• Roland Linder, Susanne Ahrens, Dagmar Köppel, Thomas Heilmann, and Frank Verheyen.
• WINEG – Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Str. 140, 22305 Hamburg, Germany. prof.dr.roland.linder@wineg.de
• Dtsch Arztebl Int. 2011 Mar 1; 108 (10): 155-62.

BackgroundEuro 1.1 billion were spent in 2009 for disease management programs (DMPs) in Germany, among them the DMP for type 2 diabetes mellitus (T2DM). Earlier studies of DMPs failed to take sufficient account of patient- and physician-related selection effects. We used innovative methods to study the medical benefit of the DMP for T2DM among insurees of the Techniker Krankenkasse, a German health insurance provider.MethodsFor this study, we analyzed claims data of the Techniker Krankenkasse from 2006 to 2008. We developed and implemented a sophisticated control group design based on propensity score interval matching. We considered a large number of variables in the baseline assessment, including socio-economic parameters, comorbidities, levels of nursing care, drug expenses, and hospital expenses.ResultsThe DMP participants did not differ from the control group with respect to the incidence of relevant comorbidities. They underwent emergency hospitalization somewhat less frequently than the control group and also generated lower costs for inpatient treatment. In every three-month period studied, the DMP participants received more prescriptions, had more contacts with physicians in private practice, and submitted higher claims for health insurance benefits than the control group.ConclusionThe current DMP for T2DM in Germany is not adequately effective. This study does not reveal any clear medical benefit from DMP participation. Selection effects were largely eliminated by means of a sophisticated control group design. Analyses of other DMPs with this method are currently being planned.

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