These results show that posttransplant clinical outcomes result in a significant increase in treatment costs. Because the economic impact of primary causes of chronic rejection (acute rejection and CMV) and delayed graft function is substantial, careful selection of the most appropriate immunosuppressive regimen is essential.

Concomitant obesity is independently associated with incremental health care costs in adult patients with type 2 diabetes and, even more so, type 1 diabetes. Results are discussed with respect to the fact that in this sample, concurrent micro- and macro-vascular complications were more frequent in type 1 diabetes. At any rate, in light of these health care costs, obesity seems relevant in both types of diabetes. Due to claims data limitations, it was not possible to distinguish obesity classes based on body height and weight information. Further research should identify adiposity thresholds for increased resource consumption using both primary and secondary data.

There are only a limited number of high quality studies showing that insulin glargine is superior regarding treatment satisfaction and HRQoL of patients with diabetes mellitus. There are fewer publications with good evidence of patient-reported outcomes than those reporting well-established outcomes using HbA1c levels or the incidence of hypoglycaemia.

BackgroundCompared to conventional human basal insulin (neutral protamine Hagedorn; NPH) the long-acting analogue insulin glargine (GLA) is associated with a number of advantages regarding metabolic control, hypoglycaemic events and convenience. However, the unit costs of GLA exceed those of NPH. This study aims to systematically review the economic evidence comparing GLA with NPH in basal-bolus treatment (intensified conventional therapy; ICT) of type 1 diabetes in order to facilitate informed decision making in clinical practice and health policy.MethodsA systematic literature search was performed for the period of January 1st 2000 to December 1st 2009 via Embase, Medline, the Cochrane Library, the databases GMS (German Medical Science) and DAHTA (Deutsche Agentur für Health Technology Assessment), and the abstract books of relevant international scientific congresses. Retrieved studies were reviewed based on predefined inclusion criteria, methodological and quality aspects. In order to allow comparison between studies, currencies were converted using purchasing power parities (PPP).ResultsA total of 7 health economic evaluations from 4 different countries fulfilled the predefined criteria: 6 modelling studies, all of them cost-utility analyses, and one claims data analysis with a cost-minimisation design. One cost-utility analysis showed dominance of GLA over NPH. The other 5 cost-utility analyses resulted in additional costs per quality adjusted life year (QALY) gained for GLA, ranging from € 3,859 to € 57,002 (incremental cost effectiveness ratio; ICER). The cost-minimisation analysis revealed lower annual diabetes-specific costs in favour of NPH from the perspective of the German Statutory Health Insurance (SHI).ConclusionsThe incremental cost-utility-ratios (ICER) show favourable values for GLA with considerable variation. If a willingness-to-pay threshold of £ 30,000 (National Institute of Clinical Excellence, UK) is adopted, GLA is cost-effective in 4 of 6 cost utility analyses (CUA) included. Thus insulin glargine (GLA) seems to offer good value for money. Comparability between studies is limited because of methodological and country specific aspects. The results of this review underline that evaluation of insulin therapy should use evidence on efficacy of therapy from information synthesis. The concept of relating utility decrements to fear of hypoglycaemia is a plausible approach but needs further investigation. Also future evaluations of basal-bolus insulin therapy should include costs of consumables such as needles for insulin injection as well as test strips and lancets for blood glucose self monitoring.

Um mögliche Zusammenhänge zwischen der zunehmenden Digitalisierung der Patientenversorgung und der Patientensicherheit zu identifizieren, haben die Autoren eine systematische Literaturrecherche in der PubMed-Datenbank des National Center for Biotechnology Information (USA) durchgeführt. Die Suche wurde auf den Bereich der Krankenhausversorgung eingegrenzt und durch eine Handsuche in einschlägigen deutschen Zeitschriften ergänzt. In den Funden zeigten sich deutliche Bezüge zwischen beiden Themen. Einerseits können bestimmte digitale Anwendungen zu einer deutlichen Verbesserung der Patientensicherheit führen. Andererseits ergeben sich aus technischen Mängeln in IT-Systemen oder durch ihre fehlerhafte Anwendung teils gravierende Risiken für die Sicherheit. Um tatsächlich die Potenziale der Digitalisierung für die Patientensicherheit zu realisieren, sind fortwährende gemeinsame Anstrengungen von Herstellern, Betreibern und Anwendern von IT-Systemen erforderlich. In order to identify possible links between the growing use of health information technology in medical care and patient safety, the authors conducted a systematic literature search using the PubMed database (National Center for Biotechnology Information, USA). The search was limited to publications related to hospital care. A search in specific German language journals was added. The identified publications showed manifold relations between digitalisation of care and patient safety. On the one hand, health IT solutions may significantly improve patient safety. On the other hand, serious risks may result from technical flaws or improper use of health IT. In order to realise the potentials of health IT solutions for the improvement of patient safety, a continuous joint effort of producers, operators and users of such systems is necessary.

No abstract

Our analysis of German claims data provides little evidence of changed indications for stenting in cases of intracranial atherosclerotic disease which one might expect to be caused by the emergence of high-level evidence.

No abstract