Economic Evaluation: serving different actors in a changing environment; some examples

This thesis deals with economic evaluations performed under different conditions and for different actors with applications in oncology and internal medicine (figure 1). It contains eight studies and is divided in three different parts. In the first 2 chapters the results of a detailed cost analysis of allogeneic stem cell transplantations are presented. Herein the costs of these interventions for a budget revisions are described in detail and subsequently the role cost analyses can have in the evaluation of medical technologies more in general is described. Following, 5 chapters describing different cost-effectiveness modelling studies are described. These deal with the economic evaluation of a variety of indications and the background of these studies varies considerably. All studies are performed with a different audience, being either reimbursement authorities, politicians or a specific medical profession and they all have their characteristic features.! As a result of these variation overlapping characteristics can be derived that economic evaluations performed in a rapidly changing environment require; these relate to the timeliness of and the flexibility and anticipation in these evaluations that make them adoptable to changes relatively easy. These are followed by a final study on the diffusion of innovative drugs in the Netherlands compared to other European countries, describing the variation in diffusion and the possible relations there are with healthcare characteristics in the individual countries. These characteristics offer possible solutions for the current lag of the Netherlands as it concerns the diffusion of innovative drugs but it is acknowledged that other aspects are important as well and it is suggested to study these in an integrated manner. In the general discussion the findings of this thesis are related to current developments and it is concluded that economic evaluations are continuously adapting to! these changes as well.

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