Daniel Gensorowsky

Background: Bullous pemphigoid (BP) is the most common autoimmune blistering disease and primarily affects older adults. As societies age and the burden of age‐related diseases increases, data on BP epidemiology, treatment patterns and healthcare burden in Germany remain limited. Objectives: To assess BP epidemiology, clinical outcomes, healthcare utilization and economic burden in adults aged ≥ 18 years in Germany. Methods: We analysed anonymized statutory health insurance claims from 6.8 million insured individuals (2010–2023). Annual cross‐sectional analyses estimated prevalence and incidence, extrapolated to the national population. In a matched incident cohort (BP, n = 2004; controls, n = 9950), we evaluated comorbidity, mortality, healthcare resource utilization, healthcare costs and pharmacologic management over up to 2 years. Mortality and costs were analysed using regression models adjusted for age, sex, calendar year, and comorbidity. Results: BP prevalence tripled from 0.05 to 0.14 cases per 1000 individuals between 2010 and 2023, with the steepest increase observed among individuals aged ≥ 80 years. Annual incidence ranged from 34 to 63 cases per million inhabitants. BP patients exhibited a higher comorbidity burden than matched controls (mean Elixhauser index 5.0 vs. 3.8) and increased mortality (1‐year mortality: 18.8% vs. 6.0%; adjusted incidence rate ratio (IRR) 3.09, 95% CI: 2.71–3.52). Healthcare utilization was higher among BP patients, including physician contacts (38 vs. 22 per year) and hospital admissions (3.3 vs. 0.7 per year). Topical and systemic corticosteroids were prescribed in 75% and 72% of patients, respectively; additional therapies included doxycycline (19.7%), dapsone (15.0%) and azathioprine (14.8%). Mean total healthcare costs during the first year were €20,881 for BP patients versus €5586 for controls, mainly attributable to inpatient care. Conclusions: BP represents a growing healthcare challenge characterized by a high comorbidity burden, increased mortality and healthcare costs. Current treatment remains reliant on systemic corticosteroids, underscoring the need for safe and effective steroid‐sparing therapies.

Background: Evidence on the economic burden of post-COVID syndrome in Germany remains limited. This study quantifies post-COVID-associated healthcare resource utilization (HCRU), sick leave, and costs. Objectives: To compare HCRU, sick leave, and costs borne by the statutory health insurance (SHI) among incident pediatric and adult post-COVID patients with matched post-COVID-free controls. Methods: This retrospective cohort study analyzed an anonymized German SHI claims database provided by GWQ ServicePlus AG. The observation period spanned October 2021 to June 2025 and included all individuals with incident COVID-19 diagnosis until September 2024. Incident post-COVID was defined as the first ICD-10-GM code (U07.4!; U09.9!) recorded ≥90 days after first COVID-19 diagnosis. Post-COVID cases were exactly matched 1:2 to post-COVID–free COVID-19 controls by calendar quarter of incident COVID-19 diagnosis, acute severity, cohort entry quarter, 5-year birth interval, sex, and Elixhauser Comorbidity Index. We estimated mean differences in HCRU, sick leave, and direct SHI-borne costs per case. Rate ratios of HCRU, sick leave, and costs per person-year were estimated using Poisson (HCRU/sick leave) and linear (costs) regression. Analyses covered 365-day, 730-day, and any follow-up period. Results: We matched 25 485 identified post-COVID cases with 49 671 controls. Matched cases and controls were comparable in age, sex, and comorbidities. Overall, during 365 days of follow-up, post-COVID patients showed higher HCRU and sick leave rates across all sectors, especially sick leave days. Mean differences per case were greatest for sick leave days (365 days: +27 days) and outpatient physician contacts (365 days: 6.9 contacts). HCRU and sick leave rates remained significantly increased over extended follow-up periods. Total SHI-borne costs per person-year were higher among post-COVID patients across all follow-up periods (all P < .001). Sector-specific costs per person-year were increased primarily in the outpatient sector and for sickness benefits (all P < .001). Mean total cost differences per case were +€1806 per case (365 days) and mean excess sickness benefits per case were +€1077. Conclusions: Documented post-COVID was associated with a substantial and sustained economic burden on the German healthcare system and society. Targeted strategies are needed to mitigate potential long-term impacts on HCRU and labor productivity.

Background: Tick-borne encephalitis (TBE) remains a public health concern in many parts of Europe despite effective vaccines. Acute disease is well described, but real-world data on the frequency, timing, and economic impact of long-term sequelae are limited.Methods: A retrospective cohort study was performed using nationwide statutory health insurance claims covering up to 6.8 million insured individuals in Germany (2013–2023). Incident TBE cases were matched 1:5 to TBE-free controls by age, sex, region, comorbidities and healthcare utilization. Neurological, mental, and general sequelae occurring ≥90 days after diagnosis or ≥30 days after hospital discharge (whichever came last) were assessed through 18 months. Healthcare utilization, direct medical costs, sick leave, and corresponding sickness benefit payments were compared.Results: Among 187 TBE patients (mean age 44 years; 57% male) and 881 controls, neurological sequelae occurred 56% more often after TBE (incidence rate ratio 1.56, 95% CI 1.13–2.15), particularly in adults ≥40 years and in men. Psychoorganic symptoms showed the largest excess (up to 18-fold). Median sequela onset was 94 days after infection. Overall costs were significantly higher among TBE patients in the post-acute phase, largely attributable to excess sick-leave days (+23.3, 95% CI 8.9–37.6) and higher sickness-benefit payments.Conclusions: TBE is associated with a substantial long-term clinical, economic and societal burden, reflected in persistent neurological symptoms, increased absenteeism, and elevated costs. Structured neurological follow-up and improved vaccination uptake, particularly in designated risk areas, may reduce preventable morbidity and insurer-borne costs, underscoring TBE’s clinical and health-system relevance in Germany.

Background: In 2003, the WHO aimed for a 75% or higher influenza vaccination rate among at-risk populations. However, this target was achieved in a few groups during selected seasons in some European countries, and never in Germany. Adults with underlying conditions (UCs) are a critical negleted group for influenza vaccination. This study aimed to identify data gaps in influenza burden and vaccination coverage among adults under 60 with UCs in Germany and bridge these gaps using real-world data.Material and Methods: We conducted systematic research and analyses using German administrative and claims databases from June 2016 to April 2024. We report on epidemiology, direct care costs, indirect costs from work incapacity, vaccination coverage rates, and describe data gaps.Results: Influenza data for high-risk populations are limited. Comprehensive data on influenza epidemiology and vaccination coverage rates (VCR) is available, though with a delay in data availability. Before and after the pandemic, individuals aged 50-59 had the highest rates of influenza-related hospitalization and ICU admission compared to younger age groups. Across all age groups and seasons, individuals with UC experienced higher rates of medically attended influenza cases, hospitalizations, and healthcare costs, with those aged 35-59 being particularly vulnerable. Vaccine coverage was higher in adults aged 35-59 compared to those aged 18-24, and in females compared to males.Limitations: Discrepancies of vaccination status, limited data availability, and variations among the extent of UCs.Conclusion: In Germany, recent policy measures have mainly targeted those aged 60 and above. While this elderly population experiences the highest disease-related impact, influenza can also lead to substantial healthcare resource utilization (HCRU) and costs in younger populations with chronic UCs; Facilitating vaccination access for this group, such as through pharmacies, is essential. Definition of quantifiable vaccination targets and measures to increase vaccination rates based on these targets are required.

Introduction Worldwide, polypharmacy and medication appropriateness-related outcomes (MARO) are growing public health concerns associated with potentially inappropriate prescribing, adverse health effects, and avoidable costs to health systems. Continuity of care (COC) is a cornerstone of high-quality care that has been shown to improve patient-relevant outcomes. However, the relationship between COC and polypharmacy/MARO has not been systematically explored. Objective The aim of this systematic review was to investigate the operationalization of COC, polypharmacy, and MARO as well as the relationship between COC and polypharmacy/MARO. Methods We performed a systematic literature search in PubMed, Embase, and CINAHL. Quantitative observational studies investigating the associations between COC and polypharmacy and/or COC and MARO by applying multivariate regression analysis techniques were eligible. Qualitative or experimental studies were not included. Information on the definition and operationalization of COC, polypharmacy, and MARO and reported associations was extracted. COC measures were assigned to the relational, informational, or management dimension of COC and further classified as objective standard, objective non-standard, or subjective. Risk of bias was assessed by using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results Twenty-seven studies were included. Overall, substantial differences existed in terms of the COC dimensions and related COC measures. Relational COC was investigated in each study, while informational and management COC were only covered among three studies. The most frequent type of COC measure was objective non-standard (n = 16), followed by objective standard (n = 11) and subjective measures (n = 3). The majority of studies indicated that COC is strongly associated with both polypharmacy and MARO, such as potentially inappropriate medication (PIM), potentially inappropriate drug combination (PIDC), drug–drug interaction (DDI), adverse drug events (ADE), unnecessary drug use, duplicated medication, and overdose. More than half of the included studies (n = 15) had a low risk of bias, while five studies had an intermediate and seven studies a high risk of bias. Conclusions Differences regarding the methodological quality of included studies as well as the heterogeneity in terms of the operationalization and measurement of COC, polypharmacy, and MARO need to be considered when interpreting the results. Yet, our findings suggest that optimizing COC may be helpful in reducing polypharmacy and MARO. Therefore, COC should be acknowledged as an important risk factor for polypharmacy and MARO, and the importance of COC should be considered when designing future interventions targeting these outcomes.

In December 2019, the Digital Health Care Act (“Digitale-Versorgung-Gesetz”) introduced a general entitlement to the provision and reimbursement of digital health applications (DiGA) for insured persons in the German statutory health insurance. As establishing a new digital service area within the solidarity-based insurance system implies several administrative and regulatory challenges, this paper aims to describe the legal framework for DiGA market access and pricing as well as the status quo of the DiGA market. Furthermore, we provide a basic approach to deriving value-based DiGA prices.To become eligible for reimbursement, the Federal Institute for Drugs and Medical Devices evaluates the compliance of a DiGA with general requirements (e.g., safety and data protection) and its positive healthcare effects (i.e., medical benefit or improvements of care structure and processes) in a fast-track process. Manufacturers may provide evidence for the benefits of their DiGA either directly with the application for the fast-track process or generate it during a trial phase that includes temporary reimbursement. After one year of \]reimbursement, the freely-set manufacturer price is replaced by a price negotiated between the National Association of Statutory Health Insurance Funds and the manufacturer. By February 2022, 30 DiGA had successfully completed the fast-track process. 73% make use of the trial phase and have not yet proven their benefit. Given this dynamic growth of the DiGA market and the low minimum evidence standards, fair pricing remains the central point of contention. The regulatory framework makes the patient-relevant benefits of a DiGA a pricing criterion to be considered in particular. Yet, it does not indicate how the benefits of a DiGA should be translated into a reasonable price. Our evidence-based approach to value-based DiGA pricing approximates the SHI’s willingness to pay by the average cost-effectiveness of one or more established therapy in a field of indication and furthermore considers the positive healthcare effects of a DiGA.The proposed approach can be fitted into DiGA pricing processes under the given regulatory framework and can provide objective guidance for price negotiations. However, it is only one piece of the pricing puzzle, and numerous methodological and procedural issues related to DiGA pricing are still open. Thus, it remains to be seen to what extent DiGA prices will follow the premise of value-based pricing.

Background: Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings). Objective: This study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. Methods: We performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ≥18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. Results: Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95% CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95% CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29% (19/66) in the control group to 23.8% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95% CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95% CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95% CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. Conclusions: Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients. Trial Registration: ClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589