[Willingness of Students of Economics to Pay for Predictive Oncological Genetic Testing - An Empirical Analysis]. / Die Zahlungsbereitschaft von Studierenden der Wirtschaftswissenschaften für prädiktive onkologische Gentests ­ eine empirische Analyse.

Objectives: The present study aims to investigate the interest of young adults in predictive oncological genetic testing and their willingness to pay for such a test. Furthermore, major determinants of the 2 variables of interest were identified. Methods: 348 students of economics from the Leibniz University of Hanover were queried in July 2013 using an extensive questionnaire. Among other things, the participants were asked if they are interested in information about the probability to develop cancer in the future and their willingness to pay for such information. Data were analysed using descriptive statistics and ordinal probit regressions. Additionally marginal effects were calculated. Results: About 50% of the students were interested in predictive oncological genetic testing and were willing to pay for the test. Moreover, the participants who were willing to pay for the test partly attach high monetary values to the information that could so be obtained. The study shows that the interest of the students and their willingness to pay were primarily influenced by individual attitudes and perceptions. Conclusions: The study proves that young adults were interested in predictive genetic testing and appreciate information about their probability of develop cancer someday.

Preferences of lung cancer patients for treatment and decision-making: a systematic literature review.

The consideration of patient preferences in decision-making has become more important, especially for life-threatening diseases such as lung cancer. This paper aims to identify the preferences of lung cancer patients with regard to their treatment and involvement in the decision-making process. We conducted a systematic literature review from 12 electronic databases and included studies published between 2000 and 2012. A total of 20 studies were included in this review. These revealed that lung cancer patients do have preferences that should be considered in treatment decisions; however, these preferences are not homogenous. We found that patients often consider life extension to be more important than the health-related quality of life or undesirable side effects. This preference seems to depend on patient age. Nausea and vomiting are the most important side effects to be avoided; the relevance of other side effects differs highly between subgroups. The majority of lung cancer patients, nevertheless, seem to prefer a passive rather than an active role in decision-making, although the self-reported preferences differed partly from the physicians' perceptions. Overall, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques.

[Epidemiology and costs of asthma in Germany - a systematic literature review]. / Epidemiologie und Kosten von Asthma bronchiale in Deutschland - eine systematische Literaturrecherche.

BACKGROUND: The aim of this study was to identify the prevalence and incidence as well as the health care costs of asthma specifically in the German setting. METHODS: Two systematic literature searches were conducted in PubMed in December 2012 (updated in March 2014). All publications in German and English were included. RESULTS: After review of title, abstracts and full publications, 17 relevant studies included information on the prevalence and incidence of asthma. The 12-month prevalence for adults ranges between 4.6 % and 6.34 % (children: 3.8 % - 11.8 %). At younger ages, asthma is more prevalent in boys. In adulthood, more women are affected. We identified seven cost-of-illness studies. The direct costs range between €â€Š690.4 m and 1.36 bn. The reported health care costs depend on the perspective, the severity of disease and the database, so that a comparison of results is difficult. CONCLUSION: All in all, this review underlines the epidemiological and health economic importance of asthma in Germany. Several studies on the prevalence of asthma are available, but there is little information on the current incidence of this disease. Further research is necessary for obtaining a comprehensive picture of the current health care costs.

Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review.

Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.

A systematic review of cost-effectiveness of monoclonal antibodies for metastatic colorectal cancer.

UNLABELLED: Metastatic colorectal cancer (mCRC) imposes a substantial health burden on patients and society. In recent years, advances in the treatment of mCRC have mainly resulted from the introduction of monoclonal antibodies (MoAbs). However, the application of these MoAbs considerably increases treatment costs. The objective of this article is to review and assess the economic evidence of MoAB treatment in mCRC. A systematic literature review was conducted and cost-effectiveness (CE) as well as cost-utility-studies were identified. For this, Medline, Embase, SciSearch, Cochrane, and nine other databases were searched from 2000 through February 2013 for full-text publications. The quality of the studies was assessed via a validated assessment tool (Quality of Health Economic Studies (QHES)). A total of 843 publications were screened. Of those, 15 studies involving the MoAbs bevacizumab, cetuximab and panitumumab met all inclusion criteria. Four studies analysed the CE of first-line treatment with bevacizumab and nine the CE of cetuximab in subsequent treatment lines. Two studies dealt with the CE of panitumumab. The analysis of sequential regimes and the direct comparison of two MoABs were analysed by only one study each. The quality of the included studies was high with the exception of one study. CONCLUSIONS: The treatment with bevacizumab, cetuximab and panitumumab is mainly considered to be not cost-effective in patients with mCRC. However, testing for Kirsten ras oncogene (KRAS) mutation prior to the treatment with cetuximab or panitumumab is found to be clearly cost-effective compared to no testing. Future research should focus on the CE of first-line treatment with cetuximab or panitumumab and studies on upcoming agents like regorafenib and aflibercept.

Clinical status, psychosocial impairments, medical treatment and health care costs for patients with inflammatory bowel disease (IBD) in Germany: an online IBD registry.

BACKGROUND: The aim of this cross-sectional study was to establish an online inflammatory bowel disease (IBD) registry for a first picture of the situation of IBD outpatients' treatment in Germany. METHODS: Between March 2006 and July 2007 IBD outpatients from 24 gastroenterological specialist practices and two hospitals in Germany were enrolled in an Internet-based registry to evaluate the outpatients' clinical status, psychological impairments, provided health care, as well as medical treatment and medication costs. RESULTS: 1032 IBD patients (ulcerative colitis/UC: 519; Crohn's disease/CD: 511; indeterminate colitis: 2) were enrolled in the study (age: 43 ± 14 years/M ± SD). Disease duration of all patients averaged 10 ± 8.5 years. In 519 UC-patients (49% male; 33% pancolitis), 66% were in remission as were 55% of CD patients (37 % male; 41 % active smokers). Associated with higher rates of disease activity (CDAI ≥ 150; CAI>4) were corticosteroids (CD, UC), topical medication (UC), relevant reported depressive symptoms (15%; 6-31%) and impairments in sexuality (21%; 9-42%). Relevant medication groups prescribed were oral aminosalicylates (UC: 70%; CD: 47%); immunosuppressive therapy - mostly azathioprine/6 MP (CD: 47%; UC: 26%), and Infliximab (CD: 8%; UC: 3%). Strongly associated with their clinical disease activity in UC as well as CD patients, 15% (6-31%) reported relevant depressive symptoms and 21% (9-42%) relevant impairments in sexuality. CONCLUSIONS: The registry constitutes a large complemental database for the patient population in Germany. About one third of the IBD patients were not in clinical remission (CDAI ≥150/CAI >4) (CD: 45%; UC: 27%), although high rates of immunosuppressive drugs (CD: 47%; UC 26%) were administered. This study shows a large burden of active disease associated with an unexpectedly high (co)morbidity and high psychosocial impairments, indicating a reduced health state in IBD patients.

[The role of economics in fair rationing]. / Gerechte Rationierung und die Rolle der Ökonomie.

For several years academic disciplines have discussed the potential conflict between scarcity of funding and fair health care. This review article shows the necessity of involving economic scientists in this discussion as well as their contribution to rationalisation, prioritisation and rationing of health care services. Thereby, it becomes clear that rationing and justice are not a contradiction per se. The interdisciplinary discussion in Germany needs less disciplinary egotism and more willingness to seek solutions and compromises. In this context the procedures followed in other countries can serve as examples.

[Methods of health economic evaluation for health services research]. / Methoden der gesundheitsökonomischen Evaluation in der Versorgungsforschung.

On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. The present paper focuses on methodological issues of economic evaluation of health care technologies. It complements the Memorandum III "Methods for Health Services Research", part 2. First, general methodological principles of the economic evaluations of health care technologies are outlined. In order to adequately reflect costs and outcomes of health care interventions in the routine health care, data from different sources are required (e. g., comparative efficacy or effectiveness studies, registers, administrative data, etc.). Therefore, various data sources, which might be used for economic evaluations, are presented, and their strengths and limitations are stated. Finally, the need for methodological advancement with regard to data collection and analysis and issues pertaining to communication and dissemination of results of health economic evaluations are discussed.

[Costs of ulcerative colitis within the German Statutory Health Insurance]. / Kosten der Colitis ulcerosa--eine Kalkulation aus der Perspektive der Gesetzlichen Krankenversicherung.

BACKGROUND AND OBJECTIVES: Studies estimating the costs of ulcerative colitis (UC) within the German setting are limited. The aim of this cross-sectional study was to collect data on the overall costs arising from the care of patients with UC and to quantify this expenditure as incurred by the German Statutory Health Insurance (SHI). METHODS: Between March 2006 and July 2007 patients from 24 ambulatory gastroenterologist practices and two hospitals were enrolled in an internet-based database. Outpatient and inpatient visits, all procedures as well as drug usage were obtained from the collected data and evaluated from the perspective of the SHI, taking also into account statutory discounts and patients' co-payments. The year 2007 was selected as the pricing period. RESULTS: Data from 519 patients with UC were collected (gender ratio 1:1; average age 46 years). The average annual cost per UC patient to the SHI is 2,477.72 Euro, 74 % of this amount results from drug usage, 10 % from inpatient care and another 10 % from ambulatory procedures. Costs increase with the severity of the disease. CONCLUSION: This is the first study to calculate the costs caused by UC and payed by the SHI in Germany. Future research should focus on collecting longitudinal data and also on comparing the resources used in the care of patients with other inflammatory bowel diseases, such as Crohn's disease.

[Costs of Crohn's disease in Germany from the perspective of the Statutory Health Insurance]. / Die direkten Kosten der Versorgung von Patienten mit Morbus Crohn aus der Perspektive der Gesetzlichen Krankenversicherung.

INTRODUCTION: Data concerning treatment reality in patients with Crohn's disease (CD) are limited in Germany. The aim of this cross-sectional study was to collect resource use data due to CD and quantify these from the perspective of the Statutory Health Insurance in Germany. METHODS: Between March 2006 and July 2007 the patients from 24 ambulatory gastroenterological specialist practices and 2 hospitals were enrolled in an internet-based online database. Based on the collected data, the outpatient and inpatient visits, all procedures as well as medication usage were determined and evaluated from the perspective of the Statutory Health Insurance taking also into consideration patient co-payments, company and pharmacy discounts. 2007 was selected as the price year. RESULTS: Data from 511 CD patients were collected, with 37 % being male. Patients were on average 41 years old. According to the calculations, an average CD patient in Germany causes costs of 3767.26 euro from the perspective of the Statutory Health Insurance. 68.5 % are medication costs, 20.5 % result from inpatient care. The costs increase with the severity of the disease. DISCUSSION: This is the first study to calculate costs due to CD (3767 euro/year) from the perspective of the Statutory Health Insurance in Germany. To illustrate the costs from the societal perspective, indirect costs need to be included in the calculation in future studies.

[Appraisal of resource use in the German health-care system from the perspective of the statutory health insurance]. / Bewertung von Ressourcenverbräuchen im deutschen Gesundheitswesen aus Sicht der Gesetzlichen Krankenversicherung.

This paper gives a systematic overview of resource use that is relevant within the German health-care system from the perspective of the statutory health insurance and how these resource uses should be priced in economic analyses. This includes all relevant cost domains from ambulatory and inpatient care as well as a detailed description of relevant data resulting from drug usage. For prescriptions the legal framework (e.g., reference pricing) is applied to list all relevant co-payments or discounts (e.g., for pharmaceutical companies) which have to be considered in patented as well as off-patent drugs. The same method is applied for ambulatory services [taking the universal remuneration scheme (EBM) into account] as well as for inpatient stays (discussing certain characteristics of the German DRG system). As a result, for the first time, a pragmatic as well as a practical approach is presented to value resource usage within the German health care system in future studies from the perspective of the statutory health insurance or, in other words, the sickness funds.

[Synchronising school entry health examinations in Lower-Saxony, Germany]. / Synchronisierung von Schuleingangsuntersuchungen in Niedersachsen.

BACKGROUND: In the German federal state of Lower-Saxony the districts are responsible for conducting school entry health examinations. There exist two different standard protocols for diagnosis and documentation, denoted as Weser-Ems (WE) and SOPHIA. In order to analyse and improve the comparability between these two protocols, a working group was established in 2006. One of the objectives was to adjust the protocols in such a way that in the future the collected data will allow for joint health reporting. METHODS: Each variable was discussed individually by the working group, and if diagnosis or documentation differed between the two protocols, specific modifications were proposed. For certain variables external expert opinions were obtained. For those variables that had to be revised quite generally, specific sub-working groups were established. As prerequisite for implementation, the recommendations of the working group had to be accepted by the user groups through majority votes. RESULTS: Of 88 (WE) or, respectively, 66 (SOPHIA) variables, 39 (WE) or, respectively, 34 variables initially fulfilled the requirements for a joint analysis. As a result of the working group, for more than 20 other variables the requirements for a joint analysis could be achieved. As soon as the sub-working groups have completed their work, also the issues of physical coordination, cognitive abilities and psychological health will be available for joint analysis. DISCUSSION: The synchronisation of school entry health examinations in Lower-Saxony is an example of how different protocols of diagnosis and documentation can be adapted to each other to enable joint data analysis without loosing their individual characteristics.

[Modelling of the costs of productivity losses due to smoking in Germany for the year 2005]. / Modellierung der Produktivitätsausfallkosten als Folge des Rauchens in Deutschland für das Jahr 2005.

PURPOSE: The aim of this study was to estimate disease-related productivity costs attributable to smoking in the year 2005 in Germany. METHODS: The calculation was based on the updated relative smoking-related disease risk found in the US Cancer Prevention Study II combined with data on smoking prevalence for Germany. With this, smoking-attributable cases resulting in premature mortality, invalidity, and temporal disability to work could be estimated. Neoplasms, diseases of the circulatory and the respiratory systems as well as health problems in children younger than one year were considered in the analysis. The human capital approach was applied to calculate years of potential work loss and productivity costs as a result of smoking. Various sensitivity analyses were conducted to test for robustness of the underlying model. RESULTS: Based on the assumptions within the model, 107,389 deaths, 14,112 invalidity cases, and 1.19 million cases of temporary disability to work were found to be due to smoking in 2005 in Germany, respectively. As a result, productivity costs of 9.6 billion were caused by smoking. CONCLUSIONS: The model showed that smoking has a high financial effect. Even so, further analyses are necessary to estimate an overall impact of smoking on the German society.