Perspective In Germany Research Articles

Economic effects of next-generation sequencing diagnostics in unspecific sepsis patients - a budget impact analysis from the healthcare providers' perspective in Germany.

Next-generation sequencing (NGS) tools have clinical advantages over blood culture but are more expensive. This study assesses the budget impact and break-even point of NGS testing costs from a healthcare provider's perspective in Germany. The budget impact was calculated based on aggregated data of German post-operative surgery cases. Simulated cost savings were calculated based on a simulated reduction in hospital length of stay (LOS) of four or eight days with a positivity rate of 71% and compared to the costs of one (scenario A) or two tests (scenario B) per case. Furthermore, the break-even point of the cost of two tests compared to saved costs through shortened LOS was conducted. For 9,450 cases, an average budget impact for scenario A and scenario B of €1,290.41 [95% CI €1,119.64 - €1,461.19] and - €208.59 [95% CI - €379.36 - - €37.81] was identified for gastrointestinal and kidney surgery cases, and €1,355.58 [95% CI €1,049.62 - €1,661.55] and €18.72 [95% CI - €324.69 - €287.24] for vascular artery surgery cases, respectively. The break-even analysis showed that using two tests per case could achieve a minimum positive contribution margin with an average of 1.9 tests per case across the study population. The results revealed a positive budget impact for one NGS test and a slightly negative budget impact for two NGS tests per case. Findings suggest that largest cost savings are generated for more severe cases and are highly dependent on the patient population.

Regional comparison of specialized outpatient and (partial) inpatient pain medicine care in Germany

Chronic pain requires graduated and staged levels of care. The aim of this study is to provide aregional overview regarding the accessibility of specialized outpatient and (partial) inpatient pain medicine care from the patient's perspective in Germany. For 1000 model patients randomly generated from German postal code location combinations, the travelling time by car (individual transport, IT)and available public transport connections (PTC) to the nearest specialized outpatient and inpatient pain medicine clinics and units were assessed using aroute planner. Outpatient facilities (in apractice setting) were mostly realistically accessible depending on the proportion of pain treatment and the networking structure. University pain outpatient clinics were at a critically reachable distance with IT for 70% of the patients (80% with PTC) and had unrealistic accessibility for 49% of the patients with IT (68% with PTC). Interdisciplinary multimodal pain programs in day clinics were at a critically reachable distance for 68% of patients with IT (83% with PTC) and in 49% (75% PTC) at an unrealistic travelling time distance considering the more intense treatment requiring frequent travel. Full inpatient interdisciplinary multimodal treatment was more realistically reachable (IT 39% critical, 14% unrealistic, PTC 61% critical, 48% unrealistic). The results show relevant nationwide differences in the accessibility of facilities for specialized pain treatment depending on the place of residence. Considering the treatment of achronic condition with long-term therapeutic goals and the need for graduated care (outpatient and inpatient treatment), the results reveal apartly critical situation from the patient's perspective.

‘The health care system is more like a business’—medical overuse from the patients’ perspective in Germany: a qualitative study

ObjectivesMedical overuse exposes patients to unnecessary risks of harm. It is an open question whether and how patients perceive the concept of medical overuse, its causes and negative consequences.DesignA qualitative...

Telemedicine Beyond Borders: A Mixed-Methods Approach to Understanding Cross-National Usage Intention.

Introduction: Drawing on the Unified Theory of Acceptance and Use of Technology 2 and the Diffusion of Innovation Theory, this article investigates the adoption of telemedicine services from a patient perspective in Germany, Spain, and the United States using a mixed-methods approach. Digital health technologies have the potential to improve access to care and to alleviate the burden on traditional health care systems and are becoming more integrated into everyday medicine. Therefore, understanding the factors that impact patients' intentions to use telemedicine is crucial to ensure successful development. Methods: Based on 1,200 surveys collected in Germany, Spain, and the United States, structural equation modeling (IBM SPSS Amos 24) is employed to test the hypotheses. The article also explores how age and gender moderate the proposed relationships. Results: Seven out of the 10 hypotheses (performance expectancy, hedonic motivation, habit, relative advantage, and perceived security) are found to be positive, direct, and statistically significant. Furthermore, findings suggest stronger effects for telemedicine usage intention for younger female users than their male counterparts. Discussion: With digital health technologies becoming more prevalent, the outcomes of this study can endorse the development of effective strategies to promote the adoption of telemedicine, ultimately improving access to care and contributing to the advancement of and modern health care.

Digital interventions for adolescents with type 1 diabetes to promote health literacy? A qualitative study on physicians’ perspective in Germany

IntroductionAdolescents with type 1 diabetes mellitus (T1D) require a high level of health literacy (HL) to prevent complications. It remains unclear what potential digital interventions have for promoting HL among...

Motivations for Adolescent COVID-19 Vaccination: A Comparative Study of Adolescent and Caregiver Perspectives in Germany.

Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines.

MT24 Digital Therapeutics (DTX): Market Access Challenges and Stakeholder Perspectives in Germany

MT24 Digital Therapeutics (DTX): Market Access Challenges and Stakeholder Perspectives in Germany

Postdoctoral researchers' perspectives on working conditions and equal opportunities in German academia.

Postdoctoral researchers (postdocs) are an essential component of the scientific workforce in German universities and research institutions and play a vital role in advancing knowledge and innovation. However, the experiences of postdocs and other early career researchers (ECRs) indicate that working conditions pose a significant challenge to the pursuit of a long-term research career in Germany-particularly for international scientists and those from marginalized groups. We examine how unstable working conditions as well as insufficient structural support for equal opportunities and diversity are significant obstacles for the career development of ECRs in German academia. We discuss these issues with the aid of an extensive survey recently conducted and published by PostdocNet, a target-group network representing the interests of postdocs across Germany's Max Planck Society. The survey drew responses from 659 postdoctoral researchers working at the Max Planck Society and represents one of the few datasets of postdoctoral researchers' perspectives in Germany. Building on these findings, we suggest actions at governmental, institutional, and individual levels to improve the working conditions of postdoctoral researchers in Germany.

A Health Economic Analysis Exploring the Cost Consequence of Using a Surgical Site Infection Prevention Bundle for Hip and Knee Arthroplasty in Germany.

According to the European Centre for Disease Prevention and Control, surgical site infections (SSIs) constitute over 50% of all hospital-acquired infections. Reducing SSIs can enhance healthcare efficiency. This study explores the cost consequences of implementing an SSI prevention bundle (SPB) in total hip and knee arthroplasty (THKA). A health-economic model followed a cohort of THKA patients from admission to 90 days postdischarge. The perioperative process was modeled using a decision tree, and postoperative recovery and potential SSI evaluated using a Markov model. The model reflects the hospital payers' perspective in Germany. The SPB includes antimicrobial incision drapes, patient warming, and negative pressure wound therapy in high-risk patients. SSI reduction associated with these interventions was sourced from published meta-analyses. An effectiveness factor of 70% was introduced to account for potential overlap of effectiveness when interventions are used in combination. Sensitivity analyses were performed to assess the robustness of model outcomes. The cost with the SPB was €4274.32 per patient, €98.27, or 2.25%, lower than that of the standard of care (€4372.59). Sensitivity analyses confirmed these findings, indicating a median saving of 2.22% (95% credible interval: 1.00%-3.79%]). The SPB also reduced inpatient SSI incidence from 2.96% to 0.91%. The break-even point for the SPB was found when the standard of care had an SSI incidence of 0.938%. Major cost drivers were the cost of inpatient SSI care, general ward, and operating room, and the increased risk of an SSI associated with unintended, intraoperative hypothermia. Varying the effectiveness factor from 10% to 130% did not substantially impact model outcomes. Introducing the SPB is expected to reduce care costs if the inpatient SSI rate (superficial and deep combined) in THKA procedures exceeds 1%. Research into how bundles of measures perform together is required to further inform the results of this computational analysis.

Moral change and the purchase-sale relationship: Critical analysis of Swiss and German companies

This study examines the awareness and causes of moral change from the economic perspective in Germany and Switzerland. Based on an analysis of value research to date and interviews with experts in B2B sales, the manifestations of moral change are critically examined and recommendations for action are derived on an employee-specific and company-wide level.

Was EU’s COVID-19 vaccine procurement strategy irrational? A re-analysis based on cost-effectiveness considerations

AimThe European Union (EU) has received criticism for being slow to secure coronavirus disease (COVID-19) vaccine contracts in 2020 before the approval of the first COVID-19 vaccine. This study aimed to retrospectively analyze the EU’s COVID-19 vaccine procurement strategy. To this end, the study retrospectively determined the minimum vaccine efficacy that made vaccination cost-effective from a societal perspective in Germany before clinical trial announcements in late 2020. The results were compared with the expected vaccine efficacy before the announcements.MethodsTwo strategies were analyzed: vaccination followed by the complete lifting of mitigation measures and a long-term mitigation strategy. A decision model was constructed using, for example, information on age-specific fatality rates, intensive care unit costs and outcomes, and herd protection thresholds. The base-case time horizon was 5 years. Cost-effectiveness of vaccination was determined in terms of the costs per life-year gained. The value of an additional life-year was borrowed from new, innovative oncological drugs, as cancer is a condition with a perceived threat similar to that of COVID-19.ResultsA vaccine with 50% efficacy against death due to COVID-19 was not clearly cost-effective compared with a long-term mitigation strategy if mitigation measures were planned to be lifted after vaccine rollout. The minimum vaccine efficacy required to achieve cost-effectiveness was 40% in the base case. The sensitivity analysis showed considerable variation around the minimum vaccine efficacy, extending above 50% for some of the input variables.ConclusionsThis study showed that vaccine efficacy levels expected before clinical trial announcements did not clearly justify lifting mitigation measures from a cost-effectiveness standpoint. Hence, the EU’s sluggish procurement strategy still appeared to be rational at the time of decision making.

Factors promoting or limiting self-determined childbirth: midwives’ perspectives in Germany

Abstract Background Claims for self-determined childbirth (SDC) have gained increasing scientific, political and societal attention. However, research on SDC is limited. This study analyzes and compares midwives’ experiences and perspectives on factors that promote or limit SDC in hospitals, birthing centers and during home births in Germany. We argue that these insights are essential in order to foster self-determination and to avoid its violation. Methods A qualitative case study was conducted based on semi-structured face-to-face interviews with midwives working in hospitals, birthing centers, and offering home births in Germany. In total, nine interviews were conducted in 2021 and have been audiotaped, transcribed, anonymized and analyzed by use of Thematic Analysis. Results The results indicate eight inter-related categories, each of which imply promoting and limiting factors: 1) Structural/ legal conditions; 2) Perception of birth (e. g. as natural or medical process; required competence and control); 3) Trust and atmosphere; 4) Getting acquainted/relationship building; 5) Birthing person’s socioeconomic position; 6) Birthing person’s preparation/ education; 7) Birthing person’s capability of decision making and expression; and 8) Behavior of accompanying persons. Moreover, we identified midwives’ strategies to extend possibilities of choice. Several factors clearly differ depending on the birth setting. Conclusions The opportunities for SDC seem to differ according to the setting (e.g. institutional routines), inter-personal relations (e.g. getting acquainted, trust), and individual factors (e.g. socioeconomic position, capabilities). Hence, political, institutional and individual strategies may support SDC in consideration of the above factors. Measures may, among others, include the improvement of information processes, the reduction of economic barriers, relationship building before and during birth as well as respective structural adjustments. Key messages • Self-determination (SD) in childbirth is influenced by several factors at individual, inter-personal, institutional and macro level. • Individual, institutional and political strategies may support SD.

Adoption of Food Species Mixtures from Farmers’ Perspectives in Germany: Managing Complexity and Harnessing Advantages

Many agronomic studies have shown the advantages of species mixtures (SM), but for food grain production, they represent only a small niche. Empirical studies that investigate reasons for SM adoption in food grain production are scarce. Here we present an in-depth study based on qualitative expert interviews with nine farmers. By means of interpretative analysis and reconstruction, socially shared models of SM adoption were built to identify the five main factors for SM adoption: (1) perceived relative mixture performance compared to sole crops, (2) suitability within the farm context (3), challenges and opportunities in mixture management due to increased complexity, (4) knowledge and technology as resources to handle mixture management and (5) quality standards in the food value chain. Relative performance was perceived as higher for SM than for sole crops for crop protection, nutrient efficiency, farm diversification, total yield stability and grain quality. The yield stability of individual crop species in SM was perceived as lower and grain impurities higher, requiring increased separation efforts. The economic potential of SM was perceived as highly variable, depending on crop value and post-harvest efforts to attain food quality. Reconstructing the mixture management process revealed that the interspecific plant interactions and emergent mixture attributes increased the cropping system complexity and affected the entire farming process. Adopting SM required knowledge about species interactions, mixture attributes and equipment settings. Large knowledge gaps for food SM were identified. The complexity of SM also provided opportunities for farmers to design mixtures that allow competition control (alternate rows) or avoid separation (relay mixtures). The main conclusions are: (1) increased complexity is a basic property of SM compared to sole crops, enabling advantages and increasing the option space to develop new sustainable cropping systems, (2) specific knowledge and technology are required for SM and are not accessible for most farmers, requiring new information channels and (3) new food SM should be developed more systematically, taking into account mixture properties and their effects on the farming process, as well as needs from the food value chain.

The Possibility of Biogas Production from Anaerobic Co-digestion of Hemp and Manure– A perspective in Germany

Replacement of fossil-based resources with renewable resources to offset the use for heating and electricity production are important for today’s social and economic growth and energy security. Anaerobic fermentation and the production of biogas generates an alternative, carbon-neutral, renewable fuel that easily can be generated from local, low-cost organic waste materials and used as replacement for fossil fuel based gaseous products.
 The anaerobic digestion experiments ran for 240 hours at a temperature of 39°C ± 2°C for the duration of the experiment.
 The combined biogas production of hemp residues and hemp stems showed that the average reduced volatile solids content for hemp residue 1 and 2 was 0.98 g with a combined biogas production of 231.31 ml/g. For the hemp stems 1 and 2 the average reduced volatile solids content was 4.06 g and the combined biogas production was 64.90 ml/g respectively. Cow manure showed average reduced volatile solids content of 0.76 g and a combined biogas production of 305.69 ml/g respectively. The biogas content without CO2 was 62% for the manure samples, 55% for the hemp stems, and 57% for the hemp residues.
 The application of co-digestion utilizing cow manure and hemp-based waste material, as feedstock could be an option, helping to increase energy security, biological diversity, and sustainability.

Comparing the long-term clinical and economic impact of ofatumumab versus dimethyl fumarate and glatiramer acetate in patients with relapsing multiple sclerosis: A cost-consequence analysis from a societal perspective in Germany.

BackgroundEvidence suggests that early highly efficacious therapy in relapsing multiple sclerosis is superior to escalation strategies.ObjectiveA cost-consequence analysis simulated different treatment scenarios with ofatumumab (OMB), dimethyl fumarate (DMF) and glatiramer acetate (GA): immediate OMB initiation as first treatment, early switch to OMB after 1 year on DMF/GA, late switch after 5 years or no switch.MethodsAn EDSS-based Markov model with a 10-year time horizon was applied. Cycle transitions included EDSS progression, improvement or stabilization, treatment discontinuation, relapse or death. Input data were extracted from OMB trials, a network meta-analysis, published literature, and publicly available sources.ResultsThe late switch compared to the immediate OMB scenario resulted in a lower proportion of patients with EDSS 0–3 (Δ − 7.5% DMF; Δ − 10.3% GA), more relapses (Δ + 0.72 DMF; Δ + 1.23 GA) and lower employment rates (Δ − 4.0% DMF; Δ − 5.6% GA). The same applies to late versus early switches. No switch scenarios resulted in worse outcomes. Higher drug acquisition costs in the immediate OMB and early switch scenarios were almost compensated by lower costs for patient care and productivity loss.ConclusionImmediate OMB treatment and an early switch improves clinical and productivity outcomes while remaining almost cost neutral compared to late or no switches.

Value-based pricing of a COVID-19 vaccine

AimThe purpose of this study is to determine the value-based price of a COVID-19 vaccine from a societal perspective in Germany. MethodsA decision model was constructed using, e.g., information on age-specific fatality rates, intensive care unit (ICU) costs and outcomes, and the full vaccination rate. Three strategies were analysed: vaccination (with 95 % and 50 % efficacy against death), a mitigation strategy, and no intervention. The base-case time horizon was 5 years. The value of a vaccine includes savings from avoiding COVID-19 mitigation measures and productivity loss, as well as health benefits from preventing COVID-19 related mortality. The value of an additional life year was borrowed from new, innovative oncological drugs, as cancer reflects a condition with a similar morbidity and mortality burden in the general population in the short term as COVID-19. ResultsA vaccine with a 95 % efficacy dominates the mitigation strategy strictly. The value-based price (€6,431) is thus determined by the comparison between vaccination and no intervention. The price is particularly sensitive to the full vaccination rate and the duration of vaccine protection. In contrast, the value of a vaccine with 50 % efficacy is more ambiguous. ConclusionThis study yields a value-based price for a COVID-19 vaccine with 95 % efficacy, which is considerably greater than the purchasing price.

Cost-effectiveness analysis for SilAtro-5-90 adjuvant treatment in the management of recurrent tonsillitis, compared with usual care only

PurposeAntibiotics are one possible treatment for patients with recurrent acute throat infections (ATI), but effectiveness can be modest. In view of worries over antibiotic resistance, treatment pathways that reduce recurrence of ATI are essential from a public health perspective. Integrative treatment strategies can be an option but there is still a high demand to provide evidence of their cost effectiveness.MethodsWe constructed a 4-state Markov model to compare the cost-effectiveness of SilAtro-5-90 as adjuvant homeopathic therapy to care as usual with care as usual alone in reducing the recurrence of ATI for children and adults with suspected moderate recurrent tonsillitis. The analysis was performed from a societal perspective in Germany over a 2-year period. Results are reported separately for children < 12 and for individuals aged 12 and over. The model draws on evidence from a multi-centre randomised clinical trial that found this strategy effective in reducing recurrence of ATI. Costs in 2019 € and outcomes after 1 year are discounted at a rate of 3% per annum.ResultsFor adults and adolescents aged 12 years and over, incremental cost per ATI averted in the adjuvant therapy group was €156.64. If individuals enter the model on average with a history of 3.33 previous ATIs, adjuvant therapy has both lower costs and better outcomes than care as usual. For children (< 12 years) adjuvant therapy had both lower costs and ATI than care as usual. The economic case is stronger if adjuvant treatment reduces surgical referral. At a hypothetical cost per ATI averted threshold of €1000 probabilistic sensitivity analysis suggests Silatro-5-90 has a 65% (adults) and 71% (children) chance of being cost-effective.ConclusionOur results indicate the importance of considering homeopathy as adjuvant therapy in the treatment of ATIs in individuals with recurrent tonsillitis from a socio-economic perspective. Further evaluation should assess how differences in uptake and sustained use of homeopathic adjuvant therapy, as well as changing patterns of antibiotic prescribing, impact on cost effectiveness.

A budget impact analysis of bezlotoxumab versus standard of care antibiotics only in patients at high risk of CDI recurrence from a hospital management perspective in Germany

BackgroundClostridioides difficile infection (CDI) is one of the leading nosocomial infections, resulting in increased hospital length of stay and additional treatment costs. Bezlotoxumab, the first monoclonal antibody against CDI, has an 1 A guideline recommendation for prevention of CDI, after randomized clinical trials demonstrated its superior efficacy vs. placebo.MethodsThe budget impact analysis at hand is focused on patients at high risk of CDI recurrence. Treatment with standard of care (SoC) + bezlotoxumab was compared with current SoC alone in the 10 most associated Diagnosis Related Groups to identify, analyze, and evaluate potential cost savings per case from the German hospital management perspective. Based on variation in days to rehospitalization, three different case consolidation scenarios were assessed: no case consolidation, case consolidation for the SoC + bezlotoxumab treatment arm only, and case consolidation for both treatment arms.ResultsOn average, the budget impact amounted to € 508.56 [range: € 424.85 - € 642.19] for no case consolidation, € 470.50 [range: € 378.75 - € 601.77] for case consolidation in the SoC + bezlotoxumab treatment arm, and € 618.00 [range: € 557.40 - € 758.41] for case consolidation in both treatment arms.ConclusionsThe study demonstrated administration of SoC + bezlotoxumab in patients at high risk of CDI recurrence is cost-saving from a hospital management perspective. Reduced length of stay in bezlotoxumab treated patients creates free spatial and personnel capacities for the treating hospital. Yet, a requirement for hospitals to administer bezlotoxumab is the previously made request for additional fees and a successful price negotiation.

Glass hybrid versus composite for non-carious cervical lesions: Survival, restoration quality and costs in randomized controlled trial after 3 years

ObjectiveThis study compared survival, restoration quality and costs of glass hybrid (GH; EQUIA Forte Fil/EQUIA Forte Coat) and resin composite restorations (RC; OptiBond FL/Filtek Supreme XTE) of sclerotic non-carious cervical lesions. MethodsThis is a cluster-randomized trial (ClinicalTrials.gov: NCT02631161). 88 patients (50–70 years) with 175 sNCCLs were randomized to receive GH or RC. Restorations were placed without mechanical cavity preparation and followed for a mean 36 (min/max: 31/55) months (variable follow-up due to COVID-19 lockdown). Restoration quality was re-evaluated at 1-, 18- and 36-months using FDI-criteria. Survival was assessed using multi-level Cox-regression analysis. Costs were estimated from a payer’s perspective in Germany. Initial costs were determined based on micro-costing using time recordings and hourly costs, and follow-up costs based on statutory insurance fee-item-catalogues. Results88 patients (175 restorations) were treated; 43 received GH (83 restorations), 45 RC (92 restorations). 17 GH and 19 RC showed total retention loss, 5 GH were partially lost (p = 0.396/Cox). FDI ratings were not sufficiently different for any domain except surface luster, where RC showed higher score (p < 0.001). Costs were initially lower for GH (32.57; SD 16.36 €) than RC (44.25; SD 21.40 €), while re-treatment costs were similar (GH: 9.15; SD 15.70 €; RC: 7.35; SD 14.51 €), resulting in significantly lower costs for GH (GH: 41.72; SD 25.08 €) than RC (51.60; 26.17 €) (p < 0.001/GLM). ConclusionsWhile survival was not significantly different, GH was significantly less costly both initially and long-term than RC for restoring non-carious cervical lesions. Clinical significanceWithin this trial, survival was not significantly different between GH and RC to restore sclerotic NCCLs. As GH was significantly less costly both initially and long-term than RC, using RC was only cost-effective for payers willing to invest high additional expenses per minimal survival gains.

Importance and Feasibility of Animal Welfare Measures from a Consumer Perspective in Germany

The subject animal welfare is increasingly in the public discourse. Consumers and policymakers are increasingly demanding products that are produced under increased animal welfare standards. The profession of the farmer involuntarily gets into disrepute. Many consumers want fundamental changes in pig farming, but are not aware of the consequences of implementation. In this representative study, consumers (n = 1101) were asked about their assessment of 33 animal welfare measures with regard to their importance and the feasibility of implementing those measures. With the help of a four-field matrix, both the perceived importance and the feasibility of the animal welfare measures surveyed were brought together. The results show four possibilities: important and easy to implement, important and not feasible, not important and easy to implement as well as not important and not feasible. The results show that any outdoor access to pasture ranks first, followed by any outdoor access to straw bedding. The results can make a significant contribution to future communication with critical consumers concerning the implementation of higher animal welfare levels, as it becomes clearer how realistic consumers are about the feasibility of several animal welfare measures. Furthermore, the results could prove useful for the design of animal welfare programs and could help famers making targeted decisions concerning stable construction and management.