Evaluating Frequency, Diagnostic Quality, and Cost of Lyme Borreliosis Testing in Germany: A Retrospective Model Analysis

Abstract

Background. Data on the economic impact of Lyme borreliosis (LB) on European health care systems is scarce. This project focused on the epidemiology and costs for laboratory testing in LB patients in Germany. Materials and Methods. We performed a sentinel analysis of epidemiological and medicoeconomic data for 2007 and 2008. Data was provided by a German statutory health insurance (DAK) company covering approx. 6.04 million members. In addition, the quality of diagnostic testing for LB in Germany was studied. Results. In 2007 and 2008, the incident diagnosis LB was coded on average for 15,742 out of 6.04 million insured members (0.26%). 20,986 EIAs and 12,558 immunoblots were ordered annually for these patients. For all insured members in the outpatient sector, a total of 174,820 EIAs and 52,280 immunoblots were reimbursed annually to health care providers (cost: 2,600,850€). For Germany, the overall expected cost is estimated at 51,215,105€. However, proficiency testing data questioned test quality and standardization of diagnostic assays used. Conclusion. Findings from this study suggest ongoing issues related to care for LB and may help to improve future LB disease management.

Epidemiology and cost of hospital care for Lyme borreliosis in Germany: Lessons from a health care utilization database analysis

“…In 2003, the total annual cost for LB in Scotland, a country with a low LB incidence, was still estimated as £331,000 (range £47,000-615,000) (Joss et al, 2003). In Germany, a study which combined retrospective investigations of proficiency testing surveys with a secondary analysis of claims data estimated costs of about 51.2 million Euro for diagnostics and treatment of LB outpatients (Müller et al, 2012).…”

“…In the absence of nationwide notification data it seems attractive to provisionally rely on other sources of data with comprehensive coverage such as hospital discharge data used in a recent study from France (Vandenesch et al, 2014) or claims data of health insurance companies. Following the latter approach, a study reported an average annual incidence of 261/100,000 for the diagnosis "LB" (Müller et al, 2012). These findings may point to an underestimation of the current impact of LB as a socioeconomic factor on the German health care system.…”

“…Ongoing deficits in the practical management of LB patients and the lack of evidence based answers to open questions such as possible spirochetal persistence after treatment and post-infectious sequelae in some patients continue to make LB a matter of vivid popular and scientific discussions. Müller et al calculated direct medical costs of about 51.2 million Euro for diagnostics and treatment of LB outpatients in Germany (Müller et al, 2012), but in general, little is known about the economic and medical impact of LB on European health care systems which result from uncertainties in the practical medical management of LB in the inand outpatient sector. Moreover, reliable data focusing on LB hospital care is rather scarce, if available at all for Europe.…”

Development of a Multiantigen Panel for Improved Detection of Borrelia burgdorferi Infection in Early Lyme Disease

“…This strategy requires both a positive first-tier enzyme immunoassay (EIA) and a positive secondtier Western blot, yielding an overall specificity of 99.5% (13,14). Two-tiered testing has several limitations; specifically, it correctly identifies only 29 to 40% of patients presenting with an EM in the early stage of Lyme disease (10), and Western blot analysis is labor-intensive, subjective, and prone to issues with reproducibility (15)(16)(17).…”

Gefahren der Übertragung von Krankheitserregern durch Schildzecken in Deutschland

“…Bei 89% der Patienten fand sich ein Erythema migrans, bei 3% eine Neuroborreliose, bei 2% ein Lymphozytom, bei <1% eine Karditis, bei 5% eine Lyme-Arthritis, bei 1% eine Acrodermatitis chronica atrophicans und eine chronische Neuroborreliose in keinem Fall. Eine Studie, basierend auf Krankenkassendaten, geht von wenigsten 215.000 LymeBorelliose-Fällen/Jahr in Deutschland aus [17], während Daten der länderspe-zifischen Meldepflicht (östliche Bundesländer) maximal 30.000 Fälle in Deutschland erwarten lassen [18].…”