Tan, S.S.

Longitudinal development of gross motor function among Dutch children and young adults with cerebral palsy: An investigation of motor growth curves (Article)

2013-04-01T00:00:00Z

Aim: The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy (CP). Method: This longitudinal study included 423 individuals (260 males, 163 females) with CP. The mean age at baseline was 9 years 6 months (SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System (GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure (GMFM-66) at 1- or 2-year intervals between 2002 and 2009. Data were analysed using non-linear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model (SLM) with a peak and decline model (PDM), followed by estimating limits and rates of gross motor development. Results: The SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I-II vs level IV and for GMFCS levels I-IV vs level V) of gross motor development. Interpretation: The results validate the existence of five distinct patterns for gross motor development by level of severity of CP.

Real-world health care costs of relapsed/refractory multiple myeloma during the era of novel cancer agents (Article)

2013-02-01T00:00:00Z

What is known and objective: High costs of novel agents increasingly put pressure on limited healthcare budgets. Demonstration of their real-world costs and cost-effectiveness is often required for reimbursement. However, few published economic evaluations of novel agents for multiple myeloma exist. Moreover, existing cost analyses were heavily based on conventionally treated patients. We investigated real-world health care costs of relapsed/refractory multiple myeloma in Dutch daily practice. Methods: A retrospective medical chart review was conducted for 139 patients treated between January 2001 and May 2009. Total monthly costs attributable to each cost component were described across all regimens and for bortezomib-, thalidomide- and lenalidomide-based treatment regimens. Results: Mean monthly total costs (€3,981) varied depending on the sequence of therapy (range: €442-€31,318). Significant cost drivers across all regimens included costs of therapy and hospital admissions. The acquisition costs for novel agents in particular accounted for 32% of mean total monthly costs. Prognostic factors associated with increased mean total monthly costs in multivariate regression analysis included low platelet counts (P = 0·01) and worsening performance status (P < 0·001). Mean total monthly costs of bortezomib- and lenalidomide-based regimens were significantly higher than those for thalidomide-based regimens in second, third and fourth treatment line. What is new and conclusions: Real-world costs during treatment of relapsed/refractory multiple myeloma vary greatly. Cost drivers include hospital admissions and acquisition costs of novel agents. Costs also vary by prognostic factors and treatment-related resource use. Future studies assessing the costs of combination therapy consisting of two or more novel agents are encouraged.

Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries (Article)

2013-01-31T00:00:00Z

Objectives: The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. Methods: National or regional databases were used to identify childbirth cases. DRG grouping algorithms and indicators of resource consumption were compared for those DRGs which account for at least 1% of all childbirth cases in the respective database. Five standardized case vignettes were defined and quasi prices (i.e. administrative prices or tariffs) of hospital deliveries according to national DRG-based hospital payment systems were ascertained. Results: European DRG systems classify childbirth cases according to different sets of variables (between one and eight variables) into diverging numbers of DRGs (between three and eight DRGs). The most complex DRG is valued 3.5 times more resource intensive than an index case in Ireland but only 1.1 times more resource intensive than an index case in The Netherlands. Comparisons of quasi prices for the vignettes show that hypothetical payments for the most complex case amount to only €479 in Poland but to €5532 in Ireland. Conclusions: Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement.

Knee replacement and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries (Article)

2013-01-17T00:00:00Z

Purpose: Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis-Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems. Methods: National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi-prices according to national DRG-based hospital payment systems ascertained. Results: Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi-prices for the most complex case vary between €4,920 in Estonia and €14,081 in Spain. Conclusions: Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries' DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs. Level of evidence: Retrospective comparative study, Level III.

Treatment costs for acute myocardial infarction in the Netherlands (Article)

2013-01-01T00:00:00Z

Background This study aimed to calculate the treatment costs of acute myocardial infarction (AMI) in the Netherlands for 2012. Also, the degree of association between treatment costs of AMI and some patient and hospital characteristics was examined. Methods For this retrospective cost analysis, patients were drawn from the database of the Diagnosis Treatment Combination (Diagnose Behandeling Combinatie, DBC) casemix system, which contains data on the resource use of all hospitalisations in the Netherlands. All costs were based on Euro 2012 cost data. Results The analysis was based on data of 25,657 patients. Mean treatment costs were estimated at € 5021, with significant cost increases for patients with percutaneous coronary intervention (PCI) treatment. ST-segment elevation myocardial infarction (STEMI) patients receiving thrombolysis incurred the lowest (€ 4286), while non-STEMI patients receiving PCI the highest costs (€ 6060). Length of stay and hospital type were strong predictors of treatment costs. Conclusions This study is the most extensive cost assessment of the treatment costs of AMI in the Netherlands thus far. Our results may be used as input for health-economic models and economic evaluations to support the decision making of registration, reimbursement and pricing of interventions in healthcare.

Explaining length of stay variation of episodes of care in the Netherlands (Article)

2012-10-22T00:00:00Z

Objectives: Diagnosis Related Group (DRG) systems aim to classify patients into mutually exclusive groups of patients, with the patients in each group having the same expected length of stay (LOS). We examined the ability of current classification variables to explain LOS variation between DRG-like Diagnosis Treatment Combination (DBC)s for ten episodes of care in the Netherlands, including breast cancer, stroke and inguinal hernia repair. Additionally, we assessed the predictive ability of some other classification variables. Methods: For each episode of care, the relevant DBC codes of all hospitalizations in 2008 were identified and all available determinants that may serve as classification variables were acquired from the national database. Ordinary least squares regression was used to examine the predictive ability of these classification variables. Results: The current classification variables are not sufficiently distinct to classify patients into mutually exclusive groups of patients. ICU admissions and hospital type may serve as valuable classification variables. Additionally, episode-specific variables may improve the Dutch grouping algorithm. Conclusions: Although it may not be feasible in the short term, grouping algorithms would benefit greatly from the introduction of classification variables tailored to the needs of specific episodes of care. A first step would be to focus on 'general' classification variables meaningful for specific episodes of care.

The economic costs of disease related malnutrition (Article)

2012-07-11T00:00:00Z

Background & aims: Disease related malnutrition (under-nutrition caused by illness) is a worldwide problem in all health care settings with potentially serious consequences on a physical as well as a psycho-social level. In the European Union countries about 20 million patients are affected by disease related malnutrition, costing EU governments up to € 120 billion annually. The aim of this study is to calculate the total additional costs of disease related malnutrition in The Netherlands. Methods: A cost-of-illness analysis was used to calculate the additional total costs of disease related malnutrition in adults (>18 years of age) for The Netherlands in 2011 in the hospital, nursing- and residential home and home care setting, expressed as an absolute monetary value as well as a percentage of the total Dutch national health expenditure and as a percentage of the total costs of the studied health care sectors in The Netherlands. Results: The total additional costs of managing adult patients with disease related malnutrition were estimated to be € 1.9 billion in 2011 which equals 2.1% of the total Dutch national health expenditure and 4.9% of the total costs of the health care sectors analyzed in this study. Conclusions: The results of this study show that the additional costs of disease related malnutrition in adults in The Netherlands are considerable.

Doelmatigheidsonderzoek in de jeugd-GGZ: op weg naar volwassenheid (Article)

2012-01-01T00:00:00Z

Psychische problemen bij kinderen van 0 tot 19 jaar vormen een belangrijk maatschappelijk probleem. Wanneer deze problemen leiden tot crimineel gedrag, staat deze problematiek nog hoger op de politieke agenda. De afgelopen jaren is in de jeugd-GGZ gewerkt aan verbetering van de zorg. Dit heeft erin geresulteerd dat de jeugd-GGZ meer en sneller zorg is gaan bieden tegen minder kosten. In 2009 werden 270.000 kinderen en hun ouders behandeld; circa 15% meer dan in 2007. De wachttijd nam af met 10% en de kosten van zorg per kind daalden jaarlijks met 1 à 2% (GGZ Nederland, 2011). Geen reden om achterover te leunen. Integendeel, er liggen nog tal van uitdagingen. In een tijd van bezuinigingen is het van groot belang dat wordt aangetoond wat de jeugd-GGZ betekent voor de samenleving en hoe er in de sector efficiënter gewerkt kan worden. Op dit moment voorziet de jeugd-GGZ twee derde van de kinderen die geestelijke gezondheidszorg behoeven, van zorg. Nog niet alle kinderen en ouders krijgen de juiste zorg in de juiste vorm en op het juiste moment (GGZ Nederland, 2011). Onderzoek naar doelmatig-heid kan helpen de kwaliteit en de kosteneffectiviteit van de jeugd-GGZ verder te verbeteren. Bij doelmatigheid draait het om de balans tussen kosten (menskracht, geld) en opbrengsten (gezondheidsverbetering, kwaliteit van leven, maatschappelijke besparingen). Doelmatigheid kan ook worden aangeduid als kosteneffectiviteit. Doelmatigheidsonderzoek binnen de jeugd-GGZ staat momenteel echter nog in de kinderschoenen. In dit artikel lichten we toe waarom en op welke manier meer doelmatigheidsonderzoek binnen deze sector gewenst is.

Handleiding voor kostenonderzoek methoden en referentieprijzen voor economische evaluaties in de gezondheidszorg (Article)

2012-01-01T00:00:00Z

Het doel van de kostenhandleiding is het verschaffen van een instrument dat onderzoekers en beleidsmakers faciliteert bij de uitvoering en beoordeling van kostenonderzoek in economische evaluaties. In dit artikel wordt de kern van de kostenhandleiding 2010 beschreven en in een internationale context geplaatst aan de hand van het stappenplan voor kostenonderzoek. In dit stappenplan wordt het berekenen van kosten gezien als een proces waarbij zeven stappen chronologisch doorlopen worden. Waar duidelijke aanbevelingen worden gedaan voor de bepaling van de reikwijdte van de economische evaluatie (stap 1), de keuze van de kostencategoriee¨n (stap 2), omgaan met onzekerheid (stap 6) en rapportage van kosten (stap 7), wordt de keuze met betrekking tot de identificatie (stap 3), volumemeting (stap 4) en waardering van eenheden (stap 5) neergelegd bij de onderzoeker. Hoewel de aanbevelingen in Nederland op specifieke onderwerpen iets afwijkt van andere Westerse landen, is het stappenplan voor kostenonderzoek vergelijkbaar met het proces dat beschreven wordt in de internationale richtlijnen. De kostenhandleiding sluit aan bij de uitgangspunten en de terminologie uit de Nederlandse richtlijnen voor farmaco-economisch onderzoek, maar de beschreven methoden kunnen ook in andere soorten onderzoek worden gebruikt.

A microcosting study of microsurgery, LINAC radiosurgery, and gamma knife radiosurgery in meningioma patients (Article)

2011-01-01T00:00:00Z

The aim of the present study is to determine and compare initial treatment costs of microsurgery, linear accelerator (LINAC) radiosurgery, and gamma knife radiosurgery in meningioma patients. Additionally, the follow-up costs in the first year after initial treatment were assessed. Cost analyses were performed at two neurosurgical departments in The Netherlands from the healthcare providers' perspective. A total of 59 patients were included, of whom 18 underwent microsurgery, 15 underwent LINAC radiosurgery, and 26 underwent gamma knife radiosurgery. A standardized microcosting methodology was employed to ensure that the identified cost differences would reflect only actual cost differences. Initial treatment costs, using equipment costs per fraction, were €12,288 for microsurgery, €1,547 for LINAC radiosurgery, and €2,412 for gamma knife radiosurgery. Higher initial treatment costs for microsurgery were predominantly due to inpatient stay (€5,321) and indirect costs (€4,350). LINAC and gamma knife radiosurgery were equally expensive when equipment was valued per treatment (€2,198 and €2,412, respectively). Follow-up costs were slightly, but not significantly, higher for microsurgery compared with LINAC and gamma knife radiosurgery. Even though initial treatment costs were over five times higher for microsurgery compared with both radiosurgical treatments, our study gives indications that the relative cost difference may decrease when follow-up costs occurring during the first year after initial treatment are incorporated. This reinforces the need to consider follow-up costs after initial treatment when examining the relative costs of alternative treatments.

Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands (Article)

2010-11-01T00:00:00Z

Introduction: Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the intensive care unit (ICU), using a modelling approach. Methods: A Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from one state to another were derived from UltiSAFE, a Dutch clinical study involving ICU patients with an expected MV-time of 2-3 days requiring analgesia and sedation. Study medication was either: CS (morphine or fentanyl combined with propofol, midazolam or lorazepam) or: RS (remifentanil, combined with propofol when required). Study drug costs were derived from the trial, whereas all other ICU costs were estimated separately in a Dutch micro-costing study. All costs were measured from the hospital perspective (price level of 2006). Patients were followed in the model for 28 days. We also studied the sub-population where weaning had started within 72 hours. Results: The average total 28-day costs were 15,626 euros with RS versus 17,100 euros with CS, meaning a difference in costs of 1474 euros (95% CI -2163, 5110). The average length-of-stay (LOS) in the ICU was 7.6 days in the RS group versus 8.5 days in the CS group (difference 1.0, 95% CI -0.7, 2.6), while the average MV time was 5.0 days for RS versus 6.0 days for CS. Similar differences were found in the subgroup analysis. Conclusions: Compared to CS, RS significantly decreases the overall costs in the ICU.

Cost-utility of exercise therapy in adolescents and young adults suffering from the patellofemoral pain syndrome (Article)

2010-08-01T00:00:00Z

The objective of this paper was to determine the cost effectiveness of exercise therapy (intervention group) compared with " usual care" (control group) in adolescents and young adults with the patellofemoral pain syndrome in primary care. This multicenter prospective randomized clinical trial with cost-utility analysis was conducted at 38 general practices and three sport medical advice centers in the Netherlands for 2007. A total of 131 patients were included. The annual direct medical costs per patient were significantly higher for the intervention group (€434) compared with the control group (€299) mainly caused by additional physiotherapy visits. The average annual societal costs per patient were significantly lower in the intervention group (€1011 vs €1.166). Productivity costs were the largest cost component, in particular costs due to reduced efficiency at paid work which were responsible for 47% and 56% of the total costs in the intervention and control group respectively. Patients in the intervention group experienced a slightly, but not significantly, higher quality of life (0.8722 vs 0.8617). With a cost effectiveness ratio of -€14 738 per quality adjusted life year, exercise therapy appears to be cost effective as compared with " usual care."

Microcosting in economic evaluations: Issues of accuracy, feasibility, consistency and generalisability (Doctoral Thesis)

2009-11-27T00:00:00Z

Omdat de diversiteit aan medische behandelingen in de afgelopen decennia enorm is gegroeid, staan de zorgbudgetten in Westerse landen voortdurend onder druk. De beslissing om bronnen voor een doeleinde aan te wenden in plaats van aan een ander doeleinde moet dus gestruktureerd worden afwogen. Deze afweging wordt doorgaans gemaakt met behulp van economische evaluaties die zowel de kosten als effecten van alternatieve medische behandelingen schatten. Hoewel de effecten van medische behandelingen minstens zo belangrijk zijn, stonden in mijn proefschrift de kosten centraal. De doelstelling was de kosten van specifieke medische behandelingen te schatten en algemene methodologische conclusies te trekken wat betreft de toepassing van drie kostenmethoden. De methoden werden toegepast in een verscheidenheid aan medische specialismen, waaronder oncologie, hematologie, intensive care medicine, tandheelkunde, huisartsgeneeskunde, cardiologie en neurochirurgie. Er bestaat nog geen consensus over de methode van voorkeur voor de kostenschatting van behandelingen. De ‘bottom up microcosting’ methode wordt over het algemeen verondersteld de meest nauwkeurige kostenschatting te geven, omdat kosten worden berekend per individuele patiënt en per individuele kostencomponent. De methode wordt echter niet op grote schaal toegepast omdat zij vanwege haar tijdsintensieve karakter nauwelijks haalbaar is. Omgekeerd wordt de ‘gross costing’ methode vanwege haar haalbaarheid het meest toegepast. ‘Gross costing’ kostenschattingen zijn echter zeer onnauwkeurig omdat kosten niet toe te wijzen zijn aan individuele patiënten of individuele kostencomponenten. De ‘top down microcosting’ methode bepaalt kosten weliswaar niet per individuele patiënt, maar wel per individuele kostencomponent. Uit mijn onderzoek is gebleken dat ‘top down microcosting’ kostenschattingen redelijk nauwkeurig zijn vergeleken met ‘bottom up microcosting’ kostenschattingen en dat de ‘top down microcosting’ methode redelijk haalbaar is vergeleken met de ‘gross costing’ methode. Daarnaast bleken ‘top down microcosting’ kostenschattingen consistent en generaliseerbaar te zijn. De conclusie van mijn proefschift is daarom dat ‘top down microcosting’ de methode van voorkeur zou moeten zijn voor de kostenschatting van medische behandelingen.

A microcosting study of diagnostic tests for the detection of coronary artery disease in the Netherlands (Article)

2009-10-01T00:00:00Z

Objective: The primary aim of the present study was to calculate the actual costs of four diagnostic tests for the detection of coronary artery disease in the Netherlands using a microcosting methodology. As a secondary objective, the cost effectiveness of eight diagnostic strategies was examined, using microcosting and reimbursement fees subsequently as the cost estimate. Design: A multicenter, retrospective cost analysis from a hospital perspective. Setting: The study was conducted in three general hospitals in the Netherlands for 2006. Interventions: Exercise electrocardiography (exECG), stress echocardiography (sECHO), single-photon emission computed tomography (SPECT) and coronary angiography (CA). Results: The actual costs of exECG, sECHO, SPECT and CA were €33, 216, 614 and 1300 respectively. For all diagnostic tests, labour and indirect cost components (overheads and capital) together accounted for over 75% of the total costs. Consumables played a relatively important role in SPECT (14%). Hotel and nutrition were only applicable to SPECT and CA. Diagnostic services were solely performed for CA, but their costs were negligible (2%). Using microcosting estimates, exECG-sECHO-SPECT-CA was the most and CA the least cost effective strategy (€397 and 1302 per accurately diagnosed patient). Using reimbursement fees, exECG-sECHO-CA was most and SPECT-CA least cost effective (€147 and 567 per accurately diagnosed patient). Conclusions: The use of microcosting estimates instead of reimbursement fees led to different conclusions regarding the relative cost effectiveness of alternative strategies.

Comparing methodologies for the allocation of overhead and capital costs to hospital services (Article)

2009-06-01T00:00:00Z

BACKGROUND: Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. OBJECTIVE: To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. METHODS: The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. RESULTS: Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. CONCLUSIONS: Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

Comparing methodologies for the cost estimation of hospital services (Article)

2009-02-01T00:00:00Z

The aim of the study was to determine whether the total cost estimate of a hospital service remains reliable when the cost components of bottom-up microcosting were replaced by the cost components of top-down microcosting or gross costing. Total cost estimates were determined in representative general hospitals in the Netherlands for appendectomy, normal delivery, stroke and acute myocardial infarction for 2005. It was concluded that restricting the use of bottom-up microcosting to those cost components that have a great impact on the total costs (i.e., labour and inpatient stay) would likely result in reliable cost estimates.

Review of a large clinical series: A microcosting study of intensive care unit stay in the Netherlands (Article)

2008-07-01T00:00:00Z

The primary objective of this study was to estimate the actual daily costs of intensive care unit stay using a microcosting methodology. As a secondary objective, the degree of association between daily intensive care unit costs and some patient characteristics was examined. This multicenter, retrospective cost analysis was conducted in the medical-surgical adult intensive care units of 1 university and 2 general hospitals in the Netherlands for 2006, from a hospital perspective. A total of 576 adult patients were included, consuming a total of 2868 nursing days. The mean total costs per intensive care unit day were 1911, with labour (33%) and indirect costs (33%) as the most important cost drivers. An ordinary least squares analysis including age, Nine Equivalent of Nursing Manpower Use score/Therapeutic Intervention Scoring System score, mechanical ventilation, blood products, and renal replacement therapy was able to predict 50% of the daily intensive care unit costs.

Costs and prices of single dental fillings in Europe: A micro-costing study (Article)

2008-01-01T00:00:00Z

Dental fillings represent an established procedure to treat tooth decay. The present paper provides a cost comparison of dental filling procedures across nine European countries. More specifically, the paper aims to estimate the costs and prices (i.e. reimbursement fees) of a single dental filling procedure in an approximately 12-year-old child with a toothache in a lower molar who presents at a dental practice, as described in a case vignette. Both amalgam and composite fillings were examined. Total costs were determined by identifying resource use and unit costs for the following cost components: diagnostic procedures, labour, materials, drugs, and overheads. Altogether, 49 practices provided data for the cost calculations. Mean total costs per country varied considerably, ranging from €8 to €156. Labour costs were the most important cost driver in all practices, comprising 58% of total costs. Overhead costs were the second-most important cost component in the majority of countries. Actual cost differences across practices within countries were relatively small. Cost variations between countries were primarily due to differences in unit costs, especially for labour and overheads, and only to a lesser extent to differences in resource use. Finally, cost estimates for a single dental filling procedure based on reimbursement fees led to an underestimation of the total costs by approximately 50%. Copyright

Stem cell transplantation in Europe: Trends and prospects (Article)

2007-11-01T00:00:00Z

The aim of the present study was to identify trends in numbers of European patients treated with autologous and allogeneic haematopoietic stem cell transplantation (HSCT) as well as to provide anticipated transplant rates for the upcoming years. The following indications were considered: haematological malignancies (acute leukaemias, myeloproliferative disorders, lymphoproliferative disorders and multiple myeloma), solid tumours and non-malignant diseases. Numbers of patients treated from 1990 to 2004 were extracted from the European Group for Blood and Marrow Transplantation database, extrapolated to 2012 using mathematic models and adjusted to the literature study and expert opinion. In Europe, a 13% raise in HSCT utilisation is to be expected from 2005 to 2010, mostly due to the growing application of reduced-intensity conditioning regimens followed by allogeneic HSCT. Growing transplant rates are likely to exert health expenditure budgets and put pressure on health care providers and health insurers in Europe. Therefore, the rapid expansion would ideally imply a simultaneous increase in HSCT budgets.

Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD) (Article)

2007-08-01T00:00:00Z

Background: The impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown. Objective: The aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers. Study design: We selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD. For comparison's sake, we also included a non-matched group of 35 children with behaviour problems and 60 children with no behaviour problem from a large school population-based study on the detection of ADHD. We collected information on the health care utilisation of the children applying the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness' (TiC-P). Their health related quality of life was collected by using the Dutch 50-item parent version of the Child Health Questionnaire (CHQ PF-50). Measurements were at baseline and at 6 months. Subsequently, we collected data on the health utilisation of the mothers and their production losses due to absence from work and reduced efficiency. Results: The mean direct medical costs per ADHD patient per year were €2040 or €1173 when leaving out one patient with a long-term hospital admission, compared to €288 for the group of children with behaviour problems and €177 for the group of children with no behaviour problems. The direct medical costs for children who had psychiatric co-morbidities were significantly higher compared to children with ADHD alone. The mean medical costs per year for the mothers of the ADHD patients were significantly higher than for the mothers of the children with behaviour problems and the mothers of children with no behaviour problems respectively €728, €202 and €154. The physical summary score showed no significant differences between the groups. However, the score on the Psychosocial Summary Score dimension was significantly lower for ADHD patients compared to the scores of the children in the two other samples. The mean annual indirect costs due to absence from work and reduced efficiency at work were €2243 for the mothers of the ADHD patients compared to €408 for the mothers of children with behaviour problems and €674 for the mothers of children with no behaviour problems. Conclusion: Our study showed that the direct medical costs of ADHD patients were relatively high. Additionally, our study indicated that ADHD appears to be accompanied by higher (mental) health care costs for the mothers of ADHD patients and by increased indirect costs for this group.