JMIR Publications

ABSTRACT

Background:

Expenditures for physiotherapy (PT) and extended outpatient physiotherapy (EAP) are increasing within Germany’s statutory accident insurance system (Berufsgenossenschaften, BGs), placing growing pressure on rehabilitation capacity and timely access to care. Digital health applications (DiGAs) are reimbursable nationwide and represent a novel component of routine rehabilitation pathways. However, their real-world system-level and economic effects in occupational rehabilitation remain insufficiently understood.

Objective:

This study aimed to evaluate how integration of DiGAs into occupational rehabilitation pathways may influence costs, service capacity, and waiting times within routine care.

Methods:

Aggregated administrative data from five BGs covering 25.9 million insured individuals (2023–2024) were analyzed using a multi-level simulation framework. The framework combined (1) probabilistic cost–consequence modeling with Monte Carlo simulation (10,000 iterations), (2) an adherence-based adoption funnel distinguishing long-term and short-term DiGA engagement, and (3) a calibrated M/M/1 queuing model validated through discrete-event simulation to estimate effects on waiting times and system capacity. Primary outcomes included net financial impact, break-even thresholds, and changes in access-related performance metrics.

Results:

Combined PT/EAP expenditures reached €404 million in 2024, increasing by 10.1% year over year. Simulation results indicated mean annual net savings of €18.4 million with a 90.7% probability of cost savings. After incorporating adherence dynamics, projected mean net savings were €16.2 million (95% CI €5.0–29.8 million), corresponding to a 100% probability of positive financial impact. Cost neutrality was maintained for DiGA prices up to €617.80 per prescription. Queuing analyses demonstrated that modest reductions in therapeutic demand could decrease mean waiting times from 17.3 to 12.8 days (−26%), equivalent to approximately 120,000 cumulative patient waiting days saved annually.

Conclusions:

Under conservative assumptions, integrating digital therapeutics into occupational rehabilitation pathways is likely to generate both economic benefits and substantial system-level capacity gains. Beyond cost effects, DiGAs may function as scalable implementation tools that alleviate bottlenecks and improve timely access to rehabilitation services in capacity-constrained health systems.