Health-Economic Evaluation of the Disease Management Program for Chronic Obstructive Pulmonary Disease in Germany

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Over the last decade, the management of COPD in Germany has gradually changed. Disease management programs (DMP) have been proposed and implemented in patients with COPD. The aim of these programs was to modify treatment patterns, thereby improving outcomes of care whilst increasing the efficient use of scarce health care resources, or even generating cost savings. Internationally, a number of studies evaluated interventions that follow the disease management approach for the management of COPD. However, the design of these interventions is highly heterogeneous and not comparable to the German setting. While there have been numerous studies evaluating DMP type 2 Diabetes in Germany, including four studies gathering retrospective claims data from sickness funds, little evidence is available for all other German DMPs, including DMP COPD.Being the first study of its kind in the German healthcare context, the primary aim of this study is to compare the cost-effectiveness of DMP COPD with standard care for COPD over a time period of 3 years. To do so, we will retrospectively evaluate administrative claims data from the BARMER/GEK, a large German sickness fund with 8.6 million insured. Patients will be included into the study (a) if with at least one inpatient ICD-10 main diagnosis for COPD of J41.-, J42.-, J43.- or J44.-, (b) if with at least one inpatient main diagnosis of J12.- to J18.- and J20.- to J22.- in combination with a secondary diagnosis for COPD of J41.-, J42.-, J43.-, or J44.-, or (c) if with at least two outpatient diagnoses for COPD of J41.-, J42.-, J43.-, or J44.- within 180 days in the year 2010. The patient cohort will then be divided into an intervention group (i.e., the patient is a member in a DMP COPD) and into a control group. We will follow-up patients for 3 years until 2013 while using data from 2008 to 2010 for risk-adjustment. Effectiveness will be measured in terms of mortality, number of (emergency) hospital visits and ability to work. Costs will be measured from the payer perspective.As the use of observational data may result in treatment selection bias, a two-step risk-adjustment will be applied. First, propensity score matching will reduce heterogeneity between the intervention and control group including socio-demographic variables, COPD specific variables and generic comorbidity measures (Elixhauser-Score). Second, based on the matched sample, regression models for each outcome are estimated, i.e. a Cox proportional hazard model for mortality, count data models for the number of (emergency) hospital visits and for the days incapable to work, and a gamma models for costs.The results might demonstrate the success of structured care programs which can be used to encourage active participation and enrolment by patients and to stimulate the participation of providers. Using a large dataset, the study might also be able to identify patient subgroups that benefit most from DMP COPD.