Koopmanschap, M.A.

The cost-effectiveness of periodic safety update reports for biologicals in Europe (Article)

2013-05-01T00:00:00Z

We analyzed the cost-effectiveness of all Periodic Safety Update Reports (PSURs) submitted for biologicals in Europe from 1995 to 2009 by comparing two regulatory scenarios: full regulation (PSUR reporting) and limited regulation (no PSUR reporting, but all other parts of the pharmacovigilance framework remain in place). During this period, PSUR reporting resulted in the detection of 2 out of a total of 24 urgent safety issues for biologicals: (i) distant spread of botulinum toxin and (ii) edema/fluid collection associated with off-label use of dibotermin-alfa. We used Markov-chain life tables to calculate costs and health effects of PSURs. The incremental cost-effectiveness ratio (ICER) of full regulation (PSUR reporting) vs. limited regulation (no PSUR reporting) for the base-case scenario was €342,110 per quality-adjusted life year (QALY) gained. It is possible to assess the cost-effectiveness of regulatory requirements using the same methods as those used in assessing the cost-effectiveness of medical interventions.

Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: A qualitative study (Article)

2013-01-25T00:00:00Z

Background: Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders' perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists.Methods: A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis.Results: Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents' narratives revealed that: the glaucoma specialists' sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU.Conclusions: Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a normal step in the professionalization of the substituting professionals is essential, as is implementing the task substitution within the window of opportunity.

Health expenditure growth: Looking beyond the average through decomposition of the full distribution (Article)

2013-01-01T00:00:00Z

Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects.

European drug reimbursement systems' legitimacy: Five-country comparison and policy tool (Article)

2012-10-01T00:00:00Z

Objectives. In a democratic system, decision makers are accountable for the reasonableness of their decisions. This presumes (i) transparency, (ii) relevance of the decision criteria, (iii) revisability of decisions, and (iv) enforcement/regulation. We aim to (i) evaluate the extent to which drug reimbursement decision-making processes in different contexts meet these conditions and (ii) develop, starting from these findings, a framework for improving the transparency and the relevance of used decision criteria. Methods. We evaluated the Austrian, Belgian, French, Dutch, and Swedish drug reimbursement systems. Based on this evaluation, we developed a framework for improving the transparency of drug reimbursement decision-making processes. It makes explicit the questions often addressed implicitly during decision-making processes as well as criteria for answering each question. Results. Transparency of appraisal processes varies across systems. Justification with explicit criteria is generally limited. Although relevant criteria are similar across systems, their operationalization varies and their role in the appraisal process is not always clear. All systems seem to implicitly address five key questions, relating to (i) the medical, therapeutic, and societal need for treatment; (ii) preparedness to pay for treating the condition as a principle and (iii) for using the treatment under consideration; (iv) preparedness to pay more compared with alternatives; and (v) actual willingness to pay from public resources. Conclusions. Transparency of the appraisal process can be improved by using an explicit decision framework. Systematic use of such a framework enhances consistency across decisions, allows justification of value judgments, and thus enhances legitimacy of societal decision making.

Similarities and differences between five European drug reimbursement systems (Article)

2012-10-01T00:00:00Z

Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations. Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant stakeholders. Results: All systems aim to balance three main objectives: system sustainability, equity and quality of care. System impact, however, is mainly assessed by drug expenditure. A national reimbursement agency evaluates reimbursement requests on a case-by-case basis. The minister has discretionary power to alter the reimbursement advice in Belgium, France, and the Netherlands. All systems make efforts to increase transparency in the decision-making process but none uses formal hierarchical reimbursement criteria nor applies a cost-effectiveness threshold value. Policies to deal with uncertainty vary: financial risk-sharing by price/volume contracts (France, Belgium) versus coverage with evidence development (Sweden, the Netherlands). Although case-by-case revisions are embedded in some systems for specific groups of drugs, systematic (group) revisions are limited. Conclusions: As shared strengths, all systems have clear objectives reflected in reimbursement criteria and all are prepared to pay for drugs with sufficient added value. However, all systems could improve the transparency of the decision-making process; especially appraisal lacks transparency. Systems could increase the use of (systematic) revisions and could make better use of HTA (among others cost-effectiveness) to obtain value for money and ensure system sustainability.

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.

Productivity costs and medical costs among working patients with knee osteoarthritis (Article)

2012-06-01T00:00:00Z

Objective: Although the knee joint is one of the joints most affected by osteoarthritis (OA), research on the economic implications of joint disease has generally focused only on OA. The goal of this study was to identify and quantify knee-related productivity and medical costs in knee OA patients with paid employment. Furthermore, we evaluated associations between productivity loss and relevant patient, health, and work characteristics. Methods: Consecutive knee OA patients with mild to moderate knee OA who were 18-65 years of age, had conservative treatment for ≥6 months, and had paid employment were included. Productivity loss and health care consumption were measured by questionnaires. The associations between productivity loss and patient, health, and work characteristics were explored with regression analyses. Results: In total, 117 knee OA patients with a mean age of 53.2 years and a mean body mass index of 28.8 kg/m2 were included. Total knee-related productivity costs and medical costs were €871 (median €411, interquartile range [IQR] €107-1,200) per patient per month, with total productivity costs of €722 (median €217, IQR €0-1,041) and total medical costs of €149 (median €137, IQR €72-198). More pain during activity and performing physically intensive work were significantly associated with productivity loss. Conclusion: The total knee-related productivity costs and medical costs of conservatively treated symptomatic knee OA patients with paid employment in The Netherlands are €871 per patient per month, with productivity costs accounting for 83% and medical costs for 17%. Productivity loss is associated with having more pain during activity and performing physically intensive work. Developing adequate treatment strategies for knee OA may be cost beneficial.

Capabilities and quality of life in Dutch psycho-geriatric nursing homes: An exploratory study using a proxy version of the ICECAP-O (Article)

2012-06-01T00:00:00Z

Purpose: To validate the ICECAP-O capability measure in psycho-geriatric elderly in nursing homes, we compared the capability scores of restrained and unrestrained clients. Both nursing staff and family were used as proxies for assessing clients' capabilities. Method: For 122 psycho-geriatric elderly, a total of 96 nursing professionals and 68 family members completed a proxy questionnaire. We investigated the convergent and discriminant validity of the ICECAP-O and measures of care dependency, health-related quality of life, and overall quality of life. We also directly compared ICECAP-O scores of the 56 clients for whom both nursing staff and family members had completed the questionnaire. Results: Convergent validity between ICECAP-O and care dependency, health-related, and overall quality of life measures could be established, as well as discriminant validity for the restrained and unrestrained groups. Nursing and family proxy ICECAP-O tariffs were not significantly correlated. Discussion ICECAP-O measures a more general concept than health-related quality of life and can differentiate between restrained and non-restrained psycho-geriatric clients. Since nurses seem to be able to assess the current quality of life of clients using the ICECAP-O more precisely than the family proxies, for now the use of nursing proxies is recommended in a nursing home setting.

Value for money of drug regulation (Article)

2012-06-01T00:00:00Z

Health Expenditure Growth: Looking beyond the Average through Decomposition of the Full Distribution (Research Paper)

2012-05-08T00:00:00Z

Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth in expenditures on hospital care is strongest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects.

The cost-effectiveness of drug regulation: The example of thorough QT/QTc studies (Article)

2012-02-01T00:00:00Z

We analyzed the cost-effectiveness of the International Conference on Harmonisation (ICH) E14 guideline that requires a thorough QT/QTc (TQT) study for all drugs under development. We compared two pharmacoeconomic scenarios: the health effects and costs resulting from implementing ICH E14 (regulation scenario) vs. not implementing ICH E14 (no regulation scenario). We used a dynamic population model to calculate the cost-effectiveness of ICH E14 for a prototype QT-prolonging antipsychotic drug entering the US and European markets. The incremental cost-effectiveness ratios of regulation vs. no regulation were .4 million per sudden cardiac death prevented and 187,000 per quality-adjusted life year (QALY) gained in users of antipsychotic drugs. The main driver of cost was the requirement for electrocardiogram (ECG) monitoring of users of QTc-prolonging drugs. Even when several of the assumptions in the model were varied, there were no results in favor of regulation. Our study shows that cost-effectiveness analysis of drug regulatory measures is feasible and should be considered before developing such measures.

Forecasting Lifetime and Aggregate Long-term Care Spending - Accounting for Changing Disability Patterns (Article)

2012-01-01T00:00:00Z

Objective: The impact population aging exerts on future levels of long-term care (LTC) spending is an urgent topic in which few studies have accounted for disability trends. We forecast individual lifetime and population aggregate annual LTC spending for the Dutch 55+ population to 2030 accounting for changing disability patterns. Methods: Three levels of (dis)ability were distinguished: none, mild, and severe. Two-part models were used to estimate LTC spending as a function of age, sex, and disability status. A multistate life table model was used to forecast age-specific prevalence of disability and life expectancy (LE) in each disability state. Finally, 2-part model estimates and multistate projections were combined to obtain forecasts of LTC expenditures. Results: LE is expected to increase, whereas life years in severe disability remain constant, resulting in a relative compression of severe disability. Mild disability life years increase, especially for women. Lifetime homecare spending—mainly determined by mild disability—increases, whereas institutional spending remains fairly constant due to stable LE with severe disability. Lifetime LTC expenditures, largely determined by institutional spending, are thus hardly influenced by increasing LE. Aggregate spending for the 55+ population is expected to rise by 56.0% in the period of 2007–2030. Conclusions: Longevity gains accompanied by a compression of severe disability will not seriously increase lifetime spending. The growth of the elderly cohort, however, will considerably increase aggregate spending. Stimulating a compression of disability is among the main solutions to alleviate the consequences of longevity gains and population aging to growth of LTC spending.

Internationale aspecten bij besluitvorming inzake geneesmiddelenvergoeding (Article)

2012-01-01T00:00:00Z

Ten behoeve van de besluitvorming over opname van geneesmiddelen in het basispakket worden in veel landen bevindingen van economische evaluatiestudies gebruikt. Een betere internationale afstemming van de assessment kan een positief effect hebben op de kwaliteit van de besluitvorming. Internationale kosteneffectiviteitsmodellen kunnen hierbij een rol spelen, maar het generaliseren van farmacoeconomisch bewijs van et ene naar het andere land is niet eenvoudig. Echter, appraisal en besluitvorming zullen een nationale aangelegenheid blijven.

Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: Design of a randomised clinical trial (Article)

2011-10-13T00:00:00Z

Background: Osteoarthritis (OA) is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hip OA. Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare) costs. However, studies evaluating cost-effectiveness of common exercise therapy in hip OA are lacking. Therefore, this randomised controlled trial is designed to investigate the cost-effectiveness of exercise therapy in conjunction with the general practitioner's (GP) care, compared to GP care alone, for patients with hip OA. Methods/Design. Patients aged 45 years with OA of the hip, who consulted the GP during the past year for hip complaints and who comply with the American College of Rheumatology criteria, are included. Patients are randomly assigned to either exercise therapy in addition to GP care, or to GP care alone. Exercise therapy consists of (maximally) 12 treatment sessions with a physiotherapist, and home exercises. These are followed by three additional treatment sessions in the 5th, 7th and 9th month after the first treatment session. GP care consists of usual care for hip OA, such as general advice or prescribing pain medication. Primary outcomes are hip pain and hip-related activity limitations (measured with the Hip disability Osteoarthritis Outcome Score [HOOS]), direct costs, and productivity costs (measured with the PROductivity and DISease Questionnaire). These parameters are measured at baseline, at 6 weeks, and at 3, 6, 9 and 12 months follow-up. To detect a 25% clinical difference in the HOOS pain score, with a power of 80% and an alpha 5%, 210 patients are required. Data are analysed according to the intention-to-treat principle. Effectiveness is evaluated using linear regression models with repeated measurements. An incremental cost-effectiveness analysis and an incremental cost-utility analysis will also be performed. Discussion. The results of this trial will provide insight into the cost-effectiveness of adding exercise therapy to GPs' care in the treatment of OA of the hip. This trial is registered in the Dutch trial registry http://www.trialregister.nl: trial number NTR1462.

Determinants of long-term care spending: Age, time to death or disability? (Article)

2011-03-01T00:00:00Z

In view of population aging, better understanding of what drives long-term care expenditure (LTCE) is warranted. Time-to-death (TTD) has commonly been used to project LTCE because it was a better predictor than age. We reconsider the roles of age and TTD by controlling for disability and co-residence and illustrate their relevance for projecting LTCE. We analyze spending on institutional and homecare for the entire Dutch 55+ population, conditioning on age, sex, TTD, cause-of-death and co-residence. We further examined homecare expenditures for a sample of non-institutionalized conditioning additionally on disability. Those living alone or deceased from diabetes, mental illness, stroke, respiratory or digestive disease have higher LTCE, while a cancer death is associated with lower expenditures. TTD no longer determines homecare expenditures when disability is controlled for. This suggests that TTD largely approximates disability. Nonetheless, further standardization of disability measurement is required before disability could replace TTD in LTCE projections models.

Cost-effectiveness of monitoring glaucoma patients in shared care: An economic evaluation alongside a randomized controlled trial (Article)

2010-11-19T00:00:00Z

Background. Population aging increases the number of glaucoma patients which leads to higher workloads of glaucoma specialists. If stable glaucoma patients were monitored by optometrists and ophthalmic technicians in a glaucoma follow-up unit (GFU) rather than by glaucoma specialists, the specialists' workload and waiting lists might be reduced. We compared costs and quality of care at the GFU with those of usual care by glaucoma specialists in the Rotterdam Eye Hospital (REH) in a 30-month randomized clinical trial. Because quality of care turned out to be similar, we focus here on the costs. Methods. Stable glaucoma patients were randomized between the GFU and the glaucoma specialist group. Costs per patient year were calculated from four perspectives: those of patients, the Rotterdam Eye Hospital (REH), Dutch healthcare system, and society. The outcome measures were: compliance to the protocol; patient satisfaction; stability according to the practitioner; mean difference in IOP; results of the examinations; and number of treatment changes. Results. Baseline characteristics (such as age, intraocular pressure and target pressure) were comparable between the GFU group (n = 410) and the glaucoma specialist group (n = 405). Despite a higher number of visits per year, mean hospital costs per patient year were lower in the GFU group (€139 vs. €161). Patients' time and travel costs were similar. Healthcare costs were significantly lower for the GFU group (€230 vs. €251), as were societal costs (€310 vs. €339) (p < 0.01). Bootstrap-, sensitivity- and scenario-analyses showed that the costs were robust when varying hospital policy and the duration of visits and tests. Conclusion. We conclude that this GFU is cost-effective and deserves to be considered for implementation in other hospitals.

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach (Article)

2010-11-17T00:00:00Z

Background: Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting.Methods: The EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients) to usual care (n = 187 patients). Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D), transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm.Results: Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75) for male patients in usual care and 2.75 (-0.61; 6.26) for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837) and €42,944 (14,081; 95,944) for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively). This stroke service is with 90% certainty cost-effective.Conclusions: Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.

The effects of timing on the cost-effectiveness of interventions for workers on sick leave due to low back pain (Article)

2010-11-01T00:00:00Z

Objective: To examine the effects of different timing of structured interventions for workers on sick leave due to low back pain on return to work (RTW), and the consequences for costs and benefits. Methods: Literature reviews were conducted to identify RTW curves and to estimate treatment effects, costs and benefits of structured interventions among workers on sick leave due to low back pain. RTW curves were mathematically described by Weibull functions and intervention effects, expressed by hazard ratios, were used to adjust these Weibull functions. Subsequently, these functions were used to evaluate the theoretical effects of interventions on reduction in number of days on sick leave and on the benefit-cost ratio. Results: The cost-benefits of a RTW intervention among workers on sick leave due to low back pain were determined by the estimated effectiveness of the intervention, the costs of the intervention, the natural course of RTW in the target population, the timing of the enrolment of subjects into the intervention, and the duration of the intervention. Conclusion: With a good RTW in the first weeks, the only early interventions likely to be cost-beneficial are inexpensive work-focused enhancements to early routine care, such as accommodating workplaces. Structured interventions are unlikely to have an additional impact on the already good prognosis when offered before the optimal time window at approximately 8 to 12 weeks. The generalisibility of the effectiveness of a RTW intervention depends on the comparability of baseline characteristics and RTW curves in target and source populations.

The importance of job control for workers with decreased work ability to remain productive at work (Article)

2010-10-18T00:00:00Z

Purpose: Workers with decreased work ability are at greater risk of reduced productivity at work. We hypothesized that work-related characteristics play an important role in supporting workers to remain productive despite decreased work ability. Methods: The study population consisted of 10,542 workers in 49 different companies in the Netherlands in 2005-2009. Productivity loss at work was defined on a 10-point scale by asking how much work was actually performed during regular hours on the last regular workday when compared with normal. Independent variables in the logistic regression analysis were individual characteristics, work-related factors, and the work ability index. Additive interactions between work-related factors and decreased work ability were evaluated by the relative excess risk due to interaction (RERI). Results: The odds ratios and 95% confidence intervals (CI) for the likelihood of productivity loss at work were 2.03 (1.85-2.22), 3.50 (3.10-3.95), and 5.54 (4.37-7.03) for a good, moderate, and poor work ability, compared with an excellent work ability (reference group). Productivity loss at work was associated with lack of job control, poor skill discretion, and high work demands. There was a significant interaction between decreased work ability and lack of job control (RERI = 0.63 95% CI 0.11-1.16) with productivity loss at work. Conclusion: The negative effects on work performance of decreased work ability may be partly counterbalanced by increased job control. This suggests that interventions among workers with (chronic) disease that cause a decreased work ability should include enlargement of possibilities to plan and pace their own activities at work.

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."

Monitoring of stable glaucoma patients (Research Report)

2010-07-01T00:00:00Z

The value of informal care - A further investigation of the feasibility of contingent valuation in informal caregivers (Article)

2010-07-01T00:00:00Z

Including informal care in economic evaluations is increasingly advocated but problematic. We investigated three well-known concerns regarding contingent valuation (CV): (1) the item non-response of CV values, (2) the sensitivity of CV values to the individual circumstances of caring, and (3) the choice of valuation method by comparing willingness-to-pay (WTP) and willingness-to-accept (WTA) values for a hypothetical marginal change in hours of informal care currently provided. The study sample consisted of 1453 caregivers and 787 care recipients. Of the caregivers, 603 caregivers (41.5%) provided both WTP and WTA values, 983 (67.7%) provided at least one. Determinants of non-response were dependent on the valuation method; primary determinants were education and satisfaction with amount of informal care provided. Caregivers' mean WTP (WTA) for reducing (increasing) informal care by 1 h was €9.13 (10.52). Care recipients' mean WTA (WTP) for reducing (increasing) informal care by 1 h was €8.88 (€6.85). Values were associated with a variety of characteristics of the caregiving situation; explanatory variables differed between WTP and WTA valuations. The differences between WTP and WTA valuations were small. Based on sensitivity CV appears to be a useful method to value informal care for use in economic evalations, non-response, however, remains a matter of concern. Copyright

Costh-effectiveness of a pressure ulcer quality collaborative (Article)

2010-06-01T00:00:00Z

ABSTRACT. BACKGROUND: A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. METHODS: We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. RESULTS: Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by euro2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. CONCLUSIONS: During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

Dear Policymaker: Have you made up your mind? (Article)

2010-05-01T00:00:00Z

Objectives: To get insight in what criteria as presented in Health Technology Assessment (HTA) studies are important for decision makers in health care priority setting. Methods: We performed a discrete choice experiment (DCE) among Dutch health care professionals (policymakers, HTA experts, advanced HTA students). In 27 choice sets, we asked respondents to elect reimbursement of one of two different health care interventions, which represented unlabeled, curative treatments. Both treatments were incrementally compared to usual care. The results of the interventions were normal outputs of HTA studies with a societal perspective. Results were analysed using a multinomial logistic regression model. Upon completion of the questionnaire we discussed the exercise with policymakers. Results: Severity of disease, costs per QALY gained, individual health gain, and the budget impact were the most decisive decision criteria. A program targeting more severe diseases increased the probability of reimbursement dramatically. Uncertainty related to cost-effectiveness was also important. Respondents preferred health gains that include quality of life improvements over extension of life without improved quality of life. Savings in productivity costs were not crucial in decision making, although these are to be included in Dutch reimbursement dossiers for new drugs. Regarding subgroups, we found that policymakers attached relatively more weight to disease severity than others but less to uncertainty. Conclusions: Dutch policymakers and other health care professionals seem to have reasonably well articulated preferences: six of seven attributes were significant. Disease severity, budget impact, and cost-effectiveness were very important. The results are comparable to international studies, but reveal a larger set of important decision criteria.

Dear Policymaker: Have you made up your mind? (Article)

2010-04-01T00:00:00Z

Monitoring of stable glaucoma patients (Research Report)

2010-01-01T00:00:00Z

A high workload for ophthalmologists and long waiting lists for patients challenge the organization of ophthalmic care. Tasks that require less specialized skills, like the monitoring of stable (well controlled) glaucoma patients could be substituted from ophthalmologists to other professionals (substitution in person). In addition, care could perhaps be provided in an ambulatory setting (substitution in location of care). To date, little is known about substituting care in ophthalmology, the organizational and professional dynamics involved and any consequences for both the quality of care and cost effectiveness. Glaucoma is the name given to a group of eye diseases characterized by damage to the optic nerve yielding gradual, irreversible loss of visual field. Glaucoma is often related to too high an intraocular pressure (IOP) and is age related. The usual care for glaucoma patients consists of diagnosis, lifelong monitoring, and treatment and is provided by ophthalmologists. However, monitoring stable glaucoma patients will presumably not require the specialist expertise of an ophthalmologist and may be carried out by less specialized professionals. Therefore, the quality of care given to stable glaucoma patients was evaluated when provided by ophthalmic technicians or optometrists based on pre-set protocols and under supervision of ophthalmologists in a Glaucoma follow-up unit (GFU) within The Rotterdam Eye Hospital (REH). The objective of this study is to evaluate an organizational intervention, a GFU for monitoring stable glaucoma patients in a hospital setting, staffed by non-physician Health Care Professionals instead of ophthalmologists. Furthermore, conditions will be formulated that need to be fulfilled to successfully substitute the monitoring care for stable glaucoma patients to a primary care optometrist (substitution in person as well as in location). The conditions will be based on the experiences with the GFU (substitution in person only).

The role of disability in explaining long-term care utilization (Article)

2009-11-01T00:00:00Z

OBJECTIVE: In view of aging populations, it is important to improve our understanding of the determination of long-term care (LTC) service use among the middle-aged and elderly population. We examined the likelihood of using 2 levels of LTC-homecare and institutional care-in the Netherlands and focused on the influence of the measured degree of disability. METHODS: We pooled 2 cross-sectional surveys-one that excluded institutionalized and one that was targeted at institutionalized individuals aged 50+. Disability is measured by impairment in (instrumental) activities of daily living (iADL, ADL) and mobility. Consistency with official Dutch LTC eligibility criteria resulted in the selection of an ordered response model to analyze utilization. We compared a model with separate disability indicators to one with a disability index. RESULTS: Age and disability, but not general health, proved to be the main determinants of utilization, with the composite index sufficiently representing the disaggregated components. The presence of at least 1 disability displayed a greater effect on utilization than any additional disabilities. Apart from disability and age, sex, living alone, psychologic problems, and hospitalizations showed a significant influence on LTC use. Some determinants affected the likelihood of homecare or institutional care use differently. CONCLUSIONS: Even after extensive control for disability, age remains an important driver of LTC use. By contrast, general health status hardly affects LTC use. The model and disability index can be used as a policy tool for simulating LTC needs.

Preventing panic disorder: Cost-effectiveness analysis alongside a pragmatic randomised trial (Article)

2009-04-24T00:00:00Z

Background: Panic disorder affects many people, is associated with a formidable disease burden, and imposes costs on society. The annual influx of new cases of panic disorder is substantial. From the public health perspective it may therefore be a sound policy to reduce the influx of new cases, to maintain the quality of life in many people, and to avoid the economic costs associated with the full-blown disorder. For this purpose, prevention is needed. Here we present the first economic evaluation of such an intervention. Methods: Randomised trial of 117 people with panic disorder symptoms not meeting the diagnostic criteria of DSM-IV panic disorder. The interventions were time-limited cognitive-behavioural therapy v care-as-usual. The central clinical endpoint was DSM-IV panic disorder-free survival over 3 months. Costs were calculated from the societal perspective. Using the bootstrap method, incremental cost-effectiveness ratios were obtained, placed in 95% confidence intervals, projected on the cost-effectiveness plane, and presented as acceptability curves. Results: The median incremental cost-effectiveness ratio is €6,198 (95% CI 2,435 - 60,731) per PD-free survival gained, which has a likelihood of 75.2% of being more acceptable from a cost-effectiveness point of view than care-as-usual when a willingness-to-pay ceiling is assumed of €10,000 per PD-free survival. The most significant cost driver was therapists' time. A sensitivity analysis indicated that cost-effectiveness improves when the number of therapist hours is reduced. Conclusion: This is the first economic evaluation alongside a prevention trial in panic disorder. The small sample (n = 117) and the short time horizon of 3 months preclude firm conclusions, but our findings suggest that the intervention may be acceptable from a cost-effectiveness point of view, especially when therapist involvement can be kept minimal. Nevertheless, our results must await replication in a larger trial with longer follow-up times before we can confidently recommend implementation of the intervention on a broad scale. In the light of our findings and given the burden of panic disorder, such a new trial is well worth the effort.

The invisible hands made visible: Recognizing the value of informal care in healthcare decision-making (Article)

2008-12-01T00:00:00Z

The healthcare sector depends heavily on the informal care provided by families and friends of those who are ill. Informal caregivers may experience significant burden as well as health and well-being effects. Resource allocation decisions, in particular from a societal perspective, should account explicitly for these effects in the social environment of patients. This is not only important to make a complete welfare economic assessment of treatments, but also to ensure the lasting involvement of informal caregivers in the care-giving process. Measurement and valuation techniques for the costs and effects of informal care have been developed and their use is becoming more common. Decision-makers in healthcare - and eventually families and patients - would be helped by more uniformity in methods.

Economic valuation of informal care: Conjoint analysis applied in a heterogeneous population of informal caregivers (Article)

2008-12-01T00:00:00Z

Objectives: This article reports the results of the application of conjoint analysis (CA) to derive a monetary value of informal care. Compared with normally recommended valuation methods such as the opportunity cost method and proxy good method, a valuation elicited through a CA might be more sensitive to the heterogeneity and dynamics of informal care. Methods: We developed a questionnaire and conducted a survey in which informal caregivers were asked to rate four different hypothetical informal caregiving situations (reflecting different combinations of care hours, care tasks, and monetary compensation). They were also asked to rate their current informal care situation compared with the four hypothetical situations. Data were obtained from postal questionnaires. These questionnaires were sent through regional support centres for informal caregivers of care recipients with various health problems. A total of 865 informal caregivers from this heterogeneous population returned a completed survey. Results: Informal caregivers require an increase of 81% in their hourly compensation for providing 21 instead of 7 hours informal care per week. This implies a compensation of €12.36 per hour at a mean hypothetical compensation in the presented scenarios. We also found that an informal caregiver's current caregiving situation and other background characteristics were associated with the scenario ratings. Conclusions: We conclude that a CA is a promising alternative for existing methods to determine a monetary value of informal care and encourage more experiments in this area.

Cost of illness: An international comparison. Australia, Canada, France, Germany and The Netherlands (Article)

2008-10-01T00:00:00Z

Objectives: To assess international comparability of general cost of illness (COI) studies and to examine the extent to which COI estimates differ and why. Methods: Five general COI studies were examined. COI estimates were classified by health provider using the system of health accounts (SHA). Provider groups fully included in all studies and matching SHA estimates were selected to create a common data set. In order to explain cost differences descriptive analyses were carried out on a number of determinants. Results: In general similar COI patterns emerged for these countries, despite their health care system differences. In addition to these similarities, certain significant disease-specific differences were found. Comparisons of nursing and residential care expenditure by disease showed major variation. Epidemiological explanations of differences were hardly found, whereas demographic differences were influential. Significant treatment variation appeared from hospital data. Conclusions: A systematic analysis of COI data from different countries may assist in comparing health expenditure internationally. All cost data dimensions shed greater light on the effects of health care system differences within various aspects of health care. Still, the study's objectives can only be reached by a further improvement of the SHA, by international use of the SHA in COI studies and by a standardized methodology.

An overview of methods and applications to value informal care in economic evaluations of healthcare (Article)

2008-04-01T00:00:00Z

This paper compares several applied valuation methods for including informal care in economic evaluations of healthcare programmes: the proxy good method; the opportunity cost method; the contingent valuation method (CVM); conjoint measurement (CM); and valuation of health effects in terms of health-related quality of life (HR-QOL) and well-being. The comparison focuses on three questions: what outcome measures are available for including informal care in economic evaluations of healthcare programmes; whether these measures are compatible with the common types of economic evaluation; and, when applying these measures, whether all relevant aspects of informal care are incorporated. All types of economic evaluation can incorporate a monetary value of informal care (using the opportunity cost method, the proxy good method, CVM and CM) on the cost side of an analysis, but only when the relevant aspects of time costs have been valued. On the effect side of a cost-effectiveness or cost-utility analysis, the health effects (for the patient and/or caregiver) measured in natural units or QALYs can be combined with cost estimates based on the opportunity cost method or the proxy good method. One should be careful when incorporating CVM and CM in cost-minimization, cost-effectiveness and cost-utility analyses, as the health effects of patients receiving informal care and the carers themselves may also have been valued separately. One should determine whether the caregiver valuation exercise allows combination with other valuation techniques. In cost-benefit analyses, CVM and CM appear to be the best tools for the valuation of informal care. When researchers decide to use the well-being method, we recommend applying it in a cost-benefit analysis framework. This method values overall QOL (happiness); hence it is broader than just HR-QOL, which complicates inclusion in traditional health economic evaluations that normally define outcomes more narrowly. Using broader, non-monetary valuation techniques, such as the CarerQol instrument, requires a broader evaluation framework than cost-effectiveness/cost-utility analysis, such as cost-consequence or multicriteria analysis.

Measuring shared decision making processes in psychiatry: Skills versus patient satisfaction (Article)

2007-07-01T00:00:00Z

Objective: To measure to what extent clinicians in a psychiatry department involve patients in decision making about treatment choice and to compare these data with patients' satisfaction rates about clinician communication behaviours. Methods: Communication was analyzed by scoring 61 audio taped consultations with a validated instrument (OPTION). Patients scored satisfaction on the same OPTION behaviours. Eight clinicians were involved, as were 61 patients. Results: The clinicians scored on average 43 points at overall 'shared decision making', on a scale of 0-100. Clinicians performed well in asking if patients had any questions. They scored low on meta-items about the decision making process: checking the preferred approach of the patient to receive information, or checking the preferred level of involvement in decision making. Satisfaction scores of a group of 29 patients showed no concern about these low scores. Conclusion: The clinicians in this study did not ask meta questions about participation in decision making. An explanation given was that they intuitively 'feel' if a patient wants to be involved or not. Patients did not express great concern about this. More experiments with clinicians openly checking desired participation levels of patients are needed, in order to learn more about possibilities in meta communication, and possible biases of clinicians. Practice implications: Our starting point was that clinicians need to become experts in all roles of their profession, as communicator as well as medical expert. Providing mirror information by assessing decision making behaviours will help to improve performance. Clinicians should be able to perform these SDM behaviours, even if patients are not asking for participation. Claims that clinicians do empathically feel if patients are able to involve in decision making, should be checked by scientific experiments.

Economic analysis for clinical practice - The case of 31 national consensus guidelines in the Netherlands (Article)

2007-02-01T00:00:00Z

Rationale, aims and objective: Evidence on the cost-effectiveness of health interventions in the development of practice guidelines has become of interest in many countries. Challenges are the quality of economic data, the use of cost-effectiveness criteria, and the consensus process. Our paper aims to assess the quality and use of economic information in the formulation of consensus guidelines in a Dutch pilot programme and to recommend improvements. Methods: Retrospective qualitative review of economic evaluations and formulated recommendations, using a checklist based on international standards. Results: The national programme to support the development of guidelines with economic analysis in multidisciplinary consensus groups run from 1998 to 2002. It has included 31 medical guidelines, addressing 23 conditions across seven International Classification of Diseases (ICD)-disease groups. Experts in health technology assessment have participated in the guidelines groups. Economic information in all guidelines varies by all criteria in the level of evidence used. Information on quality-adjusted life years gained is limited as is statistical analysis in most studies. Highest cost-effectiveness ratios reported are between €20 000 and €30 000. However, there is no uniformity in the definitions of acceptable cost-effectiveness ratios. Conclusions: Economic recommendations can be included in guidelines. Interaction between clinicians and health economists promotes a balance between medical and economic arguments. Among panellists there appears to be agreement on the level of the cost-effectiveness ratios that is acceptable. It is recommended that economic analysis is used to strengthen the evidence-base of guidelines. An evidence-grading system should include the quality of economic evaluation. Roles of policymakers and providers need to be defined.

The PEX study - Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749]. (Article)

2006-03-17T00:00:00Z

BACKGROUND: Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome.Exercise therapy is also often prescribed although evidence on effectiveness is lacking.The objective of this article is to present the design of a randomized clinical trial that examines the outcome of exercise therapy supervised by a physical therapist versus a clinically accepted "wait and see" approach (information and advice about the complaints only).The research will address to both effectiveness and cost effectiveness of supervised exercise therapy in patients with patellofemoral pain syndrome (PFPS). METHODS/DESIGN: 136 patients (adolescents and young adults) with patellofemoral pain syndrome are recruited in general practices and sport medicine centers. They will be randomly allocated receiving either 3 months of exercise therapy (or usual care.The primary outcome measures are pain, knee function and perception of recovery after 3 months and 12 months of follow up and will be measured by self reporting.Measurements will take place at baseline, 6 weeks, and 3 monthly until 1 year after inclusion in the study.Secondary outcome measurements include an economic evaluation.A cost-utility analysis will be performed that expresses health improvements in Quality Adjusted Life Years (QALYs) and incorporates direct medical costs and productivity costs DISCUSSION: This study has been designed after reviewing the literature on exercise therapy for patellofemoral pain syndrome. It was concluded that to merit the effect of exercise therapy a trial based on correct methodological concept needed to be executed.The PEX study is a randomized clinical trial where exercise therapy is compared to usual care. This trial started in April 2005 and will finish in June 2007. The first results will be available around December 2007.

Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services (Article)

2003-01-01T00:00:00Z

BACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. METHODS: Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. RESULTS: 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at 16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner - as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing) home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. CONCLUSION: This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

Een situatieschets van mantelzorgers bereikt via leden van de vereniging van budgethouders Per Saldo (Research Paper)

2003-01-01T00:00:00Z

Een persoonsgebonden budget (PgB) is een som geld waarmee mensen die hulp en begeleiding nodig hebben als gevolg van een aandoening, deze zorg naar eigen inzicht kunnen inkopen. Het PgB wordt gezien als een belangrijk instrument om verder vorm te geven aan vraagsturing in de Nederlandse gezondheidszorg. Momenteel hebben ruim 35.000 mensen een PgB. Over mensen met een PgB, budgethouders, en hun mantelzorgers is tot op heden echter weinig bekend. Daarom heeft de Erasmus Universiteit Rotterdam, in samenwerking met het Rijksinstituut voor Volksgezondheid en Milieu en de vereniging van budgethouders Per Saldo, een onderzoek onder budgethouders en hun mantelzorgers uitgevoerd. Dit is het eerste onderzoek in Nederland van deze omvang onder budgethouders, hun primaire mantelzorger en het gebruik van het PgB in verschillende zorgsituaties. In totaal werkten 609 budgethouders en 522 mantelzorgers verspreid over het hele land mee aan dit onderzoek, dat werd uitgevoerd tussen december 2001 en februari 2002. Twee op de drie budgethouders geeft aan dat ze al voor de aanvraag van het PgB wisten op welke manier ze hulp zouden inschakelen. De belangrijkste reden om een PgB aan te vragen was dan ook de wens om de benodigde zorg naar eigen inzicht in te richten (58%). Budgethouders zijn gemiddeld voor 56,5 uur per maand geïndiceerd en ontvangen een bedrag van 1308 Euro per maand. Naast het inhuren van freelancers, iemand van de reguliere of commerciële thuiszorg, gebruiken veel budgethouders een deel van het PgB om hun mantelzorger te vergoeden voor (een deel van) de zorgtaken die hij of zij verricht en voor eventuele reiskosten.

Mantelzorg in Nederland (Research Paper)

2002-01-01T00:00:00Z

Mantelzorg is een belangrijke vorm van zorg. Nederland telt circa 1,5 miljoen mantelzorgers. De Erasmus Universiteit heeft samen met het Rijksinstituut voor Volksgezondheid en Milieu en de Steunpunten Mantelzorg een onderzoek naar mantelzorg uitgevoerd. In totaal werkten 950 mantelzorgers en 552 zorgvragers mee aan dit onderzoek. Een mantelzorger is vaak een gehuwde vrouw, en zorgt meestal thuis voor een familielid. Een aanzienlijk deel heeft thuiswonende kinderen. De meeste mantelzorgers zijn gepensioneerd of huisvrouw/-man. De zorgvragers zijn meestal ouder dan 60 jaar en gehuwd, één op de vijf is weduwe of weduwnaar. Ongeveer de helft van de zorgvragers is met pensioen, één op de vier is arbeidsongeschikt. Zorgvragers zijn als gevolg van hun gebrekkige gezondheid beperkt in hun activiteit en hebben dus ondersteuning nodig. Hiervoor zijn ze afhankelijk van mantelzorgers, thuiszorg en particuliere hulp. Ruim één op de drie zorgvragers is volledig afhankelijk van mantelzorg, en ongeveer één op de vijf zelfs van één enkele mantelzorger. Ongeveer de helft van de zorgvragers heeft thuiszorg. Daarnaast heeft één op de vijf zorgvragers een particuliere hulp, voor gemiddeld acht uur per week. Voor veel mantelzorgers legt de zorgtaak beslag op een belangrijk deel van hun leven. Ze besteden er gemiddeld zeven uur per dag aan, en vaak zeven dagen per week. De belangrijkste zorgtaak is ondersteuning bij huishoudelijke activiteiten, zoals boodschappen doen, het klaarmaken van eten en drinken, schoonmaken van het huis, en de was. Daarnaast zijn sociale ondersteuning (zoals praten en troosten) en hulp bij contacten met de gezondheidszorg, (zoals bezoek aan arts of ziekenhuis), belangrijk. Eén op de vier mantelzorgers combineert de zorgtaak met betaald werk. Ongeveer 15% van de mantelzorgers is geheel of gedeeltelijk gestopt met werken om zorg te kunnen (blijven) geven. Voor veel mantelzorgers is de zorg een grote belasting. Maar liefst twee op de vijf mantelzorgers geeft aan dat de zorg (veel te) zwaar is. Volgens een objectieve maatstaf is twee op de drie mantelzorgers zelfs aanzienlijk belast. Maar verlenen van zorg geeft veel mantelzorgers ook voldoening. De helft van de mantelzorgers geeft aan de zorgtaak liever niet aan iemand anders over te willen dragen. Mantelzorgers en zorgvragers geven hun zorgsituatie gemiddeld een cijfer 6.2, oftewel, net voldoende. De mantelzorgers die aan dit onderzoek hebben meegewerkt hebben over het algemeen een goede gezondheid, zijn tevreden over hun inkomen, en voelen zich tamelijk gelukkig. Er bestaan echter grote verschillen tussen mantelzorgers. Zo kan men stellen: veel mantelzorgers hebben weinig problemen met hun mantelzorgtaak, maar een kleine groep heeft grote problemen.

Informal care in the Netherlands. A situational sketch of informal caregivers reached via Informal Care Centres (Research Paper)

2002-01-01T00:00:00Z

Informal care is a very important form of care. There are approximately 1.5 million informal caregivers in the Netherlands. Despite this large number, little is known about those providing this important service. To address this lack of knowledge, Erasmus University Rotterdam, in collaboration with the National Institute of Public Health and the Environment (RIVM) and the regional Informal Care Centres, carried out a study of informal care in the Netherlands. This is the first study of any size in the Netherlands to survey both the providers and recipients of informal care. A total of 950 informal caregivers took part in the study, which was carried out between November 2001 and February 2002. This report presents some first results.

Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes (Article)

2002-01-01T00:00:00Z

OBJECTIVE: To estimate the health-related quality of life (HRQOL) and treatment satisfaction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associated with quality of life and treatment satisfaction. RESEARCH DESIGN AND METHODS: For a sample of 1,348 type 2 diabetes patients, recruited by 29 general practitioners, we collected data regarding HRQOL. This study was performed as part of a larger European study (Cost of Diabetes in Europe - Type 2 [CODE-2]). We used a generic instrument (Euroqol 5D) to measure HRQOL. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire. RESULTS: Patients without complications had an HRQOL (0.74) only slightly lower than similarly aged persons in the general population. Insulin therapy, obesity, and complications were associated with a lower HRQOL, independent of age and sex. Although higher fasting blood glucose and HbA1c levels were negatively associated with HRQOL, these factors were not significant after adjustment for other factors using multivariate analysis. Overall treatment satisfaction was very high. Younger patients, patients using insulin, and patients with higher HbA1c levels were less satisfied with the treatment than other patients. CONCLUSIONS: Obesity and the presence of complications are important determinants of HRQOL in patients with type 2 diabetes.

Handbook of Health Economics (Article)

2001-01-01T00:00:00Z

Editors and authors should be complimented for their impressive attempt to provide a fair account of the state-of-the-art in health economics. To review such an extensive work in a short time span, we decided to select certain chapters for more in depth study. This selection was based on our areas of expertise under the restriction that all major research areas distinguished in the handbook should be covered. Before turning to the review of the separate chapters, let us first make some general comments about the handbook. An important first question is whether all relevant research areas are covered and whether this has been done in a balanced way. Of course, exhaustive coverage in one book is unattainable for a large area like health economics. Rather the question is that regarding balance and possible lack of bias. In that respect, the book focuses on the US literature and health care system with 24 chapters written by US authors and only 11 by European and Canadian authors. The more traditional economic areas are generally covered by the US authors, emphasising a neo-classical rather than an institutional paradigm, and boundary topics like ‘equity’ and the ‘measurement of health’ are covered by the non-US authors. This structure both reflects the contributions in the health economics literature and the large variation in US health care institutions, and is only troublesome in some chapters as suggested below.

Productivity losses without absence: Measurement validation and empirical evidence (Article)

1999-07-01T00:00:00Z

Productivity losses without absence are scarcely discussed in the literature. In this paper, the construct validity of three different measurement instruments for productivity losses without absence is investigated. The data were collected under employees of a Dutch trade firm, not in specific patient groups. On an average day, over 7% of the respondents were working with health problems, indicating that productivity losses without absence is quite a common problem. The amount of production losses related to these health problems are relatively small. However, for specific patient groups, the costs related to these productivity losses may be substantial. Copyright (C) 1999 Elsevier Science Ireland Ltd.

Cost-effectiveness of lung transplantation in The Netherlands: a scenario analysis (Article)

1998-01-01T00:00:00Z

STUDY OBJECTIVES: To calculate cost-effectiveness of scenarios concerning lung transplantation in The Netherlands. DESIGN: Microsimulation model predicting survival, quality of life, and costs with and without transplantation program, based on data of the Dutch lung transplantation program of 1990 to 1995. SETTING: Netherlands, University Hospital Groningen. PATIENTS: Included were 425 patients referred for lung transplantation, of whom 57 underwent transplantation. INTERVENTION: Lung transplantation. RESULTS: For the baseline scenario, the costs per life-year gained are G 194,000 (G=Netherlands guilders) and the costs per quality-adjusted life-year (QALY) gained are G 167,000. Restricting patient inflow ("policy scenario") lowers the costs per life-year gained: G 172,000 (costs per QALY gained: G 144,000). The supply of more donor lungs could reduce the costs per life-year gained to G 159,000 (G 135,000 per QALY gained; G1 =US $0.6, based on exchange rate at the time of the study). CONCLUSIONS: Lung transplantation is an expensive but effective intervention: survival and quality of life improve substantially after transplantation. The costs per life-year gained are relatively high, compared with other interventions and other types of transplantation. Restricting the patient inflow and/or raising donor supply improves cost-effectiveness to some degree. Limiting the extent of inpatient screening or lower future costs of immunosuppressives may slightly improve the cost-effectiveness of the program.

Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study (Article)

1998-01-01T00:00:00Z

OBJECTIVES: To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. DESIGN: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. SETTING: Netherlands, 1994. MAIN OUTCOME MEASURES: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. RESULTS: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (> or = 95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. CONCLUSIONS: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people.

Complementary analyses in economic evaluation of health care (Doctoral Thesis)

1994-06-15T00:00:00Z

The steady increase in health care costs and the continuous emergence of new medical technologies have forced policy makers in health care to reconsider the current resource allocation and to become more selective with investing in new health care programs. Economic evaluations can support the decision making process, by providing systematic information on the costs and the consequences for health of investing in alternative health care programs. Needless to say, economic evaluations of health care should be methodologically sound, the outcomes should be relevant for health policy and comparable to results of studies concerning other health care programs. With respect to the policy relevance it is important that the aggregation level of the analysis matches the specificity of the policy question: a study of costs and health effects of for example air pollution control will not need to be as detailed as an analysis of the cost-effectiveness of cimetidine versus surgery in peptic ulcer. Economic evaluations may never become entirely comparable, but incomparabilities due to different methodologies can be reduced considerably. This raises two questions: - what is the appropriate level of aggregation in the economic evaluation of health care? - which cost items are to be included in economic evaluations and how should these be measured and valued, in particular the indirect costs of disease?