Background:ADHD is a highly prevalent disease in childhood which often persists into adulthood, then co-occurring with common adult conditions. Especially for adult ADHD, little is known about the costs of ADHD and the additional costs of comorbid conditions.Aims:To determine medical costs of ADHD and costs of comorbidities (mood, anxiety and substance use disorders, obesity), including their co-occurrence rates, stratified by age and gender.Method:Claims data from a German Statutory Health Insurance database with approximately four million member-records per year were analysed. A total of 25,300 prevalent ADHD patients were identified by means of an ICD-10 GM diagnosis of ADHD. A 1:1 age and gender adjusted reference group without ADHD diagnosis was randomly selected. Total health claims and health care costs related to ADHD were analysed, in addition to more targeted analyses of the occurrence and costs of pre-defined common comorbidities of, in particular, adult ADHD (SUD, mood and anxiety disorders, obesity). Outcomes were mean costs per patient and occurrence rates of comorbid conditions. Surplus costs of a comorbid condition in persons with ADHD relative to costs of this condition in persons without ADHD were calculated. Subgroup analyses were conducted based on age (0–12 years, 13–17 years, 18–30years, 30+ years) and gender.Results:Patients with ADHD were €1500 more expensive annually than individuals without ADHD (p < 0.001). Main cost drivers were inpatient care, psychiatrists and psychotherapists. Mood, anxiety, substance use disorders and obesity were significantly more frequent in ADHD patients and additional costs resulting from the comorbid conditions amounted up to €2800. Costs were slightly higher in women than men and increased with age for both genders. In young adults (18–30 years) health care costs dropped notably, especially costs for the medical treatment of ADHD with stimulants and costs for psychiatrists, before rising again in the group of patients over 30 years who had higher comorbidity rates.Conclusions:Medical costs for ADHD are substantial, in part through frequently occurring comorbid conditions, and particularly in adulthood, and are likely to further accelerate in the coming years. A gap of care was found, starting with the transition age group of patients over 17 years, as indicated by reduced costs per person during young adulthood, as well as an overall strong drop in administrative prevalence. In the future, approaches to improve the situation of care and reduce costs at the same time, i.e. through managed care programmes, should be implemented and benefit from detailed knowledge on age and gender-specific cost-drivers.

Aim: Estimate incidence and costs of cardiac device infections (CDIs) in Germany. Materials & methods:Patients had an implantable cardioverter defibrillator implanted over 2010-2013 and were followed to December 2014 using German health insurance claims data. A case-controlled analysis was performed using propensity score matching methods. Results: Risk of CDI 12 months post-implant was 3.4% overall, either 2.9% for de novo procedures versus 4.4% for replacement procedures. Mean 3-year incremental expenditure per patient for patients with CDI compared with controls was €31,493 for de novo implant patients and €33,777 for replacement patients. Mean incremental expenditure was €59,419 per patient with a major infection. Conclusion: CDIs are highly expensive to manage, reinforcing the need for strategies to reduce their occurrence. [1]. These devices are recommended for selected patients in guidelines from specialty medical societies and health technology assessment agencies [2][3][4]. There is an extensive body of evidence that demonstrates benefits including prolonged survival, improved quality of life and cost-effectiveness.Implantation of cardiac devices carries a risk of adverse events. These are classifiable as access-related (e.g., pneumothorax, hemothorax and hematoma), lead-related (e.g., perforation, displacement, fracture and endocarditis), generator-related (e.g., generator failure, migration and erosion) and pocket infection. Complete removal of all hardware is recommended in medical society guidelines and other scientific documents for patients with established cardiac device-related infection (CDI), and this includes cases in which a localized pocket infection occurs in the absence of signs of systemic infection, due to high relapse rates observed with retained hardware [5][6][7]. On the other hand, cardiac implantable electronic device (CIED) removal is not required for superficial or incisional infection at the pocket site if there is no involvement of the device.A large randomized controlled trial (DANISH study) recently reported an infection rate of 4.9% in a cohort of 556 ICD/CRT-D patients over a median follow-up of 5.6 years [8]. Serious device infections occurred in 2.7% of patients, defined as requiring lead extraction or lifelong antibiotic treatment or causing death. Worryingly, the number of CDI cases has been increasing: national healthcare data for the USA reported the number of hospitalizations due to CDI rose from 5308 in the year 2003 to 9948 in 2011 [9]. The increase is attributed to multiple factors including increased use of CRT devices (which have three leads and a higher risk of infection),

Aim: This study evaluated the occurrence and associated costs of pacemaker complications in Germany from 2010 to 2013. Patients & methods: Patients with a de novo or replacement implantation of a single or dual chamber pacemaker between 2010 and 2013 were followed for 12 months post-implant using German health insurance claims data. A case–control analysis was performed using propensity score matching to estimate the costs of complications. Results: Out of 12,922 implanted patients, 12.0% had a complication in the year following the implant. Complications related to lead and pocket were found in 10.2% of all implanted patients; infections occurred in 1.7% patients. Healthcare costs up to 36 months post complication were on average €4627 higher than for pacemaker patients without a complication. Conclusion: Pacemaker complications are common and represent a burden for patients and healthcare systems generating substantial costs. Most of the pacemaker complications involved the pacing lead or pacemaker pocket.