31 December 2013. By analysis of routine data from a large healthcare provider. Diagnoses of AI were recorded and classified in primary AI, secondary AI and autoimmune polyglandular syndrome (APS). The ICD-code E27·2 (AC) was retrieved in all cohorts. We found a prevalence of 222/million for secondary and 126/million for primary AI. AC was documented with a frequency of 4·8/100 patient years. Crises were significantly more frequent in patients with primary (7·6/100 patient years) compared to those with secondary AI (3·2/100 patient years; P<0·0001). Prevalence of crises was higher in individuals with APS (10·9/100 patient years) and highest in patients with primary AI and type 1 diabetes (12·5/100 patient years). Applying a SHI database comprising more than 9 million individuals, we identified robust data about the risk of AC in different groups of patients with AI. Our data confirm and extend the clinical observation that patients with APS are at highest risk for AC. Approximately 1 of 8 patients with primary AI and type 1 diabetes suffers from an AC each year. Specific targeting of efforts aiming at the prevention of AC is necessary.

Long-term Application of Opioids for Non-Tumor Associated Pain--Impact of the S3 Guidelines for the Field of Orthopaedic Surgery and Trauma Surgery

The S3 guidelines for long-term application of opioids for non-tumour-associated pain, the so-called "LONTS", have recently been updated. German health insurance data indicated that over the last 3 to 4 years an increasing number of patients have been treated with opioids for non-tumour-associated pain. Many patients with somatoform pain disorder were treated with opioids. The S3-guidelines have therefore been modified after 5 years on the basis of a systematic literature search. Seventeen experts in the field were appointed. In addition, among 25 medical societies, one psychological society, two patient support groups, and the DGOOC and IGOST were involved in the decision making process. According to the updated S3 guidelines "LONTS", opioids are a valuable treatment option in the field of orthopaedics and trauma surgery for patients suffering from chronic arthritis or back pain. One third of the patients suffering from chronic arthritis or knee pain benefit from long-term application (< 26 weeks) and show pain relief, as well as improved range of motion without severe drug-induced side effects. Patients suffering from fibromyalgia syndrome benefited from treatment with tramadol, but no other opioid is recommended for fibromyalgia. Opioids are contraindicated in primary headaches, as well as in functional and psychological disorders with pain as the leading symptom. Treatment with opioids is associated with considerable risks, among them substance abuse, sexual dysfunction and an increased mortality rate. Supportive measures, such as physical therapy, physiotherapy and/or psychotherapy, are always recommended. Opioid analgetics are a treatment option for particular pain syndromes (arthritis, back pain). However, the latest S3 guidelines emphasise patient education and therapy. The indication, effects, side effects and therapeutic objectives should be regularly assessed, both before and during treatment. Once therapeutic goals have been achieved, measures such as physical therapy, physiotherapy or psychotherapy should be continued, whereas opioid dosage should be gradually reduced.

More than 2.5-fold increased risk for adrenal crises in patients with Addison's disease and the autoimmune polyglandular syndrome compared with secondary adrenal failure: German health insurance data 2010--2013

More than 2.5-fold increased risk for adrenal crises in patients with Addison's disease and the autoimmune polyglandular syndrome compared with secondary adrenal failure: German health insurance data 2010--2013

Risk for adrenal crises is remarkably increased in patients with the autoimmune polyglandular syndrome: German health insurance data 2010 – 2013

Introduction: Adrenal crises are potentially life-threatening complications in patients with adrenal insufficiency (AI). Our objective was to investigate the frequency of adrenal crises in patients with different forms of AI in the Techniker Krankenkasse (TK), one of the largest German Health Insurance providers, covering more than 12% of the German population.

Recommendation of rotavirus vaccination and herd effect: a budget impact analysis based on German health insurance data.

The objective of this study was to assess the budget impact and health effects of introducing rotavirus (RV) vaccination in Saxony, Germany, from a health insurance perspective. Special emphasis is given to the herd effect. We analyzed direct medical and non-medical costs of RV infection for Social Health Insurance between 2007 and 2010 based on 360,000 routine data observations from the AOK PLUS for children below 5 years of age. We compared the actual annual number of RV cases (vaccination scenario) with the number derived from 2005 (no vaccination, base case scenario). The vaccination coverage rate has increased from 5 % to 61 % between 2007 and 2010. The number of RV cases decreased by 21 % from 32,274 in 2007 to 25,614 in 2010. Based on vaccination coverage, the total cost savings per 1,000 children due to RV vaccination was estimated to be 39,686 Euros. The overall share of outpatient costs was 60 %. Mean gross cost savings were expected to be 304 Euros per avoided case. The net cost savings were expected to be 19 Euros per avoided case. About 59 % of total savings was due to herd protection resulting from increasing vaccine rates. The herd effect per avoided case increased with increasing vaccine coverage. Incidence of RV cases, vaccination costs and days absent from work were sensitive parameters. This retrospective analysis showed that the increase in RV vaccination coverage in Saxony has been budget neutral if not cost saving for sick funds.

Economic burden of neural tube defects in Germany

ObjectiveFailure of closure of the neural tube often leads to serious malformations, including spina bifida, anencephaly and encephalocoele. Despite improvements in medical and surgical treatment, the burden associated with spina bifida is substantial but country-specific data are lacking outside North America. This study aims to improve understanding of the economic implications and burden associated with the morbidity of children and adults with neural tube defects (NTDs) in Germany. Study designRetrospective data analysis. Methods2006–2009 German health insurance data of persons with NTDs (spina bifida and encephalocoele) were analysed to determine the economic burden of illness associated with NTDs in Germany. Cases were identified using ICD-10 codes; data included outpatient and inpatient care, rehabilitation, remedies and medical aids, pharmacotherapy use, long-term care and information on sick leave. The analysis was stratified by age group to provide a burden estimate specific to a person's age. To obtain an indicator of incremental burden to the Statutory Health Insurance (SHI), results were compared to the standardized healthcare expenditures according to the German Risk Compensation Scheme (RSA). ResultsOverall, 4141 persons with an ICD code related to NTDs were identified (out of a population of 7.28 million persons screened). The administrative prevalence ranged from 0.54 to 0.58 per 1000 enrollees. Of those, 3952 (95.4%) were diagnosed with spina bifida. The average annual mean healthcare expenditure of persons with spina bifida was €4532 (95% CI = 4375–4689, SD = 9590, Median = 1000), with inpatient care contributing €1358 (30.0%), outpatient care €644 (14.2%), rehabilitation €29 (0.6%), pharmacotherapy €562 (12.4%), and remedies and medical aids €1939 (42.8%). The incremental cost due to spina bifida was substantially higher than the standardized SHI expenditures for all age groups. The difference was highest for persons ≤10 years old (€10,971 vs €2360 for the age group ≤1, €8599 vs €833 for the age group 2–5 years and €10,601 vs €863 for the age group 6–10 years). The difference was smallest for the age group 41–50 years (€2524 vs €1101) and for 71 years and over (€5278 vs €4389). ConclusionExpenditures of persons with spina bifida exceeded the standardized SHI expenditures, indicating a considerable economic burden. The economic burden is continuous throughout the person's life, with high monetary impact and exposure to the healthcare system (especially in early years of life). Efforts should be devoted to improve the prevention of NTDs and provide appropriate support for persons with NTDs, parents, and caregivers—especially in early years.

Childhood Psoriasis—An Analysis of German Health Insurance Data

This study explored the epidemiology, treatment, and comorbidities of juvenile psoriasis in Germany using health insurance data. Psoriasis is a chronic inflammatory skin condition that affects approximately 2% to 3% of the world's population. Data were obtained from a database of approximately 6.7 million individuals registered with health insurance organizations throughout Germany. The analysis considered all individuals age 18 years and younger with psoriasis who were registered in 2007. Comorbidities were identified using software based on a morbidity-based risk adjustment model. A total of 138,338 patients with a diagnosis of psoriasis were identified in the database, yielding a prevalence of 2.1%. Within this group there were 4,499 children and adolescents (≤ 18 years of age), a prevalence of 0.4%. The prevalence ranged from 0.1% at the age of 1 year to 0.8% at the age of 18 years. Most of the patients were treated with topical corticosteroids (72.2%) and antipsoriatics (e.g., tars, psoralen; 20.0%). Immunosuppressants were used in 3.3% of the cases. Juvenile psoriasis was associated with numerous significant comorbidities such as rheumatoid arthritis and inflammation (2.1%); delirium, psychosis, and psychotic and dissociative disorder (1.1%); and heart disease (0.6%). Our study demonstrated that psoriasis is more prevalent in children and adolescents than some older international investigations have documented. Analysis of the health insurance data showed that juvenile psoriasis is associated with a range of comorbidities. The data also may suggest an unrecognized burden of mental health problems in young persons with psoriasis.

The real cost of treating atrial fibrillation

This editorial refers to ‘The costs of atrial fibrillation in patients with cardiovascular comorbidities—a longitudinal analysis of German health insurance data’ by T. Reinhold et al. , on page 1275. Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia greatly impairing the quality of life as well as increasing morbidity and mortality in an ever-growing cohort of patients in the ageing society, many also suffering from concomitant cardiac conditions. Domains of care for AF patients include stroke prevention, control of the ventricular rate, and symptom management in the form of medical or invasive rhythm control. As the prevalence of this condition rises and ongoing research offers more effective, yet costlier, solutions, concerns over cost containment arise. A number of investigators have previously reported on estimated costs of AF at patient and societal levels. These data established the foundation for further studies comparing costs of conservative and invasive therapeutic strategies. The article …

Response to a Letter from Dr Falk Hoffman

We thank Falk Hoffmann and Thomas Grobe for their critical reading of our manuscript ‘The costs of atrial fibrillation in patients with cardiovascular co-morbidities—a longitudinal analysis of German health insurance data’. In their letter to the editor, they stated that the outpatient costs of our study were underestimated compared with …

Outpatient costs in patients with atrial fibrillation are underestimated

With interest we read the article by Reinhold et al .1 recently published in Europace. Using German health insurance data of 14 798 patients with a mean age of 72.2 years hospitalized for atrial fibrillation in 2004 or 2005, the authors estimated costs within the first year after the index event. Average costs totalled 7.688 Euro with only 263 Euro (3%) attributable to outpatient costs. As calculations were based on a fixed price of 29.63 Euro per physician contact, these costs correspond to an average of 8.8 contacts per year. …

The costs of atrial fibrillation in patients with cardiovascular comorbidities--a longitudinal analysis of German health insurance data

Since atrial fibrillation (AFib) is one of the most frequent cardiac disorders, the primary aim of the present study was to assess the disease-related costs as well as the course of costs associated with AFib. The study was focused on a hospitalized patient subgroup with cardiac comorbidities. We undertook a retrospective review of the medical, hospital, and drug claims data in the database of a German statutory health insurance company covering ∼5 million insured persons. The data of patients suffering from AFib were extracted by using documented hospital International Classification of Diseases Revision 10 codes during 2004 and 2005. For these patients we reviewed and summarized all the charges incurred over a 1-year period after the initial index event on the basis of weekly costs and from the third-party payer's perspective. We included 14 798 patients with primary diagnosis of AFib (44.6% male patients, mean age of 72.2 ± 10.1 years). The average weekly total first-year cost after AFib was calculated at ∼148 ± 875 Euro per patient. The cumulative total cost was ∼7688 ± 954 Euro per patient for the first year. Thirty per cent of these total costs were directly associated with Afib (2,234 ± 838 Euro). Atrial fibrillation is associated with significant economic costs from the perspective of statutory health insurance. Since the largest part of costs is attributable to inpatient stays and drug usage, an efficient management of inpatient treatment structures as well as a cost-outcome-oriented drug regime seems to be outstandingly important.