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Visscher K, Kouwenberg LHJA, Oosterhoff M, Rotteveel AH, de Wit GA. Postponed healthcare in The Netherlands during the COVID-19 pandemic and its impact on self-reported health. Front Health Serv 2023; 3:1181532. [PMID: 37425992 PMCID: PMC10326615 DOI: 10.3389/frhs.2023.1181532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023]
Abstract
Background Healthcare services have been seriously disrupted during the COVID-19 pandemic. The aim of this study was to examine the extent to which Dutch citizens have experienced postponed healthcare and how this affected their self-reported health. In addition, individual characteristics that were associated with experiencing postponed healthcare and with self-reported negative health effects were investigated. Methods An online survey about postponed healthcare and its consequences was developed, and sent out to participants of the Dutch LISS (Longitudinal Internet Studies for the Social Sciences) panel (n = 2.043). Data were collected in August 2022. Multivariable logistic regression analyses were carried out to explore characteristics associated with postponed care and self-reported negative health outcomes. Results Of the total population surveyed, 31% of the panel experienced postponed healthcare, either initiated by the healthcare provider (14%), on their own initiative (12%) or as a combination of both (5%). Postponed healthcare was associated with being female (OR = 1.61; 95% CI = 1.32; 1.96), presence of chronic diseases (OR = 1.55, 95% CI = 1.24; 1.95), high income (OR = 0.62, 95% CI = 0.48; 0.80) and worse self-reported health (poor vs. excellent OR = 2.88, 95% CI = 1.17; 7.11). Overall, 40% experienced temporary or permanent self-reported negative health effects due to postponed care. Negative health effects as a result of postponed care were associated with presence of chronic conditions and low income levels (p < 0.05). More respondents with worse self-reported health and foregone healthcare reported permanent health effects as compared to those with temporary health effects (p < 0.05). Discussion People with an impaired health status are most likely to experiencing postponed healthcare and negative health consequences as a result. Furthermore, those with negative health consequences decided to forego health by themselves more often. As part of long-term plans to maintain the accessibility of healthcare services, specific attention should be paid to reaching out to people with an impaired health status.
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Affiliation(s)
- Kirsten Visscher
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Lisanne H. J. A. Kouwenberg
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Marije Oosterhoff
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Adriënne H. Rotteveel
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - G. Ardine de Wit
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, Netherlands
- Faculty of Science, Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Oosterhoff M, Kouwenberg LHJA, Rotteveel AH, van Vliet ED, Stadhouders N, de Wit GA, van Giessen A. Estimating the health impact of delayed elective care during the COVID -19 pandemic in the Netherlands. Soc Sci Med 2023; 320:115658. [PMID: 36689820 PMCID: PMC9810553 DOI: 10.1016/j.socscimed.2023.115658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/02/2022] [Accepted: 01/03/2023] [Indexed: 01/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a major impact on the continuity of healthcare provision. Appointments, treatments and surgeries for non-COVID patients were often delayed, with associated health losses for patients involved. OBJECTIVE To develop a method to quantify the health impact of delayed elective care for non-COVID patients. METHODS A model was developed that estimated the backlog of surgical procedures in 2020 and 2021 using hospital registry data. Quality-adjusted life years (QALYs) were obtained from the literature to estimate the non-generated QALYs related to the backlog. In sensitivity analyses QALY values were varied by type of patient prioritization. Scenario analyses for future increased surgical capacity were performed. RESULTS In 2020 and 2021 an estimated total of 305,374 elective surgeries were delayed. These delays corresponded with 319,483 non-generated QALYs. In sensitivity analyses where QALYs varied by type of patient prioritization, non-generated QALYs amounted to 150,973 and 488,195 QALYs respectively. In scenario analyses for future increased surgical capacity in 2022-2026, the non-generated QALYs decreased to 311,220 (2% future capacity increase per year) and 300,710 (5% future capacity increase per year). Large differences exist in the extent to which different treatments contributed to the total health losses. CONCLUSIONS The method sheds light on the indirect harm related to the COVID-19 pandemic. The results can be used for policy evaluations of COVID-19 responses, in preparations for future waves or other pandemics and in prioritizing the allocation of resources for capacity increases.
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Affiliation(s)
- Marije Oosterhoff
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Lisanne H J A Kouwenberg
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Amsterdam UMC location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Adriënne H Rotteveel
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Ella D van Vliet
- Centre for Health Protection, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
| | - Niek Stadhouders
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, PO Box 9101m 6500 HB, Nijmegen, the Netherlands.
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands; Vrije Universiteit Amsterdam, Faculty of Science, Department of Health Sciences & Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, the Netherlands.
| | - Anoukh van Giessen
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, the Netherlands.
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Willeboordse M, Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HHCM, Hahnraths MTH, Vonk L, Oosterhoff M, van Schayck CP, Winkens B, Jansen MWJ. Battling the obesity epidemic with a school-based intervention: Long-term effects of a quasi-experimental study. PLoS One 2022; 17:e0272291. [PMID: 36166426 PMCID: PMC9514666 DOI: 10.1371/journal.pone.0272291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background School-based health-promoting interventions are increasingly seen as an effective population strategy to improve health and prevent obesity. Evidence on the long-term effectiveness of school-based interventions is scarce. This study investigates the four-year effectiveness of the school-based Healthy Primary School of the Future (HPSF) intervention on children’s body mass index z-score (BMIz), and on the secondary outcomes waist circumference (WC), dietary and physical activity (PA) behaviours. Methods and findings This study has a quasi-experimental design with four intervention schools, i.e., two full HPSFs (focus: diet and PA), two partial HPSFs (focus: PA), and four control schools. Primary school children (aged 4–12 years) attending the eight participating schools were invited to enrol in the study between 2015 and 2019. Annual measurements consisted of children’s anthropometry (weight, height and waist circumference), dietary behaviours (child- and parent-reported questionnaires) and PA levels (accelerometers). Between 2015 and 2019, 2236 children enrolled. The average exposure to the school condition was 2·66 (SD 1·33) years, and 900 participants were exposed for the full four years (40·3%). After four years of intervention, both full (estimated intervention effect (B = -0·17 (95%CI -0·27 to -0·08) p = 0·000) and partial HPSF (B = -0·16 (95%CI-0·25 to -0·06) p = 0·001) resulted in significant changes in children’s BMIz compared to control schools. Likewise, WC changed in favour of both full and partial HPSFs. In full HPSFs, almost all dietary behaviours changed significantly in the short term. In the long term, only consumption of water and dairy remained significant compared to control schools. In both partial and full HPSFs, changes in PA behaviours were mostly absent. Interpretation This school-based health-promoting intervention is effective in bringing unfavourable changes in body composition to a halt in both the short and long term. It provides policy makers with robust evidence to sustainably implement these interventions in school-based routine.
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Affiliation(s)
- M. Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - N. H. M. Bartelink
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - P. van Assema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - S. P. J. Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - H. H. C. M. Savelberg
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM) and School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - M. T. H. Hahnraths
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - L. Vonk
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Centre for Public Health Limburg, Heerlen, The Netherlands
| | - M. Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M. W. J. Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Centre for Public Health Limburg, Heerlen, The Netherlands
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Oosterhoff M, Jolani S, De Bruijn-Geraets D, van Giessen A, Bosma H, van Schayck OC, Joore MA. BMI trajectories after primary school-based lifestyle intervention: Unravelling an uncertain future. A mixed methods study. Prev Med Rep 2021; 21:101314. [PMID: 33537184 PMCID: PMC7841358 DOI: 10.1016/j.pmedr.2021.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 11/03/2022] Open
Abstract
This mixed methods study aimed to examine plausible body mass index (BMI) trajectories after exposure to a primary school-based lifestyle intervention to aid in estimating the long-term intervention benefits. BMI trajectories for children at control schools (mean 7.6 years of age) were modelled until 20 years of age through extrapolating trial evidence (N = 1647). A reference scenario assumed that the observed 2-year effects of the 'Healthy Primary Schools of the Future' (HPSF) and 'Physical Activity Schools' (PAS) were fully maintained over time. This was modelled by applying the observed 2-year BMI effects until 20 years of age. Expert opinions on likely trends in effect maintenance after the 2-year intervention period were elicited qualitatively and quantitatively, and were used for developing alternative scenarios. Expert elicitation revealed three scenarios: (a) a constant exposure-effect and an uncontrolled environment with effect decay scenario, (b) a household multiplier and an uncontrolled environment with effect decay scenario, and (c) a household multiplier and maintainer scenario. The relative effect of HPSF at 20 years of age was -0.21 kg/m2 under the reference scenario, and varied from -0.04 kg/m2 (a) to -0.06 kg/m2 (b), and -0.50 kg/m2 (c). For PAS, the relative effect was -0.17 kg/m2 under the reference scenario, and varied from -0.04 kg/m2 (a, b), to -0.21 kg/m2 (c). The mixed methods approach proved to be useful in modelling plausible BMI trajectories and specifying uncertainty on effect maintenance. Further observations until adulthood could reduce the uncertainty around future benefits. This trial was retrospectively registered at Clinicaltrials.gov (NCT02800616).
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Centre MUMC+, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Shahab Jolani
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Daisy De Bruijn-Geraets
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Centre MUMC+, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Anoukh van Giessen
- Center for Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Onno C.P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA) Maastricht University Medical Centre MUMC+, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Oosterhoff M, Vanmechelen K. [Not Available]. Tijdschr Psychiatr 2021; 63:906-907. [PMID: 34978063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Oosterhoff M, Over EAB, van Giessen A, Hoogenveen RT, Bosma H, van Schayck OCP, Joore MA. Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative. BMC Public Health 2020; 20:1887. [PMID: 33297992 PMCID: PMC7724829 DOI: 10.1186/s12889-020-09744-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4-12 year olds). METHODS The Healthy Primary School of the Future (HPSF; a healthy school lunch and structured physical activity) and the Physical Activity School (PAS; structured physical activity) were compared to the regular Dutch curriculum (N = 1676). An adolescence model, calculating weight development, and the RIVM Chronic Disease Model, calculating overweight-related chronic diseases, were linked to estimate the lifetime impact on chronic diseases, quality adjusted life years (QALYs), healthcare, and productivity costs. Cost-effectiveness was expressed as the additional costs/QALY gained and we used €20,000 as threshold. Scenario analyses accounted for alternative effect maintenance scenarios and equity analyses examined cost-effectiveness in different socioeconomic status (SES) groups. RESULTS HPSF resulted in a lifetime costs of €773 (societal perspective) and a lifetime QALY gain of 0.039 per child versus control schools. HPSF led to lower costs and more QALYs as compared to PAS. From a societal perspective, HPSF had a cost/QALY gained of €19,734 versus control schools, 50% probability of being cost-effective, and beneficial equity impact (0.02 QALYs gained/child for low versus high SES). The cost-effectiveness threshold was surpassed when intervention effects decayed over time. CONCLUSIONS HPSF may be a cost-effective and equitable strategy for combatting the lifetime burden of unhealthy lifestyles. The win-win situation will, however, only be realised if the intervention effect is sustained into adulthood for all SES groups. TRIAL REGISTRATION Clinicaltrials.gov ( NCT02800616 ). Registered 15 June 2016 - Retrospectively registered.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.
| | - Eelco A B Over
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Anoukh van Giessen
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - Rudolf T Hoogenveen
- Expertise Center for Methodology and Information Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
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Bosma H, Oosterhoff M, Vermeiren AP, Willeboordse M, Joore MA, van Schayck OCP. Can school-based, health behavioural interventions tackle health inequities in childhood? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
To improve the health situation of children in primary school, many school-based interventions that are aimed at changing health behaviours, are being set up. Prior to knowing the (long-term) effectiveness of such intervention, we set out to examine whether there is room for such interventions to also tackle the health gap between children from high and low socioeconomic backgrounds.
Methods
Data from the Dutch quasi-experimental Health Primary School of the Future were used. All children from eight primary schools were included in the period 2015-2019. In the first cross-sectional phase, we studied whether there were socioeconomic differences in various health outcomes (e.g. body mass index) and whether these were smaller in children in the oldest groups (highest classes). In a two-year longitudinal approach, it was studied how socioeconomic differences in health outcomes developed in two years time and whether health behaviours could “explain” any socioeconomic differences in the outcomes. Linear and logistic regression analyses were used, including multilevel variants thereof, as well as mediation analyses.
Results
Both the cross-sectional and longitudinal analyses indicated substantial and consistent socioeconomic differences in various health outcomes. The socioeconomic differences in health appeared stronger in the oldest children (highest classes). Due to only small socioeconomic differences in health behaviours, such behaviours did not mediate the socioeconomic differences in the children's health outcomes.
Conclusions
The findings indicate substantial socioeconomic differences in health in primary school. That being longer at school did not attenuate the socioeconomic differences in health and that health behaviours did not mediate the socioeconomic differences in health suggests that there might not be much room for school-based, health behaviour interventions to easily tackle socioeconomic differences in health in childhood.
Key messages
We found substantial socioeconomic differences in child health in the Netherlands. But we found only little evidence that primary school-based, health behavioural interventions will easily tackle socioeconomic differences in child health.
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Affiliation(s)
- H Bosma
- Social Medicine, Maastricht University, Social Medicine, CAPHRI, Maastricht, Netherlands
| | - M Oosterhoff
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A P Vermeiren
- Social Medicine, Maastricht University, Social Medicine, CAPHRI, Maastricht, Netherlands
| | - M Willeboordse
- Family Medicine, Maastricht University, Maastricht, Netherlands
| | - M A Joore
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
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Oosterhoff M, van Schayck OCP, Bartelink NHM, Bosma H, Willeboordse M, Winkens B, Joore MA. The Short-Term Value of the "Healthy Primary School of the Future" Initiative: A Social Return on Investment Analysis. Front Public Health 2020; 8:401. [PMID: 32974255 PMCID: PMC7472552 DOI: 10.3389/fpubh.2020.00401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/07/2020] [Indexed: 12/05/2022] Open
Abstract
Background: This study examines the social return on investment (SROI) of the "Healthy Primary School of the Future" initiative after 2 years. Methods: Healthy Primary Schools of the Future (HPSF) provide a healthy lunch and daily structured physical activity sessions, whereas Physical Activity Schools (PAS) focus on physical activity only. We evaluated the 2-years investments and effects (N = 1,676 children) of both school environments (four schools) compared to control schools (four schools). Investments and outcomes were grouped within the healthcare, education, household & leisure, and labor & social security sector. Outcomes that could be expressed in monetary terms were used for the calculation of social return on investment. Results: HPSF and PAS created outcomes for the healthcare sector by favorable changes in health behaviors, body mass index [both significant], and medical resource use [not significant]. Outcomes for the education sector included a favorable impact on perceived social behaviors and school satisfaction, and absenteeism from school [latter not significant], and more engagement with the community was experienced. The per child investments, €859 (HPSF) and €1017 (PAS), generated a benefit of €8 (HPSF) and €49 (PAS) due to reduced school absenteeism and medical resource use. Conclusions: Within 2 years of intervention implementation, the HPSF initiative created outcomes in several sectors, but the benefits did not outweigh the investments. Follow-up assessments as well as modeling long-term outcomes are needed to assess the total value of the interventions. Until then, the SROI framework can inform strategies for obtaining stakeholder support and intervention implementation. Trial registration: The study was registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616).
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Nina H M Bartelink
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Maartje Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HHCM, Oosterhoff M, Willeboordse M, van Schayck OCP, Winkens B, Jansen MWJ. Can the Healthy Primary School of the Future offer perspective in the ongoing obesity epidemic in young children? A Dutch quasi-experimental study. BMJ Open 2019; 9:e030676. [PMID: 31676651 PMCID: PMC6830668 DOI: 10.1136/bmjopen-2019-030676] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/23/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Schools play an important role in promoting healthy behaviours in children and can offer perspective in the ongoing obesity epidemic. The 'Healthy Primary School of the Future' (HPSF) aims to improve children's health and well-being by enhancing school health promotion. The current study aims to assess the effect of HPSF on children's body mass index (BMI) z-score after 1 and 2 years follow-up and to investigate whether HPSF has different effects within specific subgroups of children. DESIGN A longitudinal quasi-experimental design. SETTING Four intervention and four control schools participated; located in a low socioeconomic status region in the Netherlands. PARTICIPANTS 1676 children (aged 4-12 years). INTERVENTIONS HPSF uses a contextual systems approach and includes health-promoting changes in the school. Central to HPSF is the provision of a daily healthy lunch and structured physical activity sessions each day. Two intervention schools implemented both changes (full HPSF), two intervention schools implemented only the physical activity change (partial HPSF). MAIN OUTCOME MEASURES BMI z-score, determined by measurements of children's height and weight at baseline, after 1 and 2 years follow-up. RESULTS The intervention effect was significant after 1-year follow-up in the partial HPSF (standardised effect size (ES)=-0.05), not significant in the full HPSF (ES=-0.04). After 2 years follow-up, BMI z-score had significantly decreased in children of both the full HPSF (ES=-0.08) and the partial HPSF (ES=-0.07) compared with children of the control schools, whose mean BMI z-score increased from baseline to 2 years. None of the potential effect modifiers (gender, baseline study year, socioeconomic status and baseline weight status) were significant. CONCLUSIONS HPSF was effective after 1 and 2 years follow-up in lowering children's BMI z-scores. No specific subgroups of children could be identified who benefitted more from the intervention. TRIAL REGISTRATION NUMBER NCT02800616.
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Affiliation(s)
- Nina H M Bartelink
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Patricia van Assema
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maartje Willeboordse
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Maria W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Heerlen, The Netherlands
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
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Abstract
A uniform approach for costing school-based lifestyle interventions is currently lacking. The objective of this study was to develop a template for costing primary school-based lifestyle interventions and apply this to the costing of the "Healthy Primary School of the Future" (HPSF) and the "Physical Activity School" (PAS), which aim to improve physical activity and dietary behaviors. Cost-effectiveness studies were reviewed to identify the cost items. Societal costs were reflected by summing up the education, household and leisure, labor and social security, and health perspectives. Cost inputs for HPSF and PAS were obtained for the first year after implementation. In a scenario analysis, the costs were explored for a hypothetical steady state. From a societal perspective, the per child costs were €2.7/$3.3 (HPSF) and €- 0.3/$- 0.4 (PAS) per day during the first year after implementation, and €1.0/$1.2 and €- 1.3/$- 1.6 in a steady state, respectively (2016 prices). The highest costs were incurred by the education perspective (first year: €8.7/$10.6 (HPSF) and €4.0/$4.9 (PAS); steady state: €6.1/$7.4 (HPSF) and €2.1/$2.6 (PAS)), whereas most of the cost offsets were received by the household and leisure perspective (first year: €- 6.0/$- 7.3 (HPSF) and €- 4.4/$- 5.4 (PAS); steady state: €- 5.0/$- 6.1 (HPSF) and €- 3.4/$- 4.1 (PAS)). The template proved helpful for costing HPSF and PAS from various stakeholder perspectives. The costs for the education sector were fully (PAS) and almost fully (HPSF) compensated by the savings within the household sector. Whether the additional costs of HPSF over PAS represent value for money will depend on their relative effectiveness.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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11
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Oosterhoff M, Joore MA, Bartelink NHM, Winkens B, Schayck OCP, Bosma H. Longitudinal analysis of health disparities in childhood. Arch Dis Child 2019; 104:781-788. [PMID: 30948361 DOI: 10.1136/archdischild-2018-316482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/06/2019] [Accepted: 03/08/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Combatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities in health outcomes? and (2) To what extent can social inequalities in health outcomes be explained by differences in children's health behaviours? DESIGN This study included 2-year follow-up data of 1259 children (4-12 years of age) who participated in the 'Healthy Primary School of the Future' project (ClinicalTrials.gov NCT02800616). SES was measured by maternal and paternal education and household income (adjusted for family size). Health outcomes were body mass index (BMI) z-score, health resource use, school absenteeism, health-related quality of life and psychosocial health, measured over 2 years of follow-up (2015-2017). Health behaviours included physical activity, and consumption of fruits, vegetables and sweetened beverages. Associations between SES and baseline health behaviours were examined, and mixed models for repeated measures were used to assess associations between SES and health outcomes over 2 years of follow-up. RESULTS A high socioeconomic background was significantly associated with better health outcomes (all outcomes). For example, children with a low SES had higher BMI z-scores (beta coefficient: 0.42, 95% CI 0.22 to 0.62) and higher consumption healthcare costs (ratio of mean costs: 2.21, 95% CI 1.57 to 3.10). Effects of SES changed very little after controlling for health behaviours. DISCUSSION Our findings strongly suggest that socioeconomic background has a pervasive impact on disparities in child health, but gives little support to the idea that social inequalities in child health can be tackled by means of lifestyle interventions.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+)/Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+)/Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nina H M Bartelink
- Department of Health Promotion, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Onno C P Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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12
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Abstract
In the article, 'A Cost Analysis of School-Based Lifestyle Interventions', we calculated the societal costs of two school-based lifestyle interventions: 'the Healthy Primary School of the Future' and 'the Physical Activity School'.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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13
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Bartelink NHM, van Assema P, Kremers SPJ, Savelberg HHCM, Oosterhoff M, Willeboordse M, van Schayck OCP, Winkens B, Jansen MWJ. One- and Two-Year Effects of the Healthy Primary School of the Future on Children's Dietary and Physical Activity Behaviours: A Quasi-Experimental Study. Nutrients 2019; 11:E689. [PMID: 30909515 PMCID: PMC6470547 DOI: 10.3390/nu11030689] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 02/08/2023] Open
Abstract
Schools can help to improve children's health. The 'Healthy Primary School of the Future' (HPSF) aims to sustainably integrate health and well-being into the school system. This study examined the effects of HPSF on children's dietary and physical activity (PA) behaviours after 1 and 2 years' follow-up. The study (n = 1676 children) has a quasi-experimental design with four intervention schools, i.e., two full HPSF (focus: nutrition and PA) and two partial HPSF (focus: PA), and four control schools. Accelerometers and child- and parent-reported questionnaires were used at baseline, after 1 (T1) and 2 (T2) years. Mixed-model analyses showed significant favourable effects for the full HPSF versus control schools for, among others, school water consumption (effect size (ES) = 1.03 (T1), 1.14 (T2)), lunch intake of vegetables (odds ratio (OR) = 3.17 (T1), 4.39 (T2)) and dairy products (OR = 4.43 (T1), 4.52 (T2)), sedentary time (ES = -0.23 (T2)) and light PA (ES = 0.22 (T2)). Almost no significant favourable effects were found for partial HPSF compared to control schools. We conclude that the full HPSF is effective in promoting children's health behaviours at T1 and T2 compared with control schools. Focusing on both nutrition and PA components seems to be more effective in promoting healthy behaviours than focusing exclusively on PA.
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Affiliation(s)
- Nina H M Bartelink
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616 6200 MD Maastricht, The Netherlands.
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, P.O. Box 33, 6400 AA Heerlen, The Netherlands.
| | - Patricia van Assema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616 6200 MD Maastricht, The Netherlands.
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Stef P J Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/ Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Maartje Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Maria W J Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, P.O. Box 33, 6400 AA Heerlen, The Netherlands.
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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14
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Oosterhoff M, Bosma H, van Schayck OCP, Evers SMAA, Dirksen CD, Joore MA. A systematic review on economic evaluations of school-based lifestyle interventions targeting weight-related behaviours among 4-12 year olds: Issues and ways forward. Prev Med 2018; 114:115-122. [PMID: 29959951 DOI: 10.1016/j.ypmed.2018.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 12/12/2022]
Abstract
Current guidelines for economic evaluations do not provide specific recommendations for the evaluation of school-based lifestyle interventions. This study examined and discussed the key aspects in the design of economic evaluations on school-based interventions targeting weight-related behaviours among 4-12 year olds. The PubMed and CRD databases (NHS EED) were searched. Grey literature was identified from reference lists and websites of relevant organizations. Full economic evaluations on school-based interventions targeting physical activity, sedentariness, or diet were selected. Key aspects included the objective, audience, intervention, comparator, population, type of analysis, perspective, costs, outcomes, and time horizon. Information was also extracted on measuring and valuing costs and outcomes, linking and extrapolating outcomes, and the maintenance of intervention effects. The 23 included studies reported on cost-effectiveness (CEAs) (N = 12), cost-utility (CUAs) (N = 9), social cost benefit (SCBA) (N = 2), and social return on investment (SROI) (N = 1) analysis. The usual practice comparator was generally not clearly defined. The SROI analysis was the single study that included outcomes in other persons than the child. Healthcare costs (N = 14), productivity costs (N = 4), and costs to the household (N = 3), or education (N = 2) sector were examined. The outcome in trial-based CEAs consisted of a variety of weight-related measures. Seven distinctive models were used to extrapolate health and/or productivity costs. To enhance the usefulness of economic evaluations on school-based lifestyle interventions in allocating public health budgets, transparent reporting on key aspects, broadening the scope of economic evaluations, and standardizing the measurement, valuation, and extrapolation of costs and outcomes should be improved. This study was conducted in Maastricht, the Netherlands.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Social Medicine, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Family Medicine, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Health Services Research, P.O. Box 616, 6200, MD, Maastricht, the Netherlands; Trimbos, Netherlands Institute of Mental Health and Addiction, Trimbos, P.O. Box 725, 3500, AS, Utrecht, the Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands
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15
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Ramaekers BLT, Wolff RF, Pouwels X, Oosterhoff M, Van Giessen A, Worthy G, Noake C, Armstrong N, Kleijnen J, Joore MA. Ixekizumab for Treating Moderate-to-Severe Plaque Psoriasis: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics 2018; 36:917-927. [PMID: 29480455 PMCID: PMC6021474 DOI: 10.1007/s40273-018-0629-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The National Institute for Health and Care Excellence invited Eli Lilly and Company Ltd, the company manufacturing ixekizumab (tradename Taltz®), to submit evidence for the clinical and cost effectiveness of ixekizumab. Ixekizumab was compared with tumour necrosis factor-α inhibitors (etanercept, infliximab, adalimumab), ustekinumab, secukinumab, best supportive care and, if non-biological treatment or phototherapy is suitable, also compared with systemic non-biological therapies and phototherapy with ultraviolet B radiation for adults with moderate-to-severe plaque psoriasis. Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Center, was commissioned as the independent Evidence Review Group. This article presents a summary of the company submission, the Evidence Review Group report and the development of the National Institute for Health and Care Excellence guidance for the use of this drug in England and Wales by the Appraisal Committee. The Evidence Review Group produced a critical review of the clinical and cost effectiveness of ixekizumab based on the company submission. The company submission presented three randomised controlled trials identified in a systematic review. All randomised controlled trials were phase III, multicentre placebo-controlled trials including 3866 participants with moderate-to-severe psoriasis. Two trials also included an active comparator (etanercept). All randomised controlled trials showed statistically significant increases in two primary outcomes, static Physician Global Assessment (0,1) and improvement of 75% from baseline in the Psoriasis Area and Severity Index. Ixekizumab was generally well tolerated in the randomised controlled trials, with similar discontinuation rates because of adverse events as placebo or etanercept. The most frequent adverse events of special interest were infections and injection-site reactions. The company submission also included a network meta-analysis of relevant comparators. The Evidence Review Group highlighted some issues regarding the systematic review process and an issue with the generalisability of the findings in that the trials failed to include patients with moderate psoriasis according to a widely used definition. This issue was considered by the Appraisal Committee and the population was deemed generalisable to patients in England and Wales. Based on the network meta-analysis, the Appraisal Committee concluded that ixekizumab was more clinically effective than adalimumab and ustekinumab, and agreed it was likely that ixekizumab was similarly effective compared with secukinumab and infliximab while tolerability was similar to other biological treatments approved for treating psoriasis. The Evidence Review Group's critical assessment of the company's economic evaluation highlighted a number of concerns, including (1) the use of relative outcomes such as Psoriasis Area and Severity Index response to model the cost effectiveness; (2) the exclusion of the consequences of adverse events; (3) the assumption of no utility gain in the induction phase; (4) equal annual discontinuation rates for all treatments; (5) the selection of treatment sequences for consideration in the analyses and; (6) the transparency of the Visual Basic for Applications code used to develop the model. Although some of these issues were adjusted in the Evidence Review Group base case, the Evidence Review Group could not estimate the impact of all of these issues, and thus acknowledges that there are still uncertainties concerning the cost-effectiveness evidence. In the Evidence Review Group base-case incremental analysis, the treatment sequence incorporating ixekizumab in the second line has an incremental cost-effectiveness ratio of £25,532 per quality-adjusted life-year gained vs. the etanercept sequence. Ixekizumab in the first-line sequence has an incremental cost-effectiveness ratio of £39,129 per quality-adjusted life-year gained compared with the treatment sequence incorporating ixekizumab in the second line. Consistent with its conclusion regarding clinical effectiveness, the Appraisal Committee concluded that the cost effectiveness of ixekizumab for treating moderate-to-severe plaque psoriasis was similar to that of other biological treatments, already recommended in previous National Institute for Health and Care Excellence guidance. The committee concluded that the incremental cost-effectiveness ratio was within the range that could be considered a cost-effective use of National Health Service resources.
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Affiliation(s)
- Bram L T Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | | | - Xavier Pouwels
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anoukh Van Giessen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | | | - Caro Noake
- Kleijnen Systematic Reviews Ltd, York, UK
| | | | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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16
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Vermeiren AP, Willeboordse M, Oosterhoff M, Bartelink N, Muris P, Bosma H. Socioeconomic multi-domain health inequalities in Dutch primary school children. Eur J Public Health 2018; 28:610-616. [DOI: 10.1093/eurpub/cky055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Angelique P Vermeiren
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Maartje Willeboordse
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Nina Bartelink
- Department of Health Promotion, CAPHRI and Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands
| | - Peter Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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17
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Willeboordse M, Jansen MW, van den Heijkant SN, Simons A, Winkens B, de Groot RHM, Bartelink N, Kremers SP, van Assema P, Savelberg HH, de Neubourg E, Borghans L, Schils T, Coppens KM, Dietvorst R, Ten Hoopen R, Coomans F, Klosse S, Conjaerts MHJ, Oosterhoff M, Joore MA, Ferreira I, Muris P, Bosma H, Toppenberg HL, van Schayck CP. Erratum to: The Healthy Primary School of the Future: study protocol of a quasi-experimental study. BMC Public Health 2017; 17:314. [PMID: 28399826 PMCID: PMC5387743 DOI: 10.1186/s12889-017-4230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 12/03/2022] Open
Affiliation(s)
- M Willeboordse
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M W Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands.,Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S N van den Heijkant
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - A Simons
- MOVARE Educational board, Kerkrade, The Netherlands
| | - B Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - R H M de Groot
- Welten Institute - Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - N Bartelink
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands.,Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S P Kremers
- Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - P van Assema
- Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - H H Savelberg
- Department of Human Movement Sciences, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - E de Neubourg
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - L Borghans
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - T Schils
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - K M Coppens
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - R Dietvorst
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - R Ten Hoopen
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - F Coomans
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - S Klosse
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - M H J Conjaerts
- Academic Hospital Maastricht, Treatment and Care Unit, Maastricht, The Netherlands
| | - M Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - M A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - I Ferreira
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands.,School of Public Health, The University of Queensland, Herston, Brisbane, Australia
| | - P Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - H Bosma
- Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - H L Toppenberg
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - C P van Schayck
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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18
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Euser AM, Stapert AF, Oosterhoff M, van Balkom IDC, Figee M. [Transcranial magnetic stimulation in obsessive compulsive disorder: a systematic review]. Tijdschr Psychiatr 2017; 59:617-625. [PMID: 29077137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Ten per cent of patients with obsessive-compulsive disorder (ocd) are resistant to treatment. For these patients, repetitive transcranial magnetic stimulation (rtms) may be an alternative form of treatment.<br/> AIM: To clarify the effect and clinical application of rtms for treatment-resistant ocd.<br/> METHOD: We searched the literature systematically and we discuss the relevant articles critically.<br/> RESULTS: We included 17 randomised controlled trials (rcts) with 502 patients. The reported trials were small and heterogeneous. A small but consistent treatment effect was found for rtms (mean decrease y-bocs score 6.6 points) compared to placebo stimulation (mean decrease y-bocs score 2.4 points). However, the differences between the effects of rtms and the effects of placebo were often not statistically or clinically significant. The effect frequently disappeared within several weeks after ending rtms and the follow-up period was never longer than three months.<br/> CONCLUSION: rtms is still not entirely suitable for inclusion in the regular treatment of resistant ocd. More information is needed about follow-up requirements and about the advisable length and intensity of the applied stimulation. Future developments may involve increasing the number of stimulation sessions, combining these with cognitive behavioral therapy and delivering a more personalised form of rtms.
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Oosterhoff M, Joore M, Ferreira I. The effects of school-based lifestyle interventions on body mass index and blood pressure: a multivariate multilevel meta-analysis of randomized controlled trials. Obes Rev 2016; 17:1131-1153. [PMID: 27432468 DOI: 10.1111/obr.12446] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/13/2016] [Accepted: 05/24/2016] [Indexed: 11/30/2022]
Abstract
Primary prevention of childhood obesity and related hypertension is warrant given that both risk factors are intertwined and track into adulthood. This systematic review and meta-analysis assess the impact of school-based lifestyle interventions on children's body mass index (BMI) and blood pressure. We searched databases and prior reviews. Eligibility criteria were the following: randomized controlled trial design, evaluation of a school-based intervention, targeting children aged 4-12 years, reporting on BMI and/or related cardiovascular risk factors, reporting data on at least one follow-up moment. The effects on BMI, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were evaluated by means of univariate and multivariate three-level random effects models. A total of 85 RCTs (91 papers) were included in the meta-analyses. In univariate models, the pooled effects were -0.072 (95%CI: -0.106; -0.038) for BMI, -0.183 (95%CI: -0.288; -0.078) for SBP and -0.071 (95%CI: -0.185; 0.044) for DBP. In multivariate analyses, the pooled effects of interventions were -0.054 (95%CI: -0.131; 0.022) for BMI, -0.182 (95%CI: -0.266; -0.098) for SBP and -0.144 (95%CI: -0.230; -0.057) for DBP. Parental involvement accentuated the beneficial effects of interventions. School-based lifestyle prevention interventions result in beneficial changes in children's BMI and blood pressure, and the effects on the latter may be stronger than and accrue independently from those in the former.
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Affiliation(s)
- M Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - M Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - I Ferreira
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, University of Queensland, Brisbane, Australia
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Willeboordse M, Jansen MW, van den Heijkant SN, Simons A, Winkens B, de Groot R, Bartelink N, Kremers SP, van Assema P, Savelberg HH, de Neubourg E, Borghans L, Schils T, Coppens KM, Dietvorst R, ten Hoopen R, Coomans F, Klosse S, Conjaerts M, Oosterhoff M, Joore MA, Ferreira I, Muris P, Bosma H, Toppenberg HL, van Schayck CP. The Healthy Primary School of the Future: study protocol of a quasi-experimental study. BMC Public Health 2016; 16:639. [PMID: 27456845 PMCID: PMC4960894 DOI: 10.1186/s12889-016-3301-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined. METHODS In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019. DISCUSSION A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society. TRIAL REGISTRATION The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 .
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Affiliation(s)
- M. Willeboordse
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - M. W. Jansen
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S. N. van den Heijkant
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - A. Simons
- MOVARE Educational board, Kerkrade, The Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - R.H.M. de Groot
- Welten Institute - Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - N. Bartelink
- Academic Collaborative Centre for Public Health Limburg, Public Health Services, Geleen, The Netherlands
- Department of Health Promotion, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - S. P. Kremers
- Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - P. van Assema
- Department of Health Promotion, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - H. H. Savelberg
- Department of Human Movement Sciences, NUTRIM, Maastricht University, Maastricht, The Netherlands
| | - E. de Neubourg
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - L. Borghans
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - T. Schils
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - K. M. Coppens
- School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - R. Dietvorst
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - R. ten Hoopen
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - F. Coomans
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - S. Klosse
- Department of Law, Maastricht University, Maastricht, The Netherlands
| | - M.H.J. Conjaerts
- Academic Hospital Maastricht, Treatment and Care Unit, Maastricht, The Netherlands
| | - M. Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - M. A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - I. Ferreira
- Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI, Maastricht University, Maastricht, The Netherlands
- School of Public Health, The University of Queensland, Herston, Brisbane Australia
| | - P. Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - H. Bosma
- Department of Social Medicine, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - H. L. Toppenberg
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Oosterhoff M, van der Maas ME, Steuten LMG. A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers. Appl Health Econ Health Policy 2016; 14:51-65. [PMID: 26334528 PMCID: PMC4740568 DOI: 10.1007/s40258-015-0198-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Diagnostic biomarkers have multiple applications along the care process and have a large potential in optimizing treatment decisions. However, many diagnostic biomarkers struggle to gain market access and obtain appropriate coverage because of a lack of evidence on their health economic impact. OBJECTIVES The aim was to review the (methodological) characteristics of recent economic evaluations on diagnostic biomarkers and examine whether these studies dealt with specific issues such as different payer perspectives, preference heterogeneity, and multiple applications in subpopulations. METHODS The PubMed database and the National Health Service Economic Evaluation Database were searched. Full economic evaluations published after 2009 assessing diagnostic biomarkers for the main non-communicable diseases in middle-income or high-income countries were considered eligible. Empirical and methodological study characteristics were summarized, as was the handling of specific issues related to the economic evaluation of personalized medicine. RESULTS Thirty-three economic evaluations were included, of which 25 were model-based analyses. The number of strategies compared ranged from two to 17 per study, and was especially large in studies assessing genetic testing in patients and their relatives. Cost-effectiveness results were most sensitive to test accuracy and costs of the biomarker (N = 7), the relative risk of an event (N = 4), and the proportion of people accepting genetic testing (N = 2). One study incorporated patient preferences, and none of the studies considered different payer perspectives, cost sharing arrangements or variable opportunity costs due to population density variability. CONCLUSIONS Published health economic evaluations of biomarkers used for diagnosing, staging diseases, and guiding treatment selection are characterized by a large number of comparators to model the potential clinical applications and to determine their value. Assessing outcomes beyond health as well as specific issues, such as different payer perspectives and patient preferences, is crucial to fully capture the potential health economic impact of diagnostic biomarkers and to inform value-based reimbursement.
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Affiliation(s)
- Marije Oosterhoff
- Panaxea b.v., Hengelosestraat 221, 7521 AC, Enschede, The Netherlands.
| | | | - Lotte M G Steuten
- Panaxea b.v., Hengelosestraat 221, 7521 AC, Enschede, The Netherlands.
- Fred Hutchinson Cancer Research Center, Seattle, USA.
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Oosterhoff M. [Reaction on 'Guideline psychiatric diagnostics 2015: strong positioning and some loose ends' (2)]. Tijdschr Psychiatr 2016; 58:557. [PMID: 27397808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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