http://repub.eur.nl/res/aut/4000/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/31997/ 2012-01-01T00:00:00Z We assessed the feasibility of using a photographic foot imaging device (PFID) as a tele-monitoring tool in the home environment of patients with diabetes who were at high risk of ulceration. Images of the plantar foot were taken three times a week over a period of four months in the home of 22 high-risk patients. The images were remotely assessed by a diabetic foot specialist. At the end of the study, 12% of images were missing, mainly due to modem or server failures (66%), or non-adherence (11%). All three referrals for diagnosed ulcers and 31 of 32 referrals for abundant callus resulted in treatment. Health-related quality of life (EQ-5D visual analogue scale), increased from 7.5 at baseline to 7.9 at end of follow-up, but not significantly. Mean scores on a visual analogue scale for different usability domains (independence, ease of use, technical aspects and value) ranged from seven to nine. The study demonstrates the feasibility of using the PFID for the early diagnosis of foot disease, which may prevent complications in high-risk patients with diabetes. http://repub.eur.nl/res/pub/38175/ 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. http://repub.eur.nl/res/pub/26676/ 2011-07-01T00:00:00Z Although persistent developmental stuttering is known to affect daily living, just how great the impact is remains unclear. Furthermore, little is known about the underlying mechanisms which lead to a diminished quality of life (QoL). The primary objective of this study is to explore to what extent QoL is impaired in adults who stutter (AWS). In addition, this study aims to identify determinants of QoL in AWS by testing relationships between stuttering severity, coping, functioning and QoL and by testing for differences in variable scores between two AWS subgroups: receiving therapy versus not receiving therapy. A total of 91 AWS filled in several questionnaires to assess their stuttering severity, daily functioning, coping style and QoL. The QoL instruments used were the Health Utility Index 3 (HUI3) and the EuroQoL EQ-5D and EQ-VAS. The results indicated that moderate to severe stuttering has a negative impact on overall quality of life; HUI3 derived QoL values varied from .91 (for mild stuttering) to .73 (for severe stuttering). The domains of functioning that were predominantly affected were the individual's speech, emotion, cognition and pain as measured by the HUI3 and daily activities and anxiety/depression as measured by the EQ-5D. AWS in the therapy group rated their stuttering as more severe and recorded more problems on the HUI3 speech domain than AWS in the non-therapy group. The EQ-VAS was the only instrument that showed a significant difference in overall QoL between groups. Finally, it was found that the relationship between stuttering severity and QoL was influenced by the individual's coping style (emotion-oriented and task-oriented). These findings highlight the need for further research into stuttering in relation to QoL, and for a broader perspective on the diagnosis and treatment of stuttering, which would take into consideration quality of life and its determinants.Learning outcomes: Readers will be able to: (1) Understand how the Wilson and Cleary (1995) model of quality of life could be applied to comprehensively assess the quality of life in adults who stutter, (2) describe how health related quality of life is impaired in adults who stutter, (3) mention affected domains of functioning that are related to health related quality of life impairment in adults who stutter, (4) describe the relationship between stuttering severity, functioning, coping and health related quality of life in adults who stutter, (5) describe differences in stuttering severity, coping style, functioning and health related quality of life between adults who stutter who have registered for therapy and adults who stutter who have not. http://repub.eur.nl/res/pub/22912/ 2011-01-01T00:00:00Z Abstract: Although persistent developmental stuttering is known to affect daily living, just how great the impact is remains unclear. Furthermore, little is known about the underlying mechanisms which lead to a diminished quality of life (QoL). The primary objective of this study is to explore to what extent QoL is impaired in adults who stutter (AWS). In addition, this study aims to identify determinants of QoL in AWS by testing relationships between stuttering severity, coping, functioning and QoL and by testing for differences in variable scores between two AWS subgroups: receiving therapy versus not receiving therapy. A total of 91 AWS filled in several questionnaires to assess their stuttering severity, daily functioning, coping style and QoL. The QoL instruments used were the Health Utility Index 3 (HUI3) and the EuroQoL EQ-5D and EQ-VAS. The results indicated that moderate to severe stuttering has a negative impact on overall quality of life; HUI3 derived QoL values varied from .91 (for mild stuttering) to .73 (for severe stuttering). The domains of functioning that were predominantly affected were the individual’s speech, emotion, cognition and pain as measured by the HUI3 and daily activities and anxiety/depression as measured by the EQ-5D. AWS in the therapy group rated their stuttering as more severe and recorded more problems on the HUI3 speech domain than AWS in the non-therapy group. The EQ-VAS was the only instrument that showed a significant difference in overall QoL between groups. Finally, it was found that the relationship between stuttering severity and QoL was influenced by the individual’s coping style (emotion-oriented and task-oriented). These findings highlight the need for further research into stuttering in relation to QoL, and for a broader perspective on the diagnosis and treatment of stuttering, which would take into consideration quality of life and its determinants. http://repub.eur.nl/res/pub/39836/ 2011-01-01T00:00:00Z During the last decade the management of CLL was subject to progressive changes in diagnostic and prognostic procedures as well as the development of new alternative treatments. The aim of this study was to assess management, costs, quality of life and survival of CLL patients in daily practice. This information is becoming more important for reimbursement decsions, as new expensive drugs are only reimbursed when the incremental cost-effectiveness ratio lies within existing thresholds. Cost-effectiveness ratios are preferably calculated both in daily practice (or real world) setting and a clinical trial setting. http://repub.eur.nl/res/pub/25004/ 2009-08-03T00:00:00Z Objective: The study aim was to assess costs of haematological adverse events (AE) related to pharmacologic treatment of chronic myeloid leukaemia (CML) patients. Methods: This was a retrospective cohort study using patient records of adults (n=91) with chronic-phase CML treated at a single university medical centre in the Netherlands. Occurrence of grade III/IV haematological AEs, defined according to CTC-NCI guidelines criteria, was derived from the laboratory registration. Mean age at time of diagnosis was 48 years; 56% male. A healthcare perspective was adopted. Cost estimates are presented in 2006 euros. Results: Average cost of an episode of anaemia was €1,572, of thrombocytopenia €2,955, and of neutropenia €1,152. The mean cost of febrile neutropenia amounted to €2,462. Conclusions: Treatment costs of AEs varied considerably. However, apart from the cost of anaemia, the results presented seem to be in line with information from the international literature. The key limitations of the study concern the relatively small cohort of patients at a single centre, the retrospective design and the various treatment regimens of CML during the follow-up. http://repub.eur.nl/res/pub/14189/ 2008-11-28T00:00:00Z Objective. To assess productivity losses due to absence from work during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment and to describe the pattern of IVF-related absence from work. Additionally, the influence of general and psychological variables on IVF-related absence from work was analyzed. Design. Prospective cohort study. Setting. Eight IVF hospitals participated in the study. Sample. Women undergoing their first treatment with IVF/ICSI. Methods. The Health and Labour Questionnaire (HLQ) was used to estimate the costs of IVF-related absence from work (n=384). Diaries were used to collect background information and reasons for IVF-related absence. Psychological data were derived using the Spielberger State and Trait Anxiety Inventory (STAI), the Beck Depression Inventory for Primary Care (BDI-PC) and the Inventory Social Relations and the Illness Cognition Questionnaire. Regression analyses were performed using two models, one without and one with psychological data, to assess the impact of the different variables on IVF-related absence from work. Main outcome measure. IVF-related absence from work and the costs of productivity losses due to IVF/ICSI per treatment. Results. Overall absence from work during IVF/ICSI treatment was on average 33 hours, of which 23 hours were attributed to IVF/ICSI. Costs of productivity losses due to IVF/ICSI were €596 per woman. Significant predictors of IVF-related absence from work were the number of hours of paid work, age and self-reported physical and/or emotional problems due to IFV treatment. Conclusions. Women experiencing emotional complaints and women with physical complaints due to IVF/ICSI reported significantly more IVF-related absence from work. http://repub.eur.nl/res/pub/29821/ 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. http://repub.eur.nl/res/pub/28825/ 2008-02-01T00:00:00Z Objective: To provide detailed information about costs of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment stages and to estimate the cost per IVF and ICSI treatment cycle and ongoing pregnancy. Design: Descriptive micro-costing study. Setting: Four Dutch IVF centers. Patient(s): Women undergoing their first treatment cycle with IVF or ICSI. Intervention(s): IVF or ICSI. Main Outcome Measure(s): Costs per treatment stage, per cycle started, and for ongoing pregnancy. Result(s): Average costs of IVF and ICSI hormonal stimulation were €1630 and €1585; the costs of oocyte retrieval were €500 and €725, respectively. The cost of embryo transfer was €185. Costs per IVF and ICSI cycle started were €2381 and €2578, respectively. Costs per ongoing pregnancy were €10,482 and €10,036, respectively. Conclusion(s): Hormonal stimulation covered the main part of the costs per cycle (on average 68% and 61% for IVF and ICSI, respectively) due to the relatively high cost of medication. The costs of medication increased with increasing age of the women, irrespective of the type of treatment (IVF or ICSI). Fertilization costs (IVF laboratory) constituted 12% and 20% of the total costs of IVF and ICSI. The total cost per ICSI cycle was 8.3% higher than IVF. http://repub.eur.nl/res/pub/35911/ 2007-09-01T00:00:00Z Background: The Dutch IVF guideline suggests triage of patients for IVF based on diagnostic category, duration of infertility and female age. There is no evidence for the effectiveness of these criteria. We evaluated the predictive value of patient characteristics that are used in the Dutch IVF guideline and developed a model that predicts the IVF ongoing pregnancy chance within 12 months. Methods: In a national prospective cohort study, pregnancy chances after IVF and ICSI treatment were assessed. Couples eligible for IVF or ICSI were followed during 12 months, using the databases of 11 IVF centres and 20 transport IVF clinics. Kaplan-Meier analysis was performed to estimate the cumulative probability of an ongoing pregnancy, and Cox regression was used for assessing the effects of predictors of pregnancy. Results: 4928 couples starting IVF/ICSI treatment were prospectively followed. On average, couples had 1.8 cycles in 12 months for both IVF and ICSI. The 1-year probability of ongoing pregnancy was 44.8% (95% CI 42.1-47.5%). ICSI for severe oligospermia had a significantly higher ongoing pregnancy rate than IVF indicated treatments, with a multivariate Hazard ratio (HR) of 1.22 (95% CI 1.07-1.39). The success rates were comparable for all diagnostic categories of IVF. The highest success rate is at age 30, with a slight decline towards younger women and women up to 35 and a sharp drop after 35. Primary subfertility with a HR of 0.90 (95% CI 0.83-0.99) and duration of subfertility with a HR of 0.97 (95% CI 0.95-0.99) per year significantly affected the pregnancy chance. Conclusions: The most important predictors of the pregnancy chance after IVF and ICSI are women's age and ICSI. The diagnostic category is of no consequence. Duration of subfertility and pregnancy history are of limited prognostic value. http://repub.eur.nl/res/pub/36605/ 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. http://repub.eur.nl/res/pub/1339/ 2002-01-01T00:00:00Z In dit rapport wordt verslag gedaan van de bruikbaarheid en toepasbaarheid van het kwaliteitskostenmodel in de praktijk. Het verslag bestaat uit 2 delen: 1) Externe verslagen over het verloop en de resultaten binnen de kwaliteitsprojecten in de zorginstellingen door de projectteams. 2) Een procesevaluatie met name gericht op de toepassing en het gebruik van kwaliteitskosten bij de uitvoering van de kwaliteitsprojecten. Algemeen blijkt het kwaliteitskostenmodel in de praktijk uitvoerbaar: met behulp van kwaliteitskosteninformatie kunnen knelpunten binnen het zorgproces aangewezen worden en kunnen prioriteiten voor verbetering worden gesteld. De toepasbaarheid van de kwaliteitskosteninformatie voor de besluitvorming binnen de kwaliteitsprojecten is nog beperkt. Hierbij spelen zowel een aantal interne als externe factoren een rol die belemmerend werken: 1) Betrokkenen zijn niet kosten-minded ingesteld, waardoor terughoudend wordt omgegaan met kostenargumenten. 2) Kostenargumenten als zodanig blijken niet direct bruikbaar als motiverend argument om draagvlak te krijgen voor kwaliteitsverbeteringen. 3) Het ontbreekt binnen de zorginstellingen veelal aan een ‘outcome’-gerichtheid die de basis vormt van de werking van het kwaliteitskostenmodel. 4) De huidige Functiegerichte Budgettering biedt weinig prikkels om vermijdbare kosten binnen het zorgproces te doen dalen of om te komen tot omzetvergroting. In het algemeen gaat de aandacht vooral uit naar mogelijkheden voor financiële besparingen (beïnvloeding op geldstromen). De mogelijke economische besparingen vragen om topdown ondersteuning en sturing vanuit het management. Daarnaast vraagt de toepassing van de methode expertise om consequenties van financiële en economische kosten in te passen in beleidsbeslissingen binnen de zorginstellingen. http://repub.eur.nl/res/pub/1317/ 2000-01-01T00:00:00Z Doelstelling: In het Sophia Kinderziekenhuis is onderzoek verricht ter optimalisering van het geneesmiddelendistributiesysteem. De geneesmiddelendistributie verloopt momenteel op sommige afdelingen via verpleegkundigen en op andere via apothekersassistenten in depotheken. Methoden: De beoordeling van beide distributiesystemen vond plaats aan de hand van de kwaliteitsindicatoren klantgerichtheid, effectiviteit en doelmatigheid. De klantgerichtheid is in kaart gebracht met behulp van interviews. Het vóórkomen van distributiefouten en microbiologische contaminatie zijn beschouwd als effectiviteitsmaten. De doelmatigheid is bepaald met een rekenmodel waarbij het geneesmiddelengebruik is gemeten en tijdmetingen en kostenberekeningen zijn uitgevoerd. Met behulp van het rekenmodel is een aantal alternatieve distributievormen doorgerekend. Resultaten: De geneesmiddeldistributie via depotheken is de meest optimale distributievorm binnen het kinderziekenhuis. De geneesmiddelenbereiding door apothekersassistenten komt tegemoet aan de toenemende complexiteit van medicatiebehoeften in een academisch kinderziekenhuis. Bij het bereiden treedt minder contaminatie op. Bovendien blijkt de depotheek het doelmatigste distributiesysteem te zijn. De nadelen van het systeem van depotheken in de huidige vorm betreffen voornamelijk de inefficiëntie van het registratiesysteem. Daarnaast vindt te weinig sturing plaats op integratie met het primaire proces. Discussie: Automatisering zal de inefficiëntie van het administratieve deel binnen het distributietraject via depotheken grotendeels wegnemen. Daarnaast wordt het management geadviseerd om aandacht te besteden aan meer afstemming met het primaire proces. Op langere termijn verdient uitbreiding van het depotheeksysteem de voorkeur, waarbij rekening zal moeten worden gehouden met zekere randvoorwaarden (bijvoorbeeld omtrent ruimten en ARBO-eisen). Het rekenmodel is onder bepaalde voorwaarden geschikt om ook buiten het Sophia te worden toegepast.