Health-Economic Evaluation of the Disease Management Program for Chronic Obstructive Pulmonary Disease in Germany
Economic Policy, Applied Economics
Final Report Abstract
Being the first study of its kind in the German healthcare context, it was the primary aim to compare costs and health resource utilisation from the payer perspective, process quality, morbidity and mortality of DMP COPD with standard care for COPD over a time period of 3 years. In order to estimate the costs and effectiveness of COPD DMP, a non-experimental, retrospective, population-based cohort study design was applied. The analysis is based on administrative data from Barmer GEK, a nationwide operating sickness fund that covers more than 10% of the German population, i.e. 8.7 million insured in 2011. Patients (>18 years of age) with COPD were identified if having >= 2 outpatient claims within 180 consecutive days or ≥ 1 hospitalization with the diagnosis 'J44'. COPD patients suffering from the following diseases that could impede an active participation in DMPs were excluded: dementia, delusional disorders, Alzheimer’s disease, mental/behavioural disorders due to psychoactive substance use (except nicotine dependence), moderate/severe intellectual disabilities and metastatic cancer. The patient cohort was subsequently divided into an intervention group, i.e. patients that enrolled in the COPD DMP for the first time at any point between 2008 and 2010 for at least 3 years (DMP group), and a control group, i.e. patients that had never been member of a COPD DMP at any point of time. Patients enrolling in COPD DMP before 2008 were excluded. For DMP members, outcomes were measured for 3 years starting from DMP enrolment (index date), while for the control group, outcomes were assessed in the 3-year period 1 January 2009 to 31 December 2011. To allow for risk adjustment, a period of 2 years prior to the index date was stipulated as the basis for determining patient-level risk profiles. Applying equally to the DMP and control group, individuals were excluded from this study if they (i) switched between the DMP and control group, (ii) had not been constantly enrolled during the 2-year risk adjustment or (iii) the 3-year observation period. Patients who died during the observation period were exempted from exclusion. After eliminating differences in observable characteristics between the DMP and the control group with entropy balancing, difference-in-difference estimators were computed to account for time-invariant unobservable heterogeneity. 215,104 individuals were included into the analysis of whom 25,269 were enrolled in the DMP. DMP patients had a reduced mortality hazard ratio (0.89, 95%CI: 0.84-0.94) but incurred excess costs of € 553 per year. DMP enrolees reveal higher healthcare utilisation with larger shares of individuals being hospitalised (3.14%), consulting an outpatient clinic due to exacerbations (11.13%) and pharmaceutical prescriptions (2.78). However, average length of hospitalisation due to COPD fell by 0.49 days, adherence to medication guidelines as well as indicators for morbidity improved. Thus, the German COPD DMP achieved significant improvements in mortality, morbidity and process quality, but at higher costs. Given a comparable low ICER per life year gained, DMP COPD may constitute a cost-effective option to promote COPD population health.
