Forecasting the Early Impact of COVID-19 on Physician Supply in EU Countries.

BACKGROUND: Many countries faced health workforce challenges even before the pandemic, such as impending retirements, negative population growth, or sub-optimal allocation of resources across health sectors. Current quantitative models are often of limited use, either because they require extensive individual-level data to be properly calibrated, or (in the absence of such data) because they are too simplistic to capture important demographic changes or disruptive epidemiological shocks such as the SARS-CoV-2 pandemic. Method: We propose a population-dynamic and stock-flow-consistent approach to physician supply forecasting that is complex enough to account for dynamically changing behaviour, while requiring only publicly available time-series data for full calibration. We demonstrate the utility of this model by applying it to 21 European countries to forecast the supply of generalist and specialist physicians to 2040, and the impact of increased health care utilisation due to Covid on this supply. RESULTS: Compared with the workforce needed to maintain physician density at 2019 levels, we find that in many countries there is indeed a significant trend towards decreasing generalist density at the expense of increasing specialist density. The trends for specialists are exacerbated by expectations of negative population growth in many Southern and Eastern European countries. Compared to the expected demographic changes in the population and the health workforce, we expect a limited impact of Covid on these trends, even under conservative modelling assumptions. Finally, we generalise the approach to a multi-professional, multi-regional and multi-sectoral model for Austria, where we find an additional suboptimal distribution in the supply of contracted versus non-contracted (private) physicians. CONCLUSION: It is therefore vital to develop tools for decision-makers to influence the allocation and supply of doctors across specialties and sectors to address these imbalances.

A national evaluation analysis and expert interview study of real-world data sources for research and healthcare decision-making.

Real-world data (RWD) can provide intel (real-world evidence, RWE) for research and development, as well as policy and regulatory decision-making along the full spectrum of health care. Despite calls from global regulators for international collaborations to integrate RWE into regulatory decision-making and to bridge knowledge gaps, some challenges remain. In this work, we performed an evaluation of Austrian RWD sources using a multilateral query approach, crosschecked against previously published RWD criteria and conducted direct interviews with representative RWD source samples. This article provides an overview of 73 out of 104 RWD sources in a national legislative setting where major attempts are made to enable secondary use of RWD (e.g. law on the organisation of research, "Forschungsorganisationsgesetz"). We were able to detect omnipresent challenges associated with data silos, variable standardisation efforts and governance issues. Our findings suggest a strong need for a national health data strategy and data governance framework, which should inform researchers, as well as policy- and decision-makers, to improve RWD-based research in the healthcare sector to ultimately support actual regulatory decision-making and provide strategic information for governmental health data policies.

Expanding the Pathogen Panel in Wastewater Epidemiology to Influenza and Norovirus.

Since the start of the 2019 pandemic, wastewater-based epidemiology (WBE) has proven to be a valuable tool for monitoring the prevalence of SARS-CoV-2. With methods and infrastructure being settled, it is time to expand the potential of this tool to a wider range of pathogens. We used over 500 archived RNA extracts from a WBE program for SARS-CoV-2 surveillance to monitor wastewater from 11 treatment plants for the presence of influenza and norovirus twice a week during the winter season of 2021/2022. Extracts were analyzed via digital PCR for influenza A, influenza B, norovirus GI, and norovirus GII. Resulting viral loads were normalized on the basis of NH4-N. Our results show a good applicability of ammonia-normalization to compare different wastewater treatment plants. Extracts originally prepared for SARS-CoV-2 surveillance contained sufficient genomic material to monitor influenza A, norovirus GI, and GII. Viral loads of influenza A and norovirus GII in wastewater correlated with numbers from infected inpatients. Further, SARS-CoV-2 related non-pharmaceutical interventions affected subsequent changes in viral loads of both pathogens. In conclusion, the expansion of existing WBE surveillance programs to include additional pathogens besides SARS-CoV-2 offers a valuable and cost-efficient possibility to gain public health information.

Austria: health system summary, 2022

This Health system summary is based on the Austria: Health System Review published in 2018 in the Health Systems in Transition (HiT) series, and relevant reform updates highlighted by the Health Systems and Policies Monitor (HSPM) (www.hspm.org). For this edition, key data have been updated to those available in July 2022 to keep information as current as possible. Health system summaries use a concise format to communicate central features of country health systems and analyse available evidence on the organization, financing and delivery of health care. They also provide insights into key reforms and the varied challenges testing the performance of the health system.

Supporting COVID-19 policy-making with a predictive epidemiological multi-model warning system.

BACKGROUND: In response to the SARS-CoV-2 pandemic, the Austrian governmental crisis unit commissioned a forecast consortium with regularly projections of case numbers and demand for hospital beds. The goal was to assess how likely Austrian ICUs would become overburdened with COVID-19 patients in the upcoming weeks. METHODS: We consolidated the output of three epidemiological models (ranging from agent-based micro simulation to parsimonious compartmental models) and published weekly short-term forecasts for the number of confirmed cases as well as estimates and upper bounds for the required hospital beds. RESULTS: We report on three key contributions by which our forecasting and reporting system has helped shaping Austria's policy to navigate the crisis, namely (i) when and where case numbers and bed occupancy are expected to peak during multiple waves, (ii) whether to ease or strengthen non-pharmaceutical intervention in response to changing incidences, and (iii) how to provide hospital managers guidance to plan health-care capacities. CONCLUSIONS: Complex mathematical epidemiological models play an important role in guiding governmental responses during pandemic crises, in particular when they are used as a monitoring system to detect epidemiological change points.

During the SARS-CoV-2 pandemic, health authorities make decisions on how and when to implement interventions such as social distancing to avoid overburdening hospitals and other parts of the healthcare system. We combined three mathematical models developed to predict the expected number of confirmed SARS-CoV-2 cases and hospitalizations over the next two weeks. This provides decision-makers and the general public with a combined forecast that is usually more accurate than any of the individual models. Our forecasting system has been used in Austria to decide when to strengthen or ease response measures.

Quality Criteria for Real-world Data in Pharmaceutical Research and Health Care Decision-making: Austrian Expert Consensus.

Real-world data (RWD) collected in routine health care processes and transformed to real-world evidence have become increasingly interesting within the research and medical communities to enhance medical research and support regulatory decision-making. Despite numerous European initiatives, there is still no cross-border consensus or guideline determining which qualities RWD must meet in order to be acceptable for decision-making within regulatory or routine clinical decision support. In the absence of guidelines defining the quality standards for RWD, an overview and first recommendations for quality criteria for RWD in pharmaceutical research and health care decision-making is needed in Austria. An Austrian multistakeholder expert group led by Gesellschaft für Pharmazeutische Medizin (Austrian Society for Pharmaceutical Medicine) met regularly; reviewed and discussed guidelines, frameworks, use cases, or viewpoints; and agreed unanimously on a set of quality criteria for RWD. This consensus statement was derived from the quality criteria for RWD to be used more effectively for medical research purposes beyond the registry-based studies discussed in the European Medicines Agency guideline for registry-based studies. This paper summarizes the recommendations for the quality criteria of RWD, which represents a minimum set of requirements. In order to future-proof registry-based studies, RWD should follow high-quality standards and be subjected to the quality assurance measures needed to underpin data quality. Furthermore, specific RWD quality aspects for individual use cases (eg, medical or pharmacoeconomic research), market authorization processes, or postmarket authorization phases have yet to be elaborated.

Comorbidities and COVID-19 hospitalization, ICU admission and hospital mortality in Austria : A retrospective cohort study.

BACKGROUND: The protection of vulnerable populations is a central task in managing the Coronavirus disease 2019 (COVID-19) pandemic to avoid severe courses of COVID-19 and the risk of healthcare system capacity being exceeded. To identify factors of vulnerability in Austria, we assessed the impact of comorbidities on COVID-19 hospitalization, intensive care unit (ICU) admission, and hospital mortality. METHODS: A retrospective cohort study was performed including all patients with COVID-19 in the period February 2020 to December 2021 who had a previous inpatient stay in the period 2015-2019 in Austria. All patients with COVID-19 were matched to population controls on age, sex, and healthcare region. Multiple logistic regression was used to estimate adjusted odds ratios (OR) of included factors with 95% confidence intervals (CI). RESULTS: Hemiplegia or paraplegia constitutes the highest risk factor for hospitalization (OR 1.61, 95% CI 1.44-1.79), followed by COPD (OR 1.48, 95% CI 1.43-1.53) and diabetes without complications (OR 1.41, 95% CI 1.37-1.46). The highest risk factors for ICU admission are renal diseases (OR 1.76, 95% CI 1.61-1.92), diabetes without complications (OR 1.57, 95% CI 1.46-1.69) and COPD (OR 1.53, 95% CI 1.41-1.66). Hemiplegia or paraplegia, renal disease and COPD constitute the highest risk factors for hospital mortality, with ORs of 1.5. Diabetes without complications constitutes a significantly higher risk factor for women with respect to all three endpoints. CONCLUSION: We contribute to the literature by identifying sex-specific risk factors. In general, our results are consistent with the literature, particularly regarding diabetes as a risk factor for severe courses of COVID-19. Due to the observational nature of our data, caution is warranted regarding causal interpretation. Our results contribute to the protection of vulnerable populations and may be used for targeting further pharmaceutical interventions.

Adjuvant anti-PD-1 antibody treatment in stage III/IV melanoma: real-world experience and health economic considerations.

BACKGROUND: Anti-programmed death 1 (PD-1) antibodies have evolved as a new standard of care in the adjuvant treatment of completely resected melanoma. Real-world data on treatment efficacy and safety as well as cost-effectiveness are still limited. PATIENTS AND METHODS: Treatment outcomes were retrospectively analyzed in a continuous patient cohort receiving adjuvant nivolumab (91 patients) or pembrolizumab (9 patients). Based on the obtained clinical data, a semi-Markov model was developed to evaluate cost-effectiveness. RESULTS: After a median follow-up of 11.5 months, disease recurrence was observed in 39 patients (39 %). The site of first recurrence was locoregional in 17, distant in 19, and combined locoregional and distant in three patients. Twelve-month estimates for recurrence- and distant-metastasis-free survival were 64.8 % and 77.4 %, respectively. Sixteen patients experienced grade 3 or 4 treatment-related adverse events, while 22 patients discontinued treatment due to adverse events. The base-case Markov model yielded an incremental cost-effectiveness ratio of 13,330 € per quality-adjusted life year for adjuvant anti-PD-1 antibody treatment compared to a simulated observation cohort. CONCLUSIONS: Real-world outcomes of adjuvant anti-PD-1 antibody therapy in completely resected melanoma appear comparable to clinical trial data. Moreover, our data suggests this treatment strategy to be cost-effective according to Austrian health economic standards.

Targeted COVID-19 Vaccination (TAV-COVID) Considering Limited Vaccination Capacities-An Agent-Based Modeling Evaluation.

(1) Background: The Austrian supply of COVID-19 vaccine is limited for now. We aim to provide evidence-based guidance to the authorities in order to minimize COVID-19-related hospitalizations and deaths in Austria. (2) Methods: We used a dynamic agent-based population model to compare different vaccination strategies targeted to the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW). First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed deriving a prioritization sequence for 2.45 million individuals, maximizing the reduction in total hospitalizations and deaths compared to no vaccination. We considered sterilizing and non-sterilizing immunity, assuming a 70% effectiveness. (3) Results: Maximum reduction of hospitalizations and deaths was achieved by starting vaccination with the elderly and vulnerable followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.45 million individuals yielded the same prioritization and avoided approximately one third of deaths and hospitalizations. Starting vaccination with HCW leads to slightly smaller reductions but maximizes occupational safety. (4) Conclusion: To minimize COVID-19-related hospitalizations and deaths, our study shows that elderly and vulnerable persons should be prioritized for vaccination until further vaccines are available.

Are Unit Costs the Same? A Case Study Comparing Different Valuation Methods for Unit Cost Calculation of General Practitioner Consultations.

OBJECTIVES: To inform allocation decisions in any healthcare system, robust cost data are indispensable. Nevertheless, recommendations on the most appropriate valuation approaches vary or are nonexistent, and no internationally accepted gold standard exists. This costing analysis exercise aims to assess the impact and implications of different calculation methods and sources based on the unit cost of general practitioner (GP) consultations in Austria. METHODS: Six costing methods for unit cost calculation were explored, following 3 Austrian methodological approaches (AT-1, AT-2, AT-3) and 3 approaches applied in 3 other European countries (Germany, The Netherlands, United Kingdom). Drawing on Austrian data, mean unit costs per GP consultation were calculated in euros for 2015. RESULTS: Mean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach (DE) and the Austrian Physicians' Chamber's price recommendations (AT-3), respectively. The mean unit cost was estimated at €18.9 based on Austrian economic evaluations (AT-1) and €17.9 based on health insurance payment tariffs (AT-2). The Dutch top-down (NL) and the UK bottom-up approaches (UK) yielded higher estimates (NL: €25.3, UK: €29.8). Overall variation reached 173%. CONCLUSIONS: Our study is the first to systematically investigate the impact of differing calculation methods on unit cost estimates. It shows large variations with potential impact on the conclusions in an economic evaluation. Although different methodological choices may be justified by the adopted study perspective, different costing approaches introduce variation in cross-study/cross-country cost estimates, leading to decreased confidence in data quality in economic evaluations.

Das österreichische Gesundheitssystem: Akteure, Daten, Analysen

Die vorliegende Analyse des österreichischen Gesundheitssystems beleuchtet aktuelle Entwicklungen in den Bereichen Organisation,Verwaltung, Finanzierung, Versorgung, Reformen und Leistungsfähigkeit des Gesundheitssystems. Die sich seit 2013 in Umsetzung befindliche große Reform steht dabei im Mittelpunkt. Das zentrale Anliegen dieser Reform, in deren Rahmen ein neues Steuerungssystem eingeführt wurde, ist die Stärkung der Koordination und Zusammenarbeit verschiedener Regierungsebenen und Selbstverwaltungsorgane durch die Förderungeiner gemeinsamen Planung und Entscheidungsfindung sowie in Ansätzen auch einer gemeinsamen Finanzierung. Trotz dieser Anstrengungen ist die organisatorische und finanzielle Struktur des österreichischenGesundheitssystems nach wie vor komplex und uneinheitlich. Die österreichische Bevölkerung weist einen guten Gesundheitszustand auf. Die Lebenserwartung bei Geburt liegt über dem EU-Durchschnitt und die niedrige vermeidbare Sterblichkeit zeigt, dass das Gesundheitsweseneffektiver ist als in den meisten EU-Ländern. Dennoch ist die Zahl der Menschen, die an Herz-Kreislauf-Erkrankungen und an Krebs sterben, imVergleich zum EU-28-Durchschnitt hoch. Tabak- und Alkoholkonsum stellen die größten Gesundheitsrisikofaktoren dar. Der Tabakkonsum ist im letzten Jahrzehnt nicht wie in den meisten EU-Ländern zurückgegangen und liegt aktuell deutlich über dem EU-28-Durchschnitt. In Bezug auf die Leistungsfähigkeit bietet das österreichischeGesundheitssystem einen guten und niederschwelligen Zugang zu Gesundheitsleistungen. Die österreichische Bevölkerung verzeichnet einen der niedrigsten unerfüllten Bedarfe an medizinischer Versorgunginnerhalb der EU. Praktisch die gesamte Bevölkerung ist durch die soziale Krankenversicherung abgesichert und hat Zugang zu einem breitgefächerten Leistungsangebot. Dennoch könnten die zunehmenden Unterschiedezwischen der Anzahl an Vertragsärzten und Wahlärzten zu sozialen und regionalen Ungleichheiten beim Zugang zur Gesundheitsversorgung beitragen. Das österreichische Gesundheitssystem ist relativ kostenintensiv. Es ist stark auf die intramurale Versorgung fokussiert, was sich an einer hohen Nutzung stationärer Leistungen und einem Ungleichgewicht in der Ressourcenallokation zwischen dem Krankenhaussektor und demextramuralen Sektor zeigt. Daher zielen die laufenden Reformen darauf ab, das Wachstum der Gesundheitsausgaben der öffentlichen Hand durch eine Ausgabenobergrenze zu senken und die übermäßige Nutzung stationärer Leistungen zu verringern. Die Effizienz der intramuralen Versorgung hat sich während der Reformperiode verbessert, jedoch stellt die fragmentierteFinanzierung zwischen dem intra- und dem extramuralen Sektor nach wie vor eine Herausforderung dar. Aktuelle Bemühungen, die darauf abzielen, die Primärversorgung nach neuem Modell flächendeckend auszubauen, sindein wichtiger Schritt, um Tätigkeiten aus dem großen und kostenintensivenKrankenhaussektor zu verlagern und die Qualifikationsprofile undEinsatzbereiche der medizinischen Fachkräfte zu erweitern.

Austria: Health System Review.

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Two major reforms implemented in 2013 and 2017 are among the main issues today. The central aim of the reforms that put in place a new governance system was to strengthen coordination and cooperation between different levels of government and self-governing bodies by promoting joint planning, decision-making and financing. Yet despite these efforts, the Austrian health system remains complex and fragmented in its organizational and financial structure. The Austrian population has a good level of health. Life expectancy at birth is above the EU average and low amenable mortality rates indicate that health care is more effective than in most EU countries. Yet, the number of people dying from cardiovascular diseases and cancer is high compared to the EU-28 average. Tobacco and alcohol represent the major health risk factors. Tobacco consumption has not declined over the last decade like in most other EU countries and lies well above the EU-28 average. In terms of performance, the Austrian health system provides good access to health care services. Austrias residents report the lowest levels of unmet needs for medical care across the EU. Virtually all the population is covered by social health insurances and enjoys a broad benefit basket. Yet, rising imbalances between the numbers of contracted and non-contracted physicians may contribute to social and regional inequalities in accessing care. The Austrian health system is relatively costly. It has a strong focus on inpatient care as characterized by high hospital utilization and imbalances in resource allocation between the hospital and ambulatory care sector. The ongoing reforms therefore aim to bring down publicly financed health expenditure growth with a global budget cap and reduce overutilization of hospital care. Efficiency of inpatient care has improved over the reform period but the fragmented financing between the inpatient and ambulatory sector remain a challenge. Current reforms to strengthen primary health care are an important step to further shift activities out of the large and costly hospital sector and improve skill mix within the health workforce.

Austria: health system review

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Two major reforms implemented in 2013 and 2017 are among the main issues today. The central aim of the reforms that put in place a new governance system was to strengthen coordination and cooperation between different levels of government and self-governing bodies by promoting joint planning,decision-making and financing. Yet despite these efforts, the Austrian health system remains complex and fragmented in its organizational and financial structure.The Austrian population has a good level of health. Life expectancy at birth is above the EU average and low amenable mortality rates indicate that health care is more effective than in most EU countries. Yet, the number of people dying from cardiovascular diseases and cancer is high compared to the EU28 average. Tobacco and alcohol represent the major health risk factors. Tobacco consumption has not declined over the last decade like in most other EU countries and lies well above the EU28 average. In terms of performance, the Austrian health system provides good access to health care services. Austria’s residents report the lowest levels of unmet needs for medical care across the EU. Virtually all the population is covered by social health insurances and enjoys a broad benefit basket. Yet, rising imbalances between the numbers of contracted and non-contracted physicians may contribute to social and regional inequalities in accessing care. The Austrian health system is relatively costly. It has a strong focus on inpatient care as characterized by high hospital utilization and imbalances in resource allocation between the hospital and ambulatory care sector. The ongoing reforms therefore aim to bring down publicly financed health expenditure growth with a global budget cap and reduce overutilization of hospital care. Efficiency of inpatient care has improved over the reform period but the fragmented financing between the inpatient and ambulatory sector remain a challenge. Current reforms to strengthen primary health care are an important step to further shift activities out of the large and costly hospital sector and improve skill mix within the health workforce.

Efficiency of the Austrian disease management program for diabetes mellitus type 2: a historic cohort study based on health insurance provider's routine data.

BACKGROUND: The Austrian diabetes disease management program (DMP) was introduced in 2007 in order to improve health care delivery for diabetics via the promotion of treatment according to guidelines. Considering the current low participation rates in the DMP and the question of further promotion of the program, it is of particular interest for health insurance providers in Austria to assess whether enrollment in the DMP leads to differences in the pattern of the provision of in- and outpatient services, as well as to the subsequent costs in order to determine overall program efficiency. METHODS: Historic cohort study comparing average annual levels of in- and outpatient health services utilization and its associated costs for patients enrolled and not enrolled in the DMP before (2006) and 2 years after (2009) the implementation of the program in Austria. Data on the use of services and data on costs were extracted from the records of the Austrian Social Insurance Institution for Business. 12,199 persons were identified as diabetes patients treated with anti-diabetic medication or anti-diabetics with insulin throughout the study period. 314 diabetics were enrolled in the DMP. RESULTS: Patients enrolled in the diabetes DMP received a more evolved pattern of outpatient care, featuring higher numbers of services provided by general practitioners and specialists (79 vs. 62), more diagnostic services (22 vs. 15) as well as more services provided by outpatient care centers (9 vs. 6) in line with increased levels of participation in medical assessments as recommended by the treatment guideline in 2009. Hospitalization was lower for DMP patients spending 3.75 days in hospital, as compared to 6.03 days for diabetes patients in regular treatment. Overall, increases in costs of care and medication throughout the study period were lower for enrolled patients (€ 718 vs. € 1.684), resulting in overall costs of € 5,393 p.c. for DMP patients and € 6,416 p.c. for the control group in 2009. CONCLUSIONS: Seen from a health insurance provider's perspective, the assessment of the Austrian diabetes DMP shows promising results indicating improved quality of outpatient care as well as overall cost advantages due to the lower hospitalization rates. Due to methodological limitations of the retrospective study and to the restricted data access, further promotion of the DMP must be accompanied by prospective research and preferably controlled trials in order to provide a solid basis for the decision of whether to include diabetes DMP into the insurer's basic benefit package.

Competence-based demands made of senior physicians: an empirical study to evaluate leadership competencies.

As a result of more economising in German hospitals, changes evolve in organising the deployment of senior medical staff. New demands are made of senior hospital management. Leadership competencies in the training and development of physicians are of prime importance to the successful perception of managerial responsibilities. The present study investigates the actual and targeted demands of leadership made of senior medical staff in terms of how these demands are perceived. To this end, the demands of leadership were surveyed using a competence-based questionnaire and investigated with a view to potentials in professional development by way of example of the senior management of psychiatric hospitals in Germany. In all, the results show high ratings in personal performance, the greatest significance being attributed to value-oriented competence in the actual assessment of demands on leadership. Besides gender-specific differences in the actual assessments of single fields of competence, the greatest differences between the targeted and the actual demands are, in all, shown to be in the competencies of self-management and communication. Competence-based core areas in leadership can be demonstrated for the professional development of physicians and an adaptive mode of procedure deduced.