title: Costs and outcomes of the German disease management programme (DMP) for chronic obstructive pulmonary disease (COPD)-A large population-based cohort study.
abstract: BACKGROUND
  To curb costs and improve health outcomes in chronic obstructive pulmonary disease (COPD), a nationwide disease management programme (DMP) was introduced in Germany in 2005. Yet, its effectiveness has not been comprehensively evaluated.
  
  
  OBJECTIVE
  To examine the effects of the German COPD DMP over three years on costs and health resource utilisation from the payer perspective, process quality, morbidity and mortality.
  
  
  METHODS
  A retrospective, population-based cohort study design is applied, using administrative data. After eliminating differences in observable characteristics between the DMP and the control group with entropy balancing, difference-in-difference estimators were computed to account for time-invariant unobservable heterogeneity.
  
  
  RESULTS
  215,104 individuals were included into the analysis of whom 25,269 were enrolled in the DMP. DMP patients had a reduced mortality hazard ratio (0.89, 95%CI: 0.84-0.94) but incurred excess costs of €553 per year. DMP enrolees reveal higher healthcare utilisation with larger shares of individuals being hospitalised (3.14%), consulting an outpatient clinic due to exacerbations (11.13%) and pharmaceutical prescriptions (2.78). However, average length of hospitalisation due to COPD fell by 0.49 days, adherence to medication guidelines as well as indicators for morbidity improved.
  
  
  CONCLUSIONS
  The German COPD DMP achieved significant improvements in mortality, morbidity and process quality, but at higher costs. Given the low ICER per life year gained, DMP COPD may constitute a cost-effective option to promote COPD population health.
authors.affiliation: Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany. Electronic address: dmitrij.achelrod@uni-hamburg.de.
authors.forename: Dmitrij
authors.initials: D
authors.lastname: Achelrod
authors.affiliation: Department of Pulmonology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: welte.tobias@mh-hannover.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany. Electronic address: jonas.schreyoegg@uni-hamburg.de.
authors.forename: Jonas
authors.initials: J
authors.lastname: Schreyögg
authors.affiliation: Hamburg Center for Health Economics (HCHE), Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany. Electronic address: tom.stargardt@uni-hamburg.de.
authors.forename: Tom
authors.initials: T
authors.lastname: Stargardt
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics*; D019468:Disease Management; D011307:Drug Prescriptions / Q000191:economics; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D011159:Population Surveillance; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies
keywords: COPD; Disease management programme (DMP); Health-economic evaluation; Managed care