Germany: DiGA Facts and Figures: German Health Insurer publishes comprehensive report

The biggest German statutory health insurance (Techniker Krankenkasse, “TK”) has published its second report on DiGA (DiGA-Report II 2024). The report was prepared by the TK, the research institute Vandage and the University of Bielefeld and provides an interesting and profound overview of various DiGA related topics.

In addition to the developments surrounding the fast-track procedure, which were examined on the basis of publicly available information from the DiGA directory and the DiGA arbitration board, the report also includes an in-depth look at the volume and cost development of DiGA supply.

Of interest are the results on the question of which DiGA were prescribed most frequently to insured persons of TK. Most DiGA have been prescribed in the period 2020-2023 for mental health purposes (32,384). This is followed by DiGA in the areas of diabetes and overweight (18,594). The third most popular application are DiGA, which are intended to help with back and knee pain (17,996). With 14,199 prescriptions, DiGA for the treatment of tinnitus are in fourth place.

The report states that 106,000 codes for DiGA were redeemed by TK from October 2020 to the end of 2023. Of these, 82 percent were issued by doctors and only 18 percent at the request of insured persons. Regarding the question of who prescribes DiGA, the report concludes that general practitioners prescribe DiGA most frequently (37.6 percent). Orthopedists are in second place (16.9 percent), followed by psychotherapists and psychiatrists with 14.7 percent. In fourth place are prescriptions by ENT specialists (14.5 percent).

Also revealing is the analysis of the question of who uses DiGA. The average age of DiGA users is 45 years. The results by age group were as follows: 18-29 years: 16.2 percent; 30-39 years: 23.5 percent; 40-49 years: 19.9 percent; 50-59 years: 24.4 percent; 60-69 years: 12.9 percent; over 70 years: 3 percent. It was found that more women use DiGA: 67.5 percent of DiGA users are women.

It was also pointed out that only around 15 percent of the users have used the DiGA a second time since the start of DiGA-services.

Moreover, the report explains in detail the pricing of DiGA in accordance with German regulations and the differences between the manufacturer price and the remuneration price. In the last quarter of the period under review (Q3/2023), the average remuneration level of EUR 221 was around 60 percent lower than the average manufacturer price of EUR 552.

Finally, the report presents a comparative, explorative analysis between DiGA users and non-users. The central data basis for these comparisons is the billing data of TK-insured persons. It was examined whether differences exist regarding morbidity, visits to the doctor, days of incapacity for work, hospital days and daily doses of medication. The analysis was carried out at the level of eleven different ICD chapters to which DiGA can be categorized.

In summary, the analysis concluded:

• No clinically relevant differences in the morbidity profiles were recognizable.
• There is a higher use of doctors by DiGA users, although this varied greatly depending on the indication area: DiGA users had an average of 1.6 (mental and behavioral disorders) to 6.1 (diseases of the nervous system) more contacts with SHI-accredited doctors per calendar year than the non-users in the comparison group. A significantly lower number of ambulant physician contacts across all eleven areas of application considered is only shown for ICD chapter XXI, to which only DiGA for the treatment of burnout syndrome are assigned.
• Regarding days of incapacity for work, there are significant differences in four ICD chapters with at least 1,000 DiGA users. Overall, DiGA users in these areas of application lost 4.8 (mental and behavioral disorders) to 7.6 (diseases of the nervous system) more days off work per year than the comparison group during the observation period.
• In terms of the average number of hospital days and the daily doses of medication administered, the trend towards higher use of services by DiGA users is less clear.

However, the report correctly points out that methodological limitations of the analysis must be considered and that certain distortions may arise due to the pragmatic approach of the analysis.