Correspondence (letter to the editor): Quo Vadis, Techniker Krankenkasse?

In January, the Techniker Krankenkasse (TK, a statutory health insurance fund in Germany), in collaboration with the Verband der Ersatzkassen (association of substitute health insurance schemes) and the statutory health insurer for North-Rhine (Kassenärztliche Vereinigung Nordrhein, KV) issued a joint press statement regarding the high quality of the disease management programs (DMP) in North-Rhine and the ensuing benefits for patients.

Now, an original research article appears, “The Benefit and Efficiency of the Disease Management Program for Type 2 Diabetes,” which was submitted to Deutsches Ärzteblatt on 29 July 2010 and published in the issue of 11 March 2011. The article’s key message is that the study does not reveal any clear medical benefit from DMP participation.

Closer reading of this original article reveals multiple inconsistencies that substantially limit the meaningfulness of the article. What would make sense is a prospective analysis over several years or even decades, and not a retrospective analysis over two years (2007/2008). The inclusion criterion of registering a patient for a further DMP also throws up questions.

In addition to so called hard end points, data on newly occurring typical comorbidities were collected and treatment successes in terms of adhering to standard values were used for the assessment.

With regard to this the observation period is insufficiently long and using adherence to normal values is a pointless reflection of surrogate parameters. Hard end points regarding mortality over a long observational period would be required in this setting.

Although, as the authors themselves cite, the statistical tests (Chi square test and Mann-Whitney U test) are not valid in their application after the so called matching, they were still used to assess the results.

The point and purpose of this publication remains speculative and does not seem to serve any medical benefit. If the TK were systematic in its approach, it would have to cancel its participation in the DMP for type 2 diabetes (T2DM), but it might lose face in the eyes of the insurance scheme members by cutting preventive healthcare services..