Defined Daily Doses: Ein Instrument zur Kostensteuerung im Gesundheitswesen?

Zusammenfassung

Die im Rahmen des AVWG verabschiedete Bonus-Malus-Regelung ist im Januar 2007 formal in Kraft getreten. Ziel der Maßnahme sind, auf Basis von „defined daily doses” (DDD), Einsparungen bei den Arzneimittelkosten. Jedoch ist ein „Missbrauch” der DDD zur Kostensteuerung nicht nur unsinnig, sondern für den Patienten unter Umständen sogar gefährlich. Am Beispiel der arteriellen Hypertonie wird gezeigt, dass die über die DDD ermittelte mittlere Dosierung für die verschiedenen AT ₁-Blocker nicht einer Wirkäquivalenz entspricht. Konsekutiv ist die Dosierung bei Verwendung einer DDD in einigen Fällen adäquat, in anderen Fällen nicht ausreichend. Folgen für den Patienten schlagen sich im kardiovaskulären Risiko nieder. Eine um nur 2 mmHg verminderte Blutdrucksenkung führt zu einer Erhöhung des Schlaganfallrisikos um 7 % über 10 Jahre. Daher muss die Kostendebatte letztlich dazu führen, dass nicht die Kosten im Verhältnis zu den DDD, sondern der „Preis” für ein Lebensjahr, mit optimal eingestelltem Blutdruck abzüglich der dadurch vermiedenen Folgekosten, als Maßstab für die Kosten-Nutzen-Betrachtung herangezogen wird.

Abstract

The within the AVWG consented Bonus-Malus regulation (Germany) has been enacted formally in January 2007. Aim of this regulation was to save money from drug expenses on the basis of “defined daily doses” (DDD). An “abuse” of DDD for cost control is, however, not only counterproductive but possibly even dangerous. Taking arterial hypertension as an example it is illustrated in this article that the DDD determined means doses are not equally effective in reducing blood pressure. Consecutively dose is adequate in some cases, but in other cases it is not. Consequences for patients are an increase in cardiovascular risk. A reduction of the blood pressure lowering effect of only 2 mmHg leads to an increased stroke risk of 7 % over 10 years. Therefore the cost debate should result in a substitution of measures for cost-benefit-ratios: Instead of estimating costs in relation to DDD the “price” of a year of life with optimal blood pressure discounted by the avoided consequential costs should be examined.

Schlüsselwörter

DDD - Hypertonie - Äquivalenzdosierung - Kosten-Nutzen Verhältnis

Key words

DDD - hypertension - equivalent dose - cost benefit ratio

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