title: Quantifying delay in access to new medical treatment: an application of risk advancement period methodology.
abstract: BACKGROUND
  We present a novel application of the concept of risk or rate advancement to compute the extent of delay in adoption of an effective new drug in 2 German health insurance systems.
  
  
  METHODS
  We identified individuals with migraines, age 18 to 65 years, in 371 primary care practices in Germany in 1994 (MediPlus, IMS Health database). These included 8173 persons covered under the statutory health insurance system and 503 persons covered by private health insurance. We derived risk and population risk advancement periods for sumatriptan compared with nonserotoninergic acute migraine therapy using multiplicative risk regression and generalized estimating equations, adjusted for patient, physician, and practice cofactors.
  
  
  RESULTS
  For patients at the mean age of the cohort, 43 years of age, sumatriptan was prescribed 1.2 (95% confidence interval [CI] = 0.3-2.0) years later among those in the statutory health insurance system compared with those who had private insurance. The lag increased by 0.6 (-0.1 to 1.3) years for every 10 years of patient age. In the age-mix of our sample, access to the health benefits of sumatriptan therapy lagged nearly 1.5 years behind in the statutory health insurance system and for Germany as a whole.
  
  
  CONCLUSIONS
  Migraine patients' access to sumatriptan therapy lagged substantially in the statutory health insurance system and in the country as a whole. Risk advancement periods provide a useful methodology for communicating major healthcare issues in a meaningful way to society and policymakers.
authors.affiliation: Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill, North Carolina, USA. kkrobot@web.de
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Krobot
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Jay S
authors.initials: JS
authors.lastname: Kaufman
authors.forename: Dale B
authors.initials: DB
authors.lastname: Christensen
authors.forename: John S
authors.initials: JS
authors.lastname: Preisser
authors.forename: Michel A
authors.initials: MA
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D005858:Germany; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D009313:National Health Programs; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*; D018170:Sumatriptan / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D017366:Serotonin Receptor Agonists; D018170:Sumatriptan