Vortragssitzung
Costs and Effectiveness of Healthcare Utilisation
Vorträge
Cost-effectiveness of a multicomponent lifestyle intervention against cognitive decline and dementia in an at-risk-population in Germany –AgeWell.de-trial
Elzbieta Buczak-Stec, University Medical Center Hamburg-Eppendorf UKE / HCHE
Christian Brettschneider, University Medical Center Hamburg-Eppendorf UKE / HCHE
Einleitung / Introduction
Dementia represents a major challenge to global health. With projected trends in population ageing and growth, the number of people with dementia is expected to increase. However, evidence suggests that there are potentially modifiable risk factors for dementia, such as depression, smoking, excessive alcohol consumption, physical inactivity or social isolation. Further, it has been suggested, that addressing those factors, may reduce the dementia prevalence and may delay the dementia progression. On the other hand, there is limited and conflicting evidence on whether the complex lifestyle interventions, which address multiple modifiable risk factors at the same time, have a positive impact on participants’ cognitive functioning. Further, the evidence is lacking on whether such prevention interventions are cost-effective. Therefore, the aim of this study is to investigate whether the multicomponent lifestyle intervention against cognitive decline (AgeWell.de clinical trial) is cost-effective.
Methode / Method
For this study, we used data form the multi-centric, two arms, cluster-randomized control trial (AgeWell.de trial). AgeWell.de is a fist multicomponent lifestyle intervention trail against cognitive decline in Germany. Eligible participants were recruited by the GPs, were 60 years and older, and had an increased dementia risk at baseline (CAIDE Dementia Risk Score ≥ 9). Participants were randomly assigned to the advanced (A) or basic (B) intervention and were followed up for 2 years. The (A) intervention included, among others, physical activity enhancement, and cognitive training. The (B) intervention (control group) included general health advice. We conducted a cost-effectiveness analysis. Health care use and the number of visits during 24 months follow up were measured using the Questionnaire for Health-Related Resource Use in Older Population (FIMA). Treatment costs comprised, among others, outpatient and inpatient care, emergency services, psychotherapy, and long-term care. Cost were valued using specific German unit costs. QALY (EQ-5D-3L) were used as a measure of health effects. Differences between interventions in terms costs were analysed using GLM models. ICER were calculated and net benefit regressions was conducted to determine the uncertainty of the point estimates of the ICER.
Ergebnisse / Results
In total, data were available for 752 participants, 358 - intervention group (69.0 (SD4.9) years old) and 394 - control group (68.9 (4.9)). Preliminary results showed, that the ICER=13,567€/QALY. Over 24 months, additional costs (823€) and additional effects (0.01 QALY) were found in the intervention compared to the control group (however, not statistically significant; p=.530).
Zusammenfassung / Conclusion
The analysis revealed that the intervention was unlikely to be cost-effective in preventing dementia risk in older adults.
AutorInnen
Elzbieta Buczak-Stec, University Medical Center Hamburg-Eppendorf UKE / HCHE
Hans-Helmut König, University Medical Center Hamburg-Eppendorf UKE / HCHE
Melanie Luppa, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig
Susanne Roehr, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig
Thomas Frese, Institute of General Practice and Family Medicine, Martin-Luther-University Halle-Wittenberg, Halle
Jochen Gensichen, Institute of General Practice/Family Medicine, University Hospital of LMU Munich
Walter E. Haefeli, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg
Wolfgang Hoffmann, German Center for Neurodegenerative Diseases (DZNE) / Institute for Community Medicine, University Medicine Greifswald
Hanna Kaduszkiewicz, Institute of General Practice, University of Kiel
Birgitt Wiese, Institute for General Practice, Work Group Medical Statistics and IT-Infrastructure, Hannover Medical School
Steffi G. Riedel-Heller, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig
Christian Brettschneider, University Medical Center Hamburg-Eppendorf UKE / HCHE
Budget impact of a high-dose influenza vaccine compared to standard vaccines in the German population aged 60 years and over.
Kathrin Pahmeier, Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
Christian Speckemeier, Essener Forschungsinstitut für Medizinmanagement (EsFoMed) GmbH
Einleitung / Introduction
While most individuals recover from seasonal influenza within a few days, certain groups such as children, the elderly, and those with preexisting medical conditions have an increased risk of complications. In Germany, vaccination against influenza is mainly advised from 60 years of age onwards and for individuals with health risk. Since 2020, an inactivated, quadrivalent high-dose influenza vaccine (IIV4-HD) has been recommended for persons aged 60+ years. The aim of this study was to calculate the budget impact of vaccinating the German population aged 60+ years with IIV4-HD compared to standard-dose influenza vaccines (IIV4-SD).
Methode / Method
An age-stratified deterministic compartment model was built to simulate the course of influenza infection for the German population in season 2019/20. Probabilities for health outcomes and cost data were searched from literature to calculate the influenza-related health and economic effects for different scenarios. In the base case analyses, the use of IIV4-HD for persons aged 60+ years instead of IIV4-SD was compared. Further analyses considered a higher relative vaccine effectiveness of IIV4-HD and increased vaccination coverage of 75% in persons aged 60+ years. Perspectives were those of the statutory health insurance (SHI) and the society. Deterministic sensitivity analyses were conducted.
Ergebnisse / Results
From SHI-perspective, vaccinating persons aged 60+ years with IIV4-HD would have prevented 277,026 infections (-1.1%) in season 2019/20 with an increase of overall direct costs of €224 million (+40.1%) compared to IIV4-SD. Separate analysis showed that raising the vaccination rate from 38.8% (base case) to 75% in individuals aged 60+ years while exclusively using IIV4-SD results in higher costs from SHI perspective of €121 million (+21.6%), but also prevents 1,566,674 influenza infections (-6.2%) when compared to the base case scenario for IIV4-SD. Compared to the scenario with IIV4-HD, a higher vaccination coverage of 75% in individuals aged 60+ while exclusively using IIV4-SD results in lower costs from SHI perspective of €-103 million (-13.2%) along with a reduction of 1,289,648 influenza infections (-5.1%).
Zusammenfassung / Conclusion
The modeling approach offers important insights on the epidemiological and budgetary impact of different vaccination scenarios. Achieving a higher vaccination coverage with IIV4-SD in persons aged 60+ years would result in lower costs and fewer influenza infections compared to the scenario with IIV4-HD and actual vaccination rates. Limitations must be taken into account as only one season was considered and data availability was restricted in some cases. However, in light of the ongoing COVID-19 pandemic and due to the increased probability of SARS-CoV-2 and influenza co-infections, research of this type is of high relevance.
AutorInnen
Kathrin Pahmeier, Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
Christian Speckemeier, Essener Forschungsinstitut für Medizinmanagement (EsFoMed) GmbH
Silke Neusser, Essener Forschungsinstitut für Medizinmanagement (EsFoMed) GmbH
Jürgen Wasem, Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen
Janine Biermann-Stallwitz, Essener Forschungsinstitut für Medizinmanagement (EsFoMed) GmbH
Cost-effectiveness of an interdisciplinary, internet-based transgender health care in Germany (i²TransHealth)
Thomas Grochtdreis, Universitätsklinikum Hamburg-Eppendorf
Einleitung / Introduction
The provision of specialized, professionally coordinated, and interdisciplinary care is relevant for the treatment of transgender and gender diverse (TGD) people diagnosed with gender incongruence/gender dysphoria. In rural areas outside the metropolitan regions, however, trans health care structures are rarely adequate or within reach. In order to improve trans health care for TGD people, an interdisciplinary, internet-based transgender health care (i²TransHealth) has been developed. The aim of this study was to determine the cost-effectiveness of i²TransHealth for treatment-seeking TGD people in rural regions of northern Germany with no or insufficient trans health care structures from a societal perspective.
Methode / Method
This study was conducted alongside a randomized-controlled trial comparing the effectiveness of i²TransHealth with a waiting list. The i²TransHealth treatment consisted of a telehealth-based e-health intervention including 1:1 chat with study therapists in combination with outpatient physician care when needed. As health effect measures, quality-adjusted life years (QALYs) were calculated based on the EQ-5D-5L index, and response to treatment based on the BSI-18 global severity index was used. Health care service utilization was assessed using service receipt inventories. The cost-effectiveness of i²TransHealth compared to a waiting list was assessed using the adjusted incremental cost-effectiveness ratio (ICER) based on seemingly unrelated regressions. Furthermore, the uncertainty of the ICER was assessed using cost-effectiveness planes and cost-effectiveness acceptability curves.
Ergebnisse / Results
Service users in the intervention group (IG; n = 90) and the control group (CG; n = 84) were on average aged 27 years. The mean QALYs of service users in the IG and CG were both 0.28 during the 4-month follow-up period. With 23.02%, service users in the IG had statistically significantly higher response to treatment compared to service users in the CG (9.21%, p = 0.011). The mean 4-month total costs were statistically significantly higher in the IG (+1390 €, p = 0.001). The corresponding ICER of i²TransHealth was 254,021 € and 10,786 € per additional QALY and response to treatment, respectively. The corresponding probability of cost-effectiveness of i²TransHealth was 20% and 75% at a WTP of 150,000 € per additional QALY and at a WTP of 15,000 € per additional response to treatment.
Zusammenfassung / Conclusion
From a societal perspective, i²TransHealth was unlikely to be cost-effective, even at high WTP per additional QALY. However, the comparison of i²TransHealth with a waiting list could have led to a distortion of the results with regard to health care service utilization. When considering additional response to treatment as health effect measure, the probability of cost-effectiveness of i²TransHealth was high, yet for an assumed WTP.