Content of cost domains and respective data source
| Cost domains | Contents and remarks | Data source* |
|---|---|---|
| *AOKN, Health Insurance Scheme (“Allgemeine Ortskrankenkasse Niedersachsen”); KVN, Physicians Association: (“Kassenärztliche Vereinigung Niedersachsen”). | ||
| 1. Healthcare costs direct | ||
| 1.1. Outpatient costs | ||
| 1.1.1. Visits to physicians | Included general practitioner, rheumatologist, and—as applicable—other specialist fees for consulting (history taking, body examination, documentation, and communication fees) | KVN |
| 1.1.2. Outpatient surgery | Outpatient surgical services performed in hospital and non-hospital settings are differently accounted for; costs for both, the procedures, and the anaesthetic support were included | AOKN and KVN |
| 1.1.3. Emergency room visits | Not separately accounted for in Germany; costs are included in the inpatient cost domains | AOKN |
| 1.1.4. Non-physician service use | Included physical medicine as well as psychological interventions | KVN |
| 1.1.5. Drugs | Costs for RA relevant subgroups were identified: DMARDs, steroids, NSAIDs, and osteoporosis drugs | AOKN Disaggregation based on PZN code (“Pharma-zentralnummern”) |
| 1.1.6. Diagnostic/therapeutic procedures and test | Disaggregation was performed to identify relevant procedures for RA and treatment surveillance: imaging of bone and chest (x rays, MRI, CT, or nuclear bone scan, ultrasound of joints and abdomen, osteodensiometry); laboratory tests (tests for inflammatory activity, other immunological tests, antibody screening, blood count, liver enzymes, kidney, and urine tests), and other procedures (joint biopsy, radioactive synovectomy) | KVN Disaggregation based on EBM code (“Einheitlicher Bewertungsmassstab”) |
| 1.1.7. Devices and aids | Total costs for devices and aids included. However, data may be of limited validity owing to complicated flow of information: prescriptions are initiated by the doctor, transferred by patients to an aids and devices magazine, and from there directly to the insurance scheme. According to the AOKN data management personnel delays and various other irregularities are very common | AOKN |
| 1.2. Inpatient costs | ||
| 1.2.1. Acute hospital facilities (without surgery) | RA related hospital admissions were identified and calculated. Owing to the accounting procedures between hospitals and health insurance schemes only summary costs per patient per stay are available; further disaggregation into costs for accommodation, diagnostics, etc, is not possible | AOKN Identification of RA related admissions based on ICD-10 (International Classification of Diseases) admission codes |
| 1.2.2. Acute hospital facilities (surgery) | RA related surgical procedures were identified and calculated separately | AOKN Identification of RA related procedures based on surgery code (OPS 301) |
| 1.2.3. Non-acute hospital facilities | Rehabilitation and nursing home expenses covered by the statutory sickness fund were included. No data were available from the retirement funds, which account for the majority of rehabilitation expenditure. Owing to the accounting procedures between hospitals and health insurance schemes only summary costs per patient per stay are available; further disaggregation is not possible | AOKN Identification of RA related admissions based on ICD-10 |
| 2. Other disease related costs (direct) | ||
| 2.1. Transportation | Total transportation costs were covered, including patient’s co-payment | AOKN |
| 2.2. Home healthcare services | Home healthcare services are covered in Germany by a special nursing insurance scheme. We did not have access to these data. However, we examined the nursing codes of the statutory health insurance (AOKN) and did not find any expenditure for this cost domain | Nursing codes of AOKN |
| 3. Productivity costs | ||
| 3.1. Loss of productivity | Included (a) sick leave payments and (b) RA related retirement payments for patients. Yearly employee income was received by sickness fund (data are always up to date because insurance rates are determined as a percentage of yearly income). Sick leave payments were calculated as daily employee income (yearly income/250 working days) times days of sick leave. A separate code covered sick leave payments from the AOKN, which allowed us to discriminate between AOKN and employer payments for sick leave. Retirement payments equalled yearly income of retired patients | AOKN |