Non-utilisation of health care services during the COVID-19 pandemic: Results of the CoMoLo study

Based on data from the CORONA-MONITORING lokal (CoMoLo) study conducted in four municipalities particularly affected by the COVID-19 pandemic, this article investigates the non-utilisation of health care services in the population aged 18 years and older (n=9,002) in relation to the period after the introduction of the containment measures in March 2020. The results show that about one third of the respondents (35.5%) gave up at least one of the surveyed health care services. The most frequent cancellations were dental (15.2%) and specialist check-ups (11.8%), followed by postponement of physiotherapy, ergotherapy or speech therapy (6.1%), cancellation of general practitioner (GP) check-ups (5.8%), postponement of psychotherapy (2.0%), postponement of planned hospital treatment (1.8%) and not going to an emergency room (0.7%). Almost 10% of the respondents reported not visiting a physician despite health complaints. Compared to respondents without such a waiver, these respondents were more often female and younger than 35 years, less often rated their health as very good or good, more often had a diagnosis of depression and more often used telemedical contacts as an alternative to visiting the practice during the pandemic. Further analyses of trends in utilisation behaviour and changes in health status over the course of the COVID-19 pandemic are important

Nichtinanspruchnahme gesundheitlicher Versorgungsleistungen während der COVID-19-Pamdemie: Ergebnisse der CoMoLo-Studie

Der vorliegende Beitrag betrachtet auf Datenbasis der in vier besonders von der COVID-19-Pandemie betroffenen Orten durchgeführten Studie CORONA-MONITORING lokal (CoMoLo) die Nichtinanspruchnahme gesundheitlicher Versorgungsleistungen in der Bevölkerung ab 18 Jahren (n = 9.002) bezogen auf die Zeit nach Einführung der Eindämmungsmaßnahmen im März 2020. Die Ergebnisse zeigen, dass etwa ein Drittel der Befragten (35,5 %) auf mindestens eine der erfragten Versorgungsleistungen verzichtete. Am häufigsten wurde die Absage zahnärztlicher (15,2 %) und fachärztlicher Kontrolltermine (11,8 %) angegeben, gefolgt von der Verschiebung physio-, ergotherapeutischer oder logopädischer Behandlungen (6,1 %), der Absage hausärztlicher Kontrolltermine (5,8 %), der Verschiebung psychotherapeutischer Behandlungen (2,0 %) und geplanter Krankenhausbehandlungen (1,8 %) sowie dem Verzicht, eine Notaufnahme aufzusuchen (0,7 %). Fast 10 % der Befragten gaben den Verzicht auf einen Arztbesuch trotz Beschwerden an. Diese Befragten waren im Vergleich zu Befragten ohne einen solchen Verzicht häufiger weiblich und jünger als 35 Jahre, schätzten ihre Gesundheit seltener als sehr gut oder gut ein, hatten häufiger die Diagnosestellung Depression und nutzten alternativ zum Praxisbesuch in der Pandemie häufiger telemedizinische Kontakte. Weitere Analysen zu Entwicklungen des Inanspruchnahmeverhaltens und Veränderungen im Gesundheitszustand im Verlauf der COVID-19-Pandemie sind wichtig

The cost-effectiveness of growth hormone replacement therapy (Genotropin®) in hypopituitary adults in Sweden

BACKGROUND: To evaluate the cost-effectiveness of growth hormone (GH) treatment (Genotropin(R)) compared with no GH treatment in adults with GH deficiency in a Swedish societal setting. METHODS: A Markov-type cost-utility simulation model was constructed and used to simulate, for men and women, morbidity and mortality for GH-treated and -untreated individuals over a 20-year period. The calculations were performed using current available prices concerning morbidity-related healthcare costs and costs for Genotropin(R). All costs and treatment effects were discounted at 3%. Costs were expressed in Euro (1[euro sign] = 9.03 SEK). GH-treated Swedish patients (n = 434) were identified from the KIMS database (Pfizer International Metabolic Database) and untreated patients (n = 2135) from the Swedish Cancer Registry and the Hospital Discharge Registry. RESULTS: The results are reported as incremental cost per quality-adjusted life year (QALY) gained, including both direct and indirect costs for GH-treated versus untreated patients. The weighted sum of all subgroup incremental cost per QALY was [euro sign]15,975 and [euro sign]20,241 for men and women, respectively. Including indirect cost resulted in lower cost per QALY gained: [euro sign]11,173 and [euro sign]10,753 for men and women, respectively. Key drivers of the results were improvement in quality of life, increased survival, and intervention cost. CONCLUSIONS: The incremental cost per QALY gained is moderate when compared with informal thresholds applied in Sweden. The simulations suggest that GH-treatment is cost-effective for both men and women at the [euro sign]55,371 (SEK 500,000 -- the informal Swedish cost-effectiveness threshold) per QALY threshold

The cost-effectiveness of growth hormone replacement therapy (Genotropin®) in hypopituitary adults in Sweden

BACKGROUND: To evaluate the cost-effectiveness of growth hormone (GH) treatment (Genotropin(R)) compared with no GH treatment in adults with GH deficiency in a Swedish societal setting. METHODS: A Markov-type cost-utility simulation model was constructed and used to simulate, for men and women, morbidity and mortality for GH-treated and -untreated individuals over a 20-year period. The calculations were performed using current available prices concerning morbidity-related healthcare costs and costs for Genotropin(R). All costs and treatment effects were discounted at 3%. Costs were expressed in Euro (1[euro sign] = 9.03 SEK). GH-treated Swedish patients (n = 434) were identified from the KIMS database (Pfizer International Metabolic Database) and untreated patients (n = 2135) from the Swedish Cancer Registry and the Hospital Discharge Registry. RESULTS: The results are reported as incremental cost per quality-adjusted life year (QALY) gained, including both direct and indirect costs for GH-treated versus untreated patients. The weighted sum of all subgroup incremental cost per QALY was [euro sign]15,975 and [euro sign]20,241 for men and women, respectively. Including indirect cost resulted in lower cost per QALY gained: [euro sign]11,173 and [euro sign]10,753 for men and women, respectively. Key drivers of the results were improvement in quality of life, increased survival, and intervention cost. CONCLUSIONS: The incremental cost per QALY gained is moderate when compared with informal thresholds applied in Sweden. The simulations suggest that GH-treatment is cost-effective for both men and women at the [euro sign]55,371 (SEK 500,000 -- the informal Swedish cost-effectiveness threshold) per QALY threshold

The costs of exacerbations in chronic obstructive pulmonary disease (COPD)

AbstractExacerbations are the key drivers in the costs of chronic obstructive pulmonary disease (COPD). The objective was to examine the costs of COPD exacerbations in relation to differing degrees of severity of exacerbations and of COPD. We identified 202 subjects with COPD, defined according to the BTS and ERS criteria. Exacerbations were divided into mild (self-managed), mild/moderate (telephone contact with a health-care centre and/or the use of antibiotics/systemic corticosteroids), moderate (health-care centre visits) and severe (emergency care visit or hospital admission). Exacerbations were identified by sending the subjects a letter inquiring whether they had any additional respiratory problems or influenza the previous winter. At least one exacerbation was reported by 61 subjects, who were then interviewed about resource use for these events. The average health-care costs per exacerbation were SEK 120 (95% CI=39–246), SEK 354 (252–475), SEK 2111 (1673–2612) and SEK 21852 (14436–29825) for mild, mild/moderate, moderate and severe exacerbations, respectively. Subjects with impaired lung function experienced more severe exacerbations, which was also reflected in the cost of exacerbations per severity of the disease during the 412 month study period (ranging from SEK224 for mild to SEK 13708 for severe cases, median SEK 940). Exacerbations account for 35–45% of the total per capita health-care costs for COPD. In conclusion, costs varied considerably with the severity of the exacerbation as well as with the severity of COPD. The prevention of moderate-to-severe exacerbations could be very cost-effective and improve the quality of life