Study design, materials and methods
A descriptive study with a retrospective, longitudinal cohort design was based on age- and sex-adjusted database from the German statutory health insurance (SHI) claims data system. This database contains data from ~4.8 million patients from over 60 SHIs nationwide and is representative for the German population (1). Patients new to IC use (HiMi – Hilfsmittelkatalog 15.25.14*) having SHI coverage with continuous insurance and complete medical records between January 2013 and December 2015 were included. Patients with IC prescriptions at minimum two years prior to index were excluded to ensure initial use (Figure 1).
Results
Data was collected from 1,100 German individuals who were new to using IC within three years of indexing (2013-2015). The most common IC indications in 47% of the patients include, but are not limited to, urologic diseases which includes neoplasms, prostate hyperplasia, prostate/bladder/kidney diseases, urethrocele, and stones, followed by spinal cord injury at 16%. Other indications included multiple sclerosis (10%), spina bifida (4%), stroke (4%) and Parkinson’s Disease (3%). Apart from diseases of the urinary tract, around one third of the patients suffer from pain and depression. Urinary tract infections (UTI) are the most frequent complications, occurring in 69% of the IC end-users during the observation period. In addition to complications with UTIs, these individuals also exhibit a generally high resource burden as they are heavily prescribed antibiotics, pain medications, opioids and antidepressants. A high burden of illness is prevalent even before initiating IC use (prior to index). Clinical complications including UTI, infections, catheter related complications, and other urinary infections were highly prevalent prior and post index but decreased from the first to second year after index (Figure 2). Clinical complications translated to high resource utilization prior and post index, including but not limited to high rate of hospitalizations, prescriptions for antibiotics, and prescriptions for pain medications.
IC end-users are associated with high healthcare costs, even prior to index (17,950€). A peak is visible in the year of initial IC use (22,418€). Total healthcare costs decreased to 20,169€ in the second year after index. Within two years of IC use, inpatient costs and sick pay decreased by more than half in comparison to pre-index (inpatient: €10,738 to €4,370 // sick pay: €496 to €247).
Interpretation of results
While there is an observed improvement in the overall healthcare condition in these individuals between the pre-index to the post index period, as demonstrated by improved clinical outcomes, resource utilization and overall costs, there is still opportunity to drive better outcomes.
The observed improvement over time suggests that certain interventions may have greater influence than others. Intermittent catheters are designed with specific needs in mind (discretion, ease of use, portability, etc). Therefore, it is important that patients have access to the products that best fit their unique medical needs so that they are able to maximize the chances of improved quality of life, independence, and wellbeing (2).