title: Decision making in Germany: is health economic evaluation as a supporting tool a sleeping beauty?
abstract: For many years, the legal situation within the statutory health insurance (SHI) system in Germany has allowed for health economic evaluations. There are various reasons why health economic evaluations have played virtually no role in decision making until now: to begin with, a method for the evaluation of the relation between benefits and costs which needed to be in accordance with the legal requirements had to be developed, the outcome of which was the efficiency frontier approach. Subsequent health care reforms have led to changing objectives and strategies. Currently, price negotiations of newly launched drugs are based on an early benefit assessment of dossiers submitted by pharmaceutical manufacturers. Other reasons might be the presently very comfortable financial situation of the statutory health insurance system as well as a historically grown societal fear and discomfort towards what is perceived to be a rationing of medicinal products. For the time being, it remains open how long the German health care system can afford to continue neglecting the benefits of health economic evaluations for drug and non-drug interventions, and when it will be time to wake this sleeping beauty.
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany. Electronic address: andreas.gerber@iqwig.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gerber-Grote
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Frank Gerd
authors.initials: FG
authors.lastname: Sandmann
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Min
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Ten Thoren
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Schwalm
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Carolin
authors.initials: C
authors.lastname: Weigel
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Balg
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mensch
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mostardt
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Seidl
authors.affiliation: Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany; Research Group for Evidence Based Public Health, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany & Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany (as of April 1(st), 2014).
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Lhachimi
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics* / Q000331:legislation & jurisprudence; D003431:Cross-Cultural Comparison; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000191:economics / Q000331:legislation & jurisprudence; D016527:Drug Costs / Q000331:legislation & jurisprudence; D005858:Germany; D015276:Health Care Rationing / Q000191:economics / Q000331:legislation & jurisprudence; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000331:legislation & jurisprudence; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence
keywords: Deutschland; Effizienzgrenze; Entscheidungsfindung; Erstattung; Germany; Health economic evaluation; IQWiG; Kosten-Nutzen-Bewertung; decision making; efficiency frontier; reimbursement