Allergic disorders of the respiratory tract - findings from a large patient sample in the German statutory health insurance system

Background: Worldwide, the number of patients with allergic diseases is global increasing, especially in the industrialized nations. Experts estimate that only about 10 % of allergic patients are treated according to the latest guidelines. The aim of this study is to map the medical care situation of patients with allergic respiratory diseases under the German statutory health insurance system and to investigate the impact on patient care since January 1, 2009, when ceilings for service volumes in allergology were implemented. Therefore, we analyzed the diagnostic and therapeutic behaviour of physicians between 2007 and 2010 by using claims data from the National Association of Statutory Health Insurance Physicians. Methods: The claims data was from the national four-birthday sample, including more than 9 million patients (13 % of the population). From this, the study cohort was extracted, including 725,000 patients with allergic rhinitis and 260,000 patients with allergic asthma. Analyzes refer to diagnostic codes and fee schedule items, e.g., as for specific immunotherapy. Results: The average number of total coded diagnoses per patient and per physician's office has generally increased, while the number of physician's offices encoding allergological diagnoses is decreasing. In contrast, the number of claimed allergological fee schedule items (especially specific immunotherapy) diminished. 7 % of patients with rhinitis and 5 % of patients with allergic asthma receive specific immunotherapy, mostly performed by specialists. Conclusion: The analysis shows an increase in the total number of allergic patients in the studied cohort. In contrast, the ratio of patients receiving specific immunotherapy seems disproportionately low. One consequence could be additional health care costs arising from the progression of these diseases, e.g., by an increase of allergic asthma.