Outpatient medication costs of patients with cystic fibrosis in Germany.
BACKGROUND
Cystic fibrosis (CF) patients need specialized long-term treatment. In order to support lung function, pharmaceuticals such as bronchodilators, 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 €69-104,477). 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 €14,884 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.
Eidt-Koch
Daniela
D
Centre for Health Economics, Leibniz University of Hannover, Hannover, Germany. de@ivbl.uni-hannover.de
Wagner
Thomas O F
TO
Mittendorf
Thomas
T
Graf von der Schulenburg
J-Matthias
JM
D000367:Age Factors; D000553:Ambulatory Care / Q000191:economics*; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000188:drug therapy / Q000191:economics*; D016527:Drug Costs; D006801:Humans; D016014:Linear Models; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires