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Bakker LJ, Thielen FW, Redekop WK, Groot CUD, Blommestein HM. Extrapolating empirical long-term survival data: the impact of updated follow-up data and parametric extrapolation methods on survival estimates in multiple myeloma. BMC Med Res Methodol 2023; 23:132. [PMID: 37248477 DOI: 10.1186/s12874-023-01952-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND In economic evaluations, survival is often extrapolated to smooth out the Kaplan-Meier estimate and because the available data (e.g., from randomized controlled trials) are often right censored. Validation of the accuracy of extrapolated results can depend on the length of follow-up and the assumptions made about the survival hazard. Here, we analyze the accuracy of different extrapolation techniques while varying the data cut-off to estimate long-term survival in newly diagnosed multiple myeloma (MM) patients. METHODS Empirical data were available from a randomized controlled trial and a registry for MM patients treated with melphalan + prednisone, thalidomide, and bortezomib- based regimens. Standard parametric and spline models were fitted while artificially reducing follow-up by introducing database locks. The maximum follow-up for these locks varied from 3 to 13 years. Extrapolated (conditional) restricted mean survival time (RMST) was compared to the Kaplan-Meier RMST and models were selected according to statistical tests, and visual fit. RESULTS For all treatments, the RMST error decreased when follow-up and the absolute number of events increased, and censoring decreased. The decline in RMST error was highest when maximum follow-up exceeded six years. However, even when censoring is low there can still be considerable deviations in the extrapolated RMST conditional on survival until extrapolation when compared to the KM-estimate. CONCLUSIONS We demonstrate that both standard parametric and spline models could be worthy candidates when extrapolating survival for the populations examined. Nevertheless, researchers and decision makers should be wary of uncertainty in results even when censoring has decreased, and the number of events has increased.
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Affiliation(s)
- L J Bakker
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands.
| | - F W Thielen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - W K Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Ca Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - H M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
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Visser LA, Uijl ID, Redekop WK, Sunamura M, Lenzen M, Boersma E, Brouwers RWM, Kemps HMC, van den Berg-Emons HJG, Ter Hoeve N. Cost-effectiveness of a cardiac rehabilitation program specifically designed for patients with obesity within the OPTICARE XL randomized controlled trial. Arch Phys Med Rehabil 2023:S0003-9993(23)00103-X. [PMID: 36868490 DOI: 10.1016/j.apmr.2023.02.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/29/2022] [Accepted: 02/02/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness of a cardiac rehabilitation (CR) program specifically designed for cardiac patients with obesity versus standard CR. DESIGN Cost-effectiveness analysis based on observations in a randomized controlled clinical trial. SETTING Three regional CR centres in the Netherlands. PARTICIPANTS Cardiac patients (N=201) with obesity (BMI≥30 kg/m2) referred to CR. INTERVENTIONS Participants were randomised to a CR program specifically designed for patients with obesity (OPTICARE XL; N=102) or standard CR. OPTICARE XL included aerobic and strength exercise and behavioural coaching on diet and physical activity during 12 weeks, followed by a 9 month after-care program with 'booster' educational sessions. Standard CR consisted of a 6 to 12-week aerobic exercise program, supplemented with cardiovascular lifestyle education. MAIN OUTCOME MEASURES An economic evaluation, with an 18-month time horizon, in terms of quality-adjusted life years (QALYs) and costs from the societal perspective was performed. Costs were reported in 2020 Euros, discounted at a 4% annual rate, and health effects were discounted at a 1.5% annual rate. RESULTS OPTICARE XL CR and standard CR resulted in comparable health gain per patient (0.958 versus 0.965 QALYs, respectively; p=0.96). Overall, OPTICARE XL CR saved costs (-€4,542) compared to the standard CR group. The direct costs for OPTICARE XL CR were higher than for standard CR (€10,712 vs. €9,951), whereas indirect costs were lower (€51,789 vs. €57,092), but these differences were not significant. CONCLUSIONS This economic evaluation showed no differences between OPTICARE XL CR and standard CR in health effects and costs in cardiac patients with obesity.
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Affiliation(s)
- L A Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
| | - I den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Capri Cardiac Rehabilitation, Rotterdam, the Netherlands
| | - W K Redekop
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, the Netherlands
| | - M Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - E Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - R W M Brouwers
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - H M C Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, the Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - N Ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Capri Cardiac Rehabilitation, Rotterdam, the Netherlands
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Bakker LJ, Goossens LM, O'Kane MJ, Uyl-de Groot CA, Redekop WK. Analysing electronic health records: The benefits of target trial emulation. Health Policy and Technology 2021. [DOI: 10.1016/j.hlpt.2021.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Visser LA, Louapre C, Uyl-de Groot CA, Redekop WK. Health-related quality of life of multiple sclerosis patients: a European multi-country study. Arch Public Health 2021; 79:39. [PMID: 33743785 PMCID: PMC7980344 DOI: 10.1186/s13690-021-00561-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inconsistent use of generic and disease-specific health-related quality of life (HRQOL) instruments in multiple sclerosis (MS) studies limits cross-country comparability. The objectives: 1) investigate real-world HRQOL of MS patients using both generic and disease-specific HRQOL instruments in the Netherlands, France, the United Kingdom, Spain, Germany and Italy; 2) compare HRQOL among these countries; 3) determine factors associated with HRQOL. METHODS A cross-sectional, observational online web-based survey amongst MS patients was conducted in June-October 2019. Patient demographics, clinical characteristics, and two HRQOL instruments: the generic EuroQOL (EQ-5D-5L) and disease-related Multiple Sclerosis Quality of Life (MSQOL)-54, an extension of the generic Short Form-36 (SF-36) was collected. Health utility scores were calculated using country-specific value sets. Mean differences in HRQOL were analysed and predictors of HRQOL were explored in regression analyses. RESULTS In total 182 patients were included (the Netherlands: n = 88; France: n = 58; the United Kingdom: n = 15; Spain: n = 10; living elsewhere: n = 11). Mean MSQOL-54 physical and mental composite scores (42.5, SD:17.2; 58.3, SD:21.5) were lower, whereas the SF-36 physical and mental composite scores (46.8, SD:22.6; 53.1, SD:22.5) were higher than reported in previous clinical trials. The mean EQ-5D utility was 0.65 (SD:0.26). Cross-country differences in HRQOL were found. A common predictor of HRQOL was disability status and primary progressive MS. CONCLUSIONS The effects of MS on HRQOL in real-world patients may be underestimated. Combined use of generic and disease-specific HRQOL instruments enhance the understanding of the health needs of MS patients. Consequent use of the same instruments in clinical trials and observational studies improves cross-country comparability of HRQOL.
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Affiliation(s)
- Laurenske A. Visser
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O.Box 1738/ 3000 DR, Rotterdam, The Netherlands
| | - Celine Louapre
- ICM Institut du cerveau et de la moelle epiniere, Sorbonne University, APHP, F-75013 Paris, France
- Department of Neurology, Sorbonne University, APHP, Paris, France
| | - Carin A. Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O.Box 1738/ 3000 DR, Rotterdam, The Netherlands
- Bayle (J) Building, Burgemeester Oudlaan 50/ 3062, PA Rotterdam, The Netherlands
| | - William K. Redekop
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O.Box 1738/ 3000 DR, Rotterdam, The Netherlands
- Bayle (J) Building, Burgemeester Oudlaan 50/ 3062, PA Rotterdam, The Netherlands
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Peultier A, Redekop WK, Boccalini S, Clayton B, Severens JL. Cost-effectiveness of imaging strategies to diagnose and select patients with non-obstructive coronary artery disease for statin treatment in the United Kingdom. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.428] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The project leading to this publication has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 668142.
Background
Patients with non-obstructive coronary artery disease (NOCAD) are at a higher risk of cardiovascular events compared to those with normal arteries. Plaque rupture is associated with increased adverse events and statin therapy seems to be beneficial for plaque stabilisation. Coronary Computed Tomography Angiography (CCTA) is currently the non-invasive imaging modality of choice for the morphological evaluation of NOCAD in the United Kingdom (UK). However, CCTA provides limited information regarding the vulnerability of plaques to rupture and the selection of patients for preventive statin treatment. Currently being tested on patients, Spectral Photon-Counting CT (SPCCT) may provide increased accuracy for vulnerable plaque detection and, in turn, improved selection of patients for statin treatment.
Purpose
We investigated the potential cost-effectiveness of SPCCT (compared to a set of CCTA-based strategies) in identifying NOCAD patients with rupture-prone plaques for preventive statin treatment.
Methods
A decision tree and a Markov trace were developed to model the expected outcomes (costs and quality-adjusted life-years (QALYs)) for a hypothetical UK cohort of 50-year-old male patients with stable chest pain and no history of CAD. Input data were obtained from the literature. Deterministic and probabilistic sensitivity analyses were performed. The impact of a pairwise variation of SPCCT sensitivity and specificity was analysed. Furthermore, five competing imaging strategies were compared in terms of their lifetime costs and effects: 1) CCTA and treat NOCAD based on imaging results, 2) CCTA and treat all NOCAD, 3) CCTA and do not treat NOCAD, 4) SPCCT with high specificity and treat NOCAD based on imaging results, and 5) SPCCT with high sensitivity and treat NOCAD based on imaging results.
Results
Our deterministic and probabilistic results showed that an improved imaging test would add value compared to CCTA. While increased specificity (to 95%) is favorable at a lower willingness to pay (WTP) (up to ∼£9,000 per QALY), increased sensitivity (to 95%) is more likely to be favorable at a higher WTP (∼£9,000 to £120,000 per QALY). The role of a CCTA-treat-none strategy and a CCTA-treat-all strategy is minimal and potential only at really low (<£2,000 per QALY) and high (>£120,000 per QALY) WTP, respectively. The uncertainty around these results is highly correlated to the uncertainty around the long-term risk for NOCAD patients to experience myocardial infarction or stroke.
Conclusion
An improved imaging test based on higher sensitivity in identifying rupture-prone coronary plaques in NOCAD patients seems to have value in guiding the decision of preventive statin treatment in the UK. However, additional data regarding the efficacy of statins and of combined treatments for NOCAD patients are needed before the cost-effectiveness of SPCCT can be precisely estimated in this population.
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Affiliation(s)
- A Peultier
- Erasmus University Rotterdam, Rotterdam, Netherlands (The)
| | - WK Redekop
- Erasmus University Rotterdam, Rotterdam, Netherlands (The)
| | - S Boccalini
- Hospital Louis Pradel of Bron, Radiology, Lyon, France
| | - B Clayton
- Royal Devon & Exeter Hospital, Exeter, United Kingdom of Great Britain & Northern Ireland
| | - JL Severens
- Erasmus University Rotterdam, Rotterdam, Netherlands (The)
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Lenk EJ, Moungui HC, Boussinesq M, Kamgno J, Nana-Djeunga HC, Fitzpatrick C, Peultier ACMM, Klion AD, Fletcher DA, Nutman TB, Pion SD, Niamsi-Emalio Y, Redekop WK, Severens JL, Stolk WA. A Test-and-Not-Treat Strategy for Onchocerciasis Elimination in Loa loa-coendemic Areas: Cost Analysis of a Pilot in the Soa Health District, Cameroon. Clin Infect Dis 2021; 70:1628-1635. [PMID: 31165855 PMCID: PMC7146010 DOI: 10.1093/cid/ciz461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/19/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Severe adverse events after treatment with ivermectin in individuals with high levels of Loa loa microfilariae in the blood preclude onchocerciasis elimination through community-directed treatment with ivermectin (CDTI) in Central Africa. We measured the cost of a community-based pilot using a test-and-not-treat (TaNT) strategy in the Soa health district in Cameroon. Methods Based on actual expenditures, we empirically estimated the economic cost of the Soa TaNT campaign, including financial costs and opportunity costs that will likely be borne by control programs and stakeholders in the future. In addition to the empirical analyses, we estimated base-case, less intensive, and more intensive resource use scenarios to explore how costs might differ if TaNT were implemented programmatically. Results The total costs of US$283 938 divided by total population, people tested, and people treated with 42% coverage were US$4.0, US$9.2, and US$9.5, respectively. In programmatic implementation, these costs (base-case estimates with less and more intensive scenarios) could be US$2.2 ($1.9–$3.6), US$5.2 ($4.5–$8.3), and US$5.4 ($4.6–$8.6), respectively. Conclusions TaNT clearly provides a safe strategy for large-scale ivermectin treatment and overcomes a major obstacle to the elimination of onchocerciasis in areas coendemic for Loa loa. Although it is more expensive than standard CDTI, costs vary depending on the setting, the implementation choices made by the institutions involved, and the community participation rate. Research on the required duration of TaNT is needed to improve the affordability assessment, and more experience is needed to understand how to implement TaNT optimally.
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Affiliation(s)
- Edeltraud J Lenk
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam.,Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands
| | - Henri C Moungui
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
| | - Michel Boussinesq
- Unité Mixte Internationale, TransVIHMI, Institut de Recherche pour le Développement, University of Montpellier, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases, Yaounde, Cameroon
| | | | | | | | - Amy D Klion
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Thomas B Nutman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sébastien D Pion
- Unité Mixte Internationale, TransVIHMI, Institut de Recherche pour le Développement, University of Montpellier, France
| | | | - William K Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam
| | - Johan L Severens
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam
| | - Wilma A Stolk
- Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands
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Visser LA, De Mul M, Redekop WK. Innovative Medical Technology and the Treatment Decision-Making Process in Multiple Sclerosis: A Focus Group Study to Examine Patient Perspectives. Patient Prefer Adherence 2021; 15:927-937. [PMID: 33994779 PMCID: PMC8114356 DOI: 10.2147/ppa.s306132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Disease-modifying therapies are given to people with multiple sclerosis (MS) to reduce disease progression and relapse frequency. Current modes of administration include oral, injectable and infusion therapy and the treatment decision-making process is complex. A novel mode of treatment administration, an implantable device, is currently under development, yet patient attitudes about the device are unknown. The aim of this study was 1) to understand the treatment decision-making process from the patient perspective and 2) to explore the possible acceptance of an implant to treat MS. METHODS Focus groups with people with MS were conducted in the Netherlands. Three topics were addressed: the treatment decision-making process, the current treatment landscape, and attitudes about the implantable device. All focus groups were recorded and transcribed and data were analyzed by raw data coding and creating themes. An online survey was conducted in the Netherlands to quantify interest in an implant. RESULTS Two focus group sessions were held (n=16 participants) and n=93 persons filled out the survey. The main theme that emerged was the constant uncertainty persons with MS face throughout their disease course and during treatment decisions (when to start, stop, continue or switch treatment). Patients were generally positive towards the implant but felt that efficacy and safety should be guaranteed. CONCLUSION People with MS want some form of control over their disease and treatment course. New medical technologies, such as an implant, may enhance the treatment landscape and with caution we postulate that it may be accepted by patients as a new mode of administration, though further research is needed. For medical technologies to be successful, patients should be engaged early on in the design process.
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Affiliation(s)
- L A Visser
- Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Correspondence: L A Visser Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle (J) Building, Room J8-15, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, the NetherlandsTel +31 10 408 8648 Email
| | - M De Mul
- Health Services Management & Organization, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - W K Redekop
- Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Peultier A, Venetsanos D, Rashid I, Severens JL, Redekop WK. European survey on acute coronary syndrome diagnosis and revascularisation treatment: Assessing differences in reported clinical practice with a focus on strategies for specific patient cases. J Eval Clin Pract 2020; 26:1457-1466. [PMID: 31994256 PMCID: PMC7587003 DOI: 10.1111/jep.13333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES While different imaging and treatment options are available in acute coronary syndrome (ACS) care, there is a lack of data regarding their use across Europe. We examined the diagnostic and treatment strategies in patients with known or suspected ACS as reported by physicians and identified variations in responses across European countries and geographical areas. METHOD A web-based clinician survey focusing on ACS imaging and revascularization treatments was circulated through email distribution lists and websites of European professional societies in the field of cardiology. We collected information on respondents' clinical setting and specialty. Reported percentages of patients receiving imaging or treatment modalities and percentages of clinicians reporting to use modalities in a range of clinical scenarios were analyzed. Statistical comparisons were performed. RESULTS In total, 69 responses were received (Sweden [n = 20], United Kingdom [n = 16], Northern/Western Europe [n = 17], Southern Europe [n = 9], and Central Europe [n = 7]). Considerable variations between geographical areas were seen in terms of reported diagnostic modalities and treatment strategies. For example, when presented with the scenario of a theoretical 45-year-old smoking female with a suspected ACS, 56% of UK clinicians reported to use coronary computed tomography angiography, compared to only 10% of Swedish clinicians (P = .002). Large variations were observed regarding the reported use of fractional flow reserve by physicians for non-culprit lesions during invasive management of myocardial infarction patients (44% in Sweden, 31% in the United Kingdom, and 30% in Northern/Western Europe vs non-use in Central and Southern Europe). CONCLUSIONS In this survey, respondents reported different diagnostic and treatment strategies in ACS care. These variations seem to have geographic components. Larger studies or real world data are needed to verify these observations and investigate their causes. More research is needed to compare the quality and efficiency of ACS care across countries and explore pathways for improvement.
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Affiliation(s)
- Anne‐Claire Peultier
- Health Technology Assessment, Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Dimitrios Venetsanos
- Coronary Artery and Vascular Disease, Heart and Vascular Theme, Department of MedicineKarolinska Institute and Karolinska University HospitalStockholmSweden
| | - Imran Rashid
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonUK
- Case Cardiovascular Research InstituteCase Western Reserve UniversityClevelandOhio
| | - Johan L. Severens
- Health Technology Assessment, Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
- Institute for Medical Technology AssessmentErasmus University RotterdamRotterdamThe Netherlands
| | - William K. Redekop
- Health Technology Assessment, Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
- Institute for Medical Technology AssessmentErasmus University RotterdamRotterdamThe Netherlands
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9
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Visser LA, Louapre C, Uyl-de Groot CA, Redekop WK. Patient needs and preferences in relapsing-remitting multiple sclerosis: A systematic review. Mult Scler Relat Disord 2020; 39:101929. [PMID: 31924590 DOI: 10.1016/j.msard.2020.101929] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/29/2019] [Accepted: 01/01/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Considering the multiple treatments approved for multiple sclerosis (MS) by the Food and Drug Administration (FDA) and European Medicines Agency (EMA), determining a treatment strategy for patients with clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) can be challenging. To date, an overview of the needs and preferences of patients at each treatment decision-making moment is lacking. Therefore, the aim of this systematic review is to examine the existing literature about the needs and preferences of patients with CIS and RRMS when making treatment decisions. METHODS A systematic search was done using Embase, Medline, PsychINFO, Web of Science and Google Scholar. Eligibility criteria included whether the article described a study of adults with CIS/RRMS and reported patient needs or preferences regarding first-line disease modifying treatment (DMT) decisions. Publications were categorized by treatment decision: initiation of first DMT (D1), DMT adherence/discontinuation (D2a/D2b), and switch to a second DMT (D3). A separate category was created for stated preference studies such as discrete choice experiment methods to examine the relative importance of different treatment attributes. Publications were compared to identify key factors. RESULTS The search yielded 2789 articles after removal of duplicates and 434 full-text publications were reviewed for eligibility. Twenty-four articles fulfilled all criteria: n = 5 (D1), n = 12 (D2a), n = 13 (D2b), and n = 3 (D3); six articles studied more than one treatment decision. The need for social support is important during D1. The most commonly reported reasons for adherence/discontinuation/switch included forgetfulness, side-effects, and injection-related reasons. Eight articles described preference studies; the most important DMT attributes were efficacy, mode and frequency of administration, and side-effect profile. CONCLUSIONS Understanding the needs and preferences of CIS/RRMS patients regarding DMT attributes and non-treatment related attributes are important to improve treatment decision-making and reduce non-adherence. Studies are needed to understand patient preferences upon treatment initiation. Furthermore, preference studies should include attributes based on the patient perspective.
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Affiliation(s)
- L A Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
| | - C Louapre
- Institut du Cerveau et de la Moelle épinière - ICM, Groupe hospitalier Pitié-Salpêtrière, 47-83, bd de l'Hôpital. 75651 Paris CEDEX 13, France.
| | - C A Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
| | - W K Redekop
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam. Bayle Building, Burgermeester Oudlaan 50. 3062 PA, Rotterdam, the Netherlands.
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10
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Peultier AC, Redekop WK, Allen M, Peters J, Eker OF, Severens JL. Exploring the Cost-Effectiveness of Mechanical Thrombectomy Beyond 6 Hours Following Advanced Imaging in the United Kingdom. Stroke 2019; 50:3220-3227. [PMID: 31637975 PMCID: PMC6824506 DOI: 10.1161/strokeaha.119.026816] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. In the United Kingdom, mechanical thrombectomy (MT) for acute ischemic stroke patients assessed beyond 6 hours from symptom onset will be commissioned up to 12 hours provided that advanced imaging (AdvImg) demonstrates salvageable brain tissue. While the accuracy of AdvImg differs across technologies, evidence is limited regarding the proportion of patients who would benefit from late MT. We compared the cost-effectiveness of 2 care pathways: (1) MT within and beyond 6 hours based on AdvImg selection versus (2) MT only within 6 hours based on conventional imaging selection. The impact of varying AdvImg accuracy and prior probability for acute ischemic stroke patients to benefit from late MT was assessed.
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Affiliation(s)
- Anne-Claire Peultier
- From Erasmus School of Health Policy and Management (A.-C.P., W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands
| | - William K Redekop
- From Erasmus School of Health Policy and Management (A.-C.P., W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands.,Institute for Medical Technology Assessment (W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands
| | - Michael Allen
- University of Exeter Medical School, United Kingdom (M.A.).,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, United Kingdom (M.A.)
| | - Jaime Peters
- Exeter Test Group, University of Exeter Medical School, United Kingdom (J.P.)
| | - Omer Faruk Eker
- Department of Neuroradiology, Lyon University Hospital, France (O.F.E.)
| | - Johan L Severens
- From Erasmus School of Health Policy and Management (A.-C.P., W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands.,Institute for Medical Technology Assessment (W.K.R., J.L.S.), Erasmus University Rotterdam, the Netherlands
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11
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Buisman LR, Rijnsburger AJ, van der Lugt A, Nederkoorn PJ, Koudstaal PJ, Redekop WK. Cost-effectiveness of novel imaging tests to select patients for carotid endarterectomy. Health Policy and Technology 2019. [DOI: 10.1016/j.hlpt.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Lenk EJ, Redekop WK, Luyendijk M, Fitzpatrick C, Niessen L, Stolk WA, Tediosi F, Rijnsburger AJ, Bakker R, Hontelez JAC, Richardus JH, Jacobson J, Le Rutte EA, de Vlas SJ, Severens JL. Socioeconomic benefit to individuals of achieving 2020 targets for four neglected tropical diseases controlled/eliminated by innovative and intensified disease management: Human African trypanosomiasis, leprosy, visceral leishmaniasis, Chagas disease. PLoS Negl Trop Dis 2018; 12:e0006250. [PMID: 29534061 PMCID: PMC5849290 DOI: 10.1371/journal.pntd.0006250] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 04/29/2015] [Accepted: 01/18/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The control or elimination of neglected tropical diseases (NTDs) has targets defined by the WHO for 2020, reinforced by the 2012 London Declaration. We estimated the economic impact to individuals of meeting these targets for human African trypanosomiasis, leprosy, visceral leishmaniasis and Chagas disease, NTDs controlled or eliminated by innovative and intensified disease management (IDM). METHODS A systematic literature review identified information on productivity loss and out-of-pocket payments (OPPs) related to these NTDs, which were combined with projections of the number of people suffering from each NTD, country and year for 2011-2020 and 2021-2030. The ideal scenario in which the WHO's 2020 targets are met was compared with a counterfactual scenario that assumed the situation of 1990 stayed unaltered. Economic benefit equaled the difference between the two scenarios. Values are reported in 2005 US$, purchasing power parity-adjusted, discounted at 3% per annum from 2010. Probabilistic sensitivity analyses were used to quantify the degree of uncertainty around the base-case impact estimate. RESULTS The total global productivity gained for the four IDM-NTDs was I$ 23.1 (I$ 15.9 -I$ 34.0) billion in 2011-2020 and I$ 35.9 (I$ 25.0 -I$ 51.9) billion in 2021-2030 (2.5th and 97.5th percentiles in brackets), corresponding to US$ 10.7 billion (US$ 7.4 -US$ 15.7) and US$ 16.6 billion (US$ 11.6 -US$ 24.0). Reduction in OPPs was I$ 14 billion (US$ 6.7 billion) and I$ 18 billion (US$ 10.4 billion) for the same periods. CONCLUSIONS We faced important limitations to our work, such as finding no OPPs for leprosy. We had to combine limited data from various sources, heterogeneous background, and of variable quality. Nevertheless, based on conservative assumptions and subsequent uncertainty analyses, we estimate that the benefits of achieving the targets are considerable. Under plausible scenarios, the economic benefits far exceed the necessary investments by endemic country governments and their development partners. Given the higher frequency of NTDs among the poorest households, these investments represent good value for money in the effort to improve well-being, distribute the world's prosperity more equitably and reduce inequity.
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Affiliation(s)
- Edeltraud J. Lenk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - William K. Redekop
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne Luyendijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Christopher Fitzpatrick
- Department of control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Louis Niessen
- Centre for Applied Health Research and Delivery, Department of International Public Health, Liverpool School of Tropical Medicine and University of Liverpool, Liverpool, United Kingdom
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | | | - Roel Bakker
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A. C. Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H. Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Jacobson
- Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Epke A. Le Rutte
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan L. Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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13
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Gaultney JG, Ng TW, Uyl-de Groot CA, Sonneveld P, van Beers EH, van Vliet MH, Redekop WK. Potential therapeutic and economic value of risk-stratified treatment as initial treatment of multiple myeloma in Europe. Pharmacogenomics 2018; 19:213-226. [DOI: 10.2217/pgs-2017-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Biomarkers associated with prognosis in multiple myeloma (MM) can be used to stratify patients into risk categories. An attractive alternative to uniform treatment (UT), risk-stratified treatment (RST) is proposed where high-risk patients receive bortezomib-based regimens while standard-risk patients receive alternative less costly regimens. An early Markov-type decision analytic model evaluated the potential therapeutic and economic value of different RST strategies compared with UT in MM patients in key European countries. Results suggest RST strategies were both cheaper and more effective than UT across all countries, with the molecular marker-only strategy RST-SKY92 producing maximum health gains (0.031–0.039 QALYs). The conclusions remained consistent in the univariate sensitivity analyses. These findings should encourage stakeholders to support the adoption of RST approaches in MM.
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Affiliation(s)
| | - Therese W Ng
- IQVIA, 210 Pentonville Road, London N1 9JY, United Kingdom
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Erik H van Beers
- SkylineDx BV, Rotterdam Science Tower, Marconistraat 16, 18th floor 3029 AK Rotterdam, The Netherlands
| | - Martin H van Vliet
- SkylineDx BV, Rotterdam Science Tower, Marconistraat 16, 18th floor 3029 AK Rotterdam, The Netherlands
| | - William K Redekop
- Erasmus School of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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14
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de Groot S, Redekop WK, Versteegh MM, Sleijfer S, Oosterwijk E, Kiemeney LALM, Uyl-de Groot CA. Health-related quality of life and its determinants in patients with metastatic renal cell carcinoma. Qual Life Res 2017; 27:115-124. [PMID: 28917029 PMCID: PMC5770482 DOI: 10.1007/s11136-017-1704-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Accepted: 09/07/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Based on improvements of progression-free survival (PFS), new agents for metastatic renal cell carcinoma (mRCC) have been approved. It is assumed that one of the benefits is a delay in health-related quality of life (HRQoL) deterioration as a result of a delay in progression of disease. However, little data are available supporting this relationship. This study aims to provide insight into the most important determinants of HRQoL (including progression of disease) of patients with mRCC. METHODS A patient registry (PERCEPTION) was created to evaluate treatment of patients with (m)RCC in the Netherlands. HRQoL was measured, using the EORTC QLQ-C30 and EQ-5D-5L, every 3 months in the first year of participation in the study, and every 6 months in the second year. Participation started as soon as possible following a diagnosis of (m)RCC. Random effects models were used to study associations between HRQoL and patient and disease characteristics, symptoms and treatment. RESULTS Eighty-seven patients with mRCC completed 304 questionnaires. The average EORTC QLQ-C30 global health status was 69 (SD, 19) before progression and 61 (SD, 22) after progression of disease. Similarly, the average EQ-5D utility was 0.75 (SD, 0.19) before progression and 0.66 (SD, 0.30) after progression of disease. The presence of fatigue, pain, dyspnoea, and the application of radiotherapy were associated with significantly lower EQ-5D utilities. CONCLUSIONS Key drivers for reduced HRQoL in mRCC are disease symptoms. Since symptoms increase with progression of disease, targeted therapies that increase PFS are expected to postpone reductions in HRQoL in mRCC.
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Affiliation(s)
- S de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands. .,Institute for Medical Technology Assessment, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - W K Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - M M Versteegh
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - S Sleijfer
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, P. O. Box 5201, 3008 AE, Rotterdam, The Netherlands
| | - E Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, P. O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - L A L M Kiemeney
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, P. O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P. O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Burgers LT, Redekop WK, Al MJ, Lhachimi SK, Armstrong N, Walker S, Rothery C, Westwood M, Severens JL. Cost-effectiveness analysis of new generation coronary CT scanners for difficult-to-image patients. Eur J Health Econ 2017; 18:731-742. [PMID: 27650359 DOI: 10.1007/s10198-016-0824-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/04/2016] [Indexed: 06/06/2023]
Abstract
AIMS New generation dual-source coronary CT (NGCCT) scanners with more than 64 slices were evaluated for patients with (known) or suspected of coronary artery disease (CAD) who are difficult to image: obese, coronary calcium score > 400, arrhythmias, previous revascularization, heart rate > 65 beats per minute, and intolerance of betablocker. A cost-effectiveness analysis of NGCCT compared with invasive coronary angiography (ICA) was performed for these difficult-to-image patients for England and Wales. METHODS AND RESULTS Five models (diagnostic decision model, four Markov models for CAD progression, stroke, radiation and general population) were integrated to estimate the cost-effectiveness of NGCCT for both suspected and known CAD populations. The lifetime costs and effects from the National Health Service perspective were estimated for three strategies: (1) patients diagnosed using ICA, (2) using NGCCT, and (3) patients diagnosed using a combination of NGCCT and, if positive, followed by ICA. In the suspected population, the strategy where patients only undergo a NGCCT is a cost-effective option at accepted cost-effectiveness thresholds. The strategy of using NGCCT in combination with ICA is the most favourable strategy for patients with known CAD. The most influential factors behind these results are the percentage of patients being misclassified (a function of both diagnostic accuracy and the prior likelihood), the complication rates of the procedures, and the cost price of a NGCCT scan. CONCLUSION The use of NGCCT might be considered cost-effective in both populations since it is cost-saving compared to ICA and generates similar effects.
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Affiliation(s)
- L T Burgers
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - W K Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M J Al
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - S K Lhachimi
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Group for Evidence-Based Public Health, BIPS -Leibniz-Institute für Prevention Research und Epidemiology, Bremen, Germany
| | | | - S Walker
- Centre for Health Economics, University of York, York, UK
| | - C Rothery
- Centre for Health Economics, University of York, York, UK
| | - M Westwood
- Kleijnen Systematic Reviews Ltd, York, UK
| | - J L Severens
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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16
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Redekop WK, Lenk EJ, Luyendijk M, Fitzpatrick C, Niessen L, Stolk WA, Tediosi F, Rijnsburger AJ, Bakker R, Hontelez JAC, Richardus JH, Jacobson J, de Vlas SJ, Severens JL. The Socioeconomic Benefit to Individuals of Achieving the 2020 Targets for Five Preventive Chemotherapy Neglected Tropical Diseases. PLoS Negl Trop Dis 2017; 11:e0005289. [PMID: 28103243 PMCID: PMC5313231 DOI: 10.1371/journal.pntd.0005289] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 04/29/2015] [Revised: 02/16/2017] [Accepted: 12/28/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminths (STH) and trachoma represent the five most prevalent neglected tropical diseases (NTDs). They can be controlled or eliminated by means of safe and cost-effective interventions delivered through programs of Mass Drug Administration (MDA)-also named Preventive Chemotherapy (PCT). The WHO defined targets for NTD control/elimination by 2020, reinforced by the 2012 London Declaration, which, if achieved, would result in dramatic health gains. We estimated the potential economic benefit of achieving these targets, focusing specifically on productivity and out-of-pocket payments. METHODS Productivity loss was calculated by combining disease frequency with productivity loss from the disease, from the perspective of affected individuals. Productivity gain was calculated by deducting the total loss expected in the target achievement scenario from the loss in a counterfactual scenario where it was assumed the pre-intervention situation in 1990 regarding NTDs would continue unabated until 2030. Economic benefits from out-of-pocket payments (OPPs) were calculated similarly. Benefits are reported in 2005 US$ (purchasing power parity-adjusted and discounted at 3% per annum from 2010). Sensitivity analyses were used to assess the influence of changes in input parameters. RESULTS The economic benefit from productivity gain was estimated to be I$251 billion in 2011-2020 and I$313 billion in 2021-2030, considerably greater than the total OPPs averted of I$0.72 billion and I$0.96 billion in the same periods. The net benefit is expected to be US$ 27.4 and US$ 42.8 for every dollar invested during the same periods. Impact varies between NTDs and regions, since it is determined by disease prevalence and extent of disease-related productivity loss. CONCLUSION Achieving the PCT-NTD targets for 2020 will yield significant economic benefits to affected individuals. Despite large uncertainty, these benefits far exceed the investment required by governments and their development partners within all reasonable scenarios. Given the concentration of the NTDs among the poorest households, these investments represent good value for money in efforts to share the world's prosperity and reduce inequity.
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Affiliation(s)
- William K. Redekop
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Edeltraud J. Lenk
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne Luyendijk
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Louis Niessen
- Centre for Applied Health Research and Delivery, Department of International Public Health, Liverpool School of Tropical Medicine and University of Liverpool, Liverpool, United Kingdom
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | | | - Roel Bakker
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A. C. Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H. Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Jacobson
- Bill & Melinda Gates Foundation, Seattle, WA, United States of America
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan L. Severens
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Wijnen B, Van Mastrigt G, Redekop WK, Majoie H, De Kinderen R, Evers S. How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: data extraction, risk of bias, and transferability (part 3/3). Expert Rev Pharmacoecon Outcomes Res 2016; 16:723-732. [PMID: 27762640 DOI: 10.1080/14737167.2016.1246961] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This article is part of the series "How to Prepare a Systematic Review (SR) of Economic Evaluations (EE) for Informing Evidence-based Healthcare Decisions" in which a five-step-approach for conducting a SR of EE is proposed. Areas covered: This paper explains the data extraction process, the risk of bias assessment and the transferability of EEs by means of a narrative review and expert opinion. SRs play a critical role in determining the comparative cost-effectiveness of healthcare interventions. It is important to determine the risk of bias and the transferability of an EE. Expert commentary: Over the past decade, several criteria lists have been developed. This article aims to provide recommendations on these criteria lists based on the thoroughness of development, feasibility, overall quality, recommendations of leading organizations, and widespread use.
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Affiliation(s)
- Bfm Wijnen
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.,b Department of Research and Development , Epilepsy Centre Kempenhaeghe , Heeze , The Netherlands
| | - Gapg Van Mastrigt
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - W K Redekop
- c Department of Health Policy and Management, Institute for Medical Technology Assessment , Erasmus University Rotterdam , Rotterdam , The Netherlands
| | - Hjm Majoie
- b Department of Research and Development , Epilepsy Centre Kempenhaeghe , Heeze , The Netherlands.,d Department of Neurology, Academic Centre for Epileptology , Epilepsy Centre Kempenhaeghe and Maastricht University Medical Centre , Maastricht , The Netherlands.,f School of Mental Health and Neuroscience , Maastricht University Medical Center , Maastricht , The Netherlands.,g School of Health Professions Education, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands
| | - Rja De Kinderen
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands
| | - Smaa Evers
- a Department of Health Services Research, CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , The Netherlands.,e Department for Economic Evaluations , Trimbos Institute, Netherlands Institute of Mental Health and Addiction , Utrecht , The Netherlands
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Ansaripour A, Uyl-de Groot CA, Foroozanfar M, Rahimimoghadam S, Redekop WK. Which is more important for doctors in a middle-income country, a national guideline or the medical literature? An adherence survey of trastuzumab use for breast cancer in Iran. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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De Groot S, Sleijfer S, Redekop WK, Oosterwijk E, Haanen JBAG, Kiemeney LALM, Uyl-de Groot CA. Variation in use of targeted therapies for metastatic renal cell carcinoma: Results from a Dutch population-based registry. BMC Cancer 2016; 16:364. [PMID: 27286871 PMCID: PMC4902930 DOI: 10.1186/s12885-016-2395-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 10/06/2015] [Accepted: 06/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND For patients with metastatic renal cell carcinoma (mRCC), targeted therapies have entered the market since 2006. The aims of this study were to evaluate the uptake and use of targeted therapies for mRCC in The Netherlands, examine factors associated with the prescription of targeted therapies in daily clinical practice and study their effectiveness in terms of overall survival (OS). METHODS Two cohorts from PERCEPTION, a population-based registry of mRCC patients, were used: a 2008-2010 Cohort (n = 645) and a 2011-2013 Cohort (n = 233). Chi-squared tests for trend were used to study time trends in the use of targeted therapy. Patients were grouped based on the eligibility criteria of the SUTENT trial, the trial that led to sunitinib becoming standard of care, to investigate the use of targeted therapies amongst patients fulfilling those criteria. Multi-level logistic regression was used to identify patient subgroups that are less likely to receive targeted therapies. RESULTS Approximately one-third of patients fulfilling SUTENT trial eligibility criteria did not receive any targeted therapy (29 % in the 2008-2010 Cohort; 35 % in the 2011-2013 Cohort). Patients aged 65+ years were less likely to receive targeted therapy in both cohorts and different risk groups (odds ratios range between 0.84-0.92); other factors like number of metastatic sites were of influence in some subgroups. Amongst treated patients, there was a decreasing trend in sunitinib use over time (p = 0.0061), and an increasing trend in pazopanib use (p = 0.0005). CONCLUSIONS Targeted therapies have largely replaced interferon-alfa as first-line standard of care. Nevertheless, many eligible patients in Dutch daily practice did not receive targeted therapies despite their ability to improve survival. Reasons for their apparent underutilisation should be examined more carefully.
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Affiliation(s)
- S De Groot
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - S Sleijfer
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - W K Redekop
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - E Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - L A L M Kiemeney
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C A Uyl-de Groot
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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de Groot S, Redekop WK, Sleijfer S, Oosterwijk E, Bex A, Kiemeney LALM, Uyl-de Groot CA. Survival in Patients With Primary Metastatic Renal Cell Carcinoma Treated With Sunitinib With or Without Previous Cytoreductive Nephrectomy: Results From a Population-based Registry. Urology 2016; 95:121-7. [PMID: 27179773 DOI: 10.1016/j.urology.2016.04.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effect of cytoreductive nephrectomy (CN) on overall survival (OS) in primary metastatic renal cell carcinoma (mRCC) patients treated with first-line sunitinib. PATIENTS AND METHODS Patients with primary mRCC treated with first-line sunitinib were selected from a Dutch population-based registry. A propensity score was calculated reflecting the probability of a patient undergoing CN prior to sunitinib using a set of known covariates, such as the Memorial Sloan Kettering Cancer Center and International mRCC Database Consortium risk factors. After propensity score matching, differences in OS were analyzed using the Kaplan-Meier method and a multivariable Cox proportional hazards model was used to evaluate the effect of CN on OS. RESULTS A total of 227 patients met the selection criteria; 74 patients (33%) underwent CN prior to sunitinib. In the matched population, the median OS of patients who underwent CN was 17.9 months compared to 8.8 months for patients treated with sunitinib only. Multivariable analysis showed that CN was an independent predictor of OS (hazard ratio 0.61, 95% confidence interval: 0.41-0.92). A subgroup analysis of patients with a time to targeted therapy of <1 year showed a median OS of 12.7 months for patients treated with CN compared to 8.0 months for patients treated with sunitinib only. The corresponding hazard ratio was 0.67 (95% confidence interval: 0.46-0.98). CONCLUSION This study suggests that CN may be effective. However, the benefit was modest when correcting for time from diagnosis to sunitinib. One important limitation is the use of a registry (with retrospectively collected data), which made it impossible to correct for unmeasured characteristics that could be associated with treatment choices or survival.
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Affiliation(s)
- Saskia de Groot
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - William K Redekop
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Egbert Oosterwijk
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Lambertus A L M Kiemeney
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Department for Health Evidence, Nijmegen, The Netherlands
| | - Carin A Uyl-de Groot
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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21
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de Vlas SJ, Stolk WA, le Rutte EA, Hontelez JAC, Bakker R, Blok DJ, Cai R, Houweling TAJ, Kulik MC, Lenk EJ, Luyendijk M, Matthijsse SM, Redekop WK, Wagenaar I, Jacobson J, Nagelkerke NJD, Richardus JH. Concerted Efforts to Control or Eliminate Neglected Tropical Diseases: How Much Health Will Be Gained? PLoS Negl Trop Dis 2016; 10:e0004386. [PMID: 26890362 PMCID: PMC4758649 DOI: 10.1371/journal.pntd.0004386] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022] Open
Abstract
Background The London Declaration (2012) was formulated to support and focus the control and elimination of ten neglected tropical diseases (NTDs), with targets for 2020 as formulated by the WHO Roadmap. Five NTDs (lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths and trachoma) are to be controlled by preventive chemotherapy (PCT), and four (Chagas’ disease, human African trypanosomiasis, leprosy and visceral leishmaniasis) by innovative and intensified disease management (IDM). Guinea worm, virtually eradicated, is not considered here. We aim to estimate the global health impact of meeting these targets in terms of averted morbidity, mortality, and disability adjusted life years (DALYs). Methods The Global Burden of Disease (GBD) 2010 study provides prevalence and burden estimates for all nine NTDs in 1990 and 2010, by country, age and sex, which were taken as the basis for our calculations. Estimates for other years were obtained by interpolating between 1990 (or the start-year of large-scale control efforts) and 2010, and further extrapolating until 2030, such that the 2020 targets were met. The NTD disease manifestations considered in the GBD study were analyzed as either reversible or irreversible. Health impacts were assessed by comparing the results of achieving the targets with the counterfactual, construed as the health burden had the 1990 (or 2010 if higher) situation continued unabated. Principle Findings/Conclusions Our calculations show that meeting the targets will lead to about 600 million averted DALYs in the period 2011–2030, nearly equally distributed between PCT and IDM-NTDs, with the health gain amongst PCT-NTDs mostly (96%) due to averted disability and amongst IDM-NTDs largely (95%) from averted mortality. These health gains include about 150 million averted irreversible disease manifestations (e.g. blindness) and 5 million averted deaths. Control of soil-transmitted helminths accounts for one third of all averted DALYs. We conclude that the projected health impact of the London Declaration justifies the required efforts. Neglected tropical diseases (NTDs) are a group of infectious diseases that occur mostly in poor, warm countries. NTDs are caused by various bacteria and parasites, such as worms. They can either be cured or prevented through drugs and other interventions, such as control of insects that spread the infection. The London Declaration is a statement by various organizations, including the World Health Organization (WHO) and pharmaceutical companies that donate the necessary drugs. The declaration endorses targets for disease reductions by 2020, as recently formulated in the WHO Roadmap, to be achieved by rigorous application of available interventions. We explore how much health can be gained if these targets are indeed achieved. We estimate that in such case 5 million deaths can be averted before 2030 and also that huge reductions in ill-health and disability can be realized. Over the period 2011–2030, a total health gain would be accomplished of about 600 million disability adjusted life years (DALYs) averted. DALYs are a measure of disease burden, consisting of life years lost and years lived with disability. This enormous health gain seems to justify similar investments as for e.g. HIV or malaria control.
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Affiliation(s)
- Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Epke A. le Rutte
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A. C. Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roel Bakker
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rui Cai
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja A. J. Houweling
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margarete C. Kulik
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Tobacco Control Research and Education, University of California at San Francisco, San Francisco, California, United States of America
| | - Edeltraud J. Lenk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne Luyendijk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Suzette M. Matthijsse
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - William K. Redekop
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Inge Wagenaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Jacobson
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Nico J. D. Nagelkerke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H. Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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22
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Buisman LR, Rijnsburger AJ, den Hertog HM, van der Lugt A, Redekop WK. Clinical Practice Variation Needs to be Considered in Cost-Effectiveness Analyses: A Case Study of Patients with a Recent Transient Ischemic Attack or Minor Ischemic Stroke. Appl Health Econ Health Policy 2016; 14:67-75. [PMID: 25917685 PMCID: PMC4740566 DOI: 10.1007/s40258-015-0167-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND AND OBJECTIVE The cost-effectiveness of clinical interventions is often assessed using current care as the comparator, with national guidelines as a proxy. However, this comparison is inadequate when clinical practice differs from guidelines, or when clinical practice differs between hospitals. We examined the degree of variation in the way patients with a recent transient ischemic attack (TIA) or minor ischemic stroke are assessed and used the results to illustrate the importance of investigating possible clinical practice variation, and the need to perform hospital-level cost-effectiveness analyses (CEAs) when variation exists. METHODS Semi-structured interviews were conducted with 16 vascular neurologists in hospitals throughout the Netherlands. Questions were asked about the use of initial and confirmatory diagnostic imaging tests to assess carotid stenosis in patients with a recent TIA or minor ischemic stroke, criteria to perform confirmatory tests, and criteria for treatment. We also performed hospital-level CEAs to illustrate the consequences of the observed diagnostic strategies in which the diagnostic test costs, sensitivity and specified were varied according to the local hospital conditions. RESULTS 56 % (9/16) of the emergency units and 63 % (10/16) of the outpatient clinics use the initial and confirmatory diagnostic tests to assess carotid stenosis in accordance with the national guidelines. Of the hospitals studied, only one uses the recommended criteria for use of a confirmatory test, 38 % (6/16) follow the guidelines for treatment. The most cost-effective diagnostic test strategy differs between hospitals. CONCLUSIONS If important practice variation exists, hospital-level CEAs should be performed. These CEAs should include an assessment of the feasibility and costs of switching to a different strategy.
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Affiliation(s)
- Leander R Buisman
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Adriana J Rijnsburger
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Heleen M den Hertog
- Department of Neurology, Medical Spectrum Twente, PO Box 50000, 7500 KA, Enschede, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - William K Redekop
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Lenk EJ, Redekop WK, Luyendijk M, Rijnsburger AJ, Severens JL. Productivity Loss Related to Neglected Tropical Diseases Eligible for Preventive Chemotherapy: A Systematic Literature Review. PLoS Negl Trop Dis 2016; 10:e0004397. [PMID: 26890487 PMCID: PMC4758606 DOI: 10.1371/journal.pntd.0004397] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neglected Tropical Diseases (NTDs) not only cause health and life expectancy loss, but can also lead to economic consequences including reduced ability to work. This article describes a systematic literature review of the effect on the economic productivity of individuals affected by one of the five worldwide most prevalent NTDs: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths (ascariasis, trichuriasis, and hookworm infection) and trachoma. These diseases are eligible to preventive chemotherapy (PCT). METHODOLOGY/PRINCIPAL FINDINGS Eleven bibliographic databases were searched using different names of all NTDs and various keywords relating to productivity. Additional references were identified through reference lists from relevant papers. Of the 5316 unique publications found in the database searches, thirteen papers were identified for lymphatic filariasis, ten for onchocerciasis, eleven for schistosomiasis, six for soil-transmitted helminths and three for trachoma. Besides the scarcity in publications reporting the degree of productivity loss, this review revealed large variation in the estimated productivity loss related to these NTDs. CONCLUSIONS It is clear that productivity is affected by NTDs, although the actual impact depends on the type and severity of the NTD as well as on the context where the disease occurs. The largest impact on productivity loss of individuals affected by one of these diseases seems to be due to blindness from onchocerciasis and severe schistosomiasis manifestations; productivity loss due to trachoma-related blindness has never been studied directly. However, productivity loss at an individual level might differ from productivity loss at a population level because of differences in the prevalence of NTDs. Variation in estimated productivity loss between and within diseases is caused by differences in research methods and setting. Publications should provide enough information to enable readers to assess the quality and relevance of the study for their purposes.
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Affiliation(s)
- Edeltraud J. Lenk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - William K. Redekop
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne Luyendijk
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Johan L. Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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24
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Burgers LT, McClellan EA, Hoefer IE, Pasterkamp G, Jukema JW, Horsman S, Pijls NHJ, Waltenberger J, Hillaert MA, Stubbs AC, Severens JL, Redekop WK. Treatment variation in stent choice in patients with stable or unstable coronary artery disease. Neth Heart J 2016; 24:110-9. [PMID: 26762359 PMCID: PMC4722012 DOI: 10.1007/s12471-015-0783-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AIM Variations in treatment are the result of differences in demographic and clinical factors (e.g. anatomy), but physician and hospital factors may also contribute to treatment variation. The choice of treatment is considered important since it could lead to differences in long-term outcomes. This study explores the associations with stent choice: i.e. drug-eluting stent (DES) versus bare-metal stents (BMS) for Dutch patients diagnosed with stable or unstable coronary artery disease (CAD). METHODS & RESULTS Associations with treatment decisions were based on a prospective cohort of 692 patients with stable or unstable CAD. Of those patients, 442 patients were treated with BMS or DES. Multiple logistic regression analyses were performed to identify variables associated with stent choice. Bivariate analyses showed that NYHA class, number of diseased vessels, previous percutaneous coronary intervention, smoking, diabetes, and the treating hospital were associated with stent type. After correcting for other associations the treating hospital remained significantly associated with stent type in the stable CAD population. CONCLUSIONS This study showed that several factors were associated with stent choice. While patients generally appear to receive the most optimal stent given their clinical characteristics, stent choice seems partially determined by the treating hospital, which may lead to differences in long-term outcomes.
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Affiliation(s)
- L T Burgers
- Institute of Health Policy & Management, and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - E A McClellan
- Department of Mathematical and Computer Sciences, Metropolitan State University of Denver, Colorado, USA
| | - I E Hoefer
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht, The Netherlands
| | - G Pasterkamp
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden UMC, Leiden, The Netherlands
| | - S Horsman
- Department of Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N H J Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - J Waltenberger
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | - M A Hillaert
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A C Stubbs
- Department of Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J L Severens
- Institute of Health Policy & Management, and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - W K Redekop
- Institute of Health Policy & Management, and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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25
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Verhoef TI, Redekop WK, de Boer A, Maitland-van der Zee AH. Economic evaluation of a pharmacogenetic dosing algorithm for coumarin anticoagulants in The Netherlands. Pharmacogenomics 2016; 16:101-14. [PMID: 25616097 DOI: 10.2217/pgs.14.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To investigate the cost-effectiveness of a pharmacogenetic dosing algorithm versus a clinical dosing algorithm for coumarin anticoagulants in The Netherlands. MATERIALS & METHODS A decision-analytic Markov model was used to analyze the cost-effectiveness of pharmacogenetic dosing of phenprocoumon and acenocoumarol versus clinical dosing. RESULTS Pharmacogenetic dosing increased costs by €33 and quality-adjusted life-years (QALYs) by 0.001. The incremental cost-effectiveness ratios were €28,349 and €24,427 per QALY gained for phenprocoumon and acenocoumarol, respectively. At a willingness-to-pay threshold of €20,000 per QALY, the pharmacogenetic dosing algorithm was not likely to be cost effective compared with the clinical dosing algorithm. CONCLUSION Pharmacogenetic dosing improves health only slightly when compared with clinical dosing. However, availability of low-cost genotyping would make it a cost-effective option.
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Affiliation(s)
- Talitha I Verhoef
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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26
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Buisman LR, Tan SS, Nederkoorn PJ, Koudstaal PJ, Redekop WK. Hospital costs of ischemic stroke and TIA in the Netherlands. Neurology 2015; 84:2208-15. [PMID: 25934858 DOI: 10.1212/wnl.0000000000001635] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/18/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES There have been no ischemic stroke costing studies since major improvements were implemented in stroke care. We therefore determined hospital resource use and costs of ischemic stroke and TIA in the Netherlands for 2012. METHODS We conducted a retrospective cost analysis using individual patient data from a national diagnosis-related group registry. We analyzed 4 subgroups: inpatient ischemic stroke, inpatient TIA, outpatient ischemic stroke, and outpatient TIA. Costs of carotid endarterectomy and costs of an extra follow-up visit were also estimated. Unit costs were based on reference prices from the Dutch Healthcare Insurance Board and tariffs provided by the Dutch Healthcare Authority. Linear regression analysis was used to examine the association between hospital costs and various patient and hospital characteristics. RESULTS A total of 35,903 ischemic stroke and 21,653 TIA patients were included. Inpatient costs were €5,328 ($6,845) for ischemic stroke and €2,470 ($3,173) for TIA. Outpatient costs were €495 ($636) for ischemic stroke and €587 ($754) for TIA. Costs of carotid endarterectomy were €6,836 ($8,783). Costs of inpatient days were the largest contributor to hospital costs. Age, hospital type, and region were strongly associated with hospital costs. CONCLUSIONS Hospital costs are higher for inpatients and ischemic strokes compared with outpatients and TIAs, with length of stay (LOS) the most important contributor. LOS and hospital costs have substantially declined over the last 10 years, possibly due to improved hospital stroke care and efficient integrated stroke services.
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Affiliation(s)
- Leander R Buisman
- From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - Siok Swan Tan
- From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Paul J Nederkoorn
- From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Peter J Koudstaal
- From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - William K Redekop
- From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
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27
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Buisman LR, Rijnsburger AJ, Koudstaal PJ, Redekop WK. Abstract W P285: Novel Imaging Technology to Select Patients with a Recent Transient Ischemic Attack or Minor Ischemic Stroke for Carotid Endarterectomy: The Relationship between Test Performance and Cost-Effectiveness. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wp285] [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: 11/16/2022]
Abstract
Background and Purpose:
Non-invasive molecular imaging tests are being developed to improve the ability to predict future strokes in patients with a recent transient ischemic attack (TIA) or minor ischemic stroke. Greater predictive ability can improve patient management, e.g., by identifying which patients will benefit more from a carotid endarterectomy than from medication alone. We estimated the minimum performance (i.e., sensitivity and specificity) that a new test must have in order for it to be cost-effective versus currently available strategies.
Methods:
We compared the cost-effectiveness of using a new imaging test (as a confirmatory test after an initial duplex ultrasonography) with a guidelines-based strategy and three strategies found in daily practice. Cost-effectiveness modelling was used to estimate the long-term costs and health outcomes of each strategy. A willingness-to-pay threshold of є30,000 per QALY gained was used to evaluate cost-effectiveness. We examined the results in two hypothetical populations (60-year-old and 80-year-old men) and varied the sensitivity and specificity to estimate the minimum test performance needed in order for the new strategy to be cost-effective versus the alternatives.
Results:
A perfect confirmatory test (100% sensitivity and specificity) at a cost of є390 is cost-effective for 60-year-old men versus all comparators. A test that is 100% sensitive must be at least 71% specific to be cost-effective versus the guidelines. A test that is 100% specific must be at least 52% sensitive to be cost-effective. Assuming 90% sensitivity, a test must have a specificity of at least 77% to be cost-effective. The minimum required performance for 80-year-old men was higher; e.g., a test that is 100% sensitive must be 88% (vs. 71%) specific to be cost-effective.
Conclusions:
A new strategy that improves risk prediction in patients with a recent TIA or minor ischemic stroke may help to reduce the risk of recurrent stroke and thereby improve health outcomes and cost-effectiveness. However, the minimum required performance may not be achievable in all patient subgroups.
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Affiliation(s)
- Leander R Buisman
- Institute of Health Policy and Management, Erasmus Univ Rotterdam, Rotterdam, Netherlands
| | - Adriana J Rijnsburger
- Institute of Health Policy and Management, Erasmus Univ Rotterdam, Rotterdam, Netherlands
| | | | - William K Redekop
- Institute of Health Policy and Management, Erasmus Univ Rotterdam, Rotterdam, Netherlands
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Verhoef TI, Redekop WK, Daly AK, van Schie RMF, de Boer A, Maitland-van der Zee AH. Pharmacogenetic-guided dosing of coumarin anticoagulants: algorithms for warfarin, acenocoumarol and phenprocoumon. Br J Clin Pharmacol 2014; 77:626-41. [PMID: 23919835 DOI: 10.1111/bcp.12220] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022] Open
Abstract
Coumarin derivatives, such as warfarin, acenocoumarol and phenprocoumon are frequently prescribed oral anticoagulants to treat and prevent thromboembolism. Because there is a large inter-individual and intra-individual variability in dose-response and a small therapeutic window, treatment with coumarin derivatives is challenging. Certain polymorphisms in CYP2C9 and VKORC1 are associated with lower dose requirements and a higher risk of bleeding. In this review we describe the use of different coumarin derivatives, pharmacokinetic characteristics of these drugs and differences amongst the coumarins. We also describe the current clinical challenges and the role of pharmacogenetic factors. These genetic factors are used to develop dosing algorithms and can be used to predict the right coumarin dose. The effectiveness of this new dosing strategy is currently being investigated in clinical trials.
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Affiliation(s)
- Talitha I Verhoef
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht
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29
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Verhoef TI, Redekop WK, Hasrat F, de Boer A, Maitland-van der Zee AH. Cost effectiveness of new oral anticoagulants for stroke prevention in patients with atrial fibrillation in two different European healthcare settings. Am J Cardiovasc Drugs 2014; 14:451-62. [PMID: 25326294 PMCID: PMC4250561 DOI: 10.1007/s40256-014-0092-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Our objectives were to investigate the cost effectiveness of apixaban, rivaroxaban, and dabigatran compared with coumarin derivatives for stroke prevention in patients with atrial fibrillation in a country with specialized anticoagulation clinics (the Netherlands) and in a country without these clinics (the UK). METHODS A decision-analytic Markov model was used to analyse the cost effectiveness of apixaban, rivaroxaban, and dabigatran compared with coumarin derivatives in the Netherlands and the UK over a lifetime horizon. RESULTS In the Netherlands, the use of rivaroxaban, apixaban, or dabigatran increased health by 0.166, 0.365, and 0.374 quality-adjusted life-years (QALYs) compared with coumarin derivatives, but also increased costs by 5,681, 4,754, and 5,465, respectively. The incremental cost-effectiveness ratios (ICERs) were 34,248, 13,024, and 14,626 per QALY gained. In the UK, health was increased by 0.302, 0.455, and 0.461 QALYs, and the incremental costs were similar for all three new oral anticoagulants (5,118-5,217). The ICERs varied from 11,172 to 16,949 per QALY gained. In the Netherlands, apixaban had the highest chance (37 %) of being cost effective at a threshold of 20,000; in the UK, this chance was 41 % for dabigatran. The quality of care, reflected in time in therapeutic range, had an important influence on the ICER. CONCLUSIONS Apixaban, rivaroxaban, and dabigatran are cost-effective alternatives to coumarin derivatives in the UK, while in the Netherlands, only apixaban and dabigatran could be considered cost effective. The cost effectiveness of the new oral anticoagulants is largely dependent on the setting and quality of local anticoagulant care facilities.
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Affiliation(s)
- Talitha I. Verhoef
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, P. O. Box 80 082, 3508 TB Utrecht, The Netherlands
- Department of Applied Health Research, University College London, London, UK
| | - William K. Redekop
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Fazila Hasrat
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, P. O. Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, P. O. Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Anke Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, P. O. Box 80 082, 3508 TB Utrecht, The Netherlands
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Gaultney JG, Franken MG, Uyl-de Groot CA, Redekop WK, Huijgens PC, van der Holt B, Lokhorst HM, Sonneveld P. Experience with outcomes research into the real-world effectiveness of novel therapies in Dutch daily practice from the context of conditional reimbursement. Health Policy 2014; 119:186-94. [PMID: 25476554 DOI: 10.1016/j.healthpol.2014.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 09/13/2014] [Accepted: 11/16/2014] [Indexed: 12/24/2022]
Abstract
Policymakers more often request outcomes research for expensive therapies to help resolve uncertainty of their health benefits and budget impact at reimbursement. Given the limitations of observational data, we assessed its usefulness in evaluating clinical outcomes for bortezomib in advanced multiple myeloma patients. Data were retrospectively collected from patients included in the pivotal Assessment of Proteasome Inhibition for Extending Remissions trial (APEX; n=333) and two groups of daily practice patients treated with bortezomib following progression from upfront therapy (n=201): real-world patients treated as of May 2009 (RW-1; n=72) and June 2012 (RW-2; n=129). Prognosis, treatment, and effectiveness were compared. Outcomes research was useful for policymakers for addressing to whom and how bortezomib was administered in daily practice. It was limited however in generating robust evidence on real-world safety and effectiveness. The quality of real-world evidence on effectiveness was low due to missing data in patient charts, existing treatment variation and the dynamics in care during the novel drug's initial market uptake period. Policymakers requesting real-world evidence on clinical outcomes for reimbursement decisions should be aware of these limitations and advised to carefully consider beforehand the type of evidence that best addresses their needs for the re-assessment phase.
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Affiliation(s)
- Jennifer G Gaultney
- Institute for Medical Technology Assessment/Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Mapi Group, De Molen 84, 3995 AX Houten, The Netherlands.
| | - Margreet G Franken
- Institute for Medical Technology Assessment/Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment/Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - William K Redekop
- Institute for Medical Technology Assessment/Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Peter C Huijgens
- Department of Haematology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Bronno van der Holt
- HOVON Data Centre, Erasmus MC Cancer Institute-Clinical Trial Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Henk M Lokhorst
- Department of Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Buisman LR, Tan SS, Koudstaal PJ, Nederkoorn PJ, Redekop WK. Hospital Costs Of Ischemic Stroke And Transient Ischemic Attack In The Netherlands. Value Health 2014; 17:A485. [PMID: 27201429 DOI: 10.1016/j.jval.2014.08.1416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- L R Buisman
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - S S Tan
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - P J Koudstaal
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - P J Nederkoorn
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W K Redekop
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Burgers LT, Goslinga-van der Gaag SME, Delhaas EM, Redekop WK. Cost Analysis of two Aftercare Strategies in Chronic Continuous Intrathecal Baclofen Therapy in Patients with Intractable Spasticity. Value Health 2014; 17:A394. [PMID: 27200917 DOI: 10.1016/j.jval.2014.08.875] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- L T Burgers
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - E M Delhaas
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - W K Redekop
- Erasmus University, Rotterdam, The Netherlands
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Buisman LR, Rijnsburger AJ, Koudstaal PJ, Redekop WK. Novel Imaging Technology To Select Patients For Individualized Therapies: Test Performance And Cost-Effectiveness. Value Health 2014; 17:A488. [PMID: 27201444 DOI: 10.1016/j.jval.2014.08.1433] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- L R Buisman
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - P J Koudstaal
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - W K Redekop
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Leunis A, Redekop WK, Lowenberg B, Uyl-De Groot CA. An Efficient Design for Cost-Effectiveness Studies of Personalized Medicine Strategies. Value Health 2014; 17:A551-A552. [PMID: 27201799 DOI: 10.1016/j.jval.2014.08.1802] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Leunis
- Institute for Medical Techonology Assessment (iMTA), Rotterdam, The Netherlands
| | - W K Redekop
- Erasmus University, Rotterdam, The Netherlands
| | - B Lowenberg
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - C A Uyl-De Groot
- Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, The Netherlands
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Versteeg H, Pedersen SS, Mastenbroek MH, Redekop WK, Schwab JO, Mabo P, Meine M. Patient perspective on remote monitoring of cardiovascular implantable electronic devices: rationale and design of the REMOTE-CIED study. Neth Heart J 2014; 22:423-8. [PMID: 25135053 PMCID: PMC4188843 DOI: 10.1007/s12471-014-0587-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the patient perspective on remote monitoring is scarce and inconsistent. Objectives The primary objective of the REMOTE-CIED study is to evaluate the influence of remote patient monitoring versus in-clinic follow-up on patient-reported outcomes. Secondary objectives are to: 1) identify subgroups of patients who may not be satisfied with remote monitoring; and 2) investigate the cost-effectiveness of remote monitoring. Methods The REMOTE-CIED study is an international randomised controlled study that will include 900 consecutive heart failure patients implanted with an implantable cardioverter defibrillator (ICD) compatible with the Boston Scientific LATITUDE® Remote Patient Management system at participating centres in five European countries. Patients will be randomised to remote monitoring or in-clinic follow-up. The In-Clinic group will visit the outpatient clinic every 3–6 months, according to standard practice. The Remote Monitoring group only visits the outpatient clinic at 12 and 24 months post-implantation, other check-ups are performed remotely. Patients are asked to complete questionnaires at five time points during the 2-year follow-up. Conclusion The REMOTE-CIED study will provide insight into the patient perspective on remote monitoring in ICD patients, which could help to support patient-centred care in the future.
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Affiliation(s)
- H Versteeg
- Department of Cardiology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands,
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Burgers LT, Nauta ST, Deckers JW, Severens JL, Redekop WK. Is it cost-effective to use a test to decide which individuals with an intermediate cardiovascular disease risk would benefit from statin treatment? Int J Cardiol 2014; 176:980-7. [PMID: 25217221 DOI: 10.1016/j.ijcard.2014.08.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 02/07/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The 2012 European guidelines recommend statins for intermediate-risk individuals with elevated cholesterol levels. Improved discrimination of intermediate-risk individuals is needed to prevent both cardiovascular disease (CVD) and statin side-effects (e.g. myopathy) efficiently since only 3-15 in every 100 individuals actually experience a cardiovascular event in the next 10 years. We estimated the potential cost-effectiveness of a hypothetical test which helps to determine which individuals will benefit from statins. METHODS AND RESULTS Prognosis of different age- and gender-specific cohorts with an intermediate risk was simulated with a Markov model to estimate the potential costs and quality-adjusted life-years for four strategies: treat all with statins, treat none with statins, treat according to the European guidelines, or use a test to select individuals for statin treatment. The test-first strategy dominated the other strategies if the hypothetical test was 100% accurate and cost no more than €237. This strategy and the treat-all strategy were equally effective but the test generated lower costs by reducing statin usage and side-effects. The treat-none strategy was the least effective strategy. Threshold analyses show that the test must be highly accurate (especially sensitive) and inexpensive to be the most cost-effective strategy, since myopathy has a negligible impact on cost-effectiveness and statin costs are low. CONCLUSION Use of a highly accurate prognostic test could reduce overall CVD risk, frequency of drug side-effects and lifetime costs. However, no additional test would add usefully to risk prediction over SCORE when it does not satisfy the costs and accuracy requirements.
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Affiliation(s)
- L T Burgers
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
| | - S T Nauta
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - J W Deckers
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - J L Severens
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - W K Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Burgers LT, Redekop WK, Severens JL. Challenges in modelling the cost effectiveness of various interventions for cardiovascular disease. Pharmacoeconomics 2014; 32:627-637. [PMID: 24748448 DOI: 10.1007/s40273-014-0155-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Decision analytic modelling is essential in performing cost-effectiveness analyses (CEAs) of interventions in cardiovascular disease (CVD). However, modelling inherently poses challenges that need to be dealt with since models always represent a simplification of reality. The aim of this study was to identify and explore the challenges in modelling CVD interventions. METHODS A document analysis was performed of 40 model-based CEAs of CVD interventions published in high-impact journals. We analysed the systematically selected papers to identify challenges per type of intervention (test, non-drug, drug, disease management programme, and public health intervention), and a questionnaire was sent to the corresponding authors to obtain a more thorough overview. Ideas for possible solutions for the challenges were based on the papers, responses, modelling guidelines, and other sources. RESULTS The systematic literature search identified 1,720 potentially relevant articles. Forty authors were identified after screening the most recent 294 papers. Besides the challenge of lack of data, the challenges encountered in the review suggest that it was difficult to obtain a sufficiently valid and accurate cost-effectiveness estimate, mainly due to lack of data or extrapolating from intermediate outcomes. Despite the low response rate of the questionnaire, it confirmed our results. CONCLUSIONS This combination of a review and a survey showed examples of CVD modelling challenges found in studies published in high-impact journals. Modelling guidelines do not provide sufficient guidance in resolving all challenges. Some of the reported challenges are specific to the type of intervention and disease, while some are independent of intervention and disease.
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Affiliation(s)
- Laura T Burgers
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands,
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Leunis A, Redekop WK, Uyl-de Groot CA, Löwenberg B. Impaired health-related quality of life in acute myeloid leukemia survivors: a single-center study. Eur J Haematol 2014; 93:198-206. [PMID: 24673368 DOI: 10.1111/ejh.12324] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the impact of acute myeloid leukemia (AML) and its treatment on health-related quality of life (HRQOL) by comparing the HRQOL of AML survivors with the HRQOL in the general population. METHODS Two HRQOL questionnaires (EQ-5D and QLQ-C30) were sent to patients diagnosed with AML between 1999 and 2011 at a single academic hospital and still alive in 2012. HRQOL in AML survivors was compared with general population reference values. Multivariate analysis was used to identify factors associated with HRQOL in AML survivors. RESULTS Questionnaires were returned by 92 of the 103 patients (89%). AML survivors reported significantly worse functioning, more fatigue, pain, dyspnea, appetite loss, and financial difficulties and lower EQ-VAS scores than the general population (P < 0.05). Impaired HRQOL in AML survivors was mainly found in survivors without a paid job. Other factors associated with a poor HRQOL were allogeneic hematopoietic stem cell transplantation and the absence of social support. CONCLUSION This single-center study showed that the HRQOL in AML survivors is worse than the HRQOL in the general population. HRQOL in these patients can be improved by adequately treating and preventing fatigue, pain, dyspnea, and appetite loss.
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Affiliation(s)
- Annemieke Leunis
- Institute for Medical Technology Assessment/Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Hendriks ME, Kundu P, Boers AC, Bolarinwa OA, Te Pas MJ, Akande TM, Agbede K, Gomez GB, Redekop WK, Schultsz C, Swan Tan S. Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology. Glob Health Action 2014; 7:23573. [PMID: 24685170 PMCID: PMC3970035 DOI: 10.3402/gha.v7.23573] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [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: 12/18/2013] [Revised: 03/01/2014] [Accepted: 03/03/2014] [Indexed: 11/25/2022] Open
Abstract
Background Disease-specific costing studies can be used as input into cost-effectiveness analyses and provide important information for efficient resource allocation. However, limited data availability and limited expertise constrain such studies in low- and middle-income countries (LMICs). Objective To describe a step-by-step guideline for conducting disease-specific costing studies in LMICs where data availability is limited and to illustrate how the guideline was applied in a costing study of cardiovascular disease prevention care in rural Nigeria. Design The step-by-step guideline provides practical recommendations on methods and data requirements for six sequential steps: 1) definition of the study perspective, 2) characterization of the unit of analysis, 3) identification of cost items, 4) measurement of cost items, 5) valuation of cost items, and 6) uncertainty analyses. Results We discuss the necessary tradeoffs between the accuracy of estimates and data availability constraints at each step and illustrate how a mixed methodology of accurate bottom-up micro-costing and more feasible approaches can be used to make optimal use of all available data. An illustrative example from Nigeria is provided. Conclusions An innovative, user-friendly guideline for disease-specific costing in LMICs is presented, using a mixed methodology to account for limited data availability. The illustrative example showed that the step-by-step guideline can be used by healthcare professionals in LMICs to conduct feasible and accurate disease-specific cost analyses.
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Affiliation(s)
- Marleen E Hendriks
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands;
| | - Piyali Kundu
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Alexander C Boers
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Oladimeji A Bolarinwa
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Mark J Te Pas
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Tanimola M Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Gabriella B Gomez
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - William K Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Constance Schultsz
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | - Siok Swan Tan
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Franken MG, Gaultney JG, Blommestein HM, Huijgens PC, Sonneveld P, Redekop WK, Uyl-de Groot CA. Policymaker, please consider your needs carefully: does outcomes research in relapsed or refractory multiple myeloma reduce policymaker uncertainty regarding value for money of bortezomib? Value Health 2014; 17:245-253. [PMID: 24636383 DOI: 10.1016/j.jval.2013.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 10/29/2013] [Accepted: 12/16/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Dutch policy regulations require outcomes research for the assessment of appropriate drug use and cost-effectiveness after 4 years of temporary reimbursement. We investigated whether outcomes research reduced policymaker uncertainty regarding the question whether the costs are worth public funding. METHODS Our cohort study included 139 patients with relapsed/refractory multiple myeloma who were treated outside of a clinical study; 72 received bortezomib and 67 did not receive bortezomib. Detailed data were retrospectively collected from medical records in 38% of Dutch hospitals. RESULTS All patients received second-line treatment; 65%, 40%, and 14%, received three, four, or five or more lines of therapy. Neither a specific treatment sequence nor an appropriate comparator could be identified because of large variation in regimes. Kaplan-Meier curves showed an increased overall survival (mean [median] 29.5 [33.2] vs. 28.0 [21.6] months) for patients treated with bortezomib (Wilcoxon P = 0.01). Total mean costs were €81,626 (range €17,793-€229,783) and €52,760 (range €748-€179,571) for patients receiving bortezomib and patients not receiving bortezomib, respectively. Patients treated with bortezomib, however, were not comparable to other patients despite attempts to correct for confounding. Therefore, it was impossible to develop a feasible model to obtain a valid incremental cost-effectiveness estimate. CONCLUSIONS It was possible to develop evidence on bortezomib's use, effects, and costs in everyday practice. Much uncertainty, however, remained regarding its cost-effectiveness. Policymakers should carefully consider whether outcomes research sufficiently decreases uncertainty or whether other options (e.g., finance- and/or outcomes-based risk-sharing arrangements) are more appropriate to ensure sufficient value for money of expensive drugs.
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Affiliation(s)
- Margreet G Franken
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
| | - Jennifer G Gaultney
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Hedwig M Blommestein
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Peter C Huijgens
- Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - William K Redekop
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
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Verhoef TI, Ragia G, de Boer A, Barallon R, Kolovou G, Kolovou V, Konstantinides S, Le Cessie S, Maltezos E, van der Meer FJM, Redekop WK, Remkes M, Rosendaal FR, van Schie RMF, Tavridou A, Tziakas D, Wadelius M, Manolopoulos VG, Maitland-van der Zee AH. A randomized trial of genotype-guided dosing of acenocoumarol and phenprocoumon. N Engl J Med 2013; 369:2304-12. [PMID: 24251360 DOI: 10.1056/nejmoa1311388] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Observational evidence suggests that the use of a genotype-guided dosing algorithm may increase the effectiveness and safety of acenocoumarol and phenprocoumon therapy. METHODS We conducted two single-blind, randomized trials comparing a genotype-guided dosing algorithm that included clinical variables and genotyping for CYP2C9 and VKORC1 with a dosing algorithm that included only clinical variables, for the initiation of acenocoumarol or phenprocoumon treatment in patients with atrial fibrillation or venous thromboembolism. The primary outcome was the percentage of time in the target range for the international normalized ratio (INR; target range, 2.0 to 3.0) in the 12-week period after the initiation of therapy. Owing to low enrollment, the two trials were combined for analysis. The primary outcome was assessed in patients who remained in the trial for at least 10 weeks. RESULTS A total of 548 patients were enrolled (273 patients in the genotype-guided group and 275 in the control group). The follow-up was at least 10 weeks for 239 patients in the genotype-guided group and 245 in the control group. The percentage of time in the therapeutic INR range was 61.6% for patients receiving genotype-guided dosing and 60.2% for those receiving clinically guided dosing (P=0.52). There were no significant differences between the two groups for several secondary outcomes. The percentage of time in the therapeutic range during the first 4 weeks after the initiation of treatment in the two groups was 52.8% and 47.5% (P=0.02), respectively. There were no significant differences with respect to the incidence of bleeding or thromboembolic events. CONCLUSIONS Genotype-guided dosing of acenocoumarol or phenprocoumon did not improve the percentage of time in the therapeutic INR range during the 12 weeks after the initiation of therapy. (Funded by the European Commission Seventh Framework Programme and others; EU-PACT ClinicalTrials.gov numbers, NCT01119261 and NCT01119274.).
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Slingerland AS, Herman WH, Redekop WK, Dijkstra RF, Jukema JW, Niessen LW. Stratified patient-centered care in type 2 diabetes: a cluster-randomized, controlled clinical trial of effectiveness and cost-effectiveness. Diabetes Care 2013; 36:3054-61. [PMID: 23949558 PMCID: PMC3781546 DOI: 10.2337/dc12-1865] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes treatment should be effective and cost-effective. HbA1c-associated complications are costly. Would patient-centered care be more (cost-) effective if it was targeted to patients within specific HbA1c ranges? RESEARCH DESIGN AND METHODS This prospective, cluster-randomized, controlled trial involved 13 hospitals (clusters) in the Netherlands and 506 patients with type 2 diabetes randomized to patient-centered (n=237) or usual care (controls) (n=269). Primary outcomes were change in HbA1c and quality-adjusted life years (QALYs); costs and incremental costs (USD) after 1 year were secondary outcomes. We applied nonparametric bootstrapping and probabilistic modeling over a lifetime using a validated Dutch model. The baseline HbA1c strata were <7.0% (53 mmol/mol), 7.0-8.5%, and >8.5% (69 mmol/mol). RESULTS Patient-centered care was most effective and cost-effective in those with baseline HbA1c>8.5% (69 mmol/mol). After 1 year, the HbA1c reduction was 0.83% (95% CI 0.81-0.84%) (6.7 mmol/mol [6.5-6.8]), and the incremental cost-effectiveness ratio (ICER) was 261 USD (235-288) per QALY. Over a lifetime, 0.54 QALYs (0.30-0.78) were gained at a cost of 3,482 USD (2,706-4,258); ICER 6,443 USD/QALY (3,199-9,686). For baseline HbA1c 7.0-8.5% (53-69 mmol/mol), 0.24 QALY (0.07-0.41) was gained at a cost of 4,731 USD (4,259-5,205); ICER 20,086 USD (5,979-34,193). Care was not cost-effective for patients at a baseline HbA1c<7.0% (53 mmol/mol). CONCLUSIONS Patient-centered care is more valuable when targeted to patients with HbA1c>8.5% (69 mmol/mol), confirming clinical intuition. The findings support treatment in those with baseline HbA1c 7-8.5% (53-69 mmol/mol) and demonstrate little to no benefit among those with HbA1c<7% (53 mmol/mol). Further studies should assess different HbA1c strata and additional risk profiles to account for heterogeneity among patients.
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van Gils CWM, de Groot S, Redekop WK, Koopman M, Punt CJA, Uyl-de Groot CA. Real-world cost-effectiveness of oxaliplatin in stage III colon cancer: a synthesis of clinical trial and daily practice evidence. Pharmacoeconomics 2013; 31:703-718. [PMID: 23657918 DOI: 10.1007/s40273-013-0061-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Previous cost-effectiveness analyses of oxaliplatin have been based on randomised trials whereas current Dutch policy requires evidence from daily practice. The objective of this study was to examine the real-world cost-effectiveness of oxaliplatin plus fluoropyrimidines (FL) versus FL-only as adjuvant treatment of stage III colon cancer. METHODS A Markov model was developed to estimate lifetime cost and quality-adjusted life-years from a hospital perspective. The effectiveness of the oxaliplatin arm was modelled by combining published efficacy data from the pivotal clinical registration trial (MOSAIC trial) with real-world (RW) data from a Dutch population-based observational study. RW patients were categorised into "eligible" or "ineligible", depending on whether the patients fulfilled the MOSAIC trial eligibility criteria. Ineligible RW patients (18 %) had a poorer prognosis than eligible RW patients (82 %) and MOSAIC trial patients. The effectiveness of the comparator was modelled using MOSAIC trial results. All cost inputs were based on RW patients and reported in Euro 2012. Cost-effectiveness analyses were performed for four different scenarios: (1) cost-effectiveness analyses based on MOSAIC trial patients; (2) cost-effectiveness analyses using MOSAIC and eligible RW patients; (3) cost-effectiveness analyses using MOSAIC and both eligible and ineligible RW patients, assuming oxaliplatin had an equal effect in ineligible and eligible patients; (4) cost-effectiveness analyses using MOSAIC and both eligible and ineligible RW patients, assuming oxaliplatin had no effect amongst ineligibles. For each scenario, univariate and probabilistic sensitivity analyses were undertaken. RESULTS MOSAIC trial patients and eligible RW patients treated with oxaliplatin had comparable 2-year disease-free survivals (79.5 vs. 78.4 %). Oxaliplatin showed an incremental QALY gain of 1.02, 1.13, 1.17 and 0.93 and incremental cost of <euro>9,961, <euro>11,055, <euro>9,814 and <euro>11,854 in scenarios 1-4, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were <euro>9,766, <euro>9,783, <euro>8,388 and <euro>12,746 in scenarios 1-4, respectively. In all scenarios, univariate and probabilistic sensitivity analyses indicated that the ICERs are acceptable and robust under a wide range of model assumptions. CONCLUSIONS The ICERs of the different scenarios that resulted from combining MOSAIC trial data with data from Dutch daily practice all suggest that FL + oxaliplatin is cost-effective versus FL alone in the adjuvant treatment of colon cancer. This article illustrates how one could design and implement a real-world cost-effectiveness study to yield internally valid results that could also be generalisable.
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Affiliation(s)
- Chantal W M van Gils
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Burgemeester Oudlaan 50, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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Verhoef TI, Redekop WK, Veenstra DL, Thariani R, Beltman PA, van Schie RMF, de Boer A, Maitland-van der Zee AH. Cost–effectiveness of pharmacogenetic-guided dosing of phenprocoumon in atrial fibrillation. Pharmacogenomics 2013; 14:869-83. [DOI: 10.2217/pgs.13.74] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: To investigate the cost–effectiveness of pharmacogenetic-guided phenprocoumon dosing versus standard anticoagulation care in Dutch patients with atrial fibrillation. Materials & methods: Using a decision-analytic Markov model, cost–effectiveness of pharmacogenetic-guided therapy versus standard care was estimated. Results: Compared with standard care, the pharmacogenetic-guided dosing strategy increased quality-adjusted life-years (QALYs) only very slightly and increased costs by €15. The incremental cost–effectiveness ratio was €2658 per QALY gained. In sensitivity analyses, the cost of genotyping had the largest influence on the cost–effectiveness ratio. In a probabilistic sensitivity analysis, the incremental costs of genotype-guided dosing were less than €20,000 per QALY gained in 75.6% of the simulations. Conclusion: Pharmacogenetic-guided dosing of phenprocoumon has the potential to increase health slightly and may be able to achieve this in a cost-effective way. Owing to the many uncertainties it is too early to conclude whether or not patients starting phenprocoumon should be genotyped. Original submitted 20 December 2012; Revision submitted 8 April 2013
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Affiliation(s)
- Talitha I Verhoef
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands.
| | - William K Redekop
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - David L Veenstra
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Rahber Thariani
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Peter A Beltman
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Rianne MF van Schie
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Anthonius de Boer
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Utrecht Institute of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, PO Box 80 082, 3508 TB Utrecht, The Netherlands
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Verhoef TI, Redekop WK, van Schie RM, Bayat S, Daly AK, Geitona M, Haschke-Becher E, Hughes DA, Kamali F, Levin LÅ, Manolopoulos VG, Pirmohamed M, Siebert U, Stingl JC, Wadelius M, de Boer A, Maitland-van der Zee AH. Cost-effectiveness of pharmacogenetics in anticoagulation: international differences in healthcare systems and costs. Pharmacogenomics 2013; 13:1405-17. [PMID: 22966889 DOI: 10.2217/pgs.12.124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Genotyping patients for CYP2C9 and VKORC1 polymorphisms can improve the accuracy of dosing during the initiation of anticoagulation with vitamin K antagonists (coumarin derivatives). The anticipated degree of improvement in the safety of anticoagulation with coumarins through genotyping may vary depending on the quality of patient care, which varies both with and among countries. The management and the cost of anticoagulant care can therefore influence the cost-effectiveness of genotyping within any given country. In this article, we provide an overview of the cost-effectiveness of pharmacogenetics-guided dosing of coumarin derivatives. We describe the organization of anticoagulant care in the UK, Sweden, The Netherlands, Greece, Germany and Austria, where a genotype-guided dosing algorithm is currently being investigated as part of the EU-PACT trial. We also explore the costs of anticoagulant care for the treatment of atrial fibrillation in these countries.
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Affiliation(s)
- Talitha I Verhoef
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Abstract
BACKGROUND This study aimed to calculate the treatment costs of acute myocardial infarction (AMI) in the Netherlands for 2012. Also, the degree of association between treatment costs of AMI and some patient and hospital characteristics was examined. METHODS For this retrospective cost analysis, patients were drawn from the database of the Diagnosis Treatment Combination (Diagnose Behandeling Combinatie, DBC) casemix system, which contains data on the resource use of all hospitalisations in the Netherlands. All costs were based on Euro 2012 cost data. RESULTS The analysis was based on data of 25,657 patients. Mean treatment costs were estimated at <euro> 5021, with significant cost increases for patients with percutaneous coronary intervention (PCI) treatment. ST-segment elevation myocardial infarction (STEMI) patients receiving thrombolysis incurred the lowest (<euro> 4286), while non-STEMI patients receiving PCI the highest costs (<euro> 6060). Length of stay and hospital type were strong predictors of treatment costs. CONCLUSIONS This study is the most extensive cost assessment of the treatment costs of AMI in the Netherlands thus far. Our results may be used as input for health-economic models and economic evaluations to support the decision making of registration, reimbursement and pricing of interventions in healthcare.
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Affiliation(s)
- R R Soekhlal
- Erasmus Universiteit Rotterdam, institute for Medical Technology Assessment, PO Box 1738, 3000 DR, Rotterdam, the Netherlands
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Franken MG, van Gils CW, Gaultney JG, Delwel GO, Goettsch W, Huijgens PC, Steenhoek A, Punt CJ, Koopman M, Redekop WK, Uyl-de Groot CA. Practical feasibility of outcomes research in oncology: Lessons learned in assessing drug use and cost-effectiveness in The Netherlands. Eur J Cancer 2013; 49:8-16. [DOI: 10.1016/j.ejca.2012.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 11/25/2022]
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Verhoef TI, Redekop WK, Hegazy H, de Boer A, Maitland-van der Zee AH. Long-term anticoagulant effects of CYP2C9 and VKORC1 genotypes in phenprocoumon users. J Thromb Haemost 2012; 10:2610-2. [PMID: 23016521 DOI: 10.1111/jth.12007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gaultney JG, Redekop WK, Sonneveld P, Uyl-de Groot CA. Novel anticancer agents for multiple myeloma: a review of the evidence for their therapeutic and economic value. Expert Rev Anticancer Ther 2012; 12:839-54. [PMID: 22716498 DOI: 10.1586/era.12.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recent advances in oncology treatment have improved patient outcomes at the expense of increasing healthcare costs. The indication multiple myeloma is especially characterized by a recent and continuing flood of expensive novel agents. A review encompassing all elements necessary to perform an economic evaluation of novel agents for multiple myeloma was conducted for thalidomide, bortezomib and lenalidomide. Improvements in efficacy have led to a switch from conventional therapy to novel agents as standard therapy. Incremental cost-effectiveness ratios for novel agents alone or in combination with conventional agents were generally regarded to be within acceptable ranges. Conflicting results were reported for the incremental cost-effectiveness of bortezomib versus lenalidomide, as unresolved questions remain regarding their comparative effectiveness. Future economic evaluations will require an assessment of the cost-effectiveness of these agents in terms of sequence within the treatment paradigm and in combination with one another.
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Affiliation(s)
- Jennifer G Gaultney
- Institute for Medical Technology Assessment/Institute of Health Policy & Management, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Agyemang C, Kunst AE, Bhopal R, Zaninotto P, Nazroo J, Unwin N, van Valkengoed I, Redekop WK, Stronks K. A cross-national comparative study of metabolic syndrome among non-diabetic Dutch and English ethnic groups. Eur J Public Health 2012; 23:447-52. [PMID: 22542542 DOI: 10.1093/eurpub/cks041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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
BACKGROUND Evidence suggests a higher prevalence of type 2 diabetes (T2D) in The Netherlands than in England, although generalized obesity prevalence is substantially lower in The Netherlands. Metabolic syndrome (MS) is more strongly associated with the risk of progression to T2D than generalized obesity. Therefore examining MS may help to better understand the differences in T2D between the two countries. We assessed whether the Dutch and English differences in T2D prevalence reflect similar differences in MS in Whites, South-Asian Indians and African-Caribbeans living in these two countries. METHODS Secondary analyses of population-based studies of 3010 participants aged 35-60 years. Metabolic syndrome was defined according to the International Diabetes Federation criteria. Prevalence ratios (PRs) were estimated using regression models. RESULTS In general, the Dutch ethnic groups had a higher prevalence of MS than their English counterparts. Adjusted PRs were 1.37[95% confidence interval (CI)1.03-1.82] and 1.52 (1.06-2.19) in White-Dutch men and women compared to White-English men and women; 2.20 (1.14-4.26) and 1.46 (0.96-2.24) in Dutch-African-Caribbean men and women compared to English-African-Caribbean men and women and 0.97 (0.74-1.27) and 1.42 (1.00-2.03) in Dutch-Indian men and women compared with their English-Indian peers, respectively. Similar patterns were also observed for some MS components, e.g. raised fasting glucose in men and central obesity in women. CONCLUSION The comparatively high prevalence of MS among Dutch ethnic groups may contribute to their high prevalence of T2D. The high levels of some MS components, e.g. raised fasting glucose in men and central obesity in women add to the high prevalence of MS in Dutch ethnic groups.
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Affiliation(s)
- Charles Agyemang
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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