Economic aspects of disease management programs in chronic diseases

This doctoral dissertation covers the topic of economic aspects of structured disease management programs (DMPs) and their interventions. As this is a very broad research field, it focuses on the chronic diseases asthma, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), type 1 and type 2 diabetes mellitus, and breast cancer, for which structured DMPs are already implemented in Germany. It consists of eight chapters. Chapter 1 gives a short introduction to DMPs and their implementation in the German statutory health care system. Chapter 2 gives an overview of the current state of findings for DMPs in Germany. In chapter 3 the research questions are motivated and specified and an overview of what this doctoral dissertation adds to research knowledge is given. Chapter 4 reviews Markov models estimating the cost-effectiveness of smoking cessation interventions in COPD patients; the quality of the Markov models is also assessed, and the consequences of model structure and input data on cost-effectiveness are evaluated. Chapter 5 deals with the adequacy of Markov models to evaluate the cost-effectiveness of complex DMP interventions in type 2 diabetes mellitus; additionally, the general quality of the model was evaluated using the quality appraisals from Philips and Caro. Chapter 6 builds up-on chapter 5 where it was shown that Markov models are, in principle, appropriate to evaluate the cost-effectiveness of DMPs in type 2 diabetes mellitus. In the last two decades, DMPs have increasingly been implemented worldwide; therefore, a systematic overview of Markov models evaluating the economic effects of DMPs is presented. Further, the quality of the models is assessed, the method by which the DMP intervention is incorporated into the model is examined, and the differences in the structure and data used in the models are considered. Chapter 7 analyzes adherence to pharmaceutical guideline care in the DMP CHD after acute myocardial infarction (AMI), which is a major part of the DMP CHD. Besides the economic effects of adherence to pharmaceutical guideline care, the factors driving rehospitalizations, death, and adherence were estimated. Finally, in chapter 8, the principal findings of the thesis are summarized; implications for health policy and management are addressed as well as tasks for future research being defined.