Health Economics
Background
Health economics research enables policymakers to make evidence-based decisions on how to allocate limited health care resources efficiently. Efficiency here is not necessarily about cutting costs, but rather about determining how to derive the maximum total benefit from limited available resources.
In the same way that evidence-based medicine makes use of formal evidence on effectiveness of interventions, health economics answer the need to formally assess the implications of choices about the deployment of resources. Since resource use is best expressed in costs, a number of economic evaluation techniques have been developed to compare costs and clinical outcomes of competing treatment alternatives in order to identify the most efficient treatment.
Service
The Health Economics Working Group at the Medical Center - University of Freiburg was established as a collaboration between the Center for Medical Biometry and Medical Informatics, the Clinical Trials Unit, and the University Heart Centre. We have a strong methodological background in regression modelling and econometrics. In addition to our own research projects, we provide methodological support for economic evaluations across all types of clinical research.
Research
Cost-benefit analyses of medical interventions from the hospital perspective
Borde, J.P., S. Nussbaum, S. Hauser, P. Hehn, J. Hübner, G. Sitaru, S. Köller, B. Schweigert, K.d. With, W.V. Kern and K. Kaier (2016): Implementing an intensified antibiotic stewardship programme targeting daptomycin use in orthopaedic surgery: a cost-benefit analysis from the hospital perspective. Infection 44(3):301-307. PubMed
Economic evaluations using data from patient registries
Kaier, K., J. Knecht, L. Nalbach and M. Körner (2024): The impact of the Covid-19 pandemic on the effectiveness of psychosomatic rehabilitation in Germany. BMC Health Services Research 24(1):719.
von der Warth, R., P. Hehn, J. Wolff and K. Kaier (2020): Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study. Health Economics Review 10(1):23. PubMed
Wolff, J., A. Gary, D. Jung, C. Normann, K. Kaier, H. Binder, K. Domschke, A. Klimke and M. Franz (2020): Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach. BMC Medical Informatics and Decision Making 20(1):21. PubMed
Kaier, K., T. Heister, J. Wolff and M. Wolkewitz (2020): Mechanical ventilation and the daily cost of ICU care. BMC Health Services Research [Epub ahead of print]. PubMed
Wolff, J., P. McCrone, A. Patel, K. Kaier and C. Normann (2015): Predictors of length of stay in psychiatry: analyses of electronic medical records. BMC Psychiatry 15:238. PubMed
Gutmann, A., K. Kaier, S. Sorg, C. von zur Mühlen, M. Siepe, M. Moser, A. Geibel, A. Zirlik, I. Ahrens, H. Baumbach, F. Beyersdorf, W. Vach, M. Zehender, C. Bode and J. Reinöhl (2015): Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System, International Journal of Cardiology 179: 231-237. PubMed
Jabbarli, R., M. Shah, C. Taschner, K. Kaier, B. Hippchen and V. Van Velthoven (2014): Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage, Neuroradiology 56(10): 817-824. PubMed
Secondary data analyses using German claims data
Oettinger, V., K. Kaier, C. von zur Mühlen, M. Zehender, C. Bode, F. Beyersdorf, P. Stachon and W. Bothe (2024): Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement. The Thoracic and Cardiovascular Surgeon 72(03):173-180.
Haverkamp, C., K. Kaier, M. Shah, C. von zur Mühlen, J. Beck, H. Urbach and S. Meckel (2024): Cerebral aneurysms: Germany-wide real-world outcome data of endovascular or neurosurgical treatment from 2007 to 2019. Journal of NeuroInterventional Surgery 16(4):365-371.
Oettinger, V., P. Hehn, C. Bode, M. Zehender, C. von zur Mühlen, D. Westermann, P. Stachon and K. Kaier (2023): Center Volumes Correlate with Likelihood of Stent Implantation in German Coronary Angiography. Journal of Interventional Cardiology 3723657.
Heidenreich, A., P. Stachon, V. Oettinger, I. Hilgendorf, T. Heidt, J. Rilinger, M. Zehender, D. Westermann, C. von zur Mühlen and K. Kaier (2023): Impact of the COVID-19 pandemic on aortic valve replacement procedures in Germany. BMC Cardiovascular Disorders 23(1):187.
Oettinger, V., A. Heidenreich, K. Kaier, M. Zehender, C. Bode, D. Duerschmied, C. von Zur Mühlen, D. Westermann and P. Stachon (2022): Hospital intervention volume affects outcomes of emergency transcatheter aortic valve implantations in Germany. Scientific Reports 12(1):17483. Link
Kaier, K., C. Bode, M. Zehender, C. von zur Mühlen and P. Stachon (2019): Modeling the Volume-Outcome Relationship for TAVR. Journal of the American College of Cardiology 74(16):2115-2116. PubMed
Oettinger, V., K. Kaier, T, Heidt, M. Hortmann, D. Wolf, A. Zirlik, M. Zehender, C. Bode, C. von Zur Mühlen and P. Stachon (2020): Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany. Heart [Epub ahead of print]. PubMed
Kaier, K., C. von zur Mühlen, A. Zirlik, W. Bothe, P. Hehn, M. Zehender, C. Bode and P. Stachon (2019): Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany, European Journal of Health Economics 20(4):625-632. PubMed
Olivier, M., M. Boeker, S. Hanser, P. Hehn and K. Kaier (2018): The PKMS (German Score for Complex Nursing Measures) as paradigm shift in the G-DRG system: a retrospective observational study based on billing data, Gesundheitsökonomie & Qualitätsmanagement 24(04):191-196. Link
Kaier, K., V. Oettinger, H.Reinecke, C. Schmoor, L. Frankenstein, P. Hehn, C. von zur Mühlen, C. Bode, M. Zehender and J. Reinöhl (2018): Volume-outcome relationship in transcatheter aortic valve implantations in Germany 2008-2014: a secondary data analysis of electronic health records, BMJ Open 8(7):e020204. Link
Wolff, J., T. Heister, C. Normann and K. Kaier (2018): Hospital costs associated with psychiatric comorbidities: a retrospective study, BMC Health Services Research 18(1):67. PubMed
Kaier, K., H. Reinecke, H. Nacy, L. Frankenstein, M. Bode, W. Vach, P. Hehn, A. Zirlik, M. Zehender and J. Reinöhl (2017): The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany, European Journal of Health Economics 19(2):223-228. Link
Kaier, K., H. Reinecke, C. Schmoor, L. Frankenstein, W. Vach, P. Hehn, A. Zirlik, C. Bode, M. Zehender and J. Reinöhl (2017): Learning Curves Among All Patients Undergoing Transcatheter Aortic Valve Implantation in Germany: A Retrospective Observational Study, International Journal of Cardiology 235:17-21. Link
Reinöhl, J., K. Kaier, H. Reinecke, L. Frankenstein, A. Zirlik, M. Zehender, C. von Zur Mühlen, C. Bode and P. Stachon (2016): Transcatheter Aortic Valve Replacement: The New Standard in Patients With Previous Coronary Bypass Grafting? JACC: Cardiovascular Interventions 9(20):2137-2143. PubMed
Reinöhl J., K. Kaier, H. Reinecke, C. Schmoor, L. Frankenstein, W. Vach, A. Cribier, F. Beyersdorf, C. Bode and M. Zehender (2015) Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice. New England Journal of Medicine 373(25): 2438-2447. PubMed
Economic evaluations alongside clinical trials
Stelzer, D., H. Binder, M. Glattacker, E. Graf, M. Hahn, M. Hollenbeck, K. Kaier, B. Kowall, N. Kuklik, G. Metzner, N. Mueller, L. Seiler, S. Stolpe and C. Blume (2024): Minimisation of dialysis risk in hospital patients with chronic kidney disease (MinDial): study protocol for a multicentre, stepped-wedge, cluster-randomised controlled trial. Trials 25(1):368.
Kaier, K., B.A. Brühmann, S. Fetzer, R. von der Warth and E. Farin-Glattacker (2024): Impact of a complex health services intervention in long-term care nursing homes on 3-year overall survival: results from the CoCare study. BMC Health Services Research 24(1):203.
Kaier, K., G. Metzner, L. Horstmeier, E.M. Bitzer, B. Heimbach, J. Kiekert, S. Voigt-Radloff and E. Farin-Glattacker (2023): The economic impact of a local, collaborative, stepped, and personalized care management for older people with chronic diseases: results from the randomized comparative effectiveness LoChro-trial. BMC Health Services Research 23:1422.
Tinsel, I., C. Schmoor, M. Börger, M. Kamp, K. Kaier, H. Hardt, T. Kloppe, A. Rakebrandt, M. Scherer, A. Bergmann, T. Görbing, S. Kutter, H. Riemenschneider and A. Maun (2023): Encouragement of patients' self-management in primary care for the prevention of cardiovascular diseases (DECADE): protocol for a cluster randomised controlled trial. BMJ Open 13(4):e071230.
Brühmann, B.A., K. Kaier, R. von der Warth and E. Farin-Glattacker (2023): Cost–benefit analysis of the CoCare intervention to improve medical care in long-term care nursing homes: an analysis based on claims data. European Journal of Health Economics 24(8):1343-1355.
De Geest, S., S. Valenta, J. Ribaut, S. Gerull, J. Mielke, M. Simon, J. Bartakova, K. Kaier, J. Eckstein, L. Leppla and A. Teynor (2022): The SMILe integrated care model in allogeneic SteM cell TransplantatIon faciLitated by eHealth: a protocol for a hybrid effectiveness-implementation randomised controlled trial. BMC Health Services Research 22(1):1067. Pubmed
Metzner, G., S. Horstmann, M. Barth, J.M. Giesler, S. Jünemann, K. Kaier, C. Schlett, N. Schroeder, M. Siebolds, F. Sinss, J. van Staa, M. Glattacker and I. Renner (2022): Evaluation of a cross-sectoral care intervention for families with psychosocial burden: a study protocol of a controlled trial. BMC Health Services Research 22(1):475. Pubmed
Bablok, I., H. Binder, D. Stelzer, K. Kaier, E. Graf, J. Wangler, M. Jansky, M. Löhr, M. Schulz, M. Kockläuner, K. Geschke, A. Wuttke-Linnemann, A. Fellgiebel and E. Farin (2021): Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare. BMC Geriatrics 21(1):222. Link
Kienle, G.S., P.G. Werthmann, B. Grotejohann, K. Kaier, I. Steinbrenner, S. Voigt-Radloff and R. Huber (2020): A multi-centre, parallel-group, randomised controlled trial to assess the efficacy and safety of eurythmy therapy and tai chi in comparison with standard care in chronically ill elderly patients with increased risk of falling (ENTAiER): a trial protocol. BMC Geriatrics 20(1):108. PubMed
Dudareva, M., M. Kümin, W. Vach, K. Kaier, J. Ferguson, M. McNally and M. Scarborough (2019): Short or Long Antibiotic Regimes in Orthopaedics (SOLARIO): a randomised controlled open-label non-inferiority trial of duration of systemic antibiotics in adults with orthopaedic infection treated operatively with local antibiotic therapy. Trials 20(1):693. PubMed
Brühmann, B. A., C. Reese, K. Kaier, M. Ott, C. Maurer, S. Kunert, B. R. Saurer und E. Farin (2019: A complex health services intervention to improve medical care in long-term care homes: study protocol of the controlled coordinated medical care (CoCare) study. BMC Health Services Research 19:332. PubMed
Frank, F., F. Bjerregaard, J. Bengel, E.M. Bitzer, B. Heimbach, K. Kaier, J. Kiekert, L. Krämer, C. Kricheldorff, K. Laubner, A. Maun, G. Metzner, W. Niebling, C. Salm, S. Schütter, J. Seufert, E. Farin and S. Voigt-Radloff (2019): Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial. BMC Family Geriatrics 19(1):64. PubMed
Voigt-Radloff, S., A. Schöpf, M. Boeker, L. Frank, E. Farin, K. Kaier, M. Körner, K. Wollmann, B. Lang, J. Meerpohl, R. Möhler, W. Niebling, J. Serong, R. Lange, P. van der Keylen and A. Maun (2019): Well informed physician-patient communication in consultations on back pain - study protocol of the cluster randomized GAP trial. BMC Family Practice 20(1):33. PubMed
Kaier, K., F. von Kampen, Baumbach, C. von Zur Mühlen, P. Hehn, W. Vach, M. Zehender, C. Bode and J. Reinöhl (2017): Two-year post- discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany, BMC Health Services Research 17:473. PubMed
Kaier, K., S. Hils, S. Fetzer, P. Hehn, A. Schmid, D. Hauschke, L. Bogatyreva, B. Jänigen and P. Pisarski (2017): Results of a randomized controlled trial analyzing telemedically supported case management in the first year after living donor kidney transplantation - a budget impact analysis from the healthcare perspective, Health Economics Review 7:1. Link
Kaier, K., A. Gutmann, H. Baumbach, C. von Zur Mühlen, P. Hehn, W. Vach, F. Beyersdorf, M. Zehender, C. Bode and J. Reinöhl (2016): Quality of life among elderly patients undergoing transcatheter or surgical aortic valve replacement - a model-based longitudinal data analysis, Health and Quality of Life Outcomes 14(1): 109. PubMed
Kaier, K., A. Gutmann, W. Vach, S. Sorg, M. Siepe, C. von Zur Mühlen, M. Moser, P. Blanke, F. Beyersdorf, M. Zehender, C. Bode and J. Reinöhl (2015): "Heart Team" decision making in elderly patients with symptomatic aortic valve stenosis who underwent AVR or TAVI-a look behind the curtain. Results of the prospective TAVI Calculation of Costs Trial (TCCT), EuroIntervention 11(8):793-798. PubMed
Reinöhl, J., K. Kaier, A. Gutmann, S. Sorg, C. von Zur Mühlen, M. Siepe, H. Baumbach, M. Moser, A. Geibel, A. Zirlik, P. Blanke, W. Vach, F. Beyersdorf, C. Bode and M. Zehender (2015): In-hospital resource utilization in surgical and transcatheter aortic valve replacement. BMC Cardiovascular Disorder 15:132. PubMed
The economics of infectious diseases
Hazard, D., M. von Cube, K. Kaier and M. Wolkewitz (2021): Predicting Potential Prevention Effects on Hospital Burden of Nosocomial Infections: A Multistate Modeling Approach. Value in Health 24(6):830-838. Pubmed
Kaier, K., T. Heister, E. Motschall, P. Hehn, T. Bluhmki and M. Wolkewitz (2019): Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression. Epidemiology and Infection 147:e314. PubMed
Kaier, K., T. Heister, T. Götting, M. Wolkewitz and N.T. Mutters (2019): Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital. BMC Infectious Diseases 19:1028. PubMed
Heister, T., M. Wolkewitz, P. Hehn, J. Wolff, M. Dettenkofer, H. Grundmann and K. Kaier (2019): Costs of hospital-acquired Clostridium difficile infections: an analysis on the effect of time-dependent exposures using routine and surveillance data. Cost Effectiveness and Resource Allocation 17:16. PubMed
Kaier, K., M. Wolkewitz, P. Hehn, N.T. Mutters and T. Heister (2019): The impact of hospital-acquired infectionson the patient-level reimbursement-cost relationshipin a DRG-based hospital payment system. International Journal of Health Economics and Management 15(2):e0227345. PubMed
Kaier, K., N.T. Mutters and M. Wolkewitz (2019): Measuring the financial burden of resistance: What should be compared? Clinical Infectious Diseases [Epub ahead of print]. PubMed
Engler-Hüsch, S., T. Heister, N.T. Mutters, J. Wolff and K. Kaier (2018): In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital, BMC Health Services Research 18:737. PubMed
Heister, K. Kaier and M. Wolkewitz (2017): Estimating the burden of nosocomial infections: Time dependency and cost clustering should be taken into account, American Journal of Infection Control 45(1): 94-95. Link
Heister, T., C. Hagist and K. Kaier (2015): Resistance Elasticity of Antibiotic Demand in Intensive Care, Health Economics 26(7):892-909. Link
Kaier, K. and U. Frank (2013): In search of useful methods for measuring health and economic consequences of antimicrobial resistance, Clinical Infectious Diseases 57(8): 1220-1222. PubMed
Kaier, K. (2012): Economic implications of the dynamic relationship between antibiotic use and hospital-acquired infections, Value in Health 15(1): 87-93. PubMed
Kaier, K. (2012): Economic modeling of the persistence of antimicrobial resistance, Natural Resource Modeling, 25(2): 388-402. Link
Kaier, K. and S. Moog (2012): Economic consequences of the demography of MRSA patients and the impact of broad-spectrum antimicrobials, Applied Health Economics and Health Policy, 10(4): 227-234. PubMed
Pharmacoeconomic analyses
Al Said, S., K. Kaier, W. Sumaya, D. Alsaid, D. Duerschmied, R.F. Storey, C.M. Gibson, D. Westermann and S. Alabed (2024): Non-vitamin-K-antagonist oral anticoagulants (NOACs) after acute myocardial infarction: a network meta-analysis. Cochrane Database of Systematic Reviews 2024(1):CD014678.
Olivier, C.B., L. Struß, N. Sünnen, K. Kaier, L.A. Heger, D. Westermann, J.J. Meerpohl and K.W. Mahaffey (2024): Accuracy of Event Rate and Effect Size Estimation in Major Cardiovascular Trials: A Systematic Review. JAMA Netw Open 7(4):e248818.
Schwander, B, K. Kaier, M. Hiligsmann, S. Evers and M. Nuijten (2022): Does the Structure Matter? An External Validation and Health Economic Results Comparison of Event Simulation Approaches in Severe Obesity. PharmacoEconomics 40(9):901-915. Pubmed
Al Said, S., K. Kaier, E. Nury, D. Alsaid, B. Meder, C.M. Gibson, J. Bax, J.J. Meerpohl and H. Katus (2021): Non‐vitamin K antagonist oral anticoagulants (NOACs) after transcatheter aortic valve replacement (TAVR): a network meta‐analysis (Protocol). Cochrane Database of Systematic Reviews 10:CD013745. Link
Wolff, J., G. Hefner, C. Normann, K. Kaier, H. Binder, C. Hiemke, S. Toto, K. Domschke, M. Marschollek and A. Klimke (2021): Polypharmacy and the risk of drug-drug interactions and potentially inappropriate medications in hospital psychiatry. Pharmacoepidemiology and Drug Safety 30(9):1258-1268. Pubmed
Al Said, S., S. Alabed , K. Kaier, A.R. Tan, C. Bode, J.J. Meerpohl and D. Duerschmied (2019): Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis. Cochrane Database of Systematic Reviews 12:CD013252. PubMed
Kaier, K. (2013): The impact of pricing and patent expiration on demand for pharmaceuticals: an examination of the use of broad-spectrum antimicrobials, Health Economics, Policy and Law 8(1): 7-20. PubMed
Kaier, K. and U. Frank (2010): Measuring the externality of antibacterial use from promoting antimicrobial resistance, PharmacoEconomics 28(12): 1123-1128. PubMed
Economic considerations of benefit assessment in Germany
Kaier, K. and S. Fetzer (2015): Das Arzneimittelmarktneuordnungsgesetz (AMNOG) aus ökonomischer Sicht, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 58: 291-297. PubMed
Schwander, B., K. Banz, K. Kaier and S. Walzer (2014): Evaluation of a Possible Predictor for Federal Joint Committee Decisions on Early Benefit Assessments according to the German Action the Reform of the Market for Medicinal Products, Health Policy 117(3): 334-344. PubMed