Körperliche Aktivität und Gewichtsreduktion

Einleitung / Introduction

Obesity is a condition associated with considerable health impact and disease related costs which is currently subject to rapid innovation: There are various new interventions in the growing field of digital health applications that aim at decreasing weight and increasing physical activity. However, these applications are difficult to evaluate economically: On the cost side, they can be characterised by high fixed costs and corresponding economies of scale, as well as an environment of rapid technological change. On the effect side, many digital-specific benefits such as data protection may not be well captured by quality-adjusted life years, the standard benefit measure of cost-utility analysis. This raises the question of whether welfarist or extra welfarist approaches to economic evaluation are better suited to their evaluation. Embedded in a comprehensive project that compares different types of economic evaluation, this study presents the study design and preliminary results of a willingness to pay analysis of a digital weight loss intervention within the German population.

Methode / Method

Using the contingent valuation method, we conduct an online survey which is based on iterative bidding to elicit the participants’ willingness to pay for the healthcare app. The online survey contains extensive information on the risks and costs of obesity-related illnesses, a survey on willingness to pay and questions on the characteristics of the participants (weight, height, digital infrastructure, level of education and state of health). Results using different starting values will be compared to test for anchor effects. For a statistic analysis, we will use a multivariate Tobit regression to analyse mean willingness to pay and the influence of other variables.

Ergebnisse / Results

We expect potential correlations between individual characteristics (income, health, digital infrastructure) and willingness to pay. From a methodological perspective, different starting bids in the iterative bidding process could result in different levels of willingness to pay (Anchor-Effect).

Zusammenfassung / Conclusion

To our knowledge, this is the first cost-benefit analysis of a digital health intervention in Germany using contingent valuation. It is likely that mean willingness to pay differs from the current reimbursement of similar digital health applications which may be relevant for reimbursement price negotiations in the future. Future work will assess implications of differing cost-effectiveness results using different evaluation methods for evaluating digital health applications.

Authors

Kevin Helms, Universität Bremen, Institut für Public Health und Pflegeforschung (IPP), Abteilung Management im Gesundheitswesen

Oliver Lange, Universität Bremen, Institut für Public Health und Pflegeforschung (IPP), Abteilung Management im Gesundheitswesen

Wolf Rogowski, Universität Bremen, Institut für Public Health und Pflegeforschung (IPP), Abteilung Management im Gesundheitswesen

Einleitung / Introduction

Physical activity is indicated as an important part of secondary prevention for patients with cardiovascular disease, yet physical activity levels remain low even after cardiac rehabilitation programs. A complex intervention to increase everyday physical activity with incentives for a daily step goal could overcome the short-dated effects of structured rehabilitation sports programs. In the development phase of the intervention, the preferences of the program participants should be investigated in order to design a patient-centred intervention that increases their willingness to participate and their adherence to the program.

Methode / Method

A discrete choice experiment (DCE) to measure preferences for incentives was developed based on literature and expertise of project partners. The attributes of the DCE were different incentives, with the setting being an intervention design of a daily prescribed step goal. We included motivational text messages, peer group performance information, feedback frequency, social control, and financial incentives in our design. An opt-out question was also presented. The DCE questionnaire was sent out to participants of the STEMI study, a prospective cohort study including people who are admitted with myocardial infarction (MI) at the Clinic of Cardiology of the University Clinic Düsseldorf, six weeks after initial treatment for MI. At this time, most of the participants just finished a cardiac rehabilitation program. The relative importance and preference weights of the DCE were calculated using logistic regression methods.

Ergebnisse / Results

A total of 134 participants completed the DCE. 76.7% of participants were male, mean age was 60.8 and 74.8% completed a rehabilitation program. The feedback frequency and the financial incentive were the attributes with the greatest relative importance concerning the perceived program effectiveness. The social control incentive was the only attribute with a negative coefficient. However, when analysing the stated intention to participate in the opt-out question, the social control incentive has a significant positive coefficient, highlighting the importance of including an opt-out question when eliciting patient preferences for a behaviour change program.

Zusammenfassung / Conclusion

This study provides insight into how behaviour change interventions can be designed to meet the preferences of program participants. A social control incentive as a component of a physical activity program could lead to mixed effects concerning perceived helpfulness of the program and participation rejection.

Authors

Jan Dyczmons, Deutsches Diabetes-Zentrum

Nadja Kairies-Schwarz, Heinrich-Heine-Universität Düsseldorf

Mickaël Hiligsmann, Maastricht University

Markus Vomhof, Heinrich-Heine-Universität Düsseldorf

Jana Sommer, Heinrich-Heine-Universität Düsseldorf

Andrea Icks, Heinrich-Heine-Universität Düsseldorf / Deutsches Diabetes-Zentrum

Einleitung / Introduction

Physical activity (PA) plays a key role in non-communicable disease prevention and in maintaining the functional ability that enables well-being in older age, potentially leading to cost savings for the healthcare system and society. In Germany, there are only a few studies on the relationship between PA and costs, particularly those that consider indirect costs. Therefore, two studies were conducted to examine this association based on 1) a large population-based sample aged 20-74 years and 2) a clinical trial population of (pre-)frail older adults aged 70+ years.

Methode / Method

Both studies employed a cross-sectional design. The first study used baseline data from the German National Cohort (NAKO) study (n=157,648). The second study used baseline data from the PromeTheus randomized-controlled trial (n=385). In both studies, direct healthcare costs were calculated based on self-reported information on health-related resource use. Indirect costs considered were productivity losses due to sick leave or health-related early retirement (study 1) and informal care (study 2). PA was assessed with the Global Physical Activity Questionnaire (GPAQ) and the German Physical Activity Questionnaire for mid-aged and older adults (German-PAQ-50+) in study 1 and study 2, respectively. PA was categorized into insufficient/sufficient and PA intensity levels according to the World Health Organization guidelines for aerobic PA. Mean costs of the different PA groups were estimated using two-part and generalized linear models.

Ergebnisse / Results

In both studies, sufficient PA was associated with lower costs than insufficient PA. In study 1, the difference was especially evident in the population aged 60+ years and when only leisure PA was considered. The direction of the association between PA and costs differed between PA domains: An inverse association was observed between leisure PA and costs, whereas a direct association was found between occupational PA and costs. Adjusting for the number of comorbidities reduced the differences between activity groups, but the trend persisted. In study 2, the cost difference between PA intensity groups was largely driven by differences in informal care costs and decreased substantially when frailty status was accounted for in the analyses.

Zusammenfassung / Conclusion

By including not only healthcare but also indirect costs, the analyses highlighted the wider societal consequences of insufficient PA beyond the healthcare system. Longitudinal studies are needed that enhance the understanding of the temporal relationship between PA and (healthcare) costs and the potentially mediating or confounding role of chronic diseases or health status in this context. This would allow drawing stronger conclusions about the economic impact of insufficient PA at the population level.

Authors

Sophie Gottschalk

Hans-Helmut König

Kilian Rapp

NAKO Study group

Judith Dams

Einleitung / Introduction

Bariatric surgery is currently the most effective intervention to improve health and quality of life (QoL) of patients with morbid obesity. Long-term post-operative care is necessary to ensure therapeutic success, but follow-up is not reliably reimbursed in Germany. Obesity centers try to provide follow-up, but are rapidly reaching their financial and staffing limits. The aim of the ACHT-study was to evaluate the effect of a structured cross-sectoral follow-up program for patients after a bariatric operation on general health and quality of life and compare outcomes to patients receiving usual care.

Methode / Method

The 18 month follow-up program (ACHT) has eight components: structured “close-to home” medical care, regular dietary counseling, a bariatric case manager, personalized exercise program, an electronic patient file, a patient smartphone app , psychological support, and integration in a quality assurance registry. Patients were recruited from 6 obesity centers in Bavaria from 2020-2022 as part of a multicenter, prospective, non-randomized comparative study. An early intervention group (IG1) started the program 3 weeks after bariatric surgery and a late intervention group (IG2) started 18 months (m.) after surgery. Patients were compared to controls, who had been operated at the same surgical centers, and received usual care at 18 and 36 m. after surgery respectively. The primary endpoint, health status was measured using a modified King's Score (values from 0 to 36). The score assesses health impairment caused by obesity in 12 domains, with values ranging from 0 (=normal finding) to 3 (=advanced impairment). Secondary endpoints were generic ((Euroqol-5D-5L (EQ-5D-5L)) and disease specific (Bariatric Quality of Life Index (BQL)) QoL. Differences between the groups were assessed with regression models adjusting for age, sex, surgical center and type of operation.

Ergebnisse / Results

238 patients were included, of which 188 patients completed the ACHT study as planned (IG1: n=89, 76% female; IG2: n=99, 79% female). After 18 m., the modified King’s Score of IG1 patients (n=72) was significantly better than control patients (n=159) (5.86 vs. 7.19 respectively; p=0.02). QoL of IG1 patients was also significantly better than controls (EQ-5D-5L: 0.93 vs. 0.88; p<0.001; BQL: 4.19 vs. 3.92; p<0.01). No significant differences were found between the IG2 patients and control patients regarding the modified King’s Score or QoL.

Zusammenfassung / Conclusion

The present results indicate that long-term post-operative care after bariatric-metabolic surgery can be successfully provided by trained ambulatory practices outside of obesity centers without any loss of quality in medical care, as measured by the modified King’s Score and QoL instruments. Evaluation of program costs and medical care costs are still underway.

Authors

Renee Stark, Institute of Public Health and prevention, TUM

Bettina Zippel-Schultz, Deutsche Stiftung für chronisch Kranke

Anne Neumann, Deutsche Stiftung für chronisch Kranke

Anna Renz, Deutsche Stiftung für chronisch Kranke

Ann-Cathrin Koschker, Universitätsklinikum Würzburg

Christina Haas, Universitätsklinikum Würzburg

Michael Hanselmann, Institute of Public Health and prevention, TUM

Martin Faßnacht-Capeller, Universitätsklinikum Würzburg

Michael Laxy, Institute of Public Health and prevention, TUM