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5. Collaborative Ambulatory Orthopaedic Care in Patients with Hip and Knee Osteoarthritis: A Retrospective Comparative Cohort Study on Health Utilisation and Economic Outcomes.

Author

MÜLLER, ANGELINA, GRUHN, SEBASTIAN, SAWICKI, OLGA A., GLUSHAN, ANASTASIYA, WITTE, CLAUDIA, KLAASEN-MIELKE, RENATE, LEMBECK, BURKHARD, BEYER, MARTIN, GERLACH, FERDINAND M., GREINER, WOLFGANG, and KARIMOVA, KATERYNA

Subjects
*KNEE osteoarthritis, *EVALUATION of medical care, *MUSCULOSKELETAL system diseases, *OUTPATIENT medical care, *HIP osteoarthritis, *ECONOMIC impact, *EVALUATION of human services programs, *CONFIDENCE intervals, *MULTIVARIATE analysis, *PHYSICAL therapy, *MEDICAL care costs, *RETROSPECTIVE studies, *COST control, *REGRESSION analysis, *MEDICAL care use, *COMPARATIVE studies, *INTERPROFESSIONAL relations, *MEDICAL referrals, *HOSPITAL care, *DESCRIPTIVE statistics, *RESEARCH funding, *ORTHOPEDICS, *ODDS ratio, *DATA analysis software, *LONGITUDINAL method, *ECONOMICS
Abstract

Objective: To evaluate a novel healthcare programme for the treatment of patients with hip and knee osteoarthritis in southern Germany in terms of clinical and health economic outcomes. The study is based on claims data from 2014 to 2017. Methods: We conducted a retrospective comparative cohort study of 9768 patients with hip and knee osteoarthritis, of whom 9231 were enrolled in a collaborative ambulatory orthopaedic care programme (intervention group), and 537 patients received usual orthopaedic care (control group). Key features of the programme are coordinated care, morbidity-adapted reimbursement and extended consultation times. Multivariable analysis was performed to determine effects on health utilisation outcomes. The economic analysis considered annual costs per patient from a healthcare payer perspective, stratified by healthcare service sector. Besides multivariable regression analyses, bootstrapping was used to estimate confidence intervals for predicted mean costs by group. Results: Musculoskeletal-disease-related hospitalisation was much less likely among intervention group patients than control group patients [odds ratio (OR): 0.079; 95% CI: 0.062–0.099]. The number of physiotherapy prescriptions per patient was significantly lower in the intervention group (RR: 0.814; 95% CI: 0.721–0.919), while the likelihood of participation in exercise programmes over one year was significantly higher (OR: 3.126; 95% CI: 1.604–6.094). Enrolment in the programme was associated with significantly higher ambulatory costs (€1048 vs. €925), but costs for inpatient care, including hospital stays, were significantly lower (€1003 vs. €1497 and €928 vs. €1300 respectively). Overall annual cost-savings were €195 per patient. Conclusions: Collaborative ambulatory orthopaedic care was associated with reduced hospitalisation in patients with hip and knee osteoarthritis. Health costs for programme participants were lower overall, despite higher costs for ambulatory care. [ABSTRACT FROM AUTHOR]

Published
2023
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6. Health State Utility Values Used in Economic Evaluation of Meningococcal Vaccination: A Systematic Review

Author

Witte, J., Gruhn, Sebastian, Wick, M., Damm, O., and Greiner, Wolfgang

Abstract

Objectives Invasive meningococcal disease (IMD) is a major public health challenge associated with high case-fatality and life-long disabilities in survivors. Approximately 20% of survivors suffer at least one disability, including physical, neurological and psychological sequalae. Health state utility values (HSUVs) are needed to assess associated health outcomes in economic evaluations of new vaccines. This study aims to give a structured overview of HSUVs used in meningococcal vaccination Methods We systematically searched PubMed and EMBASE for economic evaluations of meningococcal vaccination published until January 15, 2022. The review focused on type, value, and source of reported HSUVs and is presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Results A total of 29 publications were included. Eighteen models examined MenB vaccination strategies, 11 MenC/MenACWY vaccination. Utility data were reported for both, acute disease and sequalae, while reporting of the utilities used often showed weaknesses (e.g., unclear or inaccurate sources). HSUVs applied for the acute phase ranged from -0.51 to 0.860. Considered sequalae included physical (n=22/29), neurological (21/29), or psychological/behavioral sequalae (6/29). Utility data on sequalae were Conclusions There are reporting gaps and weaknesses in the current evidence base for utilities used in economic models of meningococcal vaccination. Transparent evaluation and reporting of utility data are essential in economic evaluation. As caregiver spillover utilities and QALY adjustment factors enable consideration of the societal preference for interventions that prevent rare, but severe diseases, they should be evaluated in models and be discussed with decision-making bodies.

Published
2022

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