Programme Costing of a Physical Activity Programme in Primary Prevention: Should the Costs of Health Asset Assessment and Participatory Programme Development Count?

This analysis aims to discuss the implications of the “health asset concept”, introduced by the WHO, and the “investment for health model” requiring a “participatory approach” of cooperative programme development applied on a physical activity programme for socially disadvantaged women and to demonstrate the related costing issues as well as the relevant decision context. The costs of programme implementation amounted to €48,700. Adding the costs for developing the programme design of €48,800 results in total costs of €97,500; adding on top of that the costs of asset assessment running to €35,600 would total €133,100. These four different cost figures match four different types of potentially relevant decisions contexts. Depending on the decision context the total costs, and hence the incremental cost-effectiveness ratio of a health promotion intervention, could differ considerably. Therefore, a detailed cost assessment and the identification of the decision context are of crucial importance

Economic Evaluation and Transferability of Physical Activity Programmes in Primary Prevention: A Systematic Review

This systematic review aims to assess the characteristics of, and the clinical and economic evidence provided by, economic evaluations of primary preventive physical exercise interventions, and to analyse their transferability to Germany using recommended checklists. Fifteen economic evaluations from seven different countries met eligibility criteria, with seven of the fifteen providing high economic evidence in the special country context. Most of the identified studies conclude that the investigated intervention provide good value for money compared with alternatives. However, this review shows a high variability of the costing methods between the studies, which limits comparability, generalisability and transferability of the results

Utilization of primary care physicians by obese men and women: review for Germany and results from the MONICA/KORA cohorts S3/F3 and S4/F4

Objectives To provide a review on the obesity-associated utilization of outpatient primary care physicians (PCPs) by adults in Germany, analyze associations between moderate and severe obesity and the utilization of outpatient PCP care, and systematize the results using the behavioral model of health services use. Methods For the review, a literature search was conducted in PubMed for the print publication period of January 1, 1998 to December 31, 2012, and adults as the target group. The first author assessed these publicationsby screening titles, abstracts, and, if necessary, full texts. For the empirical study, self-reported PCP data were collected within twopopulation-based cohorts (baseline surveys: Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)-S3 1994/95 and Cooperative Health Research in the Region of Augsburg (KORA)-S4 1999/2001; follow-ups: KORA-F3 2004/05 andKORA-F4 2006/08) in the region of Augsburg, Germany, and were pooled for present purposes. Adults (N =  5,171)aged 25–64 years at baseline participated. Thenumber of visits to PCPat follow-up was compared across four groups defined by body mass index (BMI) at baseline. Body weight and height were measured anthropometrically. Hierarchical generalized linear negative binomial regressions adjusted for age at baseline, school education, survey cohort, and diabetes status were conducted. Results First, the review of population-based studies on obesity-associated PCP utilization found significantly higher use in obese than in nonobese groups as measured by the number of visits per annum. Second, the analysis of data from the MONICA/KORA cohorts S3/F3 and S4/F4 showed that women had almost one-third (31.3%) more PCP visits than men, and PCP visits linearly increased with the BMI group, with the highest mean number of PCP visits in severely obese individuals (4.7 vs. 2.8 in normal weight). Third, among women, all overweight groups had more PCP visits than the normal-weight group (4.3, 4.5, and 5.0, vs. 3.1). Among men, those with severe obesity reported higher utilization than the other three BMIgroups (4.4 vs. 2.6 in the normal-weight group, 2.8 in the preobesity group, and 3.1 given moderate obesity). Conclusion In population-based studies in Germany, obesity is associated with excess utilization of PCPs in terms of number of visits, holding especially for severe obesity. Excess PCP utilization is associated only with severe obesity among men, but with all three degrees of overweight among women. This pattern parallels obesity-associated reduction in physical health-related quality of life. Future studies should replicate these findings and examine the roles of enabling and contextual factors in this context, for instance, income as an effect modifier and the gender-specific impact of regional PCP density. &nbsp

The Economic Burden of Obesity in Germany: Results from the Population-Based KORA Studies

Objective: To estimate the excess costs of obese compared to normal-weight persons in Germany based on self-reported resource utilisation and work absence. Methods: Five cross sectional surveys of cohort studies in southern Germany were pooled resulting in 9,070 observations for 6,731 individuals (31-96 years). BMI was measured in the study centre. Self-reported health care utilisation and work absence was used to estimate direct and indirect costs for the year 2011 based on unit costs. Using regression analyses, adjusted costs for different BMI groups were calculated. Results: Overweight and obese people showed significantly higher odds of health care utilisation and productivity losses compared with normal-weight people in most categories. Total direct/indirect costs were significantly higher with increasing severity of obesity (pre-obese (1.05 (0.90-1.23) / 1.38 (1.11-1.71)), obesity level I (1.18 (1.00-1.39) / 1.33 (1.02-1.73)), obesity level II (1.46 (1.14-1.87) / 1.77 (1.18-2.65)) or level III (2.04 (1.40-2.97) / 1.99 (1.20-3.30)) compared to normal-weight participants. In particular, higher obesity classes were significantly associated with increased costs for medication, general practitioner utilisation and work absence. Conclusion: Our results show that overweight and obesity are associated with enormous societal direct and indirect costs in Germany. This supports the evidence from previous top-down studies, but provides important new information based on a large pooled data set and measured BMI

Prices of over-the-counter drugs used by 15-year-old adolescents in Germany and their association with socioeconomic background

Abstract Background In Germany, over-the-counter (OTC) drugs are normally reimbursed up to the age of 12 years only. The aim of this study was to analyse prices of over-the-counter drugs used by adolescents in Germany and their association with socioeconomic factors. Methods Based on the German GINIplus and LISAplus birth cohorts, data on drug utilization among 15-year-old adolescents (n = 4677) were collected using a self-administered questionnaire. The reported drugs were subdivided into prescription drugs and OTC drugs. The drugs’ prices were tracked by the pharmaceutical identification numbers. Results Overall, 1499 OTC drugs with clearly identifiable prices were eligible for analysis. Their mean price was €9.75 (95% confidence interval: €9.27–10.22). About 75% of the OTC drugs cost less than €10. Higher mean prices were associated with residing in Munich (€10.74; 95% confidence interval: €9.97–11.52) and with higher paternal education (e.g. highest education level: €10.17; 95% confidence interval: €9.47–10.86). Adolescents residing in Munich (in comparison with the less wealthy region of Wesel) and adolescents with higher educated fathers were also significantly more likely to use OTC drugs costing ≥ €10 or ≥ €25, respectively. Conclusions The price of €10 for non-reimbursable OTC drugs may represent a (psychological) threshold. Higher prices could discourage especially adolescents from a lower socioeconomic background from taking medically advisable but non-reimbursable OTC drugs