German Health System Research Articles

Primary Care Aspects in the German Coalition Agreement 2021

Despite statewide rising numbers of family physicians during the last legislative period, their overall health care providing capacity has declined, mainly due to their working part-time. In the legislative period starting in 2021, this trend appears likely to continue. The German Health System Advisory Council foresees the number of general practitioners (GPs) who will have to be replaced by the next federal election in 2025 as exceeding 26,000. This results in a need for political action to sustain the primary care workforce. We conducted a content analysis of the coalition agreement 2021 between SPD, Greens and FDP with regard to explicit and related topics of GP care. A mixed inductive-deductive classification of the included text passages was used to thematically structure the results. A total of 34 relevant text passages were identified between pages 8 to 139 of the coalition agreement. Family physician care was explicitly addressed only once, when the planned abolition of budgeting was discussed. Other proposals which affect family physicians work included reduction of bureaucracy, prevention, or easier access to medical care for disadvantaged groups. Other passages of the coalition agreement regarding security of medical supply, included demand planning, innovative healthcare models, and cross-sectoral care. One focus of the coalition agreement was on digitalization. It mentions e. g., a digitization strategy for the healthcare sector, telemedicine services, and the electronic medical record, including opt-out possibility. Other assessed passages included projects to facilitate research or climate change and health. Despite the lack of mention of family physicians in the coalition agreement, many projects relate to the work of family physicians. Some of the ideas mentioned have also already been written down by the German Society for General Practice and Family Medicine (DEGAM) in its positions on the future of general practice, digitization or climate change and health. The planned projects in the coalition agreement have the potential to strengthen health care by family doctors and also make it more attractive for young doctors. However, further measures may be necessary to maintain GP care in the short and long term.

The impact of SARS-CoV-2 measures on patient samples and complication rates in spine surgery - A single center analysis.

Over the past two years during the pandemic, the German health system has taken drastic measures, like the continuous use of face masks for all staff, restrictions of hospital visits as well as cancellation of elective surgical procedures. As a potential side effect of these measures, a significant reduction of surgical site infections was reported for neurosurgical patients. The purpose of our study was to analyze the impact of these measures on spinal surgery. We performed a retrospective analysis to compare patient samples, procedures and infection rates before (January 2019 - March 2020) and during (April 2020 - June 2021) the pandemic to evaluate the impact of the measures mentioned above. Demographic and clinical data were collected and correlated with the occurrence of postoperative complications, especially infection. Our analysis showed no relevant decrease of spine surgeries (838 surgeries in non-pandemic group vs. 831 surgeries pandemic group). The most common postoperative complication was wound infection in both groups, followed by urinary tract infection and pneumonia. In both patient groups, infections were more prevalent in surgeries of multilevel posterior instrumentation. Comparing the two groups of patients, a slight, non-significant (0.5%) reduction of overall postoperative complications in the pandemic group was observed. However, the number of spinal surgeries classified as emergencies in our institution increased by 10.2% during the last 15 months of the COVID-19 pandemic. In line with this finding the urgent transfer of patients from smaller hospitals increased by 14.2%, compared to previous years. The volume of spinal surgeries remained high and complication rates stable during the pandemic. A reason why complication rates did not drop as reported previously might be a significant change in patient sample due to the increase of emergency surgeries. A decrease of complication rates, especially infections by the measures of infection prevention for the pandemic was not observed.

Experiencing COVID-19, home isolation and primary health care: A mixed-methods study.

Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.

Piloting a Health System Performance Assessment for Germany - insights from trend and equity analyses

Abstract Background Health System Performance Assessment (HSPA) is a tool for the evaluation of the performance and efficiency of a health system and can be used for evidence-based policymaking. For the first time, a country specific HSPA for the German health system is piloted with a focus on trend and equity analyses. Methods Based on the conceptual framework developed in a feasibility study, the pilot study in Germany has being conducted between 2020 and 2023. The framework includes 90 internationally compatible indicators, each of which can be assigned to one of nine dimensions (e.g., access, quality, population health, responsiveness, efficiency). The aim of this pilot study is to conduct trend analyses over the period 2000-2020 and equity analyses (e.g., age, gender, region, education). Data from 56 different national and international secondary data sources (e.g., epidemiologic registry data, claims data, and survey data) were collected, analyzed, and compiled in a report. Results In total, 84 of the 90 indicators could be analyzed with data for Germany. The indicators (e.g., access to acute care, 30-day mortality, amenable mortality rate) are prepared as a trend analysis for Germany for up to 20 years and with regard to various equity aspects. Most indicators can be presented in international comparison with eight selected European countries (e.g., Denmark, France). Furthermore, recommendations were derived to improve the availability and/or quality of data. Conclusions The first German HSPA pilot study provides valuable insights into the performance of the health system. The results based on the analysis of the 90 indicators are an important basis for identifying inequities and needs for improvement. In the future, the lessons learned from the pilot study can be helpful for a permanent implementation of a German HSPA. However, the fragmented data structure in Germany will be a future challenge. Key messages • The first country specific health system performance assessment for the German health system was conducted as a pilot study. • Trends over time, inequities, and needs for improvement can be derived from the analysis of 90 indicators.

Health system efficiency in Germany: results of a pilot study to assess health system performance

Abstract Background Improved efficiency is one overall goal in WHO’s Health Systems Framework. Efficiency is an important dimension of health system performance assessment (HSPA). HSPA is used as a tool to monitor and evaluate the performance of health systems and to support evidence-based policymaking. In the pilot study for a first German HSPA, efficiency was assessed as one dimension. Methods Indicators were selected based on a systematic search of established instruments in national and international HSPA initiatives. Criteria for the inclusion of indicators were data availability and international comparability. Where possible, indicators were evaluated in terms of their development over time (2000-2020), in comparison to eight European countries (e.g., Austria, Denmark, France), and regarding equity aspects (e.g., age, gender, region). Results Eight indicators to assess the efficiency of the German health system were identified and analysed accordingly. They cover the pharmaceutical sector, outpatient and inpatient care, and system-wide efficiency. Trend analyses were possible for all indicators, and most were also suitable for international comparisons. Overall, results of the chosen indicators indicate a moderate health system efficiency. The volume of generics as share of all pharmaceuticals, e.g., was 83% in Germany in 2019 (country average: 54%) and has been steadily increasing since 2000. In contrast, expenses for pharmaceuticals overall rose from 1.4% of GDP in 2004 to 1.7% in 2019, whereas it declined from 1.3% to 1.1% on average in the other countries. Conclusions Within this first pilot study, a systematic and comparative German HSPA measuring the efficiency of the German health system using eight predefined indicators was proven to be feasible. The results give insights into efficiency measurements across different sectors, e.g., pharmaceuticals, identify developments of efficiency over time, and can support evidence-based policymaking. Key messages • In the pilot study for a first German HSPA, efficiency was evaluated using eight indicators covering pharmaceuticals, outpatient and inpatient care, and system-wide efficiency. • Based on the available data, which allowed trend analyses for all indicators and comparisons to eight European countries for most indicators, Germany’s health system efficiency can still be improved.

Health System Performance Assessment: Does Germany provide good access to healthcare?

Abstract Background Providing equal access to health care is a major goal of health systems and a criterion for health system performance assessment (HSPA). The first systematic HSPA for Germany has been piloted in 2021. Access is one dimension of the conceptual framework (others are, e.g., population health, quality, and efficiency), which will be analysed in the following. Methods Nine indicators to measure access were selected based on a systematic search of established instruments in (inter)national HSPA initiatives. Included indicators are availability and accessibility of services (e.g., waiting times) and financial risk protection, among others. Other criteria for the inclusion of indicators were data availability and international comparability. Indicators were evaluated in terms of their trend over time (2000-2020), in international comparison (e.g., Austria, Denmark, France), and according to various equity categories (e.g., age, gender, region). Results The indicator access to palliative care could not be evaluated due to lack of data. Overall, access is good in Germany. Internationally, Germany performs better than average on most of the indicators, and its performance has improved over time. Physician density in the inpatient and outpatient sectors has increased since 2000 and is above the average of comparator countries. For some specialties, physician density in rural areas is lower than in urban areas, but the gap has decreased in recent years and does not apply to primary care. Furthermore, only 0.3% of the total population report having foregone care, although they had considered it necessary. Conclusions Nine indicators were identified and calculated to assess the performance of the German health system in terms of access to healthcare. Access can be assessed as predominantly positive, but inequities exist. Identified gaps and future extensions, e.g., additional data sources, can provide impetus for evidence-based policy management. Key messages • First systematic Health System Performance Assessment for Germany has been piloted. • Access to health care is good in Germany, both over time and in international comparison, but inequities exist.

Piloting the first health system performance assessment for Germany: key results and learnings

Abstract Background Health System Performance Assessment (HSPA) is a tool to monitor and evaluate the performance of health systems and to inform evidence-based policymaking. For the first time, a country specific HSPA is currently being piloted for Germany. Methods The HSPA is based on a newly developed conceptual framework including nine dimensions (e.g., access, quality, efficiency, population health). Indicators were selected based on a systematic search of (inter)national studies and HSPA initiatives. Where possible, indicators were analysed in their development over time (2000-2020), in comparison to eight European countries (e.g., Austria, Denmark, France), and along up to seven equity dimensions (e.g., sex, age, income, education, region). Results Overall, 90 indicators were included in the HSPA. Trend and equity analyses were possible for almost all and country comparisons for most indicators. A few indicators could not be analysed at all due to missing data. The overall HSPA provides an in-detail picture of Germany's health system. Access, for example, can be rated as good in Germany compared to the other countries, as insurance coverage and physician density are high, and unmet needs and waiting times for elective surgery are low. Results for quality are not as good, e.g., cancer survival rates, but most indicators show a positive trend. While population health outcomes are average in country comparison (e.g., fetal and infant mortality), resource input is comparatively high. Consequently, overall efficiency can still be improved (e.g., amenable mortality per total health expenditure). Conclusions This first HSPA for Germany allows new insights to the performance of the German health system which are important for policy and research. While the pilot benefitted a lot from previous HSPA initiatives, data availability remains one of the biggest challenges.

Research designs and instruments to detect physiotherapy overuse of low-value care services in low back pain management: a scoping review protocol

BackgroundThe provision of low-value care services in low back pain management is a problem of global scope. Inappropriate imaging, overmedication, and overused invasive therapies are prevalent in physician services. Yet, little is known about overused low-value physiotherapy services. Most studies addressing physiotherapy overuse in low back pain management arose from countries in which physiotherapy is established in primary care. However, measures and instruments addressing physiotherapy overuse limitedly fit legislative conditions of health systems in which physiotherapy is a service of secondary care. Thus, this scoping review’s purpose is to map existing research designs and instruments aiming to detect overused low-value physiotherapy services taking specific healthcare settings and aspects of medical overuse into account.MethodsThe development of this scoping review is guided by the Arksey and O’Malley framework. A two-step, peer-reviewed search strategy in accordance with the PRESS checklist will be conducted on MEDLINE (PubMed), Web of Science, and CINHAL. Additionally, gray literature will be searched on Google Scholar. Preprints of empirical studies will be included. Initially, two reviewers will independently screen articles for eligibility by title and abstract. A third reviewer will mediate discrepancies. Uncertainties will be eliminated by a full-text analysis or by contacting the corresponding authors. A four-step analytical process will guide result reporting focusing on major research questions outlined in this protocol. Numerical and narrative tables, graphics, and narrative summaries will be the methods to summarize and collate results. In the final step, the German health system will serve as an exemplary setting and frame to practically apply results.DiscussionResults of this scoping review will help researchers to systematically select overuse measures referring to aspects of the overuse typology, specific healthcare settings, and physiotherapy services. It will further provide information on the limitations of present studies and will give advice on how to address them. Moreover, this review will illustrate to what degree existing studies succeed to comprehensively cover the concept of the overuse typology.Systematic review registrationThis protocol has been registered on the open science framework (https://doi.org/10.17605/OSF.IO/PMF2G).

Necessity and Ways to Develop Care Goals for the Health System in Germany - a Position Paper of the DNVF

ZusammenfassungGesundheits- und Versorgungsziele sind eine unverzichtbare Grundvoraussetzung für ein funktionierendes Gesundheitssystem. Das Dilemma des deutschen Gesundheitssystems ist, dass es nicht planvoll weiter entwickelt wurde, sondern dass es historisch gewachsen ist. In den letzten Jahren hat es sich im freien Spiel der Kräfte zu dem entwickelt, was es heute ist. Den aktuellen Zustand beschreibt die OECD so: Die Kosten des deutschen Gesundheitssystems entsprechen nicht den oft nur durchschnittlichen Gesundheitsergebnissen für die Bevölkerung. Zur Erfüllung der gesetzlichen Anforderungen (vor allem SGB V §§ 12, 27 und 70) braucht die Gesundheitsversorgung/das Gesundheitssystem in Deutschland konkrete Ziele. Eine Orientierung an Versorgungszielen zieht Maßnahmen auf allen Ebenen der Versorgung nach sich: auf der Makroebene (Gesamtsystem/gesamte Bevölkerung), auf der Mesoebene (unterteilt nach Regionen, spezifischen Bevölkerungsgruppen etc.) sowie auf der Mikroebene ( Patient:innen und Leistungserbringer) Ausgehend von nationalen und internationalen Erfahrungen zeigt das vorliegende Positionspapier des DNVF e.V. (Deutsches Netzwerk Versorgungsforschung) das Potenzial, wie operationalisierte Versorgungsziele eine effektive, finanzierbare und qualitativ hochwertige Gesundheitsversorgung gewährleisten können. Der Koalitionsvertrag der Ampelregierung propagiert eine Neuausrichtung mit Patient:innen bezogenen Versorgungszielen. Jetzt gilt es, aus dieser Absichtserklärung konkrete und umsetzbare Ziele abzuleiten und dabei alle wesentlichen Gruppen zu beteiligen. Ergänzend werden in diesem Prozess Werte und ethische Normen für die Umsetzung vereinbart. Das BMG (Bundesministerium für Gesundheit) sollte den Prozess der gesellschaftlichen Willensbildung zur Definition von Nationalen Versorgungszielen ermöglichen und fördern. Dazu bedarf es einer klaren politischen Willensbildung. Als Ergebnis liegen am Ende des Prozesses die Nationalen Versorgungsziele vor, die zusammen mit evidenzbasierten Fakten sowie mit validen und belastbaren Daten in einem Handbuch „Nationale Versorgungsziele“ veröffentlicht und gepflegt werden. Die operative Verantwortung für die Umsetzung könnte bei dem neu zu gründenden Bundesinstitut für öffentliche Gesundheit liegen, wie es bereits im Koalitionsvertrag der Ampelkoalition angekündigt wurde. Das DNVF ist bereit, an der Entwicklung von Versorgungszielen aktiv mitzuwirken.

Assessment of health system performance in Germany: Survey-based insights into the perspective of people with private health insurance.

The World Health Organization (WHO) defined intermediate and overall goals to assess the performance of health systems. As the population perspective becomes more important for improving health systems, the aim of this study was to gain insights into the perspective of people with private health insurance (PHI) in Germany along the predefined WHO goals. A cross-sectional survey was conducted in 2018 among people with PHI in Germany. The questionnaire included items on all intermediate (access, coverage, quality, and safety) and overall WHO goals (improved health, responsiveness, social and financial risk protection, and improved efficiency). Descriptive analyses were conducted for the total sample and subgroups (gender, age, income, and health status). In total, 3601 respondents (age 58.5±14.6; 64.7% male) assessed the German health system. For example, 3.3%-7.5% of the respondents with subjective needs reported forgone care in the past 12months due to waiting time, distance, or financial reasons and 14.4% suspected medical errors in their care. During the last physician visit 94.2% experienced respectful treatment but only 60.6% perceived coordination of care as good. Unnecessary health services were perceived by 24.2%. For many items significant subgroup differences were found, particularly for age groups (18-64 vs. 65+). Conducting a health system performance assessment from the population perspective gained new and unique insights into the perception of people with PHI in Germany. Areas to improve the health system were seen in, for example, coordination of care, financial risk protection, and quality of care, and inequalities between subgroups were identified.

Strengthening health system governance in Germany: looking back, planning ahead.

Health system governance has been receiving increasing attention in health system research since the 1980s. The contemporary challenges that the German health system is faced with are often closely linked to governance issues. Although Germany has the highest health expenditure as a share of Gross Domestic Product (GDP) in the European Union (EU), the spending on healthcare is out of proportion to the health outcomes of the population. The reason for this lies mainly in the complexity of the German health system which is hard to steer due to several administrative levels in the country and numerous policy actors to whom the decision-making power on healthcare provision is delegated. In this paper, we present the results of focus group discussions on governance and build upon the insights gained through the Neustart project of the Robert Bosch Foundation. Based on an internationally recognised health governance framework from the World Health Organization (WHO), experts who work in, on or for the German health system addressed health governance challenges. They provided evidence-based recommendations for the new legislative period (2021-2025) on transparency, accountability, participation, integrity and capacity of the German health system.

MIMIC-IV as a Clinical Data Schema.

Routinely collected electronic health records (EHR) in clinical information systems (CIS) are often heterogeneous, have inconsistent data formats and lack of documentation. We use the well-known open-source database schema of MIMIC-IV to address this issue aiming to support collaborative secondary analysis. Over 154 million data records from a German ICU have already been mapped and inserted into the schema successfully. However, discrepancies between the German and US health systems as well as specifics in our clinical source data hinder the direct translation to MIMIC. Evaluating and improving mapping completeness is part of the ongoing research.

The Global Wealth Chains of Private‐Equity‐Run Physician Practices

ABSTRACTCurrently, numerous physician practices in industrial and emerging countries are being taken over by private equity firms and integrated into novel physician corporations. This involves private equity firms producing a global wealth chain (GWC) between their investors and the target asset, using offshore financial centres to facilitate tax‐avoiding reflux of capital. Moreover, they are opening up ambulatory health care as an asset for capital investment by overcoming previous market barriers to ambulatory health care via a legal construct. In this paper, we trace the spatial links of these finance‐side and sector‐specific corporate chains based on a capital flow analysis of private equity takeovers of Medical Care Centres (MCCs) in Bavaria, Germany. With our heuristics of a double‐layered GWC, which enables the extraction of value from the German health system, we contribute to the emerging GWC debate that aims to conceptualise the complex and often opaque spatialisations of financialisation processes.

Financial difficulties in breast cancer survivors with and without migration background in Germany—results from the prospective multicentre cohort study BRENDA II

PurposeWe aimed to explore the trajectory of financial difficulties among breast cancer survivors in the German health system and its association with migration background.MethodsIn a multicentre prospective study, breast cancer survivors were approached four times (before surgery, before and after adjuvant therapy, five years after surgery) and asked about their migration history and financial difficulties.Migrants were defined as born/resided outside Germany or having citizenship/nationality other than German. Financial difficulties were ascertained with the financial difficulties item of the European Organisation for Research and Treatment of Cancer Core Instrument (EORTC QLQ-C30) at each time-point (cut-off > 17). Financial difficulties were classified in trajectories: always (every time-point), never (no time-point), initial (first, not fourth), delayed (only fourth), and acquired (second and/or third, not first).A logistic regression was conducted with the trajectories of financial difficulties as outcome and migration background as exposure. Age, trends in partnership status, and educational level were considered as confounders.ResultsOf the 363 participants included, 49% reported financial difficulties at at least one time-point.Financial difficulties were reported always by 7% of the participants, initially by 5%, delayed by 10%, and acquired by 21%.Migrants were almost four times more likely to report delayed (odds ratio [OR] = 3.7; 95% confidence interval [CI] 1.3, 10.5) or acquired (OR = 3.6; 95% CI 1.6, 8.4) financial difficulties compared to non-migrant participants.ConclusionSurvivors with a migration background are more likely to suffer from financial difficulties, especially in later stages of the follow-up. A linguistically/culturally competent active enquiry about financial difficulties and information material regarding supporting services/insurances should be considered.

Sustainability in ophthalmology : Adaptation to the climate crisis and mitigation

Die Klimakrise bedroht die Gesundheit heutiger und künftiger Generationen und stellt das Gesundheitssystem vor besondere Herausforderungen. Zur Anpassung an den anthropogene Klimawandel sind umfängliche Adaptationsstrategien und eine Mitigation des Klimawandels notwendig. In der Medizin sowie in der Augenheilkunde gibt es vielfältige Möglichkeiten zur Reduktion des CO2(Kohlendioxid)-Fußabdrucks, die es zu ergreifen gilt, die ordnungspolitisch gefördert und eingefordert werden sollten. Das aufkommende Feld der datengesteuerten Nachhaltigkeit kann Werkzeuge liefern, um den ökologischen Fußabdruck der eigenen Tätigkeit zu evaluieren sowie Optimierungen zu initiieren. Lebenszyklusanalysen können Instrumente für systematische Ökobilanzen sein und nachhaltige Produkt- und Praxisentscheidungen ermöglichen. Das deutsche Gesundheitssystem sollte eine quantifizierbare und holistische Strategie zur CO2-Reduktion entwickeln; Nachhaltigkeit könnte zukünftig ein Leistungsindikator sein. Dieser Artikel diskutiert mit augenärztlicher Perspektive Beispiele zur Adaptation an die Klimakrise und zur Mitigation; dies schließt kleine Maßnahmen, die jeder Einzelne umsetzen kann, als auch größere, strukturelle Ansätze ein.

Forecast of Omicron Wave Time Evolution

The temporal evolution of the omicron wave in different countries is predicted, upon adopting an early doubling time of three days for the rate of new infections with this mutant. The forecast is based on the susceptible–infectious–recovered/removed (SIR) epidemic compartment model with a constant stationary ratio k=μ(t)/a(t) between the infection (a(t)) and recovery (μ(t)) rates. The assumed fixed early doubling time then uniquely relates the initial infection rate a0 to the ratio k; this way the full temporal evolution of the omicron wave is determined here. Three scenarios (optimistic, pessimistic, intermediate) and the resulting pandemic parameters are considered for 12 different countries. Parameters include the total number of infected persons, the maximum rate of new infections, the peak time and the maximum 7-day incidence per 100,000 persons. The monitored data from Great Britain underwent a clear maximum SDI of 1865 on 7 January 2022. This maximum is a factor 5.0 smaller than our predicted value in the optimistic case and may indicate a dark number of omicron infections of 5.0 in Great Britain. For Germany we predict peak times of the omicron wave ranging from 32 to 38 and 45 days after the start of the omicron wave in the optimistic, intermediate and pessimistic scenario, respectively, with corresponding maximum SDI values of 7090, 13,263 and 28,911. Adopting 1 January 2022 as the starting date our predictions imply the maximum of the omicron wave to be reached between 1 February and 15 February 2022. Rather similar values are predicted for Switzerland. Due to an order of magnitude smaller omicron hospitalization rate, in concert with a high percentage of vaccinated and boosted population, the German health system can cope with a maximum omicron SDI value of 2800 which is about a factor 2.5 smaller than the corresponding value 7090 for the optimistic case. By either reducing the duration of intensive care during peak time, and/or by making use of the nonuniform spread of the omicron wave across Germany, it seems that the German health system can barely cope with the omicron wave and thus avoid triage decisions. The reduced omicron hospitalization rate also causes significantly smaller mortality rates compared to the earlier mutants in Germany. Within the optimistic scenario, we predict 7445 fatalities and a maximum number of 418 deaths/day due to omicron. These numbers range in order of magnitude below the ones known from the beta mutant.

Cost-Utility Analysis of a Latanoprost Cationic Emulsion (STN1013001) versus Other Latanoprost in the Treatment of Open-Angle Glaucoma or Ocular Hypertension and Concomitant Ocular Surface Disease in Germany.

PurposeThis study aimed to estimate the cost–utility and economic value of STN1013001, a latanoprost cationic emulsion vs other latanoprost formulations (henceforth latanoprost) in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) and concomitant ocular surface disease (OSD) in Germany.MethodsAn early 5-year Markov model-supported cost–utility analysis was performed to estimate costs, quality-adjusted life years (QALYs) and life-years saved (LYS) for STN1013001 vs latanoprost from the German health system perspective. The model included seven mutually exclusive health states and adopted a 1-year cycle length. The model was populated with pooled data derived, by means of a questionnaire, from a convenience sample of five German glaucoma specialists. Remaining data were derived from published sources. Data provided by the ophthalmologists included annual treatment adherence probabilities, utility values and resource utilization. The half-cycle correction as well as a discount rate of 3.0% per year were applied to costs (expressed in €2020), life-year saved (LYS) and QALYs. The incremental cost–utility ratio (ICUR) was contrasted against the informal willingness-to-pay (WTP) threshold for incremental LYS saved or QALY gained (€30,000) proposed for Germany. One-way and probabilistic sensitivity analyses (OWSA; PSA) tested the robustness of the base case ICUR.ResultsOver the 5-year time horizon, STN1013001 strongly dominates latanoprost as it is less costly (€1003.65 vs €1145.37; −12.37%) and produces more QALYs (2.612 vs 2.365; +10.44%) per notional patient. Baseline findings were robust against all the variations included in OWSA. PSA shows that STN1013001 has a 100% probability of being cost-effective vs Latanoprost at each WTP threshold for incremental QALY gained.ConclusionOnce on the market, STN1013001 will provide a cost-effective and possibly strongly dominant therapy vs latanoprost for OAG/OHT+OSD patients from a German health system perspective. Future empirical research should confirm these findings.

Interventions for Children and Adolescents Living in Foster or Institutional Care - A Systematic Review

Children or adolescents living in foster or institutional care received so far insufficient consideration in therapy intervention research. At the same time, they are a high-risk group for developing mental illness. The aim of this systematic review is to record evidence-based psychotherapeutic interventions of the past 15 years on a national and international level that address children and young people living in foster care and youth welfare institutions and their mental health. Through a systematic literature research, interventions for the target group described were identified and analyzed about their specificity and evidence. From 170 publications, ten interventions with sufficient evidence could be included in the present analysis. The result of the current literature research shows that further specialized psychiatric-psychotherapeutic interventions for children in foster care and youth welfare institutions are necessary. Regarding the transferability to the German youth welfare and health system, cross-system and interdisciplinary cooperation is needed. Hereafter further research is required to establish specific and evidence-based intervention approaches.

POSA52 A Year-on-Year Comparison Overall German Healthcare Resource Utilization in COVID Versus Non-COVID Times: A German Claims Data Analysis

The COVID-19 pandemic impacted the German health system comprehensively. This study compared overall healthcare resource utilization (HCRU) in the first half of 2020 (COVID-19 lockdown time) with the utilization observed in previous years (2017-2019).

Non-verbal cognitive development, learning, and symptoms of PTSD in 3- to 6-year-old refugee children

As IQ tests are commonly used as key assessment method, we address the question whether our commonly used standardized IQ tests are appropriate for children from families of diverse cultures and different educational levels in a refugee population. We examined 109 refugee children aged 3–7 years (M = 5.10 years, SD = 1.25) with the “Kaufman Assessment Battery for Children “ (KABC-II; Kaufmann & Kaufmann, 2015) on a language-free scale (Scale of Intellectual Functioning, SIF) and learning performance (subtest Atlantis). With a non-verbal IQ of 81.5 (SD = 18.01), the population mean of the refugee children is more than one standard deviation lower than the mean of the German norm population. Standardized scores follow the normal distribution and are not correlated to any of the assessed markers of adversity (flight duration, time spent in Germany, child PTSD in parent rating, parental symptom load, and parental education level).Conclusion: The interpretation of IQ test results for refugee children should be done cautiously as results may underestimate their cognitive capacity. Environmental factors, such as high illiteracy among parents in this study, the lack of institutional education of children and high lifetime stress, may explain our findings.Trial registration: DRKS00021150.What is Known:• There is a high pervasiveness for the use of standardized IQ tests in the German health and education system to determine eligibility for special education and social services.What is New:• Refugee children score significantly lower than German children in a language-free IQ test. As results are normally distributed and not correlated to any of the assessed markers of adversity, the low scores in the refugee group might be due to missing formal education.