Viruses and infections

Einleitung / Introduction

German health care system endured the pandemic with a relatively small increase in all-cause mortality rate and small changes in hospital admissions in general. However, hospital admissions for ambulatory care sensitive conditions (back pain, chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension), which are highly preventable when appropriate ambulatory care is provided, experienced higher declines than the hospital admissions for emergency cases such as acute myocardial infarction, stroke, and appendectomy and cancer surgeries. In this work, we will examine the changes in health care use (hospital admissions and ambulatory care utilization) and all-cause mortality rates of the population with ambulatory care sensitive conditions to better understand the impact of the pandemic on those patients in Germany.

Methode / Method

We employ data from several sources in our analysis. Our primary data source are anonymized claims data (2016-2022) from several German statutory health insurance companies provided by GWQ ServicePlus AG. . We obtained data on weather from Deutscher Wetterdienst, and public and school holidays from Deutscher Gewerkschaftsbund and Kultusminister Konferenz. We consider inpatient admissions, ambulatory care visits and all-cause mortality for patients with ambulatory care sensitive conditions. Mortality and changes in health care utilization during the pandemic will be examined controlling for age group, sex, comorbidities, and Kassenärztlichen Vereinigung (KV) region of the patients, weather conditions, public and school holidays using linear regression models.

Ergebnisse / Results

On average, hospital admission rates and ambulatory care visits declined by 21% and 7% of the prepandemic utilization rates, respectively for ambulatory care sensitive conditions during the pandemic, while all-cause mortality rate of the patients with ambulatory care sensitive conditions did not statistically significantly differ from that of the prepandemic rates. The declines in both hospital and ambulatory care utilization were the highest for chronic obstructive pulmonary disease patients and the lowest for heart failure patients.

Zusammenfassung / Conclusion

Large declines in hospital admission rates for ambulatory care sensitive conditions during the pandemic with no significant impact on mortality rates points to possible overutilization of hospitals for ambulatory care sensitive conditions before the pandemic. However, it is important to examine longer term mortality rates as data become available to study the longer term impacts of the changes in health care use among patients with ambulatory care sensitive conditions during the pandemic in future research.

Authors

Esra Eren Bayindir, Hamburg Center for Health Economics

Lea Grotenrath, GWQ ServicePlus AG

Christian Kümpel, GWQ ServicePlus AG

Jonas Schreyögg, Hamburg Center for Health Economics

Einleitung / Introduction

Respiratory Syncytial Virus (RSV) disease burden is substantial in older adults, placing increased pressure on the healthcare system. Several RSV vaccines are in clinical development, including the novel mRNA vaccine candidate, mRNA-1345 . We estimate the potential public health impact of vaccination with mRNA-1345 in adults aged ≥60 years in Germany.

Methode / Method

A static decision-tree model was used to calculate costs and outcomes of potential mRNA-1345 vaccination for adults aged ≥60 years over two years; outcomes were projected over a lifetime and discounted back at 3 percent. The model assumed that patients either received vaccination or no vaccination and if infected with RSV, either developed acute respiratory disease (ARD) or lower respiratory tract disease (LRTD). Under clinically relevant simplifying assumptions , each manifestation may lead to outpatient healthcare use, inpatient health care use or no treatment. The average epidemiological data from 2014 to 2023 was included for both modelled seasons for medically attended respiratory infections (MARI) and RSV-associated hospitalizations, incorporating seasonality. Data on mortality has been drawn from the literature. Vaccine effectiveness against RSV-ARD (68.4%) and RSV-LRTD (83.7%) was incorporated from clinical trials and assumes waning of vaccine effectiveness over 24 months. The vaccine effectiveness against RSV-LRTD was assumed for RSV hospitalization. Age-specific vaccine uptake was assumed to be similar to the 2021/22 influenza uptake. Direct costs were implemented for outpatient and inpatient visits and indirect costs captured productivity losses due to the acute phase of the disease. The cost-reference year was 2022.

Ergebnisse / Results

In the status-quo scenario without vaccination, the model estimates an epidemiological burden of 1,216,000 RSV-ARDs, 315,000 RSV-LRTDs, 45,800 RSV hospitalizations and 4500 RSV deaths annually. Vaccinating a hypothetical population of adults aged ≥60 years against RSV would reduce RSV burden by 486,000 RSV-ARD cases, 103,000 RSV-LRTD cases, 15,100 RSV-associated hospitalizations, and 1500 RSV-associated deaths. Direct yearly costs in the no-vaccination scenario amount to €1549 million for inpatient treatment and €51 million for outpatient treatment. Indirect costs amount to €42 million. mRNA-1345 reduces the RSV burden by 17,100 life-years and 20,100 QALYs, respectively.

Zusammenfassung / Conclusion

The mRNA-1345 RSV vaccine can potentially avoid a considerable number of hospitalizations and may help to reduce the pressure on the health care system especially during the seasonal peak of various respiratory infections.

Authors

Stefan Scholz, Moderna Germany GmbH

Kelly Fust, Quadrant Health Economics Inc.

Michele Kohli, Quadrant Health Economics Inc.

Darshan Mehta, Moderna Inc.

Parinaz Ghaswalla, Moderna Inc.

Bernhard Ultsch, Moderna Germany GmbH

Einleitung / Introduction

Die stetige Zunahme der antimikrobiellen Multiresistenz (AMR) ist ein originäres One Health-Problem, da Menschen, Tiere und die Umwelt durch die Entstehung und Ausbreitung von Resistenzen gegenseitig beeinflusst werden. Die Beherrschung dieser komplexen und zugleich sehr dynamischen Problematik kann nicht mehr durch einfache, lokal anwendbare Maßnahmen gelöst werden können, sondern erfordert vielmehr Systemdenken und eine koordinierte Zusammenarbeit diverser Ebenen der Gesellschaft.

Methode / Method

Für eine erste Annäherung an die AMR-Thematik sollen anhand von System Dynamics (SD) Modellierungen die Ursache-Wirkungsbeziehungen von Antibiotikaresistenzen aus der One-Health-Systemperspektive heraus visualisiert werden. Die partizipatorische Herangehensweise bindet durch Befragungen und einen interaktiven Workshop verschiedene Stakeholder aus Vorpommern aktiv im Datenerhebungs- und Modellierungsprozess ein.

Ergebnisse / Results

Im Ergebnis wird ein konzeptionelles Causal-Loop-Diagramm zum rationalen Umgang mit Antibiotika exemplarisch für die One-Health-Region Vorpommern erarbeitet. Dieses bietet einen umfassenden Überblick über mehrere identifizierte Schlüsselfaktoren im Zusammenhang mit dem regionalen Antibiotikamanagement und über die Art und Weise, wie diese Faktoren kausal auf verschiedenen Ebenen zusammenwirken.

Zusammenfassung / Conclusion

Das finale SD-Model ermöglicht es Entscheidungsträgern, ein tiefes Verständnis für das regionale Antibiotika- und Resistenzmanagement unter der One-Health-Perspektive zu entwickeln und in der Folge geeignete Hebelpunkte im rationalen Umgang mit Antibiotika aufzuzeigen.

Authors

Claudia Hübner, Universität Greifswald

Einleitung / Introduction

Hospital-acquired infections (HAI) not only have serious negative impacts on patients, such as an increased mortality and a reduced health-related quality of life, but also pose great economic burden for the healthcare system. For example, patients infected with a HAI have a longer length of stay in the hospital compared to patients without HAI. These excess LOS result in blocked bed days, which in turn lead to higher opportunity costs for the hospital. The aim of this study was to estimate the opportunity costs for a German hospital based on the LOS, the daily revenue (DR) and the occupancy rate.

Methode / Method

We analyzed costing data from a surgical and orthopedic unit of a German hospital from 2016. To generate a well-balanced sample, we used propensity score matching. After matching, we estimated the difference in LOS and DR between HAI patients and non-HAI patients using a linear regression model. Following this, we calculated the opportunity costs incurred by the hospital by treating patients with HAI. To determine potential cost drivers, we performed a subgroup analysis for each covariate. All costs are reported in 2016 EUR.

Ergebnisse / Results

In the final analyses, we included 81 HAI patients matched with 208 non-HAI patients. The largest share of the HAI patients (77.0%) had a surgical site infection. We found patients with HAI to have a longer LOS (10.2 days, p < .001) and lower daily revenues (EUR -308.2, p < .001) compared to non-HAI patients on average. Beside the infection, we found age, comorbidity, and number of operation to have a significant impact on the LOS as well. The resulting opportunity costs for the hospital resulted in EUR 8,952.90 per case.

Zusammenfassung / Conclusion

We can conclude that HAI pose a substantial economic burden for hospitals. From a health economic perspective, there is an urgent need for the implementation of infection control interventions, such as the involvement of a prevention link physician/nurse. The cost-effectiveness of infection control measures in German hospitals should be analyzed in future economic evaluation.

Authors

Lulseged Asegu, Chair for institutional economics and health policy, department philosophy, politics and economics, Witten/Herdecke University, Witten, Germany

Anne Kitschen, Chair for institutional economics and health policy, department philosophy, politics and economics, Witten/Herdecke University, Witten, Germany

Dirk Sauerland, Chair for institutional economics and health policy, department philosophy, politics and economics, Witten/Herdecke University, Witten, Germany