Zu den Inhalten springen

Institut für Medizinische Biometrie
und Statistik (IMBI)

Health Economics


Health economics research enables policymakers to make evidence-based decisions on how to allocate limited health care resources efficiently. Efficiency here is not necessarily about cutting costs, but rather about determining how to derive the maximum total benefit from limited available resources.

In the same way that evidence-based medicine makes use of formal evidence on effectiveness of interventions, health economics answer the need to formally assess the implications of choices about the deployment of resources. Since resource use is best expressed in costs, a number of economic evaluation techniques have been developed to compare costs and clinical outcomes of competing treatment alternatives in order to identify the most efficient treatment.


The Health Economics Working Group at the Medical Center - University of Freiburg was established as a collaboration between the Center for Medical Biometry and Medical Informatics, the Clinical Trials Unit, and the University Heart Centre. We have a strong methodological background in regression modelling and econometrics. In addition to our own research projects, we provide methodological support for economic evaluations across all types of clinical research.


Cost-benefit analyses of medical interventions from the hospital perspective

Borde, J.P., S. Nussbaum, S. Hauser, P. Hehn, J. Hübner, G. Sitaru, S. Köller, B. Schweigert, K.d. With, W.V. Kern and K. Kaier (2016): Implementing an intensified antibiotic stewardship programme targeting daptomycin use in orthopaedic surgery: a cost-benefit analysis from the hospital perspective. Infection 44(3):301-307. PubMed

Economic evaluations using data from patient registries

Wolff, J., A. Gary, D. Jung, C. Normann, K. Kaier, H. Binder, K. Domschke, A. Klimke and M. Franz (2020): Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach. BMC Medical Informatics and Decision Making 20(1):21. PubMed

Kaier, K., T. Heister, J. Wolff and M. Wolkewitz (2020): Mechanical ventilation and the daily cost of ICU care. BMC Health Services Research [Epub ahead of print]. PubMed

Wolff, J., P. McCrone, A. Patel, K. Kaier and C. Normann (2015): Predictors of length of stay in psychiatry: analyses of electronic medical records. BMC Psychiatry 15:238. PubMed

Gutmann, A., K. Kaier, S. Sorg, C. von zur Mühlen, M. Siepe, M. Moser, A. Geibel, A. Zirlik, I. Ahrens, H. Baumbach, F. Beyersdorf, W. Vach, M. Zehender, C. Bode and J. Reinöhl (2015): Analysis of the additional costs of clinical complications in patients undergoing transcatheter aortic valve replacement in the German Health Care System, International Journal of Cardiology 179: 231-237. PubMed

Jabbarli, R., M. Shah, C. Taschner, K. Kaier, B. Hippchen and V. Van Velthoven (2014): Clinical utility and cost-effectiveness of CT-angiography in the diagnosis of nontraumatic subarachnoid hemorrhage, Neuroradiology 56(10): 817-824. PubMed

Secondary data analyses using German claims data

Kaier, K., C. Bode, M. Zehender, C. von zur Mühlen and P. Stachon (2019): Modeling the Volume-Outcome Relationship for TAVR. Journal of the American College of Cardiology 74(16):2115-2116. PubMed

Oettinger, V., K. Kaier, T, Heidt, M. Hortmann, D. Wolf, A. Zirlik, M. Zehender, C. Bode, C. von Zur Mühlen and P. Stachon (2020): Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany. Heart [Epub ahead of print]. PubMed

Kaier, K., C. von zur Mühlen, A. Zirlik, W. Bothe, P. Hehn, M. Zehender, C. Bode and P. Stachon (2019): Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany, European Journal of Health Economics 20(4):625-632. PubMed

Olivier, M., M. Boeker, S. Hanser, P. Hehn and K. Kaier (2018): The PKMS (German Score for Complex Nursing Measures) as paradigm shift in the G-DRG system: a retrospective observational study based on billing data, Gesundheitsökonomie & Qualitätsmanagement 24(04):191-196. Link

Kaier, K., V. Oettinger, H.Reinecke, C. Schmoor, L. Frankenstein, P. Hehn, C. von zur Mühlen, C. Bode, M. Zehender and J. Reinöhl (2018): Volume-outcome relationship in transcatheter aortic valve implantations in Germany 2008-2014: a secondary data analysis of electronic health records, BMJ Open 8(7):e020204. Link

Wolff, J., T. Heister, C. Normann and K. Kaier (2018): Hospital costs associated with psychiatric comorbidities: a retrospective study, BMC Health Services Research 18(1):67. PubMed

Kaier, K., H. Reinecke, H. Nacy, L. Frankenstein, M. Bode, W. Vach, P. Hehn, A. Zirlik, M. Zehender and J. Reinöhl (2017): The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany, European Journal of Health Economics 19(2):223-228. Link

Kaier, K., H. Reinecke, C. Schmoor, L. Frankenstein, W. Vach, P. Hehn, A. Zirlik, C. Bode, M. Zehender and J. Reinöhl (2017): Learning Curves Among All Patients Undergoing Transcatheter Aortic Valve Implantation in Germany: A Retrospective Observational Study, International Journal of Cardiology 235:17-21. Link

Reinöhl, J., K. Kaier, H. Reinecke, L. Frankenstein, A. Zirlik, M. Zehender, C. von Zur Mühlen, C. Bode and P. Stachon (2016): Transcatheter Aortic Valve Replacement: The New Standard in Patients With Previous Coronary Bypass Grafting? JACC: Cardiovascular Interventions 9(20):2137-2143. PubMed

Reinöhl J., K. Kaier, H. Reinecke, C. Schmoor, L. Frankenstein, W. Vach, A. Cribier, F. Beyersdorf, C. Bode and M. Zehender (2015) Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice. New England Journal of Medicine 373(25): 2438-2447. PubMed

Economic evaluations alongside clinical trials

Kienle, G.S., P.G. Werthmann, B. Grotejohann, K. Kaier, I. Steinbrenner, S. Voigt-Radloff and R. Huber (2020): A multi-centre, parallel-group, randomised controlled trial to assess the efficacy and safety of eurythmy therapy and tai chi in comparison with standard care in chronically ill elderly patients with increased risk of falling (ENTAiER): a trial protocol. BMC Geriatrics 20(1):108. PubMed

Dudareva, M., M. Kümin, W. Vach, K. Kaier, J. Ferguson, M. McNally and M. Scarborough (2019): Short or Long Antibiotic Regimes in Orthopaedics (SOLARIO): a randomised controlled open-label non-inferiority trial of duration of systemic antibiotics in adults with orthopaedic infection treated operatively with local antibiotic therapy. Trials 20(1):693. PubMed

Brühmann, B. A., C. Reese, K. Kaier, M. Ott, C. Maurer, S. Kunert, B. R. Saurer und E. Farin (2019: A complex health services intervention to improve medical care in long-term care homes: study protocol of the controlled coordinated medical care (CoCare) study. BMC Health Services Research 19:332. PubMed

Frank, F., F. Bjerregaard, J. Bengel, E.M. Bitzer, B. Heimbach, K. Kaier, J. Kiekert, L. Krämer, C. Kricheldorff, K. Laubner, A. Maun, G. Metzner, W. Niebling, C. Salm, S. Schütter, J. Seufert, E. Farin and S. Voigt-Radloff (2019): Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial. BMC Family Geriatrics 19(1):64. PubMed

Voigt-Radloff, S., A. Schöpf, M. Boeker, L. Frank, E. Farin, K. Kaier, M. Körner, K. Wollmann, B. Lang, J. Meerpohl, R. Möhler, W. Niebling, J. Serong, R. Lange, P. van der Keylen and A. Maun (2019): Well informed physician-patient communication in consultations on back pain - study protocol of the cluster randomized GAP trial. BMC Family Practice 20(1):33. PubMed

Kaier, K., F. von Kampen, Baumbach, C. von Zur Mühlen, P. Hehn, W. Vach, M. Zehender, C. Bode and J. Reinöhl (2017): Two-year post- discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany, BMC Health Services Research 17:473. PubMed

Kaier, K., S. Hils, S. Fetzer, P. Hehn, A. Schmid, D. Hauschke, L. Bogatyreva, B. Jänigen and P. Pisarski (2017): Results of a randomized controlled trial analyzing telemedically supported case management in the first year after living donor kidney transplantation - a budget impact analysis from the healthcare perspective, Health Economics Review 7:1. Link

Kaier, K., A. Gutmann, H. Baumbach, C. von Zur Mühlen, P. Hehn, W. Vach, F. Beyersdorf, M. Zehender, C. Bode and J. Reinöhl (2016): Quality of life among elderly patients undergoing transcatheter or surgical aortic valve replacement - a model-based longitudinal data analysis, Health and Quality of Life Outcomes 14(1): 109. PubMed

Kaier, K., A. Gutmann, W. Vach, S. Sorg, M. Siepe, C. von Zur Mühlen, M. Moser, P. Blanke, F. Beyersdorf, M. Zehender, C. Bode and J. Reinöhl (2015): "Heart Team" decision making in elderly patients with symptomatic aortic valve stenosis who underwent AVR or TAVI-a look behind the curtain. Results of the prospective TAVI Calculation of Costs Trial (TCCT), EuroIntervention 11(8):793-798. PubMed

Reinöhl, J., K. Kaier, A. Gutmann, S. Sorg, C. von Zur Mühlen, M. Siepe, H. Baumbach, M. Moser, A. Geibel, A. Zirlik, P. Blanke, W. Vach, F. Beyersdorf, C. Bode and M. Zehender (2015): In-hospital resource utilization in surgical and transcatheter aortic valve replacement. BMC Cardiovascular Disorder 15:132. PubMed

The economics of infectious diseases

Kaier, K., T. Heister, E. Motschall, P. Hehn, T. Bluhmki and M. Wolkewitz (2019): Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression. Epidemiology and Infection 147:e314. PubMed

Kaier, K., T. Heister, T. Götting, M. Wolkewitz and N.T. Mutters (2019): Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital. BMC Infectious Diseases 19:1028. PubMed

Heister, T., M. Wolkewitz, P. Hehn, J. Wolff, M. Dettenkofer, H. Grundmann and K. Kaier (2019): Costs of hospital-acquired Clostridium difficile infections: an analysis on the effect of time-dependent exposures using routine and surveillance data. Cost Effectiveness and Resource Allocation 17:16. PubMed

Kaier, K., M. Wolkewitz, P. Hehn, N.T. Mutters and T. Heister (2019): The impact of hospital-acquired infectionson the patient-level reimbursement-cost relationshipin a DRG-based hospital payment system. International Journal of Health Economics and Management 15(2):e0227345. PubMed

Kaier, K., N.T. Mutters and M. Wolkewitz (2019): Measuring the financial burden of resistance: What should be compared? Clinical Infectious Diseases [Epub ahead of print]. PubMed

Engler-Hüsch, S., T. Heister, N.T. Mutters, J. Wolff and K. Kaier (2018): In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital, BMC Health Services Research 18:737. PubMed

Heister, K. Kaier and M. Wolkewitz (2017): Estimating the burden of nosocomial infections: Time dependency and cost clustering should be taken into account, American Journal of Infection Control 45(1): 94-95. Link

Heister, T., C. Hagist and K. Kaier (2015): Resistance Elasticity of Antibiotic Demand in Intensive Care, Health Economics 26(7):892-909. Link

Kaier, K. and U. Frank (2013): In search of useful methods for measuring health and economic consequences of antimicrobial resistance, Clinical Infectious Diseases 57(8): 1220-1222. PubMed

Kaier, K. (2012): Economic implications of the dynamic relationship between antibiotic use and hospital-acquired infections, Value in Health 15(1): 87-93. PubMed

Kaier, K. (2012): Economic modeling of the persistence of antimicrobial resistance, Natural Resource Modeling, 25(2): 388-402. Link

Kaier, K. and S. Moog (2012): Economic consequences of the demography of MRSA patients and the impact of broad-spectrum antimicrobials, Applied Health Economics and Health Policy, 10(4): 227-234. PubMed

Pharmacoeconomic analyses

Al Said, S., S. Alabed , K. Kaier, A.R. Tan, C. Bode, J.J. Meerpohl and D. Duerschmied (2019): Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis. Cochrane Database of Systematic Reviews 12:CD013252. PubMed

Kaier, K. (2013): The impact of pricing and patent expiration on demand for pharmaceuticals: an examination of the use of broad-spectrum antimicrobials, Health Economics, Policy and Law 8(1): 7-20. PubMed

Kaier, K. and U. Frank (2010): Measuring the externality of antibacterial use from promoting antimicrobial resistance, PharmacoEconomics 28(12): 1123-1128. PubMed

Economic considerations of benefit assessment in Germany

Kaier, K. and S. Fetzer (2015): Das Arzneimittelmarktneuordnungsgesetz (AMNOG) aus ökonomischer Sicht, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 58: 291-297. PubMed

Schwander, B., K. Banz, K. Kaier and S. Walzer (2014): Evaluation of a Possible Predictor for Federal Joint Committee Decisions on Early Benefit Assessments according to the German Action the Reform of the Market for Medicinal Products, Health Policy 117(3): 334-344. PubMed