The objective of this study was to assess the budget impact and health effects of introducing rotavirus (RV) vaccination in Saxony, Germany, from a health insurance perspective. Special emphasis is given to the herd effect. We analyzed direct medical and non-medical costs of RV infection for Social Health Insurance between 2007 and 2010 based on 360,000 routine data observations from the AOK PLUS for children below 5 years of age. We compared the actual annual number of RV cases (vaccination scenario) with the number derived from 2005 (no vaccination, base case scenario). The vaccination coverage rate has increased from 5 % to 61 % between 2007 and 2010. The number of RV cases decreased by 21 % from 32,274 in 2007 to 25,614 in 2010. Based on vaccination coverage, the total cost savings per 1,000 children due to RV vaccination was estimated to be 39,686 Euros. The overall share of outpatient costs was 60 %. Mean gross cost savings were expected to be 304 Euros per avoided case. The net cost savings were expected to be 19 Euros per avoided case. About 59 % of total savings was due to herd protection resulting from increasing vaccine rates. The herd effect per avoided case increased with increasing vaccine coverage. Incidence of RV cases, vaccination costs and days absent from work were sensitive parameters. This retrospective analysis showed that the increase in RV vaccination coverage in Saxony has been budget neutral if not cost saving for sick funds.

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. The asymmetry between the patient as a layman and the physician as an expert is a key element in health economics. However, a change to a higher degree of patient autonomy has taken place. Furthermore, there is a consensus in a positive correlation between general education and productivity of medical care. This paper focuses on the individual investments of laymen in specific medical education as a decision problem in which the ex-post strategies of the individual are consultation and self-care as imperfect substitutes. It is assumed that specific knowledge increases the self-diagnosis competence (self-protection) and the self-care productivity (self-insurance) as dimensions of autonomy. The analysis is divided into two forms of ex-post decision making according to individual rationality: 1. ambiguity 2. Terms of use: Documents inuncertainty. An elaboration of necessary conditions for investments in education is undertaken. JEL-Classification: D01, D80, I12 , I20

study design, number of covariates adjusted and adjusted for BMI and cardiovascular diseases. Subgroup and sensitivity analysis were also done. Heterogeneity and publication bias were also assessed. RESULTS: 24 studies were included in the analysis. The pooled risk ratio of PD due to hypertension (nϭ8) was 0.78 (95% CI, 0.67-0.92, I2ϭ71.85%), due to high serum cholesterol (nϭ7) was 0.95 (95% CI, 0.77-1.17, I2ϭ 75.86%), and due to diabetes (nϭ14) was 0.94 (95% CI, 0.76-1.16, I2ϭ 89.62%). Subgroup analysis showed a significant difference in effect estimate pooled by cohort and case-control studies (Pin-teractionϽ0.001). Pooled analysis of cohort studies for diabetes showed a pooled risk ratio of 1.34 (95%CI, 1.12-1.60, I2ϭ76.77%). We found no significant difference in any subgroup analysis. CONCLUSIONS: We found evidence of significant inverse associations of hypertension, hypercholesterolemia, and diabetes mellitus with the risk of PD. Further well-designed investigations of the association of vascular risk factors with the risk of PD are needed, particularly large-scale prospective studies.

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