The economic burden of diabetic retinopathy in Germany in 2002.

BACKGROUND: The aims of our study were to describe the costs associated with diabetic retinopathy (DR), and to evaluate its economic impact in Germany. METHODS: Forty-one German ophthalmologists, randomly selected from a physicians' database in Germany, provided information on adult Type 1 and Type 2 diabetic patients with DR (n = 207). This information included socio-demographics, clinical characteristics and resource use during the year 2002. National-level cost estimates were calculated, based on these results and the prevalence data on DR in Germany. RESULTS: This study found that costs associated with DR tend to increase as DR progresses, being highest in patients with proliferative DR and lowest in patients with mild, non-proliferative DR. The German statutory health insurance (Gesetzliche Krankenversicherung, GKV) covered two-thirds of the total costs paid by all the payers. The total cost of DR from a societal perspective was calculated at 3.51 euros bn for the year 2002, and from the GKV perspective amounted to 2.23 euros bn. CONCLUSIONS: This study is the first comprehensive study to provide estimates of costs associated with DR in Germany. These costs were estimated to account for approximately 1.5% of the total health-care expenditure in 2002.

Constructing an Index for the Subjective Well-being Under Neuroleptics scale (SWN), short form: applying structural equation modeling for testing reliability and validity of the index.

Structural equation modeling (SEM) has been widely used in psychology and sociology for testing validity of measurement instruments. However, this statistical technique has so far played minor role in quality-of-life research. The main objective of this paper is to demonstrate the potential of SEM for constructing and testing the validity of a Subjective Well-being under Neuroleptics (SWN) index for patients with schizophrenia. For these purposes, data from the GEO study (Gesundheitsökonomische Evaluation von Olanzapin in Deutschland; Health economics study of olanzapine in the treatment of schizophrenia in Germany) were used. The GEO is a prospective, comparative, noninterventional, observational study. A total of 646 participants treated with either olanzapine (n = 416) or haloperidol (n = 230) were enrolled in the study; 360 patients were available for factor analyses. The short (20-item) form of the SWN scale was administered to assess patients' perspectives on their quality of life. The structural equation models (SEMs) were then applied to construct 5- and 10-item indexes based on SWN. The data indicate that the 5-item index is the most time-saving approach for evaluating perceptions of well-being (and thus, quality of life) among patients with schizophrenia. The application of SEM showed no appreciable loss of validity of this index.

[Costs of long-term complications in type 2 diabetes patients in Germany. Results of the CODE-2 Study]. / Kosten für Spätkomplikationen bei Diabetes mellitus Typ 2 in Deutschland. Ergebnisse der CODE-2-Studie.

METHODS: In the German arm of CODE-2((R)) (Costs of Diabetes in Europe - Type 2), medical, demographic and economic data were collected retrospectively for a period of 1 year on the basis of medical files of 809 patients by personal interviews with 135 primary care physicians. The results were extrapolated to the German diabetes type 2 population. The influence of micro- and macrovascular complications on total costs was analyzed. Costs of three major complications (ulcer, amputation, and stroke/PRIND) were determined. Here, comorbidities with other major complications were excluded. RESULTS: About half of the patients with diabetes type 2 had severe diabetes-related comorbidity, 56.2% showing more than one. For patients with macro- or microvascular complications, the costs increase 2.5 up to 4.1 times in comparison to the average health-insured patient. Costs for patients with ulcer of the lower extremities added to a mean total of EURO 7,537.- (DM 14,742.-) in the year of complication occurring. For patients undergoing amputation, mean annual costs of EURO 10,796.- (DM 21,115.-) arose. In diabetes patients suffering from a stroke, costs in the respective year summed up to EURO 7,147.- (DM 13,987.-). Amputations therefore led to a more than sixfold increase in costs, ulcer and stroke to a more than fourfold increase compared to diabetes patients without complications. CONCLUSIONS: This analysis demonstrates the huge financial expenditure for managing specific diabetes-related complications and long-term effects. In order to reduce total costs, the focus should turn to early prevention of complications. Targeted intervention studies will have to prove that an initial increase in treatment costs due to preventive measures can be more than compensated by savings occurring from prevention of complications.

Bootstrap confidence intervals for costs-of-illness of type 2 diabetes mellitus in Germany.

OBJECTIVE: The Costs of Diabetes in Europe-Type 2 study (CODE-2, SmithKline Beecham plc) measures costs of managing patients with type 2 diabetes mellitus in Germany. The aim of this analysis was to assess the uncertainty of these estimates. DESIGN AND SETTING: The German study arm was based on a sample of 809 patients with type 2 diabetes registered in general practices. Information on socioeconomic data, medical resource use, and clinical data was collected retrospectively for 1998. PATIENTS AND PARTICIPANTS: Patients were grouped in five strata based on their complication status, because of the high impact of complications on costs. To obtain higher credibility of resulting estimates, rare complication groups were overrepresented. To be representative, results were weighted using real prevalence data on complications from a prestudy. MAIN OUTCOME MEASURES AND RESULTS: Within each stratum, results were calculated as arithmetic mean except for demographic data, where the median was applied as input for weighted averages. Because the degree of precision of calculated estimates was not accessible analytically, 95% confidence intervals (CIs) were computed via bootstrapping of 10,000 independent bootstrap samples for each of the calculated estimates. All costs are given for the payers' perspective in German Deutsche Mark (DM). Costs per patient and year for ambulatory care were DM 775 with 95% CI (721-835), for hospitalizations DM 2771 (2242-3342), for drug treatment DM 1496 (1399-1598), and for rehabilitation DM 120 (70-177). The indirect cost was DM 372 (144-645). From the perspective of the sickness funds, cost per patient and year was DM 5539 (5184-5894). Mean HbA1c status was 7.51% (7.37-7.66) with the majority of patients not achieving glycemic control below 6.5%. CONCLUSION: Bootstrap CIs are remarkably narrow. Combining a weighted stratification with bootstrap estimation is an appropriate method for analyzing the weighted average of highly variable and skewed parameters such as costs of diabetes.