Response to a Letter from Dr Falk Hoffman

We thank Falk Hoffmann and Thomas Grobe for their critical reading of our manuscript ‘The costs of atrial fibrillation in patients with cardiovascular co-morbidities—a longitudinal analysis of German health insurance data’. In their letter to the editor, they stated that the outpatient costs of our study were underestimated compared with other published studies and reports that are based on third-party payer's datasets. Principally, we are in line with both authors—against the background of other analyses our results on outpatients costs seem to be underestimated. Therefore, we rescrutinized our data analysis and economic evaluation without identifying any analytic inaccuracies. Hence, the underlying dataset might be the source for underestimation. This assumption was confirmed after consulting the insurance company that provided the data for our analysis. Since the beginning of 2004, the German statutory health insurance companies received outpatient data based on a single insurant. We suppose that the available data may not be complete due to teething problems with the data transfer. However, we do not expect that the overall cost results of our study were deeply influenced by this uncertainty, particularly keeping in mind the principal problems in economic assessment of outpatient physician visits from the statutory health insurance perspective in Germany. That is mainly due to the fact that German outpatient physician services are paid by a fixed budget per insurant to the physicians association, regardless of whether an insured person will really contact his physician or not, respectively, regardless of the frequency of physicians' contacts.

Conflict of interest: none declared.