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Outpatient medication costs of patients with cystic fibrosis in Germany

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Abstract

Background

Cystic fibrosis (CF) patients need specialized long-term treatment. In order to support lung function, pharmaceuticals such as broncho-dilators, mucolytic agents or anti-inflammatory drugs have to be used. Oral, inhaled or intravenous antibacterial therapy is of special importance for patients who have problems with chronic bacterial colonization of the lung and airways. In case of pancreatic insufficiency, digestive enzymes have to be substituted with every meal. Furthermore, patients often need additional supplements of vitamins as well as high caloric food. All of these aspects lead to high medication use in CF patients.

Objective

To analyse outpatient medication costs for CF in Germany from a sickness funds perspective (plus some out-of-pocket payments by patients).

Methods

Medication data were evaluated from seven different outpatient CF centres. Data were recorded via medication lists by the physicians, reporting name of medication, dosage and pharmaceutical form. As the medications are mostly used long term, resource use was valued using the largest available package sizes. Prices were taken from the German ‘Rote Liste’ with year 2006 values. Annual and daily medication costs were analysed for different age groups. In addition, cost-influencing factors were analysed via correlation analyses.

Results

A total of 3150 pharmaceutical records from 301 CF patients were collected. Mean annual costs for medication were €21 603 per patient (range €69–104477). Correlation analyses showed significant correlations between costs of medication and age, co-morbidities (such as pancreatic insufficiency and diabetes mellitus) and clinical parameters such as bacterial colonization of the lung, as well as functional parameters (percent of vital capacity, forced expiratory volume in 1 second, maximal expiratory flow at 25% of forced vital capacity). For example, mean annual costs for medication were €23 815 and h14 884 for patients with and without bacterial colonization of the lung, respectively. Other correlation factors yielded similar cost dispersions between patients with and without the factors.

Conclusions

Costs of outpatient medication for CF patients significantly depend on age, co-morbidities and other clinical parameters. Hence, non-optimal treatment could lead to a significantly higher burden for the healthcare system.

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Acknowledgements

We would like to thank the Mukoviszidose e.V., the German Cystic Fibrosis Association, as well as the clinics and patients for their support and the information they provided for this analysis. We especially thank Andreas Reimann (Mukoviszidose e.V.) as well as the CF Study Group members from the following clinics: Manfred Ballmann (CF-Pediatric Centre, Hannover Medical School, Germany), Matthias Griese (CF-Pediatric Centre, Ludwig Maximilian University, Munich, Germany), Frank-Michael Müller (CF-Pediatric Centre, University of Heidelberg, Germany), Hans-Georg Posselt (CF-Pediatric Centre, Johann Wolfgang Goethe-University, Frankfurt, Germany), Tobias Welte (CF-Adult-Centre, Hannover Medical School, Germany), Matthias Wiebel (CF-Adult Centre, University of Heidelberg, Germany).

The study has been approved by the ethics committees of the involved clinics.

The study was funded by the Mukoviszidose e.V, the German Cystic Fibrosis Association. Thomas O.F. Wagner is a board member of, and has received grants from, the Mukoviszidose e.V. However, the research for this study was independent of this relationship and of the funding as the authors at all times had full authority over the outcomes and the preparation of the manuscript.

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Correspondence to Dr Daniela Eidt-Koch.

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Eidt-Koch, D., Wagner, T.O.F., Mittendorf, T. et al. Outpatient medication costs of patients with cystic fibrosis in Germany. Appl Health Econ Health Policy 8, 111–118 (2010). https://doi.org/10.2165/11313980-000000000-00000

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Keywords

  • Cystic Fibrosis
  • Cystic Fibrosis Patient
  • Bacterial Colonization
  • Pancreatic Insufficiency
  • Sickness Fund