Impact of Attention-Deficit/Hyperactivity Disorder (ADHD) on prescription dug spending for children and adolescents: increasing relevance of health economic evidence

<p>Abstract</p> <p>Background</p> <p>During the last decade, pharmaceutical spending for patients with attention-deficit-hyperactivity disorder (ADHD) has been escalating internationally.</p> <p>Objectives</p> <p>First, to estimate future trends of ADHD-related drug expenditures from the perspectives of the statutory health insurance (SHI; Gesetzliche Krankenversicherung, GKV) in Germany and the National Health Service (NHS) in England, respectively, for children and adolescents age 6 to 18 years. Second, to evaluate the budgetary impact on individual prescribers (child and adolescent psychiatrists and pediatricians treating patients with ADHD) in Germany.</p> <p>Methods</p> <p>A model was developed to predict plausible scenarios of future pharmaceutical expenditures for treatment of ADHD. Model inputs were derived from demographic and epidemiological data, a literature review of past spending trends, and an analysis of new pharmaceutical products in development for ADHD. Only products in clinical development phase III or later were considered. Uncertainty was addressed by way of scenario analysis. For each jurisdiction, five scenarios used different assumptions of future diagnosis prevalence, treatment prevalence, rates of adoption and unit costs of novel drugs, and treatment intensity.</p> <p>Results</p> <p>Annual ADHD pharmacotherapy expenditures for children and adolescents will further increase and may exceed €310 m (D; E: ₤78 m) in 2012 (2002: ~€21.8 m; ~₤7.0 m). During this period, overall drug spending by individual physicians may increase 2.3- to 9.5-fold, resulting from the multiplicative effects of four variables: increased number of diagnosed cases, growing acceptance and intensity of pharmacotherapy, and higher unit costs of novel medications.</p> <p>Discussion</p> <p>Even for an extreme low case scenario, a more than six-fold increase of pharmaceutical spending for children and adolescents is predicted over the decade from 2002 to 2012, from the perspectives of both the NHS in England and the GKV in Germany. This budgetary impact projection represents a partial analysis only because other expenditures are likely to rise as well, for instance those associated with physician services, including diagnosis and psychosocial treatment. Further to this, by definition budgetary impact analyses have little to nothing to say about clinical appropriateness and about value of money.</p> <p>Conclusion</p> <p>Providers of care for children and adolescents with ADHD should anticipate serious challenges related to the cost-effectiveness of interventions.</p

VDEW-Jahresbericht 1999

Available from TIB Hannover: ZB 323(1999) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

VDEW-Jahresbericht 1997

Available from TIB Hannover: ZB 323(1997) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Strommarkt Deutschland 1996 Die oeffentliche Elektrizitaetsversorgung

Nach einem kurzen Ueberblick ueber die wichtigsten Kenndaten der Elektrizitaetswirtschaft der Bundesrepublik Deutschland wird ueber die bedeutendsten Ergebnisse dieses Wirtschaftszweiges im Berichtsjahr berichtet, wobei Stromerzeugung, Stromverbrauch und Stromverteilung im Vordergrund stehen. Zahlreiche mehrfarbige Diagramme verdeutlichen die Zahlenangaben. Im Anhang werden zahlreiche Tabellen wiedergegeben. (orig.)A brief survey of key data of the German electric power industry is followed by a report on the developments and results for the year covered. Emphasis is on electric power generation, electric power consumption and distribution. Several coloured diagrams serve to illustrate the data. Several tables are annexed. (orig.)SIGLEAvailable from TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Mikrobiologisch-hygienische Untersuchungen ueber die Anwendung von Brannt- und Loeschkalk zur Klaerschlammentseuchung

TIB: RO 6451(4)+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Untersuchungen zur Eignung von Wirbelschichtasche fuer hydraulisch gebundene Tragschichten

Industrial by-products, e.g. fluidized bed ashes, shall be utilized as far as possible in order to prevent additional load on scarce dumping grounds. It was one of the objectives of the project to investigate whether fluidized bed ashes can be utilized in road constructions, i.e. in hydraulically-bound layers. Nine bed and ten filter ashes were taken from different furnaces all over the Federal Republic of Germany and their material properties were determined. By analyzing the material properties of two further samples, taken from four representative bed and filter ashes, information was to be obtained about the uniformity of the ashes. According to the analysis, the ashes demonstrated partly large variations and different properties. Further investigations, necessary from the civil engineering point of view, were carried out at samples of these selected ashes by varying the cement quality and the amount of cement added. It turned out that it is possible to utilize bed ashes with a mineral material blend of 100 weight.-% and filter ashes with 20 and/or 30 weight.-%. Regarding the public water compatibility, it was determined that considerable sulphate concentrations and electrical conductivity in the eluate of the pure ashes are reduced to negligible values due to the consolidation of the construction materials. (orig.)Um eine weitere Belastung des knappen Deponieraums zu vermeiden sollen industrielle Nebenprodukte, wie z.B. Wirbelschichtasche, soweit wie moeglich verwertet werden. Im Rahmen dieses Projektes sollte untersucht werden, ob ein Einsatz von Wirbelschichtasche im Strassenbau in hydraulisch gebundenen Schichten moeglich ist. Hierzu wurden bundesweit neun Bett- und zehn Filteraschen aus Wirbelschichtfeuerungen beprobt und deren stoffliche Eigenschaften ermittelt. Durch Bestimmung der stofflichen Eigenschaften von zwei weiteren Probenahmen an je vier repraesentativen ausgewaehlten Bett- und Filteraschen sollte ein Anhalt ueber die Gleichmaessigkeit der anfallenden Aschen gewonnen werden. Es zeigte sich, dass die Aschen z.T sehr grosse Schwankungen der Eigenschaften aufwiesen. Die weiteren bautechnisch erforderlichen Untersuchungen zur Ermittlung der Eignung von Wirbelschichtasche fuer hydraulisch gebundene Schichten wurde an Probekoerpern aus diesen ausgewaehlten Aschen unter Variation der Zementzugabemenge und der Zementart durchgefuehrt. Es ergab sich, dass ein Einsatz der Bettaschen im Mineralstoffgemisch von 100 Gew.-% und der Filteraschen von 20 bzw. 30 Gew.-% moeglich ist. Bei den Untersuchungen zur Gewaesservertraeglichkeit wurde festgestellt, dass erhebliche Sulfatkonzentrationen und elektrische Leitfaehigkeiten im Eluat der reinen Aschen durch die Verfestigung der Baustoffgemische auf unbedenkliche Werte reduziert wurden. (orig.)Available from TIB Hannover: F95B421+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany); VGB-Forschungsstiftung, Essen (Germany)DEGerman

Development of a goalball-specific performance test

Höner O, Hermann T, Prokein T. Entwicklung eines goalballspezifischen Leistungstests. In: Würth S, Panzer S, Krug J, Alfermann D, Deutsche Vereinigung für Sportwissenschaft, eds. Sport in Europa. Schriften der Deutschen Vereinigung für Sportwissenschaft. Vol 151. Hamburg, Germany: Feldhaus Verlag; 2005: 331