http://repub.eur.nl/res/aut/3677/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/31865/ 2003-11-20T00:00:00Z Cost-effectiveness analysis (CEA) provides one means by which decision-makers may assess and potentially improve the performance of health systems. The process can help to ensure that resources devoted to health systems are achieving the maximum possible benefit in terms of outcomes that people value. Over the past three decades there has been an exponential growth in the number of economic appraisals performed in health. Following standard textbooks on economic evaluations, most of these CEA studies pursue an incremental approach which requires comparison of the additional costs of an intervention over current practice with additional health benefits. Such an incremental approach, however, is unable to provide policy makers with all necessary information relating to decisions like: "Do the resources currently devoted to health achieve as much as they could?", or "How best to use additional resources if they become available?". This thesis proposes a broader sectoral approach via the application of a generalized CEA framework which also al!ows examination of existing inefficiencies in the health system- that is, the wide variations in CE ratios observed among interventions that are currently in use suggest there is considerable room to improve efficiency by moving from inefficient interventions currently in use to efficient interventions that are under-utilised. In developing countries in particular reallocation of scarce financial resources is most important. http://repub.eur.nl/res/pub/10314/ 2003-01-01T00:00:00Z BACKGROUND: This article presents cost-effectiveness analyses of the major diabetes interventions as formulated in the revised Dutch guidelines for diabetes type 2 patients in primary and secondary care. The analyses consider two types of care: diabetes control and the treatment of complications, each at current care level and according to the guidelines. METHODS: A validated probabilistic diabetes model describes diabetes and its complications over a lifetime in the Dutch population, computing quality-adjusted life years and medical costs. Effectiveness data and costs of diabetes interventions are from observational current care studies and intensive care experiments. Lifetime consequences of in total sixteen intervention mixes are compared with a baseline glycaemic control of 10% HBA1C. RESULTS: The interventions may reduce the cumulative incidence of blindness, lower-extremity amputation, and end-stage renal disease by >70% in primary care and >60% in secondary care. All primary care guidelines together add 0.8 quality-adjusted life years per lifetime. CONCLUSION: In case of few resources, treating complications according to guidelines yields the most health benefits. Current care of diabetes complications is inefficient. If there are sufficient resources, countries may implement all guidelines, also on diabetes control, and improve efficiency in diabetes care.