For old and very old people in the need of long-term home care, it is increasingly challenging to handle daily oral care and to attend routine appointments at the dentist. As frailty increases, these problems intensify. Without adequate oral care and regular control checkups, oral health deteriorates which in turn can negatively affect those systemic diseases that caused the care dependency.

However, the consequences of a discontinuation of professional dental care for oral and general health are often unknown. Moreover, there is no mandatory correspondence between general practitioners, dentists, nurses, and relatives or patients. The InSEMaP projects tries to shed light on this precarious situation of people in the need of home care and aims to improve their dental health.Factors that are associated with the dental care of ambulatory patients will be identified and corresponding health care processes will be described. An analysis of routinely collected health insurance claims data will be used to investigate associations between the need for long-term care, dental care, morbidity, and health care costs. Furthermore, examination by a dentist and radiologicdiagnostic will reveal any undiscovered oral health issues of ambulatory long-term care patients. The knowledge drawn from these results will be used to create a new health care plan for this population in which all stakeholders of the health care process are considered.

The project is funded for three years with 1.363 Million EURO in total. If the novel health care approach is successful, it could be continued to consequently achieve an improved oral health care of persons in need of ambulatory care. Due to a mutual association of oral and systemic health, this could lead to an overall increase of health and life quality of ambulatory long-term care patient

Sponser: Innovationsfonds

Funding period: 2021-2024

Responsibility: Working group III

Within ABSCHaLoM, a three-arm randomized controlled trial will be conducted to evaluate conventional and tele-exercise courses for older people living in the new eastern states of Germany in terms of prevention of falls and fall-related injuries as well as improvement of motor functionality and physical activity. More than 2,700 people aged 70 to 90 years will be enrolled in the study and randomly assigned to the conventional exercise group, the tele-exercise group, or the control group. In this context, the Department of Health Economics and Health Services Research of the University Medical Center Hamburg-Eppendorf conducts a health economic evaluation to compare the conventional and the tele-exercise courses with a control group. Health care utilization will be collected retrospectively over 12 months based on a questionnaire for health-related resource use in elderly populations. In addition, the health care utilization due to falls and the EQ-5D-5L to measure generic health-related quality of life will be assessed retrospectively every 3 months. Costs of health care utilization will be calculated from a societal perspective using standardized unit costs. Quality-adjusted life years (QALYs) will be calculated as health effects based on utilities derived from the EQ-5D-5L. Cost-effectiveness after 12 months will be determined by differences in costs and QALYs between the two intervention groups and the control group and related in the form of incremental cost-utility ratios. Non-parametric bootstrapping will be used to analyze its uncertainty. In addition, cost-effectiveness acceptability curves will be constructed on the basis of the net benefit regression method in order to visualize the statistical uncertainty of the cost-utility ratios.

Sponsor: Innovationsfond

Funding period: 2022-2026

Responsibility: Working group I

The multicentre, randomised controlled trial project, “Telemedicine-based, multidisciplinary intervention to stabilise the home care setting” (TemPus), will use a telemedical intervention based on the principles of mobile geriatric rehabilitation to strengthen home care. This intervention will aim at people in need of care and their family carers. The intervention will be delivered to individuals in need of care via video calls in a one-to-one tele-setting. Family carers will be assessed for stressors and resilience factors in order to provide them with tailored training (e.g. in nutrition, continence and home adaptations) and respite care. Alongside this study, the Department of Health Economics and Health Services Research at the University Medical Center Hamburg-Eppendorf will determine the costs of the intervention. A health economic evaluation will be carried out. Use of healthcare services will be assessed using a modified version of the FIMA questionnaire. Health outcomes will be assessed using the EQ-HWB and EQ-5D-5L. Based on these, incremental cost-effectiveness ratios and cost-effectiveness acceptance curves will be calculated.

Sponsor: Innovationsfonds

Funding period: 2026-2029

Responsibility: Working group I

As part of a multicenter randomized controlled trial, a multidimensional program for more par-ticipation of community-dwelling and increasingly frail persons in old age will be investigated. The aim of this program is to delay further loss of function and to improve participation. The core component of the multidimensional program is a twelve-month training program. Addi-tional components, such as counselling in issues of social participation and psychosocial is-sues as well as nutrition and home environment will be provided, if required. Accompanying to this trial, the department of health economics and health services research of the University Medical Center Hamburg-Eppendorf will estimate the intervention costs. Furthermore, a health economic evaluation will be performed. For assessing health effects, quality-adjusted life years will be calculated based on the EQ-5D-5L. Based on these, incremental cost-effectiveness ratios will be calculated and cost-effectiveness acceptability curves will be constructed.

Sponsor: Innovationsfonds

Funding period: 2020-2023

Responsibility: Working group I

The project GeRas is a multicenter randomized controlled trial evaluating an intervention that aims to improve the sustainability of geriatric rehabilitation outcomes after discharge from inpatient rehabilitation clinics. Primary endpoints are improvement of physical function, participation and independence of the participants after returning to their homes. Participants are randomized into three study arms (2 intervention groups, 1 control group receiving regular care). The first intervention group consists of a structured training program, an interface management between the social service at the rehabilitation clinic and care managers (“Versorgungsmanager:innen”) of the health insurance company, and a structured review of the person-environment fit. These components are delivered via in-home visits and telephone calls. In the second intervention group, the same components are delivered via a telemedicine platform. The Department of Health Economics and Health Services Research of the University Medical Center Hamburg-Eppendorf is responsible for the accompanying economic evaluation of the project. This includes determining the intervention costs and analyzing the cost-effectiveness of the intervention(s). Health effects are determined by quality-adjusted life years based on the EQ-5D-5L. Health-related resource utilization is assessed via questionnaires and monetarily valued based on standardized unit costs. Results are presented as incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.

Sponsor: Innovationsfonds

Funding period: 2022-2025

Responsiblity: Working group I

In a multicenter, prospective randomized controlled trial patients with anorexia nervosa, who underwent inpatient treatment, receive 20 sessions of an individual psychotherapy, mainly delivered by videoconference, after discharge from hospital. The control group is treated by optimized treatment-as-usual. Primary efficacy endpoint is the Body Mass Index at the end of treatment after 8 months.

The Department of Health Economics and Health Services Research conducts a cost-utility analysis based on interview data. The analysis uses data from the 14-months assessment and will be performed from the societal perspective. Direct and indirect costs are considered. Quality-adjusted life years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are the incremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by a cost-effectiveness-acceptability curve (CEAC).

Sponsor: Federal Ministry of Education and Research

Funding period: 2020-2024

Responsibility: Working group II

In the project “ENHANCE”, a multi-center randomized controlled trial for the treatment of posttrau-matic stress disorder related to childhood maltreatment will be conducted. Treatment consists of out-patient trauma-focused cognitive behavioral therapy (STAIR-Exposure) or outpatient trauma-focused psychodynamic therapy (TF-PDT). Patients in the control group are on a 6-months waiting list. Outcome measures will be assessed at baseline, after 8 and 16 sessions, post-therapy as well as 6 and 12 months post-therapy.

In this context, the department of health economics and health services research will conduct an economic evaluation comparing STAIR-Exposure and TF-PDT with a control group (waiting list). Direct and indirect costs will be calculated from the societal perspective based on health care utilization, reduced productivity at work and work loss days. For assessing health effects, quality-adjusted life years (QALYs) will be calculated based on utilities derived from the EQ-5D-5L. Incremental cost-effectiveness ratios (ICER) will be calculated and cost-effectiveness acceptability curves (CEAC) will be constructed based on net-benefit regressions.

Sponsor: Federal Ministry of Education and Research

Funding period: 2019-2023

Responsibility: Working group I

In a bicenter (LMU Munich, Charité Berlin), prospective randomized controlled trial patientsposttraumatic stress disorder (PTSD) that developed after inpatient treatment at an intensive careunit, receive 3 sessions of an adapted version of narrative exposure therapy delivered by the primarycare physician. Additionally, a phone based case management conducted by the practice team will beimplemented. The control group is treated by optimized treatment-as-usual. Primary efficacyendpoint is the symptom severity of PTSD after 6 months.
The Department of Health Economics and Health Services Research conducts a cost-utility analysisbased on interview data. The analysis uses data from the 12-months assessment and will beperformed from the societal perspective. Direct and indirect costs are considered. Quality-adjustedlife years (QALY) based on the EQ-5D-5L serve as effectiveness measure. Endpoints are theincremental cost-effectiveness-ratio (ICER) and the probability of cost-effectiveness assessed by acost-effectiveness-acceptability curve (CEAC).

Sponsor: Deutsche Forschungsgemeinschaft

Funding period: 2018-2023

Responsibility: Working group II

The pilot project StroCare involves the implementation and evaluation of cross-sectoral acute inpatient stroketreatment followed by neurological rehabilitation. The main advantage when compared to usual care is the explicitmanagement of the transition between acute treatment and subsequent rehabilitation. This transition isfacilitated by case-managers of the statutory health insurance company and an electronical portal solution,which supports the transfer of clinical data between providers.

The institute of health economics and health service research will determine how the costs for stroke carechange when compared to usual care. To that end, routine claims data of the statutory health insurance companyBarmer will be analyzed. Costs will also be assessed by sector to identify changes in individual cost segments(i.e. inpatient and outpatient costs, care expenses, costs for medications and remedies). To ensure comparabilitybetween groups, Entropy balancing will be used, in order to balance treatment and control group withrespect to sociodemographic and clinical sample characteristics. Subsequently, the costs in the different segmentswill be compared by employing two-part models and generalized linear models – with a difference in differenceapproach. To assess specific parameters of utilization such as the number of hospital days, count models(e.g. negative binomial models) will be employed.

Sponsor: Innovationsfonds

Funding period: 2019-2023

Responsibility: Working group I

Sponsor: Deutsches Zentrum für Herz-Kreislaufforschung e.V. (DZHK)

Funding period: 2017-2021

Responsibility: Working group II

Around 40 percent of people over the age of 75 in Germany suffer from cardiovascular diseases; it accounts for more than half of all deaths in this age group. In particular, the frequency of progressive heart valve disease and coronary heart disease increases with age. Older people with multiple diseases are also at increased risk for heart surgery, which often involves a long recovery period. Only about half of the patients are able to leave the hospital directly after such an operation; every tenth person affected requires long-term care.
A cardiac rehabilitation program is particularly advisable for people who have suffered a heart attack, have cardiac insufficiency or coronary artery disease. However, it can be just as useful to prepare patients over the age of 75 in a targeted manner for an upcoming major heart surgery. Such a cross-sectoral two-week "prehabilitation program" is to be developed and evaluated in the PRECOVERY project. The program examines whether the health of the patients participating in the prehabilitation measure called "Karl-Heinz" (Kognitiv & cArdiale PRehabiLitation vor HErZINterventionen) improves in the following year compared to the participating control group.
In addition, health economic aspects are taken into account and the intervention costs of the program are determined. The project is designed as a randomized controlled study in which 211 patients are randomly assigned to an intervention group and a control group. Eight cardiological/cardiosurgical specialist centers throughout Germany are taking part. The project will be funded for four years with a total of around 5.3 million euros.
If successful, the postoperative recovery process can be supported and accelerated and the program can be included in standard care. This would improve overall cardiac care.

Sponsor: Innovationsfonds

Funding period: 2022-2026

Responsibility: Dirk Heider

Pancreatic cancer is usually detected in late stages and most patients die within one year after diagnosis. The project PANCAID aims at developing a breakthrough blood test based on the technique of liquid biopsy that allows for the detection of pancreas cancer in its early stages and can hence improve life expectancy substantially.

The Department of Health Economics and Health Services Research is in charge of the work package on modelling of early detection strategies and health economic evaluation. Objectives are the development of a computer-based simulation model for assessing the long-term consequences of various early detection strategies, the comparison of costs and effects of these strategies, the identification of sensitive parameters that influence the (cost-)effectiveness of the different strategies as well as providing information to decision-makers on the budget impact of novel early detection strategies.

Sponsor: European Union (Horizon Europe)

Funding period: 2023-2027

Responsibility: Working group II

The OPTICH project involves the development and testing of a novel aspiration device for the removal of intracerebral haemorrhages. The aim will be to treat them more quickly and gently than existing devices allow. Initially, laboratory trials will be carried out, followed by a clinical feasibility study covering both the instrument and new treatment protocols. Additionally, the Department for Health Economics and Health Services Research will analyse the economic burden of intracerebral haemorrhages using BARMER's health insurance data. The ultimate goal is to develop a model that can analyse the costs and benefits of the new aspiration device.

Sponsor: Federal Ministry of Reserach, Technology and Space

Funding period: 2024-2027

Responsibility: Working group I

Sponsor: Innovationsfonds

Funding period: 2025-2029

Responsibility: Working group II

Sponsor: Innovationsfonds

Funding period: 2025-2028

Responsibility: Working group II

Sponsor: Innovationsfonds

Funding period: 2026-2029

Responsibility: Working group II

Description: Climate change is associated with an increase in weather conditions that affect health. The aim of this retrospective cohort study is to investigate the effects of weather conditions on health, as well as to assess health attributable to weather conditions. Merging health insurance claims data and weather data enables an investigation at patient level where individual characteristics such as age, sex and care dependency, as well as pre-existing and current health conditions can be considered. We will use a broad and representative population sample to find associations between weather and health by using multilevel machine learning methods (WP 1). Based on these results, we will create a risk prediction tool based on both weather and health conditions to assess the risks for vulnerable groups and forecast health service use during health-affecting weather condition periods (WP 2). Furthermore, mortality, hospital admissions, sick leave days, DALYs and health care costs, that are directly attributable to weather conditions (“excess” effects), will be identified and separated from time trends and seasonal effects (WP 3) by applying the following analyses: Time-series analysis of persons over time and related weather conditions, and cross-sectional comparisons of all persons between periods with relevant and average weather conditions will be carried out.
We expect to reveal partly unknown associations between weather and health in Germany. The risk prediction tool will identify relevant weather conditions and vulnerable groups and assign risk scores accordingly, and may help to establish preventive lifestyles and forecast health service use. Moreover, we expect to estimate the amount of excess health care use, mortality, sick leave days and health care costs attributable to certain weather conditions.

Funding: German Federal Ministry of Education and Research

Funding period: 2023-2028

Responsibility: Working group III

Sponsor: Eigenmittel des UKE, Industriesponsoren

Funding period: 2016-2026

Responsibility: Professorship for Interdisciplinary Health Care Epidemiology

Link: HCHS