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Article History

Received: 30 July 2019

Accepted: 29 March 2020

First Online: 22 April 2020

Ethics approval and consent to participate

: This study used anonymized German claims data. Data contributing to the InGef Research Database are stored at a specialized data center according to §284 in combination with §70 and §71 Social Code Book (“Sozialgesetzbuch”, SGB) V. Access to the data is restricted to health service research and is granted on a study by study basis from the InGef on behalf of the participating statutory health insurances. The data center is owned by statutory health insurances and provides data warehouse services. In the data center (acting as a trust center), data with respect to individual insured members and health care providers (e.g. physicians, practices, hospitals, pharmacies) are anonymized by coarsening or by removing individual variables. Since all patient-level data in the InGef Research Database are no longer social data according to § 67 Abs. 2 SGB X in combination with Art. 4 Nr. 1 of the General Data Protection Legislation (“Datenschutz-Grundverordnung”, DSGVO), institutional review board/ethical approval and informed consent of the patient was not required. Furthermore, regions that are smaller than federal states or patient cohorts with less than 100 individuals were not analyzed in a granular way and patient counts below 5 were reported as “< 5”.

: Not applicable.

: MR, SM, and RW are full time employees of MSD SHARP & DOHME GmbH. KS, CJ, and SB are full-time employees of Xcenda, acting as contractors of MSD SHARP & DOHME GmbH for the execution of this study. MH received honoraria as speaker and member of medical advisory boards from MSD Sharp & Dohme GmbH, Astra Zeneca, Gedeon Richter and honoraria as an author for Thieme and Springer.