***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Worldwide , information infrastructures have developed rapidly towards big data over the past few years . The evolution of powerful computers has made it possible to improve the data exchange process within the healthcare system [ 1 ] . This technological trend has also triggered new and powerful possibilities in health service-related research ( e.g. , cl aims data analyses ) , because it now allows the analysis of more complex and larger data sets . In this editorial , we focus on cl aims data analyses , because they are an important and powerful source of information to support the decision-making processes of healthcare stakeholders , research ers , and policy-makers regarding various aspects of the healthcare system . A few years ago , the statutory health insurance ( SHI ) companies in Germany made their data available for research purpose s , because they realized the comprehensive potential of these data for both rational allocation of re sources and for health services research to optimize healthcare provisions . The German government increasingly supports and funds cl aims data research , thus confirming the growing relevance of such research . Furthermore , recently , this research field developed a sophisticated method ological framework for comprehensively analyzing and interpreting the data in the context of various research questions . The significant increase in the number of cl aims data studies ( and frequency of policy-relevant research ) confirms this trend [ 2 , 3 ] ( see Fig. 1 ) . Cl aims data studies mainly use the information stored in data warehouses of the SHI . As a form of administrative data , primarily collected for billing and reimbursement purpose s , cl aims data belong to the category of secondary data . These data are transmitted directly from healthcare providers to SHI funds , which include information on ( all ) cross-sector contacts between the insured and the healthcare system in their data base . Compared with clinical trials , cl aims data analyses could reflect real-life healthcare provisions . Further advantages of this data source are the costefficient generation of data and a typically large study population compared with r and omized controlled trials , which research ers often view as the gold st and ard for providing information on treatment efficacy and safety in a clinical setting . These data also help include groups that are typically more difficult to observe through primary data collection ( e.g. , children , severely ill individuals , dementia patients , or residents of nursing homes ) . Over the last 15 years , almost one-third of the published cl aims data studies have focused on health economics [ 2 ] . Furthermore , due to its advantages , research ers have previously used this data source for health services research on treatment patterns , under and overtreatment of specific diseases , epidemiology studies , and as an input factor for modeling studies [ 4 ] . The aim of all these studies was to increase transparency and efficiency of the healthcare system by analyzing real-world evidence . Moreover , the latest national call for proposals confirms that there is both an increase in the importance of and positive development in cl aims data research . The German government and the Federal Joint Committee ( Gemeinsamer Bundesausschuss , G-BA ) established the ‘ Innovation Fund ’ , which will provide funding of 75 million euros per year for projects dealing with health service research over a period of 4 years . In such projects , it is & Sarah Neubauer Background : The matching of favorable human leukocyte antigen ( HLA ) combinations is rarely performed in penetrating keratoplasty procedures for primary prophylaxis of immune reactions . However , clinical studies suggest that the incidence of graft rejection decreases substantially when patients receive favorably matched grafts . Objective : The aim of this study was to assess the cost-effectiveness of HLA matching for patients undergoing penetrating keratoplasty in everyday clinical practice . Methods : In the absence of a r and omized controlled clinical trial , we used administrative data from the Freiburg University Eye Hospital in Germany . Our study population consisted of all patients who underwent their first keratoplasty between 11/2003 and 01/2010 and for whom information on HLA histocompatibility was available . We used propensity score matching to estimate a causal effect of favorable HLA matching , parametric survival regression techniques to predict graft survival and expert opinion to model incremental cost for HLA matching . Because the availability of favorable HLA histocompatibility ultimately depends on the patients ' HLA phenotype , we modeled the incremental cost-effectiveness ratio ( ICER ) as a function of the probability that a patient will receive a favorably matched HLA , and used expert opinion to set a point estimate . Results : We predicted that corneal grafts with favorable HLA matching were associated with improved rejection-free graft survival time ( more than 1,000 days ) . We estimated the incremental cost of HLA matching  at EUR 1,200 and the ICER at EUR 4.62 per additional day of graft survival . Conclusions : The ICER of HLA matching is acceptable , given the high cost of alternative treatment and the shortage of corneal donors in Germany Summary The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents . Given a willingness-to-pay ( WTP ) of 50,000 EUR per year free of femoral fracture , the probability that the intervention is cost-effective is 83 % . Introduction Despite their increased risk of falls and fractures , nursing home residents have been neglected in economic evaluations of fall prevention programs so far . The purpose of this study was to analyze , for the first time , the cost-effectiveness of a multifactorial fall prevention program in nursing home residents . Methods This study is part of a prospect i ve , unblinded , cluster , nonr and omized , controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting . The analyzed sub sample was derived from cl aims data and consisted of data on intervention ( n = 256 , residents n = 10,178 ) and control homes ( n = 893 , residents n = 22,974 ) , representing all insurants of a sickness fund ( AOK Bavaria , Germany ) who were 65 years or older , residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance . Time free of femoral fracture ( ICD-10 , S72 ) was used as measure of health effects . Femoral fracture-related costs and intervention costs were measured from a payer perspective . Multivariate regression models were applied . Sensitivity analyses were performed and cost-effectiveness acceptability curves computed . Results Within the first year of the intervention , femoral fracture rate was significantly reduced , result ing in a nonsignificant incremental mean time of 1.41 days free of femoral fracture . Incremental mean total direct costs were 29 EUR per resident , which was not significant . The incremental cost-effectiveness ratio ( ICER ) was 7,481 EUR per year free of femoral fracture . The probability of an ICER < 50,000 EUR per year free of femoral fracture was 83 % . Conclusion Depending on the amount the decision-maker is willing to pay for the incremental effect , the fall prevention program might be cost-effective within the first year . Future studies should exp and the range of costs and effects measured In brachioradial pruritus and notalgia paraesthetica , the 8 % capsaicin patch is a novel and effective , but cost-intense , therapy . Routine data for 44 patients were collected 6 months retrospectively and prospect ively to first patch application . The cost to health insurance and the patient , and patient-reported outcomes were analysed ( visual analogue scale , numerical rating scale , verbal rating scale for pruritus symptoms , Dermatological Life Quality Index , and Patient Benefit Index ) . Mean inpatient treatment costs were reduced by € 212.31 , and mean outpatient treatment and medication costs by € 100.74 per patient ( p.p . ) . However , these reductions did not offset the high cost of the patch itself ( € 767.02 p.p . ) ; thus the total cost to health insurance increased by € 453.97 p.p . ( p ≤ 0.01 ) . The additional costs of therapy to the patient decreased by € 441.06 , thus the overall cost p.p . remained approximately the same ( € 3,306.03 vs. € 3,318.94 ) . Capsaicin patch therapy result ed in reduced pruritus , improved quality of life and greater patient benefit , thus long-term cost-efficiency analyses are necessary BACKGROUND In two recent r and omised clinical trials , a meta- analysis and in an effectiveness study analysing routine data from the U.S. Veterans Administration the superiority of the newer atypical drugs over typical antipsychotic drugs , concerning both their efficacy and their side-effect profile , has been question ed . AIMS OF THE STUDY To analyse the effectiveness and cost of atypical versus typical antipsychotic treatment for schizophrenia in routine care . METHODS Cohort study using routine care data from a statutory sickness fund with 5.4 million insured in Germany . To be included , patients had to be discharged with a diagnosis of schizophrenia in 2003 and fulfil membership criteria . Main outcome measures were rehospitalisation rates , mean hospital bed days , mean length of stay , cost of inpatient and pharmaceutical care to the sickness fund during follow-up and medication used to treat side-effects . RESULTS 3121 patients were included into the study . There were no statistically significant differences in the effectiveness of atypical and typical antipsychotics on rehospitalisation during follow-up ( rehospitalisation rate ratio 1.07 , 95 % confidence interval 0.86 to 1.33 ) . However , there were consistent observations of atypical antipsychotics being more effective for severe cases of schizophrenia ( 14.6 % of study population ; > 61 prior bed days per year in 2000 - 2002 ) in the follow-up period , whereas for the other severity strata typical antipsychotics seemed more effective in reducing various rehospitalisation outcomes .  Patients treated with atypical antipsychotics  received significantly less prescriptions for anticholinergics or tiaprid ( relative risk 0.26 , 95 % confidence interval 0.18 to 0.38 ) . DISCUSSION The effectiveness of atypical antipsychotics for schizophrenia on rehospitalisation measures appeared similar to that of typical antipsychotics . With the exception of severe cases , the higher costs for atypical antipsychotics were not offset by savings from reduced inpatient care . Major limitations include the lack of statistical power for subgroup analyses , the lack of clinical severity scale data and of life-course medical history data which both increase the risk of residual confounding by disease severity . CONCLUSIONS This study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care . IMPLICATION S FOR HEALTH CARE PROVISION AND USE From a clinical perspective , this study provides evidence that the effectiveness of atypical and typical antipsychotics measured in terms of hospital readmissions appears to be similar in routine care . IMPLICATION S FOR HEALTH POLICIES Routine data studies can yield valuable information for policy decision-makers on the costs and the effectiveness of pharmaceuticals in routine care , complementing efficacy data from r and omised clinical trials currently used for licensing and reimbursement decisions . IMPLICATION S FOR FURTHER RESEARCH The non-significant differences in the effectiveness of atypical compared to typical antipsychotics according to severity of disease should be investigated in a prospect i ve observational study or in a r and omised clinical trial Context Dissatisfaction with traditional care for patients with chronic conditions is leading to new models of care . Contribution The investigators found that protocol -based care by medical assistants for patients with diabetes mellitus , chronic obstructive pulmonary disease , or chronic heart failure did not prevent rehospitalization but did improve quality of life at a reasonable cost . Caution Relatively few practice s were included in the study . Implication Medical assistants can participate in new models of care for patients with chronic conditions . Primary care faces the challenge of caring for an increasing number of patients with multiple chronic conditions with a diminishing workforce ( 1 , 2 ) . These patients are at high risk for potentially avoidable hospitalizations , which result in substantial system-level health care spending ( 3 ) and affect patient quality of life ( 4 ) . Although most hospitalizations are deemed unavoidable ( 5 , 6 ) , primary care physicians report that self-management support and intensified monitoring could prevent 40 % of hospitalizations in patients with multiple chronic conditions ( 7 ) . Studies of nurse-led care management interventions that focus on patients at high risk for future health care use , such as Guided Care ( 8) or Geriatric Re sources for Assessment and Care of Elders ( 9 ) , have recently evaluated self-management support and intensified monitoring . Despite substantial improvements in quality of care ( 8) and reductions in health care use ( 10 ) , these interventions did not reduce overall health care spending ( 8 , 10 ) , partly because savings from reduced health care use were offset by the costs of these interventions . In small primary care setting s ( solo practice s or 2-person partnerships ) , re sources are often limited and extensive collaborative models , such as multiprofessional care management , may be difficult to implement . The medical assistant workforce is one of the fastest growing workforces in primary care practice s in the United States ( 11 ) , and all primary care practice s in Germany employ medical assistants . Medical assistants in the United States are trained in a 3-year part-time curriculum in practice ( 3920 hours ) and vocational school ( 840 hours ) . Despite recent attempts to involve medical assistants in chronic care , their work focuses primarily on clerical duties ( including reception ) and routine tasks , such as blood sampling or electrocardiogram recording , and their median annual salary is $ 28860 ( 11 ) . Certified medical assistants in the United States and Germany are comparable with regard to education , tasks , and remuneration ( 11 ) 
    Output:
    
Conclusions This review confirms that routine data has become an increasingly common data source for health economic evaluations in Germany .
While most studies addressed the application of routine data , this analysis reveals deficits in considering method ological particularities and in reporting quality of economic evaluations based on routine data .
Nevertheless , this review demonstrates the overall potential of routine data for economic evaluations