OBJECTIVES: Retrospective analyses of medical claims data serve as a cornerstone in HEOR, supporting clinical and economic studies around disease burden. This study compared how different datasets in two unique healthcare systems (i.e., USA and Germany) quantified disease burden using claims data, highlighting nuances associated with the data collected and how these enable characterization of unmet need. Additionally, the study identified implications for life science companies interested in leveraging claims analyses in these markets to support strategic decision making.

METHODS: A case study-based approach was leveraged to quantify disease burden (e.g., incidence, hospital visits, length of stay, re-admission), in pediatric patients with RSV using claims data in the US (Komodo® open and closed claims) and in Germany (DAK-insurance data). A comprehensive comparison of the study methodology involved in each country was performed, including associated benefits and limitations.

RESULTS: Both DAK and Komodo provide a holistic view of HCRU related disease burden. RSV incidence rates were estimated to be 46 per 1000 in patients under age 1 in 2021/22 in the US, versus 47.7 in Germany. In Germany, 55.7% of RSV patients under age 1 were hospitalized; distinction between inpatient or ER discharge was not captured. In comparison, 39% of patients were hospitalized in the US, with specificity across inpatient and ER settings. German data offers visibility into ventilation and treatments for inpatient cases, but in the US, this insight is only available when other data (e.g., chargemaster) is linked to claims.

CONCLUSIONS: Both datasets can support robust publication-grade HCRU studies. US claims data provides additional clinical specificity but only when linked with other sources with complex analytical requirements. Germany offers rich data linked across several setting of care, to inform HCRU use cases for more holistic decision-making. Data sources in each market have unique limitations that must be considered through robust analysis design.