Academic journal article Applied Health Economics and Health Policy

Outpatient Medication Costs of Patients with Cystic Fibrosis in Germany

Academic journal article Applied Health Economics and Health Policy

Outpatient Medication Costs of Patients with Cystic Fibrosis in Germany

Article excerpt

Background

Cystic fibrosis (CF) patients need specialized long-term treatment. Among the essential elements of the basic disease-controlling therapy for CF are inhalation and other pharmacological therapies. In order to support lung function, pharmaceuticals such as bronchodilators, mucolytic agents or anti-inflammatory drugs have to be used. Mucolytic agents are targeted to prevent increasing viscosity of bronchial secretion. Bronchodilators support the extension of airways in the bronchial purgation mechanism. In addition, anti-inflammatory drugs are an essential part of disease-controlling therapy for CF patients with asthma.[1,2] Many CF patients also have an exocrine pancreas insufficiency and have to substitute digestive enzymes with every meal. Also, patients often need additional supplements of vitamins. Furthermore, being underweight can be countered with high caloric food and, if necessary, with drinks and food via special feeding tubes.

Oral, inhaled or intravenous antibacterial therapy is of special importance for patients who have problems with chronic bacterial colonization of the lung and airways. Oral antibacterial therapy is intermittently used to prevent acute infections or as continuous therapy. Intravenous antibacterial therapy is mainly used against the predominant Gram-negative bacteria Pseudomonas aeroginosa (PSA) or Stenotrophomonas spp, and special bacteria such as Burkholderia xenovorans (Cepacia complex).[1-3] In addition, a combination of different pharmaceutical interventions can be appropriate depending on the current severity of the infection. Even though bacterial affection in the lung itself cannot be eliminated with these interventions, a decrease in inflammation can be achieved. The intravenous antibacterial therapy can take place in an outpatient setting or in the hospital. This more or less depends on the condition of the patient and whether the same drug was previously well tolerated in the patient. The costs of intravenous antibacterial treatment for CF have been thoroughly studied.[4-9] As only outpatient medication was regarded in this study, medication costs for intravenous therapy were not considered in the calculations.

CF patients in Germany are treated by an interdisciplinary team in specialized clinics at (mostly) university hospitals. Outpatient treatment and medication is usually provided by the hospital, but reimbursed as outpatient services financed by the health insurance system.

Due to the nature of the disease, CF treatment is typically associated with a high utilization of medications. As these drugs in certain cases were exclusively developed for CF treatment, costs tend to be high. Additional data were available in the study (e.g. costs for outpatient care, etc.) and are reported elsewhere (Eidt-Koch D, unpublished data). For this paper, the main emphasis was given to medication costs as this aspect of the overall treatment process is of paramount importance to sickness funds and society. Hence, the aim of this work was to analyse in detail the costs of outpatient medication for CF patients in Germany from a sickness funds perspective. In addition, there were a few medications included in the calculation that are paid for by patients and not by sickness funds.

Methods

This multicentre, cross-sectional, observational study was based on medication utilization data from CF patients receiving continuous outpatient treatment in seven German paediatric and adult CF outpatient units based at university hospitals in Hannover, Frankfurt, Heidelberg and Munich between April and August 2006. All patients who were treated during 1 month at any one of the clinics were included in the study. Patients were excluded if they refused to give written consent to join the study.

Medication data specific for the treatment of CF were gathered via a questionnaire that was filled out by treating physicians. For a period of 1 month they recorded for every patient the brand name of the drug, the dosing regimen and the pharmaceutical form. …

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