Publikationen

Wilke T. Non-Adherence in outpatient prophylaxis after major orthopedic surgery. Value in Health. 2009;12(7):A221.

Abstract

OBJECTIVES

In current guidelines, extended thromboprophylaxis after a hip and knee replacement surgery is recommended. Based on the largest empirical survey to date dealing with the question of LMWH (low molecular weight heparins) nonadherence (NA), this study aims to deal with two main topics: (1) the study assesses whether there is any quantitative relevance of outpatient thromboprophylaxis in Germany; and (2) the degree of any non-adherence of patients in LMWH outpatient prophylaxis is assessed. 

METHODS

For data collection we performed structured telephone interviews with 1415 hip and knee replacement patients. Non-adherence was determined by syringe count and by indirect and direct questions to patients. All in all, 6 different non-adherence indicators based on patient interviews were defined. For multivariate analysis of factors explaining patients`non-adherence (based on WHO recommendations), we estimated 3 different logistic regressions models. 

RESULTS

For about 90% of patients, outpatient prophylaxis is of relevance in Germany. Non-adherence rates in LMWH outpatient prophylaxis range between 13% and 21% depending on the indicator used for measurement. Non-adherent patients miss between 38–53% of all their outpatient LMWH injections. If patients attend an outpatient rehabilitation program, the probability of their non-adherence increases significantly. Moreover, the non-adherence probability increases with each additional day of bridging (days between acute hospitalization and start of rehabilitation). Nonadherence is lower in patients who fear any thrombosis or who believe that antithrombotic drugs are the most important measure in thromboprophylaxis. 

CONCLUSIONS

Non-adherence in outpatient thromboprophylaxis seems to be a serious challenge. It

can also be assumed that outpatient prophylaxis in other countries is at least as important as it is in Germany, for the simple reason that most other countries do not have a comprehensive network of inpatient rehabilitation clinics.

Wilke T. Oral anticoagulation after major hip and knee replacement surgeries. Value in Health. 2008;11(6):A390.

Abstract

OBJECTIVES

Dabigatranetexilate (Pradaxa®) is an oral direct thrombin inhibitor. Clinical data show that once-daily Dabigatranetexilate 220 mg is as effective as enoxaparin 40 mg qd for

the prophylaxis of venous thromboembolism following total hip or knee replacement surgeries (THR/TKR). However, an oral treatment for orthopaedic thromboprophylaxis offers potential benefits to hospitals when compared to the existing injectible low molecular heparins (LWMH) in terms of reduced administration

costs. METHODS: A cost minimization analysis was performed from the perspective of acute care and rehabilitation hospitals in Germany. Use of Dabigatranetexilate following THR/TKR was compared to LWMH in six acute care and six rehabilitation

hospitals. Nine hypotheses for possible administrative cost differences between a subcutaneaous and an oral anticoagulant were identified. Each hypothesis was separately examined and evaluated in each hospital using process cost analysis. Resource use and cost data were collected by using the hospitals’ own data and by interviewing and observing doctors and nurses.

RESULTS

The analysis shows that within the German hospital system the introduction of the new oral anticoagulation drug like Dabigatranetexilate might lead to an estimated saving of €2.43 per patient per day in an acute care hospital setting and €1.40 per

patient per day in a rehabilitation hospital. Extrapolating this data to an acute care hospital that performs 1000 knee and hip replacements per year, with an average length of stay (LOS) of 10 days, use of an oral anticoagulant could reduce costs by approximately €24,300 per year. Extrapolating to a rehabilitation hospital that treats 1000 TKR/THR patients per year, with an average LOS of 21 days could potentially save the hospital €29,400 per year.

CONCLUSIONS

Wilke T, Winkler J. Reflux in Germany. Results of a Survey. The Open Gastroenterology Journal. 2008;2:28-37

Abstract

BACKGROUND

The aim of this study, conducted over a period of two weeks in summer 2006, was to collect representative data about reflux in Germany. 

METHODS

1,892 persons in five German cities and the Federal city-state of Berlin were questioned about the frequency and severity of their reflux symptoms, and what treatments they had opted for. Moreover, this study collected data about sociodemographic and socioeconomic status of the respondents. So the relationship between this status and the prevalence of reflux symptoms and individual treatment decisions could be analyzed. 

RESULTS

Approximately 50% of the interviewees had personally experienced typical reflux symptoms. Approximately 21% of the sample had suffered from these symptoms during the 4 weeks prior to the survey. Typical sociodemographic factors such as gender and socioeconomic factors such as social status explain neither the appearance nor the severity of reflux symptoms; age alone exerts a small positive influence on both variables. Approximately 80% of the interviewees with acute reflux treated their symptoms; dominant choices in this context are dieting, self-medication with OTC drugs, and the consultation of medical experts. 

CONCLUSIONS

Comparing results of this survey with earlier data, reflux prevalence in Germany is rising. Mostly, acutely ill patients treat their symptoms. Surprisingly, socioeconomic status plays no role in explaining treatment decisions of patients.

Wilke T, Kulle M, Gotal G, Hohmann C. Tablette versus Spritze – eine betriebswirtschaftlich-pharmakoökonomische Analyse von Antikoagulanzien in sechs Krankenhäusern. Gesundh ökon Qual manag 2006;11(3):184-190.

Abstract

The thrombin-inhibitor Melagatran/Ximelagatran (Exanta®) is the first drug for prophylaxis of venous thromboembolism after total hip or knee replacement surgeries (THR/TKR) that patients can take orally in hospitals. In a managerial pharmacoeconomic analysis of six German hospitals the use of Melagatran/Ximelagatran was compared to the use of low molecular weight heparins. The analysis shows that the application of the new drug leads to an economic advantage for the hospital of 2.78 EURO per patient and day. The result has straight implications for drug decisions in hospitals. In order to demonstrate that fact, that price difference between Melagatran/Ximelagatran and low molecular weight heparins was derived that leads exactly to their “economic neutrality” from the hospital point of view.