Vortragssitzung
Cost-effectiveness
Vorträge
Cost-effectiveness of patient-tailored feedback interventions after online depression screening: Evidence from the DISCOVER trial
Léon Gerardo Kreis, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
Einleitung / Introduction
Depressive disorders have a high prevalence and cause a large burden of disease. Depression screening is already widely applied, feedback interventions in combination with screening methods are still to be investigated to a broad extent. The DISCOVER trial was a web-based, three-armed randomized controlled trial (RCT) on patient-tailored feedback after online depression screening. The objective of this work was to conduct the cost-effectiveness analysis (CEA) of the DISCOVER trial from a societal perspective.
Methode / Method
In the RCT, participants underwent online depression screening and were immediately randomized into one of three study arms if screened positive. NO FEEDBACK (NF) participants received no feedback on their screening results, STANDARD FEEDBACK (SF) participants received generic feedback, and TAILORED FEEDBACK (TF) participants were presented with patient-tailored feedback including further information based on their responses. The time horizon of the trial was six months. Main outcome was the incremental cost-effectiveness ratio (ICER), defined as the ratio of incremental costs (healthcare costs and productivity losses) and quality-adjusted life years (QALY). HRQL was measured by means of the EQ-5D-5L. To assess the uncertainty around the ICER, cost-effectiveness acceptability curves were constructed based on the net benefit regression approach, applying linear OLS regressions. Furthermore, four different scenarios of sensitivity analyses were conducted, one of which considered depression-free-days (DFD) as an outcome.
Ergebnisse / Results
927 participants (NF: 304; SF: 315; TF: 308) were included at baseline. During follow-up, HRQL increased for all study arms . NF participants experienced the most QALY, SF the least. Total costs were lowest for TF and highest for NF. All differences were statistically not significant. NF and TF both exhibited dominance over SF. The ICER of TF compared to NF was €101,904/QALY. Cost-effectiveness probability of TF against NF ranged between 39% and 79% (willingness-to-pay range: €0/QALY-€160,000/QALY). Sensitivity analyses showed robustness of results. DFD during follow-up were highest for TF, lowest for NF. In this case, TF was dominant over both NF and SF. At a WTP of €12.5/DFD, its cost-effectiveness probability was around 81% compared to NF and 91% compared to SF.
Zusammenfassung / Conclusion
Regarding QALY, both TF and NF are highly likely to be cost-effective compared to SF. The cost-effectiveness between TF and NF highly depends on assumed WTP margins. Considering DFD, TF is highly probable to be cost-effective. Long-term effects of feedback interventions remain to be investigated.
AutorInnen
Léon Kreis, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
Hans-Helmut König, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
Franziska Sikorski, Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie
Bernd Löwe, Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie
Sebastian Kohlmann, Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie
Christian Brettschneider, Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung
Health economic evaluation of the personalized peer support program (P-SUP) for patients with type 2 diabetes and/or coronary artery disease
Helene Könnecke, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln
Einleitung / Introduction
Disease Management Programs (DMPs) aim to provide standardized, evidence-based and structured patient care. In Germany, DMPs have been shown to improve the quality and patient-centeredness of care. With regard to self-management support, there is still potential for improvement compared to international standards. The aim of the P-SUP program is to support patients with type 2 diabetes mellitus (T2DM) and/or coronary artery disease (CAD) in successful self-management through a multimodal program including peer support.
Methode / Method
The core of the intervention consists of structured peer support group meetings where the group participates in physical exercise sessions and educational lectures on exercise, nutrition, or disease-related knowledge. In addition, a specially designed online platform, personalized feedback for patients on medical outcomes from their general practitioners, and regular telephone coaching for vulnerable patients are provided to increase intrinsic motivation and activation. Similar projects have been evaluated from a health economic perspective, such as Aktivtreff Diabetes (Johansson et al., 2016) in Austria and a group-based peer support program in Ireland (Gillespie et al., 2012). However, P-SUP goes beyond existing designs by representing a complex intervention that integrates multiple components into one program, targeting both community impact and individual patient needs.
Ergebnisse / Results
The aim of the health economic evaluation of the program is to analyze its cost-effectiveness from the perspective of the statutory health insurance (SHI). Secondary analyses will focus on potential heterogeneity of effects based on subgroup analysis. Intervention costs will be collected from project accounting data. Routine SHI data and project data will be imported and merged for analysis. Deterministic and probabilistic sensitivity analyses will be conducted to account for uncertainty. Preliminary results will be available at the time of the presentation.
Zusammenfassung / Conclusion
The P-SUP program represents an important step forward in the effort to enhance disease management and self-management support for patients with type 2 diabetes mellitus and/or coronary artery disease.
AutorInnen
Helene Könnecke, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln
Uwe Konerding, Universität Bamberg
Sebastian Appelbaum, Universität Bamberg
Lisa Giesen, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln
Marcus Redaèlli, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln
Anette Graute, Uniklinik Essen
Max Scholl, Deutsche Sporthochschule Köln
Christian Funke, Uniklinik Düsseldorf
Frank Vitinius, Klinik für Psychosomatik und Psychotherapie, Medizinische Fakultät, Uniklinik Köln (Universität zu Köln)
Lucas Küppers, Institut für Hausarztmedizin, Universitätsklinikum Bonn
Stephanie Stock, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Uniklinik Köln
Costing clinical pathways for robotic colorectal surgery in Germany
Alfonso Valenzuela Hurtado, Heidelberg Institute of Global Health, Heidelberg University
Einleitung / Introduction
Clinical pathways (CPs) are guidelines to standardize processes, improve quality of care and maximize resources through the implementation of evidence-based care for a medical procedure, thus reducing variation and risk. Our aim was to conduct a costing study of implementing CPs for robotic colorectal surgery in Germany to assess the cost of robotic surgery with a CP compared to standard robotic surgery without a CP.
Methode / Method
CPs for robotic colorectal surgery were implemented in a third level facility, the Department of Abdominal, Vascular and Endocrine Surgery of the University Hospital Halle (Saale). This was a non-interventional costing study with a hospital level perspective. We carried out a micro-costing study using the three standard steps. First, we identified all resources involved in the implementation of the CPs mentioned above and classified them as variable costs and fixed costs. Second, we resorted to different methods such as direct observation, physical counting, interviews with experts and the use of hospital technical documents to measure resource consumption. And third, for the valuation of the resources identified and measured, we used internal information from the hospital, scientific literature, and market prices. This included the costs related to perioperative care and treatment of complications, up to 30 days after hospital discharge. Finally, we adjusted our values in a sensitivity analysis.All analyses were done according to the intention-to-treat principle. No patients were excluded from the analyses due to complications or excessive length of stay.
Ergebnisse / Results
The total sample comprised 63 patients, 21 from group 1 (robotic colorectal surgery with CP usage) and 42 from group 2 (robotic colorectal surgery without CP usage). The mean cost per patient in group 1 was €12,663 , with a variation from €8,093 to €26,475; while the mean cost per patient in group 2 was €11,128 with a variation from €8,357 to €17,628. The cost drivers for group 1 were materials and disposables and staff, with 33% and 20% of total costs respectively. For group 2 they accounted for 38% and 20% of total costs. For the sensitivity analysis, we considered the capacity utilization of the robot (number of possible surgeries). With 100% utilization in group 1 there was a mean cost per patient of €12,356, in group 2 of €10,821. At 20% utilization, group 1 had a mean cost per patient of €17,837 and group 2 of €16,302.
Zusammenfassung / Conclusion
Robotic colorectal surgery using a CP for the treatment of patients is not associated with cost reductions compared to robotic surgery without CP usage. Staff expenses and materials are the main cost drivers in both groups. The present evidence does not support CPs as a tool for cost reduction in robotic colorectal surgery.
AutorInnen
Alfonso Valenzuela Hurtado, Heidelberg Institute of Global Health, Heidelberg University
Ulrich Ronellenfitsch, Universitätsklinikum Halle (Salle)
Onur Bayram, Universitätsklinikum Halle (Salle)
Jörg Kleeff, Universitätsklinikum Halle (Salle)
Manuela De Allegri, Heidelberg Institute of Global Health, Heidelberg University
Kosten-Effektivitäts-Analyse eines onlinebasierten Motivationsprogramms zur Reduktion der problematischen Mediennutzung und zur Erhöhung der Behandlungsmotivation bei Internetnutzungsstörungen – Ergebnisse der OMPRIS-Studie
Anja Niemann, Universität Duisburg-Essen, Lehrstuhl für Medizinmanagement
Einleitung / Introduction
Das Internet ist allgegenwärtig und bietet vielfältige Nutzungsmöglichkeiten. Damit einher geht jedoch das Risiko von Internetnutzungsstörungen (IUD), die einen relevanten Einfluss auf Volkswirtschaften zeigen. Im Rahmen der vom Innovationsfonds des G-BA (Förderkennzeichen 01VSF18043) geförderten Studie OMPRIS, wurde ein vierwöchiges online-Programm zur Behandlung von IUD in den Bereichen Onlinespiele, Cybersex und soziale Netzwerke, mit dem Ziel einer Reduktion der Mediensuchtsymptome, entwickelt. Aus gesundheitsökonomischer Sicht bietet die Intervention ein Einsparpotenzial, z.B. durch die Vermeidung/Verringerung psychiatrischer Komorbiditäten oder Reduktion indirekter Kosten. Ziel der Analyse ist die Berechnung der Kosten-Effektivität der Interventionsgruppe (IG) verglichen mit der Wartekontrollgruppe (WKG) aus Perspektive der GKV und der Gesellschaft.
Methode / Method
Die Studie wurde als RCT und multizentrisch im Wartekontroll-Design angelegt. Personen mit riskantem oder pathologischem Internetgebrauch wurden einbezogen. Der Ressourcenverbrauch (indirekte, direkte (nicht-)medizinische Kosten) wurde mittels standardisiertem Fragebogen zur Baseline (T0) und nach der Intervention/Wartezeit (T2) erhoben. Hierbei wurde ein Fokus auf Verbräuche aufgrund psychischer Belastungen gelegt. Preise basierten auf Standardkostensätzen und eigenen Recherchen z.B. EBM und Lohnkosten. Medikamente wurden über die LAUER TAXE® bewertet. Zusätzlich wurden die Interventionskosten berechnet. Als Effektmaß wurde der primäre Endpunkt AICA-S, eine Skala zur Bewertung von Internet- und Computerspielsucht, herangezogen. Mittels Berechnung des Reliable Change Index (RCI), basierend auf einer deutschen Normstichprobe, wurden Personen mit und ohne Reliable Change (RC) des AICA-S unterschieden. Die ICER wurde unter Anwendung des Difference-in-Difference-Verfahrens berechnet.
Ergebnisse / Results
In die Analyse wurden 169 (IG n=81, WKG n=88) Personen eingeschlossen. Das mittlere Alter lag bei 32 (SD 12,1) Jahren. 75% der Kohorte waren männlich, 2% divers. Der AICA-S zeigte keine signifikanten Gruppenunterschiede zu T0 (IG 12,4; WKG 12,5). Zu T2 verbesserte sich der AICA-S in beiden Gruppen, in der IG jedoch deutlicher, sodass ein statistisch signifikanter Gruppenunterschied zu T2 entstand (IG 6,8; WKG 11). Der RCI wurde mit 3,45 berechnet. Basierend hierauf zeigten 65% (IG) bzw. 27% (WKG) der Personen einen RC des AICA-S (p<0.001). Die Kosten pro Person mit RC betrugen 861€ (GKV) bzw. 1.110€ (Gesellschaft).
Zusammenfassung / Conclusion
Die Intervention führt zu einer Verbesserung der Mediensuchtsymptomatik unter Einsatz moderat erhöhter finanzieller Mittel. Einsparungen durch eine Reduktion oder Vermeidung von Psychotherapie sind denkbar. Zur Beurteilung der langfristigen Kosten-Effektivität ist eine Verlängerung der Beobachtung notwendig.