Prevention In Germany Research Articles

Advanced nursing practise as a preventive approach for adults with intellectual disabilities

Abstract Background Various barriers impede access to preventive health services for people with intellectual disabilities in Germany. As a result, they are more likely to suffer from certain chronic diseases. Internationally, Advanced Nursing Practice (ANP) has proven to be a suitable approach to care for this group. In Germany, ANP is not yet widespread. The aim of this study is to improve healthcare for people with intellectual disabilities through ANP-led case management. Methods A randomized controlled trial was conducted in an urban community setting. Inclusion criteria were: ICD-10 diagnosis F70-F79, age ≥18 and care level ≤3. The intervention group (IG) received four outreach home visits focused on prevention and health promotion. The control group (CG) received usual care. Allocation was done using computer-assisted, permuted block randomization. Researchers were blinded during data collection and analysis. The primary outcome was health status after 12 months (t2) (WHODAS). Secondary outcomes were health status after 6 months (t1), health-related quality of life (HQOL) after 6 and 12 months (EQ5D-VAS), and resilience after 6 and 12 months (RS-11). Analysis was performed via ANCOVA with Bonferroni correction at a significance level of 0.025. Results 214 participants were randomized. At t2, 176 participants remained (IG: n = 85, CG: n = 91). Health status at t2 showed a mean difference (MD) of -4.58 points in favor of the IG (p = 0.01). For resilience, a MD of + 1.95 (t2) points in favor of the IG was obtained (p = 0.05). We measured a MD for HQOL of -1.19 (p = 0.72) in favor of the CG. Conclusions A clinically relevant effect of ANP-led case management was achieved on the health status, but not on resilience and HQOL. ANP for people with intellectual disabilities can contribute to health promotion and thereby improve the community health. Therefore, ANP can be used as an innovative approach in the course of reorganization of healthcare for vulnerable populations in Germany. Key messages • ANP-led case management can have a clinically relevant effect on the heal status of people with intellectual disabilities over the course of one year. • ANP-led case management can be seen as a new approach to health promotion and disease prevention in Germany.

Advancing suicide prevention in Germany, Austria and Switzerland: a qualitative study.

Suicide is a significant public health problem, impacting individuals, families and communities worldwide. Effective suicide prevention requires a comprehensive approach with diverse integrated interventions and collaboration across sectors, stakeholders and professions. This study aims to identify challenges, gaps and success factors in current suicide prevention efforts in Germany, Austria and Switzerland, providing specific recommendations for advancement. We conducted online, semi-structured interviews with 36 suicide prevention experts from Germany, Austria and Switzerland, incorporating perspectives from policy, science and practice. Interviews were conducted between September 2022 and February 2023, audio-recorded, transcribed verbatim and analyzed using the Framework method. Despite progress in national strategies and coordinated efforts for suicide prevention, challenges such as resource scarcity, stigma and structural issues in psychiatric and psychotherapeutic care persist. The interviewees identified several areas for advancement, including developing targeted prevention measures for men and older people, strengthening collaboration across sectors, stakeholders and professions, and increasing the involvement of individuals with lived experience. While the COVID-19 pandemic has exacerbated challenges in psychiatric and psychotherapeutic care, it has concurrently strengthened interest in suicide prevention among policymakers and the media. National suicide prevention strategies play a crucial role in setting priorities, raising public awareness, and guiding action. However, since most suicide prevention efforts are still predominantly health sector-driven, a more comprehensive approach is needed to promote the involvement of all relevant actors and address suicidality as a collective societal responsibility. Tailoring prevention programs for risk groups like older people and men is important, as these populations show high suicide rates and face a lack of targeted interventions. Our study underscores the importance to continuously monitor, refine and strengthen collaborative and evidence-based suicide prevention efforts.

Digitisation and health: Second nationwide survey of internet users in Germany.

Rapid digitisation of health occurred during the COVID-19 pandemic worldwide. In October 2020, we conducted a survey on digital health technology use in Germany. This study aimed to conduct a second survey to investigate in more detail the internet use in health context and digital technology use for health promotion and disease prevention in Germany. A cross-sectional, nationwide telephone survey was conducted in November 2022. Anonymous data on internet and digital technology use, digital health literacy, and sociodemographic characteristics were analysed using descriptive statistics and binary logistic regressions. The 1020 participants were aged 18-92 years, 53% were male, 62% completed primary or secondary education, 71% resided in large cities, and 45% reported a country-average net household income. Overall, 61% reported internet use in health context via 1-4 devices. Among those, more than 50% used the internet and apps to obtain general health information and less than 50% used digital technologies for physical activity promotion or cancer prevention. Overall, 34% were confident in using the internet for health decisions and 71% preferred to receive health information non-digitally (e.g. on paper). Internet, app, and digital technology use were associated with higher digital health literacy and income, and residence in larger cities. Digital technologies were used for physical activity promotion by younger and for cancer prevention by older participants. The internet and digital technologies were predominantly used to obtain health information, but less often for health promotion and disease prevention in 2022 in Germany. While health app and digital technology use for physical activity promotion increased, the confidence in using online information for health decisions decreased in 2022 relative to 2020. Factors that promote confidence in online health information and digital technology use for health promotion and disease prevention need to be investigated in future studies.

COVID-19 vaccination in children and adolescents

The COVID-19 pandemic posed special challenges for the existing structures for vaccination prevention in Germany with respect to 1) understanding the role and aims of those involved and the interests of the children and 2) the definition of adequate criteria and assessment of the risk of severe diseases in children. Do the priorities of different groups of interest differ in the recommendations for COVID-19 vaccination? Which data on the pathogenicity of different variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) are necessary and how did they change during the pandemic? The tasks, objectives and perception of politics and the German national vaccination advisory committee regarding vaccination of children are discussed in the face of summarized recent data on clinical manifestations of pediatric SARS-CoV‑2 infections among children and adolescents in Germany, which could be estimated by combining different German data sources. The perspectives of politics and children differ but are legitimate when they are clearly stated. The decisive risk for a severe course or the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV‑2 (PIMS-TS) per 10,000 SARS-CoV‑2 infections for the decision on vaccination from the perspective of children, decreased during the course of the pandemic with dominance of the omicron variant. Severe courses of COVID-19 still predominantly affect children with underlying diseases. The age-stratified analysis of vaccinated and nonvaccinated children showed that the alterations in the pathogenicity of the virus in the course of the pandemic is particularly reflected in the reduction in the risk of PIMS-TS. The general reduction of severe courses of COVID-19 again can be explained by the characteristics of variants of concern (VOC) as well as increasing vaccination rates and immunity following a SARS-CoV‑2 infection. The primary goal of COVID-19 vaccination in children and adolescents is the prevention of severe courses of the disease. In pediatric risk groups the best possible immunity or immune protection by vaccination should be strived for. It is currently unclear whether catch-up vaccination in already infected or vaccinated children or whether forthcoming healthy children will need vaccination, aiming for hybrid immunity.

Different Perspectives of Patients and Physicians on LDL-C Target Achievement in the Treatment of Hypercholesterolemia: Results on Secondary Prevention from the German PROCYON Survey.

Low-density lipoprotein cholesterol (LDL-C) reduction in hypercholesterolemia patients at very high cardiovascular (CV) risk is essential in preventing future CV events. The objective was to assess the perception on hypercholesterolemia management in secondary prevention in Germany. PROCYON was a two-part online survey, including a patient questionnaire as well as a physician questionnaire. A total of 109 general practitioners, internists, and cardiologists participated. The current ESC/EAS recommendation for high-risk patients is followed by 19.3% of the physicians. The majority (80.7%) reported an LDL-C target failure rate of at least 30%. More than two thirds (71.6%) have stated treating less than half of their patients with the maximum approved statin dose. The survey included 1696 secondary prevention patients. The majority (86.7%) consult their general practitioner for hypercholesterolemia; 54.0% consult a cardiologist (multiple answers allowed). Most patients (87.0%) were receiving lipid-lowering medication. Among these, 800 (54.2%) reported improved LDL-C levels since diagnosis, 569 (38.6%) reported no improvement, and 106 (7.2%) had no information. Of the treated patients with (N' = 800) and without (N' = 569) improvement, 34.3% vs. 37.3% were on their initial drug and dose, 24.8% vs. 23.7% received multiple drug therapy, 48.9% vs. 48.9% reported a dose change, and 16.1% vs. 14.2% had discontinued at least one drug (multiple answers). Disease knowledge was rated as good or very good by 29.8% of patients. PROCYON demonstrated insufficient ESC/EAS guideline implementation regarding target levels and therapeutic escalation strategies. Furthermore, a lack of specialist involvement and patient education was identified.

Practice of perioperative phantom limb pain prevention in Germany: anationwide survey

The prevalence of phantom limb pain after major amputation remains high and affected patients suffer from relevant impairments in the quality of life. Perioperative treatment strategies may prevent phantom limb pain. This study aims to assess the state of the perioperative anesthesiological pain management for major amputations. Furthermore, it analyzes potentials for optimization and barriers towards abetter treatment of patients with amputations. This online survey was distributed by the German Society of Anesthesiology and Intensive Care Medicine (DGAI) mailing list of anesthesiological consultants. It was approved by the Charité ethics board. Overall, 402 persons participated in this survey. Mostly, general anesthesia (85%), regional anesthesia (63%) and neuraxial anesthesia (49%) were performed in different combinations. Furthermore, 72% of participants reported using i.v. opioids postoperatively, mostly applied via patient-controlled analgesia (PCA). In contrast, preoperative regional anesthesia (74%) and gabapentinoids (67%) were seen as potential methods to improve treatment; however, barrier analysis revealed that treatment options are limited especially by organizational aspects and intrinsic patient factors. This survey describes the current practice of phantom limb pain prevention in Germany. It shows an unmet need for specialized perioperative pain treatment. As the evidence regarding treatment recommendations is limited, further research questions can be deduced from this study.

The Temporal Unfolding of Crises: Synchronizing Rhythms and the Construction of Urgency

Despite the continuing interest in studying crises, our knowledge of how these adverse situations unfold over time is still fragmented. Based on an empirical study of the German government agency Robert Koch-Institute, which is responsible for disease control and prevention in Germany and hence for the ongoing COVID-19 pandemic, we develop a process model of the constitution of urgency to act in the unfolding of crises based on music theory. In this paper, we argue that such urgency to act, i.e., the tact of a crisis, enables actors to synchronize temporal rhythms of responses to the crisis. In particular, we describe four temporal synchronizing practices—initiating, highlighting, releasing, and aligning—through which actors in organizations synchronize different rhythms of responses to a crisis and aim to create urgency to act. The main contribution of our paper is a more nuanced understanding of the role of temporality in crises in general, and the proactive role of organizations in particular.

Patient and Physician Reported Perception on Hypercholesterolemia Management in Primary Prevention in Germany: Results from a Nationwide Online Survey.

IntroductionEffective hypercholesterolemia management is essential in primary prevention of cardiovascular events. The objective of PROCYON was to assess the perception on hypercholesterolemia management in primary prevention and to identify reasons for insufficient target attainment in clinical practice in Germany.MethodsPROCYON was a two-part online survey including a patient questionnaire on treatment status and disease knowledge and a physician questionnaire on guideline awareness and patient management. A conjoint analysis on the relative importance of cardiovascular risk factors was incorporated.ResultsOf 3798 primary prevention patients included, 1632 (43.0%) received lipid-lowering medication. Of these, 790 (48.4%) reported improved low-density lipoprotein cholesterol (LDL-C) levels, 670 (41.1%) reported no improvement, and 172 (10.5%) had no information. Of the treated patients with (N′ = 790) and without (N′ = 670) improvement, 52.4% vs. 47.9% were on their initial drug and dose, 8.9% vs. 9.0% received multiple drug therapy, 34.7% vs. 38.8% reported a dose change, and 16.0% vs. 19.4% had discontinued at least one drug (multiple answers). In total, 109 physicians participated. In the conjoint analysis, LDL-C level was attributed the highest relative importance (32.0%), followed by diabetes (24.5%) and systolic blood pressure (15.8%). Lipid-lowering therapy is initiated at an LDL-C level > 150 mg/dl by 63 physicians (57.8%). One third (n = 35; 32.1%) stated that ≥ 60% of their primary prevention patients do not receive lipid-lowering medication.ConclusionPROCYON suggests a need for consequent LDL-C target-based treatment implementation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02266-3.

Cost-Effectiveness of Lipid-Lowering Therapies for Cardiovascular Prevention in Germany

PurposeNovel pharmaceutical treatments reducing cardiovascular events in dyslipidaemia patients must demonstrate clinical efficacy and cost-effectiveness to promote long-term adoption by patients, physicians, and insurers.ObjectiveTo assess the cost-effectiveness of statin monotherapy compared to additive lipid-lowering therapies for primary and secondary cardiovascular prevention from the perspective of Germany’s healthcare system.MethodsTransition probabilities and hazard ratios were derived from cardiovascular outcome trials for statin combinations with icosapent ethyl (REDUCE-IT), evolocumab (FOURIER), alirocumab (ODYSSEY), ezetimibe (IMPROVE-IT), and fibrate (ACCORD). Costs and utilities were retrieved from previous literature. The incidence of major adverse cardiovascular events was simulated with a Markov cohort model. The main outcomes were the incremental cost-effectiveness ratios (ICER) per quality adjusted life year (QALY) gained.ResultsFor primary prevention, the addition of icosapent ethyl to statin generated 0.81 QALY and €14,732 costs (ICER: 18,133), whereas fibrates yielded 0.63 QALY and € − 10,516 costs (ICER: − 16,632). For secondary prevention, the addition of ezetimibe to statin provided 0.61 QALY at savings of € − 5,796 (ICER: − 9,555) and icosapent ethyl yielded 0.99 QALY and €14,333 costs (ICER: 14,485). PCSK9 inhibitors offered 0.55 and 0.87 QALY at costs of €62,722 and €87,002 for evolocumab (ICER: 114,639) and alirocumab (ICER: 100,532), respectively. A 95% probability of cost-effectiveness was surpassed at €20,000 for icosapent ethyl (primary and secondary prevention), €119,000 for alirocumab, and €149,000 for evolocumab.ConclusionsFor primary cardiovascular prevention, a combination therapy of icosapent ethyl plus statin is a cost-effective use of resources compared to statin monotherapy. For secondary prevention, icosapent ethyl, ezetimibe, evolocumab, and alirocumab increase patient benefit at different economic costs.

Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention

Early Childhood Intervention for Children of Parents with Mental Health Issues - Results of the Research Program of the National Center for Early Prevention In Germany, networks and measures of early childhood intervention (ECI) have been implemented nationwide. By specifically targeting families with multiple psychosocial challenges, ECI contributes to the enhancement of families' parenting skills, in order to promote equal opportunities for all children to grow up healthy and safe. In many families supported by ECI measures at least one parent shows symptoms of a mental health disorder, which poses a major challenge to ECI practitioners. Nevertheless, there is a lack of valid scientific knowledge about the proportion of young families living with symptoms of mental disorders, the degree to which parents' psychic burdens affect care in ECI measures and about the cooperation of different care providing systems. The National Center for Early Prevention (NCEP) monitors and evaluates the scaling up of ECI networks and measures in Germany. The present article compiles results of different NCEP studies focusing on parents with mental illness in Early Childhood Intervention. Results are discussed with regard to their relevance for further improving the care systems.

The impact of crime on apartment prices in Hamburg, Germany

PurposeThe purpose of this study is to examine the impact of crime on apartment prices for Hamburg, Germany, for the years 2012 to 2017.Design/methodology/approachThe authors use a panel data setting with fixed effects estimators and temporal lags to moderate the endogeneity concerns related to crime. The authors consider the effect of total crime, violent and property crime and some sub-categories of crime.FindingsThe estimates show that it takes two to three years for prices to react, with the longer run elasticity reaching −0.12 for total crime, −0.15 for property crime and −0.06 for violent crime. The elasticities are much larger in high-crime areas (−0.22 for total crime, −0.28 and −0.09 for property and violent crime) and elevated also in low-income areas.Social implicationsThe finding that property crime matters more in terms of quantitative impact for housing values than violent crime provides reasonable grounds for rethinking the resource allocation of public spending on crime clearance and prevention in Germany. Far more emphasis on preventing property crime appears in order and especially so in the lower income or higher crime areas, which are significantly more affected by crime and in particular property crime than those in high income or low crime areas.Originality/valueThe estimates for Hamburg provide the first detailed results of the impact of crime on real estate prices in Germany. It is also the first study for Continental Europe using panel data.

Sustainable strengthening of Public Health in Germany through Attractive Career Paths - Core Requirements for a Public Health Strategy for Germany in the Area of Human Resources

The demand for a well-trained public health workforce is increasing in view of the increased importance of health promotion and disease prevention in Germany. However, many career paths in public health are non-transparent, which creates additional barriers for interested young professionals and contributes to the existing gap between demand and supply. Against the backdrop of international frameworks and the specific labor market situation in Germany, the working group 11 "Career Paths in Public Health" of the 3rd Symposium of the Future Forum Public Health discussed current challenges and formulated initial solutions.

Workshop: National approaches to Public health; policy, strategies, legislation and implementation in Europe

Abstract Background During the past decades, the growth of knowledge to prevent disease on the one hand and the growth of public acceptance to prevent disease on the other hand led to form public health systems. Soon after, health was no longer considered as an individual responsibility only, and more effective interventions against health threats and communicable diseases were developed. As a result, public agencies and authorities were established to implement newly discovered interventions against health threats and to prevent non-communicable diseases. Though, the orientation of public health agencies and authorities shifted from prevention of disease to promotion of health in almost all countries, their public health systems are developed widely differently. While some countries look back to traditionally established public health systems, others are pursuing different approaches to achieve Health in All Policies through policy and legislation in Wales or are now evaluating their public health policies after a ten-years-strategy, like Sweden and still others have only recently (2015) introduced a new Preventive Health Care Act and follow a bottom up approach called “Future Forum Public Health”, like Germany. Objectives This workshop aims at presenting the very different perspectives on the achievement of public health and different systems around Europe. Both, the disparity of the approaches and their different forms, and different stages of their development will be addressed by each presentation. Despite differences of the public health systems in each context, the workshop will focus on identifying shared features and common challenges of the countries with the goal of identifying inspiring examples and discussing criteria of transferability. During the discussion that will follow, different possibilities of cooperation and exchange will be assessed and debated. In particular, the workshop will encompass a presentation from Wales on “the future generation’s act” and will include information on the requirements to turn the legislation into practice. The Swedish input will focus on the Swedish national public health policy and its achievements after ten years. France will give an overview of the structural developments during the last ten years. The presentation from Germany will consist of contrasting a top-down and a bottom-up approach, namely the act to strengthen health promotion and prevention in Germany on the one hand and the future forum public health on the other hand. And last but not least, we will hear about the particular success of the Slovenian example with a newly shaped and largely developed public health system. Key messages Acquiring insight into different approaches to achieve improvements in public health based on alternative systems is important to identify inspiring examples, shared features and common challenges. Identification of criteria of transferability of public health strategies, legislation and policies between countries, and requirements for implementation are crucial for learning from best practice.

Study Designs for Effect Evaluation in Disease Prevention and Health Promotion - Meaning of Internal and External Validity in Intervention Studies

Health promotion and disease prevention in Germany have become more important as a result of the Prevention Act that gives special attention to the setting. So far, however, there is neither a common understanding of the terms of this approach, nor are its potentials empirically derived. Therefore, a discussion about suitable evaluation and study concepts is required. The aims of this study were to address the meaning of internal and external validity of intervention studies in health promotion and disease prevention. We provide an overview of the achievable bias control for different study designs and provide examples for the evaluation of setting-based approaches. Interventions in settings are often characterized by a multitude of measures, actors and intervention contexts. Methods of analysis from evidence-based medicine are viewed critically for health promotion and disease prevention in Germany. Such studies are considered to provide a high degree of internal validity, but the extrapolation of the results to "reality" is viewed as low. In contrast, the extrapolation of study results is not more of a challenge for setting projects than for any other research area. It is not limited by different contexts, but rather by different causal relationships. Impact assessment aims at causally attributing an observed outcome to the intervention. Thus, the epistemological requirements do not differ between studies that are designed for internal or external validity. The international discussion focuses on the refinement of (quasi)-experimental study designs. Examples for the evaluation of setting projects, mainly from Germany, illustrate that those alternative methods have already been used in evaluation practice. A challenge for health promotion and disease prevention in settings is to systematically assess the different needs for evidence-basing. At present, there is a wealth of findings in a large number of intervention fields. These findings must be compiled and analyzed to determine whether and to what extent further evaluations need to be initiated and by which methods.

Physicians' lifestyle advice on primary and secondary cardiovascular disease prevention in Germany: A comparison between the STAAB cohort study and the German subset of EUROASPIRE IV.

We assessed prevalence and determinants in appropriate physician-led lifestyle advice (PLA) in a population-based sample of individuals without cardiovascular disease (CVD) compared with a sample of CVD patients. PLA was assessed via questionnaire in a subsample of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort free of CVD (primary prevention sample) and the German subset of the fourth EUROASPIRE survey (EUROASPIRE-IV) comprising CVD patients (secondary prevention sample). PLA was fulfilled if the participant reported having ever been told by a physician to: stop smoking (current/former smokers), reduce weight (overweight/obese participants), increase physical activity (physically inactive participants) or keep to a healthy diet (all participants). Factors associated with receiving at least 50% of the PLA were identified using logistic regression. Information on PLA was available in 665 STAAB participants (55 ± 11; 55% females) and in 536 EUROASPIRE-IV patients (67 ± 9; 18% females). Except for smoking, appropriate PLA was more frequently given in the secondary compared with the primary prevention sample. Determinants associated with appropriate PLA in primary prevention were: diabetes mellitus (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.88-10.95), hyperlipidaemia (OR 3.12; 95% CI 2.06-4.73) and hypertension (OR 1.74; 95% CI 1.15-2.62); in secondary prevention: age (OR per year 0.96; 95% CI 0.93-0.98) and diabetes mellitus (OR 2.33; 95% CI 1.20-4.54). In primary prevention, PLA was mainly determined by the presence of vascular risk factors, whereas in secondary prevention the level of PLA was higher in general, but the association between CVD risk factors and PLA was less pronounced.

Cardiovascular risk algorithms in primary care: Results from the DETECT study

Guidelines for prevention of cardiovascular diseases use risk scores to guide the intensity of treatment. A comparison of these scores in a German population has not been performed. We have evaluated the correlation, discrimination and calibration of ten commonly used risk equations in primary care in 4044 participants of the DETECT (Diabetes and Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment) study. The risk equations correlate well with each other. All risk equations have a similar discriminatory power. Absolute risks differ widely, in part due to the components of clinical endpoints predicted: The risk equations produced median risks between 8.4% and 2.0%. With three out of 10 risk scores calculated and observed risks well coincided. At a risk threshold of 10 percent in 10 years, the ACC/AHA atherosclerotic cardiovascular disease (ASCVD) equation has a sensitivity to identify future CVD events of approximately 80%, with the highest specificity (69%) and positive predictive value (17%) among all the equations. Due to the most precise calibration over a wide range of risks, the large age range covered and the combined endpoint including non-fatal and fatal events, the ASCVD equation provides valid risk prediction for primary prevention in Germany.

Who should waste less? Food waste prevention and rebound effects in the context of theSustainable Development Goals

The issue of food waste prevention plays a role in global and national policies. Such prevention can reap economic and, in particular, environmental benefits. As our study shows, these environmental benefits are often lost due to indirect rebound effects. Income differences play a crucial role here.Addressing food waste prevention is one target of theSustainable Development Goals (SDGs)and a major task for theUN Environmental Programmeand the European Commission. It is promising in terms of its environmental saving potential. However, it also leads to consumers being able to save money, which they then are likely to spend, thus again causing a negative environmental impact. This dimension of the so-called indirect rebound effect, which prevents the desired ecological benefits from being achieved, is investigated in this paper. By using a single-region environmentally extended input-output model from a production perspective, the indirect rebound effects from food waste prevention in Germany are analysed. Any political action needs to consider not only a differentiation in income class, but also alternative concepts such as the principles of sufficiency in order to achieve all ecological benefits and specifically the third target ofSDG 12.

Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058.

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-who-have-sex-with-men (MSM). The high cost of PrEP has until recently been a primary barrier to its use. In 2017, generic PrEP became available, reducing the costs by 90%.AimOur objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.MethodsWe calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV) epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective using a 40-year time horizon starting in 2018.ResultsPrEP can avert 21,000 infections (interquartile range (IQR): 16,000–27,000) in the short run (after 2 years scale-up and 10 years full implementation). HIV care is predicted to cost EUR 36.2 billion (IQR: 32.4–40.4 billion) over the coming 40 years. PrEP can increase costs by at most EUR 150 million within the first decade after introduction. Ten years after introduction, PrEP can become cost-saving, accumulating to savings of HIV-related costs of EUR 5.1 billion (IQR: 3.5–6.9 billion) after 40 years. In a sensitivity analysis, PrEP remained cost-saving even at a 70% price reduction of antiretroviral drug treatment and a lower effectiveness of PrEP.ConclusionIntroduction of PrEP in Germany is predicted to result in substantial health benefits because of reductions in HIV infections. Short-term financial investments in providing PrEP will result in substantial cost-savings in the long term.

The Act to Strengthen Health Promotion and Prevention in Germany

The Act to Strengthen Health Promotion and Prevention in Germany

The Act to Strengthen Health Promotion and Prevention in Germany

The Act to Strengthen Health Promotion and Prevention in Germany