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Veldwijk J, Smith IP, Oliveri S, Petrocchi S, Smith MY, Lanzoni L, Janssens R, Huys I, de Wit GA, Groothuis-Oudshoorn CGM. Comparing Discrete Choice Experiment with Swing Weighting to Estimate Attribute Relative Importance: A Case Study in Lung Cancer Patient Preferences. Med Decis Making 2024; 44:203-216. [PMID: 38178591 PMCID: PMC10865764 DOI: 10.1177/0272989x231222421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Discrete choice experiments (DCE) are commonly used to elicit patient preferences and to determine the relative importance of attributes but can be complex and costly to administer. Simpler methods that measure relative importance exist, such as swing weighting with direct rating (SW-DR), but there is little empirical evidence comparing the two. This study aimed to directly compare attribute relative importance rankings and weights elicited using a DCE and SW-DR. METHODS A total of 307 patients with non-small-cell lung cancer in Italy and Belgium completed an online survey assessing preferences for cancer treatment using DCE and SW-DR. The relative importance of the attributes was determined using a random parameter logit model for the DCE and rank order centroid method (ROC) for SW-DR. Differences in relative importance ranking and weights between the methods were assessed using Cohen's weighted kappa and Dirichlet regression. Feedback on ease of understanding and answering the 2 tasks was also collected. RESULTS Most respondents (>65%) found both tasks (very) easy to understand and answer. The same attribute, survival, was ranked most important irrespective of the methods applied. The overall ranking of the attributes on an aggregate level differed significantly between DCE and SW-ROC (P < 0.01). Greater differences in attribute weights between attributes were reported in DCE compared with SW-DR (P < 0.01). Agreement between the individual-level attribute ranking across methods was moderate (weighted Kappa 0.53-0.55). CONCLUSION Significant differences in attribute importance between DCE and SW-DR were found. Respondents reported both methods being relatively easy to understand and answer. Further studies confirming these findings are warranted. Such studies will help to provide accurate guidance for methods selection when studying relative attribute importance across a wide array of preference-relevant decisions. HIGHLIGHTS Both DCEs and SW tasks can be used to determine attribute relative importance rankings and weights; however, little evidence exists empirically comparing these methods in terms of outcomes or respondent usability.Most respondents found the DCE and SW tasks very easy or easy to understand and answer.A direct comparison of DCE and SW found significant differences in attribute importance rankings and weights as well as a greater spread in the DCE-derived attribute relative importance weights.
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Affiliation(s)
- J. Veldwijk
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
- Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Julius Centrum, Utrecht, the Netherlands
| | - I. P. Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Julius Centrum, Utrecht, the Netherlands
| | - S. Oliveri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - S. Petrocchi
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M. Y. Smith
- Alexion AstraZeneca Rare Disease, Boston, MA, USA
- Department of Regulatory and Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - L. Lanzoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - R. Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - I. Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - G. A. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Julius Centrum, Utrecht, the Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam & Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - C. G. M Groothuis-Oudshoorn
- Health Technology and Services Research (HTSR), Faculty of Behavioural Management and Social Sciences, University of Twente, Enschede, the Netherlands
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Rotteveel AH, Lambooij MS, Over EAB, Hernández JI, Suijkerbuijk AWM, de Blaeij AT, de Wit GA, Mouter N. If you were a policymaker, which treatment would you disinvest? A participatory value evaluation on public preferences for active disinvestment of health care interventions in the Netherlands. Health Econ Policy Law 2022; 17:428-443. [PMID: 35670359 DOI: 10.1017/s174413312200010x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Currently, it is not known what attributes of health care interventions citizens consider important in disinvestment decision-making (i.e. decisions to discontinue reimbursement). Therefore, this study aims to investigate the preferences of citizens of the Netherlands toward the relative importance of attributes of health care interventions in the context of disinvestment. METHODS A participatory value evaluation (PVE) was conducted in April and May 2020. In this PVE, 1143 Dutch citizens were asked to save at least €100 million by selecting health care interventions for disinvestment from a list of eight unlabeled health care interventions, described solely with attributes. A portfolio choice model was used to analyze participants' choices. RESULTS Participants preferred to disinvest health care interventions resulting in smaller gains in quality of life and life expectancy that are provided to older patient groups. Portfolios (i.e. combinations of health care interventions) resulting in smaller savings were preferred for disinvestment over portfolios with larger savings. CONCLUSION The disinvestment of health care interventions resulting in smaller health gains and that are targeted at older patient groups is likely to receive most public support. By incorporating this information in the selection of candidate interventions for disinvestment and the communication on disinvestment decisions, policymakers may increase public support for disinvestment.
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Affiliation(s)
- A H Rotteveel
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Julius Centre for Primary care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
- Erasmus School for Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - M S Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - E A B Over
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - J I Hernández
- Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | - A W M Suijkerbuijk
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - A T de Blaeij
- Centre for Safety of Substances and Products, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - G A de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Julius Centre for Primary care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - N Mouter
- Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
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Rotteveel AH, Reckers-Droog VT, Lambooij MS, de Wit GA, van Exel NJA. Societal views in the Netherlands on active disinvestment of publicly funded healthcare interventions. Soc Sci Med 2021; 272:113708. [PMID: 33516087 DOI: 10.1016/j.socscimed.2021.113708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To obtain public support for the active disinvestment (i.e. policy decision to stop reimbursement) of healthcare interventions, it is important to have insight in what the public thinks about disinvestment and which considerations they find relevant in this context. Currently, evidence on relevant considerations in the disinvestment context is limited. Therefore, this study aimed to explore the societal views in the Netherlands on the active disinvestment of healthcare interventions and obtain insight into the considerations that are relevant for those holding the different views. METHODS A Q-methodology study was conducted among a purposively selected sample of citizens (n = 43). Data were collected in June and July 2019. Participants individually ranked a set of 43 statements broadly covering the issues that participants could consider relevant in the disinvestment context, from 'least agree' to 'most agree'. Qualitative feedback on the statement ranking was collected from each participant using a questionnaire. Principal component analysis followed by oblimin rotation was used to identify clusters of participants with similar statement rankings. These clusters/factors were interpreted as distinct viewpoints using the factor arrays and qualitative questionnaire responses of participants. RESULTS Four viewpoints were identified. People holding viewpoint I believe that reimbursement of necessary healthcare should be maintained, irrespective of its costs. People holding viewpoint II agree with viewpoint I, although they believe that necessity should be objectively determined. People holding viewpoint III think that unnecessary, ineffective and inefficient healthcare should be disinvested. People holding viewpoint IV, consider it most important that disinvestment decision-making processes are transparent and consistent. CONCLUSION Insight in the distinct viewpoints identified in this study contributes to a better understanding of why it has been considered difficult to obtain public support for disinvestment of healthcare interventions, and can help policymakers to change their approach to disinvestment to increase public support.
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Affiliation(s)
- A H Rotteveel
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - V T Reckers-Droog
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - M S Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G A de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - N J A van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Suijkerbuijk AWM, Over EAB, Opsteegh M, Deng H, van Gils PF, Marinovic AAB, Lambooij M, Polder JJ, Feenstra TL, van der Giessen JWB, de Wit GA, Mangen MJ. A social cost-benefit analysis of two One Health interventions to prevent toxoplasmosis. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.795] [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: 11/12/2022] Open
Abstract
Abstract
Background
In the Netherlands, toxoplasmosis ranks third in disease burden among foodborne pathogens, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. We performed a Social Cost-Benefit Analysis (SCBA) to evaluate the net value of two potential interventions, freezing meat and improving biosecurity in pig farms, for the Dutch society.
Methods
We assessed the costs and benefits of the two interventions and compared them with the current practice of education, especially during pregnancy. A ‘minimum scenario’ and a ‘maximum scenario’ was assumed, using input parameters with least benefits to society and input parameters with most benefits to society, respectively.
Results
The freezing meat intervention was far more effective than the biosecurity intervention. Despite high freezing costs, freezing two meat products: steak tartare and mutton leg yielded net social benefits in both the minimum and maximum scenario, ranging from €10.6 million to €31 million for steak tartare and €0.6 million to €1.5 million for mutton leg. The biosecurity intervention would result in net costs in all scenarios ranging from €1 million to €2.5 millions.
Conclusions
From a public health perspective (i.e. reducing the burden of toxoplasmosis) freezing steak tartare and leg of mutton is to be considered.
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Affiliation(s)
| | | | | | - H Deng
- RIVM, Bilthoven, Netherlands
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de Wit GA, van Gils PF, Over EAB, Suijkerbuijk AWM, Lokkerbol J, Smit F, Spit WJ, Evers SMAA, de Kinderen RJA. Social cost-benefit analysis of regulatory policies to reduce alcohol use in The Netherlands. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
If all costs and all benefits of alcohol use are expressed in monetary terms, the net costs were 2,3 to 4,2 billion euro in 2013. Examples of the costs of alcohol are less productivity at work, costs of police and justice and traffic accidents.
Methods
In this study three regulatory policies have been modelled using the Social Cost-Benefit Analysis (SCBA) approach. Regulatory policies aimed at curbing alcohol consumption were (1) an increase in excise taxes, (2) a reduction of the number of sales venues, and (3) a total mediaban for advertising alcohol.
Results
In the long run, over a period of 50 years, an increase in excise taxes of 50% will result in societal benefits of 4.5 to 10.7 billion euro, an increase of excise taxes of 200% will result in societal benefits of 12.2 to 35.8 billion euro. The societal benefits of closure of 10% of sales venues are estimated at 1.8 to 4.3 billion euro after 50 years, and at 4.6 to 10.7 billion euro when 25% of sales venues would be closed. The societal benefits of a mediaban would amount to 3.5 to 7.8 billion euro after 50 years, but this estimate is surrounded by uncertainty.
Conclusions
Regulatory policies aimed at reducing the amount of alcohol consumed, such as a further increase of excise taxes, a reduction of the number of sales venues and a total mediaban, will result in savings for society at large. However, costs and benefits are spread unequally over the different stakeholders.
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Affiliation(s)
| | | | | | | | | | - F Smit
- Trimbos Institute, Utrecht, Netherlands
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Suijkerbuijk AWM, Mangen MJJ, Haverkate MR, Bantjes SE, Ruijs WLM, Swaan CM, Visser LG, Over EAB, Luppino FS, de Wit GA. Rabies vaccination strategies in a western country: a cost evaluation. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Rabies is a fatal but preventable infectious disease with a large disease burden in endemic countries. The risk of contracting rabies for travellers from a Western country is low. However, an increasing number of Dutch travellers, potentially exposed to rabies abroad, consult a clinician for post-exposure prophylaxis. In this study, several interventions were examined on how they might influence costs involved in rabies treatment and prevention, including the most recent vaccination guidelines and the use of intradermal vaccination.
Methods
A decision tree based economic model was constructed. Costs of new versus old guidelines, intramuscular versus intradermal vaccination, and post-exposure treatment subsequent to increased vaccination coverage in several risk groups were calculated and compared to each other. Statistical uncertainty with respect to numbers of travellers and vaccination coverage was assessed.
Results
Costs were highest using the old guidelines, estimated at €15.1 million (€405 per vaccinated person). Intradermal vaccinations in combination with the new guidelines led to the lowest costs, estimated at €10.1 million (€270 per vaccinated person). A higher vaccination uptake resulted in higher overall costs. The ratio between the additional vaccinated persons and additional costs in all risk groups was similar, around €104 per person.
Conclusions
The new rabies vaccination guidelines reduced total costs. Strategies with increased vaccination uptake led to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs. Although intradermal administration of rabies vaccination on a large scale can reduce total costs of pre-exposure prophylaxis and can positively influence vaccination uptake, it remains a costly intervention.
Key messages
The new vaccination guidelines reduce total costs of rabies prevention. Intradermal administration of rabies vaccination on a large scale can further reduce total costs of pre-exposure prophylaxis. Strategies with increased vaccination uptake lead to fewer rabies immunoglobulin administrations and fewer vaccinations after exposure but at higher total costs.
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Affiliation(s)
| | - M J J Mangen
- Infectious Diseases, Epidemiology and Surveillance, RIVM, Bilthoven, Netherlands
| | - M R Haverkate
- National Coordination Centre Communicable Disease Control, RIVM, Bilthoven, Netherlands
| | - S E Bantjes
- National Coordination Centre Communicable Disease Control, RIVM, Bilthoven, Netherlands
| | - W L M Ruijs
- National Coordination Centre Communicable Disease Control, RIVM, Bilthoven, Netherlands
| | - C M Swaan
- National Coordination Centre Communicable Disease Control, RIVM, Bilthoven, Netherlands
| | - L G Visser
- Department of Infectious Diseases, LUMC, Leiden, Netherlands
| | - E A B Over
- Nutrition, Prevention and Health Services, RIVM, Bilthoven, Netherlands
| | - F S Luppino
- Eurocross Assistance, ECA, Leiden, Netherlands
| | - G A de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Nutrition, Prevention and Health Services, RIVM, Bilthoven, Netherlands
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7
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de Kinderen RJA, Wijnen BFM, Evers SMAA, Hiligsmann M, Paulus ATG, de Wit GA, van Gils PF, Over EAB, Suijkerbuijk AWM, Smit F. Social cost-benefit analysis of tobacco control policies in the Netherlands. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the Netherlands approximately 23% of the population of 15 years and older smokes. The main research questions were to identify what social costs- and benefits can be expected when various tobacco control policies would be implemented in The Netherlands, how do costs and benefits change over time, and which sectors in society could expect to incur costs and in which sectors accrue profits.
Methods
A SCBA was conducted using a combination of the Chronic Disease Model developed by the National Institute for Public Health and the Environment (RIVM), the SimSmoke model and a specially designed excel model. Policies included both tax increases (i.e. increase of excise tax on tobacco of 5% or 10% each year) and a policy package as proposed by the World Health Organization (i.e. including mass media campaigns and mediabans).
Results
When no new policy measures are implemented, the prevalence of smoking will decrease by 2.3 percentage points over the next 35 years. The policies reviewed in this report have the potential to decrease smoking prevalence by 14.2 percentage points (and in a ‘smoking-free society scenario, by as much as 17.4 percentage points). Furthermore, the results show that the intervention costs for all scenarios are minimal, and that investing in health is beneficial as seen from both the public health and fiscal perspective.
Conclusions
This study demonstrated that reducing the prevalence of smoking has beneficial effects for various stakeholders within the Dutch society: such as employers (e.g. increased productivity) and consumers (e.g. increase quality of life).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - F Smit
- Trimbos Institute, Utrecht, Netherlands
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Over EAB, van Gils PF, Suijkerbuijk AWM, Lokkerbo J, de Wit GA. Social cost-benefit analysis of Cognitive Behavioral Therapy for alcohol and cannabis addiction. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.792] [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: 11/14/2022] Open
Abstract
Abstract
Background
A considerable number of people with an alcohol or cannabis addiction currently do not receive addiction care. Some hundreds of thousands persons in the Netherlands suffer from alcohol dependency, while some tens of thousands adolescents suffer from cannabis addiction.
Methods
A (hypothetically) enhanced uptake of CBT in specialized addiction care centers was modeled using the SCBA approach. Two SCBA’s were performed: one with respect to alcohol addiction and the other regarding cannabis addiction among adolescents.
Results
Per person treated with CGT, these benefits accumulate to about 12,000 euro (range 10.000 - 14.000 euro). These profits originate from improved health and less mortality, improved quality of life and higher productivity. A decrease in the number of persons with an alcohol addiction will also lead to lower costs for police and justice following from less criminal activities. Furthermore, CGT is effective as treatment for adolescents with cannabis addiction. Per person treated with CGT, societal benefits accumulate to about 11.000 euro (range 9.700 - 13.000 euro). Here, the net benefits arise from improved health, improved quality of life, reduced early school leaving and higher incomes for those clients who have successfully participated in CGT in addiction care.
Conclusions
This study shows that society can benefit from an increase in people treated with CGT in specialized addiction care. Such an increase in number of people treated could for instance be realized by educational programs for professionals who come across people with dependency problems, such as general practitioners, professionals working in emergency care and youth care.
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Van Gils P, Suijkerbuijk AWM, de Wit GA, Polder JJ, Koopmanschap MA. Societal Expenditure on Prevention. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.341] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
In 2015, Dutch healthcare expenditure exceeded 85 billion euros. But what about prevention? In this study we estimated national expenditure on prevention. A distinction was made between health protection, health promotion and disease prevention. In the estimation of prevention expenditures, this study is limited to universal, selective and indicated prevention, as healthcare-related prevention can hardly be distinguished from curative care. This study analyzed expenditure on preventive activities in the Netherlands in 2015 and took a societal perspective.
Methods
We used various sources to investigate spending on prevention in 2015. Insofar as costs were part of healthcare expenditure, estimates were based on the Care Accounts of Statistics Netherlands. For the remainder, we estimated expenditure using annual reports and annual accounts of governments and other organizations. We included preventive activities by consumers, industry, NGOs, insurance companies, and government.
Results
In 2015, an estimated € 12.4 billion (1.8% of the GDP) was spent on prevention: € 2.4 billion on disease prevention (19%), € 0.6 billion on health promotion (5%) and € 9.4 billion on health protection (76%). This is a decrease of 17% compared to 2007, the last year that a similar estimate was made. Within health promotion, the largest expenditure was for working conditions and safety: € 160 million. € 67 million was spent on mental disorders. The largest expenditure item within disease prevention was dental care: € 675 million. Within health protection, this was the sewer by more than € 3 billion.
Conclusions
Spending on prevention is relatively low compared to total spending on healthcare. The largest part is targeted at health protection. In the coming years there may be an increase in expenditure, due to more governmental prevention policies such as the National Prevention Agreement.
Key messages
Spending on prevention is relatively low compared to total spending on healthcare. Relatively little money for health protection.
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Affiliation(s)
| | | | - G A de Wit
- RIVM, Bilthoven, Netherlands
- Utrecht University, Utrecht, Netherlands
| | - J J Polder
- Tilburg University, Tilburg, Netherlands
- RIVM, Bilthoven, Netherlands
| | - M A Koopmanschap
- RIVM, Bilthoven, Netherlands
- Erasmus University, Rotterdam, Netherlands
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Van Gils PF, Suijkerbuijk AWM, van der Vliet N, Polder JJ, de Blaeij A, de Wit GA, Staatsen B. Health benefits through prevention: there is still a lot to be gained. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.340] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
In November 2018, the Ministry of Health, Welfare and Sports presented the National Prevention Agreement (NPA). Within this NPA, interventions targeting smoking, being overweight and problematic alcohol use were proposed to induce lifestyle changes. In addition to measures aimed at these three themes, there is also a range of interventions that are promising, either because they could be cost saving or cost-effective, or because they have a positive impact on burden of disease. We explored which preventive interventions are promising in the Dutch context and systematically quantified costs, savings and health effects.
Methods
In a literature search via the website kosteneffectviteitvanpreventie.nl we selected interventions that: a) have not yet been introduced in the Netherlands; and b) were promising with respect to effectiveness and cost-effectiveness. All interventions, including health protection and environmental measures, were eligible. We estimated the number of people who are eligible and compliant, costs and possible savings related to the interventions and health effects in terms of DALYs avoided. Interventions were ranked with regard to possible savings and DALYs avoided.
Results
Our exploration shows a number of preventive interventions that are cost saving or cost-effective. These interventions are aimed at anxiety and depression, heart disease, skin cancer, fractures, air quality and road safety. Examples of cost-saving or cost-effective interventions are a food tax on food and drinks with high fat/sugar content, screening an aneurysm of the aorta and fully subsidized sound insulation of homes.
Conclusions
Our study shows that there are much more preventive opportunities than those presented in the NPA. The substantiation of the interventions is often based on foreign research and findings therefore cannot be simply translated to the Netherlands. However, the interventions identified in this study are promising and deserve further consideration.
Key messages
Health gain by environmental measures. Many interventions are not systematically implemented.
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Affiliation(s)
| | | | | | - J J Polder
- RIVM, Bilthoven, Netherlands
- Tilburg University, Tilburg, Netherlands
| | | | - G A de Wit
- RIVM, Bilthoven, Netherlands
- Utrecht University, Utrecht, Netherlands
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Lagerweij GR, Moons KGM, de Wit GA, Koffijberg H. Interpretation of CVD risk predictions in clinical practice: Mission impossible? PLoS One 2019; 14:e0209314. [PMID: 30625177 PMCID: PMC6326414 DOI: 10.1371/journal.pone.0209314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/31/2017] [Accepted: 12/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background Cardiovascular disease (CVD) risk prediction models are often used to identify individuals at high risk of CVD events. Providing preventive treatment to these individuals may then reduce the CVD burden at population level. However, different prediction models may predict different (sets of) CVD outcomes which may lead to variation in selection of high risk individuals. Here, it is investigated if the use of different prediction models may actually lead to different treatment recommendations in clinical practice. Method The exact definition of and the event types included in the predicted outcomes of four widely used CVD risk prediction models (ATP-III, Framingham (FRS), Pooled Cohort Equations (PCE) and SCORE) was determined according to ICD-10 codes. The models were applied to a Dutch population cohort (n = 18,137) to predict the 10-year CVD risks. Finally, treatment recommendations, based on predicted risks and the treatment threshold associated with each model, were investigated and compared across models. Results Due to the different definitions of predicted outcomes, the predicted risks varied widely, with an average 10-year CVD risk of 1.2% (ATP), 5.2% (FRS), 1.9% (PCE), and 0.7% (SCORE). Given the variation in predicted risks and recommended treatment thresholds, preventive drugs would be prescribed for 0.2%, 14.9%, 4.4%, and 2.0% of all individuals when using ATP, FRS, PCE and SCORE, respectively. Conclusion Widely used CVD prediction models vary substantially regarding their outcomes and associated absolute risk estimates. Consequently, absolute predicted 10-year risks from different prediction models cannot be compared directly. Furthermore, treatment decisions often depend on which prediction model is applied and its recommended risk threshold, introducing unwanted practice variation into risk-based preventive strategies for CVD.
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Affiliation(s)
- G. R. Lagerweij
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
- Dutch Heart Institute, Utrecht, the Netherlands
- * E-mail:
| | - K. G. M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - G. A. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Healthcare, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - H. Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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12
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Bolkenstein HE, de Wit GA, Consten ECJ, Van de Wall BJM, Broeders IAMJ, Draaisma WA. Cost-effectiveness analysis of a multicentre randomized clinical trial comparing surgery with conservative management for recurrent and ongoing diverticulitis (DIRECT trial). Br J Surg 2018; 106:448-457. [DOI: 10.1002/bjs.11024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/30/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022]
Abstract
Abstract
Background
The results of the DIRECT trial, an RCT comparing conservative management with elective sigmoid resection in patients with recurrent diverticulitis or persistent complaints, showed that elective sigmoid resection leads to higher quality of life. The aim of this study is to determine the cost-effectiveness of surgical treatment at 1- and 5-year follow-up from a societal perspective.
Methods
Clinical effectiveness and resource use were derived from the DIRECT trial. The actual resource use and quality of life (EQ-5D-3L™ score) were documented prospectively per individual patient and analysed according to the intention-to-treat principle for up to 5 years after randomization. The main outcome was the incremental cost-effectiveness ratio (ICER), expressed as costs per quality-adjusted life-year (QALY).
Results
The study included 106 patients, of whom 50 were randomized to surgery and 56 to conservative treatment. At 1- and 5-year follow-up an incremental effect (QALY difference between groups) of 0·06 and 0·43 respectively was found, and an incremental cost (cost difference between groups) of €6957 and €2674 respectively, where surgery was more expensive than conservative treatment. This resulted in an ICER of €123 365 per additional QALY at 1-year follow-up, and €6275 at 5 years. At a threshold of €20 000 per QALY, operative treatment has 0 per cent probability of being cost-effective at 1-year follow-up, but a 95 per cent probability at 5 years.
Conclusion
At 5-year follow-up, elective sigmoid resection in patients with recurring diverticulitis or persistent complaints was found to be cost-effective. Registration number: NTR1478 (www.trialregistrer.nl).
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Affiliation(s)
- H E Bolkenstein
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - G A de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | | | - I A M J Broeders
- Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - W A Draaisma
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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13
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Suijkerbuijk AWM, van Gils PF, Bonačić Marinović AA, Feenstra TL, Kortbeek LM, Mangen MJJ, Opsteegh M, de Wit GA, van der Giessen JWB. The design of a Social Cost-Benefit Analysis of preventive interventions for toxoplasmosis: An example of the One Health approach. Zoonoses Public Health 2017; 65:185-194. [PMID: 29131528 DOI: 10.1111/zph.12417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Indexed: 01/01/2023]
Abstract
Toxoplasma gondii infections cause a large disease burden in the Netherlands, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. Infections in humans occur via exposure to oocysts in the environment and after eating undercooked meat containing tissue cysts, leading to asymptomatic or mild symptoms, but potentially leading to the development of ocular toxoplasmosis. Infection in pregnant women can lead to stillbirth and disorders in newborns. At present, prevention is only targeted at pregnant women. Cat vaccination, freezing of meat destined for undercooked consumption and enhancing biosecurity in pig husbandries are possible interventions to prevent toxoplasmosis. As these interventions bear costs for sectors in society that differ from those profiting from the benefits, we perform a social cost-benefit analysis (SCBA). In an SCBA, costs and benefits of societal domains affected by the interventions are identified, making explicit which stakeholder pays and who benefits. Using an epidemiological model, we consider transmission of T. gondii after vaccination of all owned cats or cats at livestock farms. To identify relevant high-risk meat products that will be eaten undercooked, a quantitative microbial risk assessment model developed to attribute predicted T. gondii infections to specific meat products will be used. In addition, we evaluate serological monitoring of pigs at slaughter followed by an audit and tailor made advice for farmers in case positive results were found. The benefits will be modelled stochastically as reduction in DALYs and monetized in Euro's following reference prices for DALYs. If the balance of total costs and benefits is positive, this will lend support to implementation of these preventive interventions at the societal level. Ultimately, the SCBA will provide guidance to policy makers on the most optimal intervention measures to reduce the disease burden of T. gondii in the Netherlands.
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Affiliation(s)
- A W M Suijkerbuijk
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - P F van Gils
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - A A Bonačić Marinović
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T L Feenstra
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - L M Kortbeek
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M-J J Mangen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M Opsteegh
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - G A de Wit
- Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J W B van der Giessen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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14
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Mangen MJJ, Stibbe H, Urbanus A, Siedenburg EC, Waldhober Q, de Wit GA, van Steenbergen JE. Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile. Vaccine 2017; 35:3215-3221. [PMID: 28483198 DOI: 10.1016/j.vaccine.2017.04.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/21/2016] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007. METHODS Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002-2006 and 2007-2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections - as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately. RESULTS The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY. DISCUSSION AND CONCLUSION This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore discus how to reduce costs per risk-group, increase effects or when to integrate the vaccination in regular healthcare.
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Affiliation(s)
- M-J J Mangen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
| | - H Stibbe
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - A Urbanus
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - E C Siedenburg
- Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Q Waldhober
- Netherlands Association of Community Health Services, Utrecht, The Netherlands
| | - G A de Wit
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands; Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J E van Steenbergen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Centre of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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15
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Dieleman JM, de Wit GA, Nierich AP, Rosseel PM, van der Maaten JM, Hofland J, Diephuis JC, de Lange F, Boer C, Neslo RE, Moons KG, van Herwerden LA, Tijssen JG, Kalkman CJ, van Dijk D. Long-term outcomes and cost effectiveness of high-dose dexamethasone for cardiac surgery: a randomised trial. Anaesthesia 2017; 72:704-713. [PMID: 28317094 DOI: 10.1111/anae.13853] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
Abstract
Prophylactic intra-operative administration of dexamethasone may improve short-term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long-term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double-blind, placebo-controlled DExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In the DECS trial, patients received a single intra-operative dose of dexamethasone 1 mg.kg-1 (n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12-month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72-1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI £-1672 to -137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality-adjusted life year. We conclude that intra-operative high-dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness.
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Affiliation(s)
- J M Dieleman
- Department of Anesthesiology and Intensive Care, University Medical Center, Utrecht, the Netherlands
| | - G A de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - A P Nierich
- Department of Cardiothoracic Anesthesia, Isala Klinieken, Zwolle, the Netherlands
| | - P M Rosseel
- Department of Cardiothoracic Anesthesia, Amphia Ziekenhuis, Breda, the Netherlands
| | - J M van der Maaten
- Department of Anesthesiology, University Medical Center, Groningen, the Netherlands
| | - J Hofland
- Department of Cardiothoracic Anesthesia, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J C Diephuis
- Department of Cardiothoracic Anesthesia, Medisch Spectrum Twente, Enschede, the Netherlands
| | - F de Lange
- Department of Cardiothoracic Anesthesia, Medical Center, Leeuwarden, the Netherlands
| | - C Boer
- Department of Anesthesiology, Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - R E Neslo
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - K G Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - L A van Herwerden
- Department of Cardiothoracic Surgery, University Medical Center, Utrecht, the Netherlands
| | - J G Tijssen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - C J Kalkman
- Department of Anesthesiology and Intensive Care, University Medical Center, Utrecht, the Netherlands
| | - D van Dijk
- Department of Anesthesiology and Intensive Care, University Medical Center, Utrecht, the Netherlands
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16
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van den Wijngaard CC, Hofhuis A, Harms MG, Haagsma JA, Wong A, de Wit GA, Havelaar AH, Lugnér AK, Suijkerbuijk AWM, van Pelt W. The burden of Lyme borreliosis expressed in disability-adjusted life years. Eur J Public Health 2015; 25:1071-8. [PMID: 26082446 DOI: 10.1093/eurpub/ckv091] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lyme borreliosis (LB) is the most commonly reported tick-borne infection in Europe and North America. In the last 15 years a 3-fold increase was observed in general practitioner consultations for LB in the Netherlands. To support prioritization of prevention and control efforts for LB, we estimated its burden expressed in Disability-Adjusted Life Years (DALYs). METHODS We used available incidence estimates for three LB outcomes: (i) erythema migrans (EM), (ii) disseminated LB and (iii) Lyme-related persisting symptoms. To generate DALYs, disability weights and duration per outcome were derived using a patient questionnaire including health-related quality of life as measured by the EQ-5D. RESULTS We estimated the total LB burden for the Netherlands in 2010 at 10.55 DALYs per 100,000 population (95% CI: 8.80-12.43); i.e. 0.60 DALYs for EM, 0.86 DALYs for disseminated LB and 9.09 DALYs for Lyme-related persisting symptoms. Per patient this was 0.005 DALYs for EM, 0.113 for disseminated LB and 1.661 DALYs for a patient with Lyme-related persisting symptoms. In a sensitivity analysis the total LB burden ranged from 7.58 to 16.93 DALYs per 100,000 population. CONCLUSIONS LB causes a substantial disease burden in the Netherlands. The vast majority of this burden is caused by patients with Lyme-related persisting symptoms. EM and disseminated Lyme have a more modest impact. Further research should focus on the mechanisms that trigger development of these persisting symptoms that patients and their physicians attribute to LB.
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Affiliation(s)
- Cees C van den Wijngaard
- 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Agnetha Hofhuis
- 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Margriet G Harms
- 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Juanita A Haagsma
- 2 Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - Albert Wong
- 3 National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - G A de Wit
- 4 National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Care, Bilthoven, The Netherlands 5 Julius Centre for Health Sciences and Primary Care, University Medical Hospital Utrecht, Utrecht, The Netherlands
| | - Arie H Havelaar
- 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands 6 Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Anna K Lugnér
- 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Anita W M Suijkerbuijk
- 4 National Institute of Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Care, Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- 1 National Institute of Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, The Netherlands
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17
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Greving JP, Kaasjager HAH, Vernooij JWP, Hovens MMC, Wierdsma J, Grandjean HMH, van der Graaf Y, de Wit GA, Visseren FLJ. Cost-effectiveness of a nurse-led internet-based vascular risk factor management programme: economic evaluation alongside a randomised controlled clinical trial. BMJ Open 2015; 5:e007128. [PMID: 25995238 PMCID: PMC4442232 DOI: 10.1136/bmjopen-2014-007128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the cost-effectiveness of an internet-based, nurse-led vascular risk factor management programme in addition to usual care compared with usual care alone in patients with a clinical manifestation of a vascular disease. DESIGN Cost-effectiveness analysis alongside a randomised controlled trial (the Internet-based vascular Risk factor Intervention and Self-management (IRIS) study). SETTING Multicentre trial in a secondary and tertiary healthcare setting. PARTICIPANTS 330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with ≥2 treatable vascular risk factors not at goal. INTERVENTION The intervention consisted of a personalised website with an overview and actual status of patients' vascular risk factors, and mail communication with a nurse practitioner via the website for 12 months. The intervention combined self-management support, monitoring of disease control and pharmacotherapy. MAIN OUTCOME MEASURES Societal costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness. RESULTS Patients experienced equal health benefits, that is, 0.86 vs 0.85 QALY (intervention vs usual care) at 1 year. Adjusting for baseline differences, the incremental QALY difference was -0.014 (95% CI -0.034 to 0.007). The intervention was associated with lower total costs (€4859 vs €5078, difference €219, 95% CI -€2301 to €1825). The probability that the intervention is cost-effective at a threshold value of €20,000/QALY, is 65%. At mean annual cost of €220 per patient, the intervention is relatively cheap. CONCLUSIONS An internet-based, nurse-led intervention in addition to usual care to improve vascular risk factors in patients with a clinical manifestation of a vascular disease does not result in a QALY gain at 1 year, but has a small effect on vascular risk factors and is associated with lower costs. TRIAL REGISTRATION NUMBER NCT00785031.
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Affiliation(s)
- J P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H A H Kaasjager
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - J W P Vernooij
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M M C Hovens
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - J Wierdsma
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H M H Grandjean
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G A de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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van Giessen A, Moons KGM, de Wit GA, Verschuren WMM, Boer JMA, Koffijberg H. Tailoring the implementation of new biomarkers based on their added predictive value in subgroups of individuals. PLoS One 2015; 10:e0114020. [PMID: 25622035 PMCID: PMC4306488 DOI: 10.1371/journal.pone.0114020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022] Open
Abstract
Background The value of new biomarkers or imaging tests, when added to a prediction model, is currently evaluated using reclassification measures, such as the net reclassification improvement (NRI). However, these measures only provide an estimate of improved reclassification at population level. We present a straightforward approach to characterize subgroups of reclassified individuals in order to tailor implementation of a new prediction model to individuals expected to benefit from it. Methods In a large Dutch population cohort (n = 21,992) we classified individuals to low (<5%) and high (≥5%) fatal cardiovascular disease risk by the Framingham risk score (FRS) and reclassified them based on the systematic coronary risk evaluation (SCORE). Subsequently, we characterized the reclassified individuals and, in case of heterogeneity, applied cluster analysis to identify and characterize subgroups. These characterizations were used to select individuals expected to benefit from implementation of SCORE. Results Reclassification after applying SCORE in all individuals resulted in an NRI of 5.00% (95% CI [-0.53%; 11.50%]) within the events, 0.06% (95% CI [-0.08%; 0.22%]) within the nonevents, and a total NRI of 0.051 (95% CI [-0.004; 0.116]). Among the correctly downward reclassified individuals cluster analysis identified three subgroups. Using the characterizations of the typically correctly reclassified individuals, implementing SCORE only in individuals expected to benefit (n = 2,707,12.3%) improved the NRI to 5.32% (95% CI [-0.13%; 12.06%]) within the events, 0.24% (95% CI [0.10%; 0.36%]) within the nonevents, and a total NRI of 0.055 (95% CI [0.001; 0.123]). Overall, the risk levels for individuals reclassified by tailored implementation of SCORE were more accurate. Discussion In our empirical example the presented approach successfully characterized subgroups of reclassified individuals that could be used to improve reclassification and reduce implementation burden. In particular when newly added biomarkers or imaging tests are costly or burdensome such a tailored implementation strategy may save resources and improve (cost-)effectiveness.
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Affiliation(s)
- A. van Giessen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- * E-mail:
| | - K. G. M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - G. A. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - W. M. M. Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J. M. A. Boer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H. Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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19
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Suijkerbuijk AWM, van Gils PF, Greeven PGJ, de Wit GA. [Cost-effectiveness of addiction care]. Tijdschr Psychiatr 2015; 57:498-507. [PMID: 26189418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. AIM To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. METHOD We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. RESULTS The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. CONCLUSION Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.
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20
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Veldwijk J, Lambooij MS, Bredenoord A, van Kranen H, Dekker E, Kallenberg F, Smit HA, de Wit GA. Public Preferences for Genetic Screening for Colorectal Cancer: A Discrete Choice Experiment. Value Health 2014; 17:A647. [PMID: 27202328 DOI: 10.1016/j.jval.2014.08.2344] [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)
- J Veldwijk
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - M S Lambooij
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - A Bredenoord
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - H van Kranen
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - E Dekker
- Academic Medical Center, Amsterdam, The Netherlands
| | - F Kallenberg
- Academic Medical Center, Amsterdam, The Netherlands
| | - H A Smit
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - G A de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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21
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Vissink CE, Huijts SM, de Wit GA, Bonten MJM, Mangen MJJ. Hospitalization Costs For Community-Acquired Pneumonia In Elderly In The Netherlands. Value Health 2014; 17:A671. [PMID: 27202463 DOI: 10.1016/j.jval.2014.08.2483] [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)
- C E Vissink
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - S M Huijts
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - G A de Wit
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J M Bonten
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J J Mangen
- University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Van Giessen A, Wilcher B, Peters J, Hyde C, Moons KG, de Wit GA, Koffijberg H. HEALTH ECONOMIC EVALUATION OF DIAGNOSTIC AND PROGNOSTIC PREDICTION MODELS. A SYSTEMATIC REVIEW. Value Health 2014; 17:A560. [PMID: 27201849 DOI: 10.1016/j.jval.2014.08.1850] [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)
- A Van Giessen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - C Hyde
- Exeter University, Exeter, UK
| | - K G Moons
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - G A de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H Koffijberg
- University Medical Center Utrecht, Utrecht, The Netherlands
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Veldwijk J, Determann D, Lambooij MS, van Til JA, Korfage IJ, de Bekker-Grob E, de Wit GA. How Do Individuals Complete The Choice Tasks In A Discrete Choice Experiment? Value Health 2014; 17:A567-A568. [PMID: 27201883 DOI: 10.1016/j.jval.2014.08.1891] [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)
- J Veldwijk
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - D Determann
- National institute for public health and the environment, Bilthoven, The Netherlands
| | - M S Lambooij
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J A van Til
- University of Twente, Enschede, The Netherlands
| | - I J Korfage
- University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - G A de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Veldwijk J, Essers BAB, Dirksen CD, Smit HA, Lambooij MS, de Wit GA. Survival or Mortality: Framing of the Risk Attribute in a Discrete Choice Experiment. Value Health 2014; 17:A330. [PMID: 27200566 DOI: 10.1016/j.jval.2014.08.615] [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)
- J Veldwijk
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - B A B Essers
- Clinical and Medical Technology Assessment, Maastricht University Medical Centre; CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - C D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H A Smit
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - M S Lambooij
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - G A de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Wermeling PR, Gorter KJ, Stellato RK, de Wit GA, Beulens JWJ, Rutten GEHM. Effectiveness and cost-effectiveness of 3-monthly versus 6-monthly monitoring of well-controlled type 2 diabetes patients: a pragmatic randomised controlled patient-preference equivalence trial in primary care (EFFIMODI study). Diabetes Obes Metab 2014; 16:841-9. [PMID: 24635880 DOI: 10.1111/dom.12288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/05/2014] [Accepted: 03/08/2014] [Indexed: 11/28/2022]
Abstract
AIM To investigate effectiveness and cost-effectiveness of 6-monthly monitoring compared with 3-monthly monitoring of well-controlled type 2 diabetes patients in primary care. METHODS A pragmatic randomised controlled patient-preference equivalence trial was performed. From April 2009 to August 2010, 2215 patients from 233 general practitioners across the Netherlands were included. Patients were eligible if between 40- and 80-years-old, diagnosed with type 2 diabetes for more than a year, treated by their general practitioner, not on insulin treatment and well-controlled during the last year (HbA1c ≤ 58 mmol/mol, systolic blood pressure ≤ 145 mmHg and total cholesterol ≤ 5.2 mmol/l). Patients without a strong preference for their monitoring frequency were randomised to 3-monthly or 6-monthly monitoring. Follow-up was 18 months. The primary outcome is the percentage of patients remaining under: HbA1c ≤ 58 mmol/mol, systolic blood pressure ≤ 145 mmHg and total cholesterol ≤ 5.2 mmol/l. Equivalence was assumed if the two-sided 95% confidence interval (CI) was between -5 and 5%. Cost-effectiveness was determined using a cost-minimisation analysis. RESULTS In the 3-monthly group 69.5% remained under good cardiometabolic control, versus 69.8% in the 6-monthly group (difference: 0.3%; 95%CI: -6.2-6.7%). All secondary outcomes were equivalent for 3-monthly and 6-monthly monitoring, except the systolic blood pressure target, physical activity and antihypertensive drug use. Six-monthly monitoring was €387 (£333) cheaper per patient compared to 3-monthly monitoring during the study period. CONCLUSIONS Patients with good cardiometabolic control and without preference for their monitoring frequency can visit the primary care physician less often. The cost-savings can be considerable.
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Affiliation(s)
- P R Wermeling
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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26
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Oostdijk EAN, de Wit GA, Bakker M, de Smet AMGA, Bonten MJM. Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis. BMJ Open 2013; 3:bmjopen-2012-002529. [PMID: 23468472 PMCID: PMC3612803 DOI: 10.1136/bmjopen-2012-002529] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). DESIGN A post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20). SETTING 13 Dutch ICUs. PARTICIPANTS Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990). INTERVENTIONS SDD or SOD. PRIMARY AND SECONDARY OUTCOME MEASURES Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation. RESULTS Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving. CONCLUSIONS SDD and SOD were both effective and cost-saving in Dutch ICUs.
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Affiliation(s)
- Evelien A N Oostdijk
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Vernooij JWP, Kaasjager HAH, van der Graaf Y, Wierdsma J, Grandjean HMH, Hovens MMC, de Wit GA, Visseren FLJ. Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial. BMJ 2012; 344:e3750. [PMID: 22692651 PMCID: PMC3374126 DOI: 10.1136/bmj.e3750] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate whether an internet based, nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinically manifest vascular disease. DESIGN Prospective randomised controlled trial. SETTING Multicentre trial in secondary and tertiary healthcare setting. PARTICIPANTS 330 patients with a recent clinical manifestation of atherosclerosis in the coronary, cerebral, or peripheral arteries and with at least two treatable risk factors not at goal. INTERVENTION Personalised website with an overview and actual status of patients' risk factors and mail communication via the website with a nurse practitioner for 12 months; the intervention combined self management support, monitoring of disease control, and drug treatment. MAIN OUTCOME MEASURES The primary endpoint was the relative change in Framingham heart risk score after 1 year. Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor. RESULTS Participants' mean age was 59.9 (SD 8.4) years, and most patients (n=246; 75%) were male. After 1 year, the relative change in Framingham heart risk score of the intervention group compared with the usual care group was -14% (95% confidence interval -25% to -2%). At baseline, the Framingham heart risk score was higher in the intervention group than in the usual care group (16.1 (SD 10.6) v 14.0 (10.5)), so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score. This produced a relative change of -12% (-22% to -3%) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and -8% (-18% to 2%) adjusted for the baseline score. Of the individual risk factors, a difference between groups was observed in low density lipoprotein cholesterol (-0.3, -0.5 to -0.1, mmol/L) and smoking (-7.7%, -14.9% to -0.4%). Some other risk factors tended to improve (body mass index, triglycerides, systolic blood pressure, renal function) or tended to worsen (glucose concentration, albuminuria). CONCLUSION An internet based, nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease. TRIAL REGISTRATION Clinical trials NCT00785031.
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Affiliation(s)
- J W P Vernooij
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands
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Helsper CW, Hellinga HL, van Essen GA, de Wit GA, Bonten MJM, van Erpecum KJ, Hoepelman AIM, Richter C, de Wit NJ. Real-life costs of hepatitis C treatment. Neth J Med 2012; 70:145-153. [PMID: 22516582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hepatitis C virus infection is a serious health threat in today's society. Improved identification strategies have increased the number of patients undergoing the expensive treatment with ribavirin and peg-interferon, inducing a substantial economic burden. METHODS In a retrospective cohort study in three treatment centres in the Netherlands, files of patients treated between 2001 and 2010 were systematically searched for all cost-inducing treatment details. Costs of treatment resulting in sustained viral response (SVR), relapse, non-response and the costs per cured patient were specified for genotype and treatment setting. Determinants of costs were determined by multivariate linear regression. RESULTS The mean 'real-life' treatment costs excluding side effects for genotype 1/4 and genotype 2/3 were approximately € 12,900 and € 9900 for all patients, € 15,500 and € 10,100 for treatment resulting in SVR and € 16,800 and € 12,100 for relapse, respectively. Costs per cured patient were € 28,500 and € 15,400 respectively. The costs of non-response were approximately € 8000 for all genotypes. Costs of side effects can be high and are mainly caused by incidental treatment for neutropenia. Medication is the main component of treatment costs. Treatment costs were higher in the academic setting due to longer duration and higher costs of side effects. Regression analysis confirms duration as the main determinant of treatment costs excluding side effects. CONCLUSION The 'real-life' costs of treatment are mainly determined by treatment duration, medication costs and costs of side effects. The costs of unsuccessful treatment are considerable as are the costs of side effects. Therefore, future research should aim at increasing SVR rates, reducing treatment duration and preventing side effects.
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Affiliation(s)
- C W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
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Abstract
BACKGROUND In cost-effectiveness analysis (CEA), it is common to compare a single, new intervention with 1 or more existing interventions representing current practice ignoring other, unrelated interventions. Sectoral CEAs, in contrast, take a perspective in which the costs and effectiveness of all possible interventions within a certain disease area or health care sector are compared to maximize health in a society given resource constraints. Stochastic league tables (SLT) have been developed to represent uncertainty in sectoral CEAs but have 2 shortcomings: 1) the probabilities reflect inclusion of individual interventions and not strategies and 2) data on robustness are lacking. The authors developed an extension of SLT that addresses these shortcomings. METHODS Analogous to nonprobabilistic MAXIMIN decision rules, the uncertainty of the performance of strategies in sectoral CEAs may be judged with respect to worst possible outcomes, in terms of health effects obtainable within a given budget. Therefore, the authors assessed robustness of strategies likely to be optimal by performing optimization separately on all samples and on samples yielding worse than expected health benefits. The approach was tested on 2 examples, 1 with independent and 1 with correlated cost and effect data. RESULTS The method was applicable to the original SLT example and to a new example and provided clear and easily interpretable results. Identification of interventions with robust performance as well as the best performing strategies was straightforward. Furthermore, the robustness of strategies was assessed with a MAXIMIN decision rule. CONCLUSION The SLT extension improves the comprehensibility and extends the usefulness of outcomes of SLT for decision makers. Its use is recommended whenever an SLT approach is considered.
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Affiliation(s)
- H Koffijberg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (HK, GAdW)
| | - G A de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (HK, GAdW),Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands (GAdW, TLF)
| | - T L Feenstra
- Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands (GAdW, TLF),Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands (TLF)
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Wassenberg MWM, Kluytmans JAJW, Bosboom RW, Buiting AGM, van Elzakker EPM, Melchers WJG, Thijsen SFT, Troelstra A, Vandenbroucke-Grauls CMJE, Visser CE, Voss A, Wolffs PFG, Wulf MWH, van Zwet AA, de Wit GA, Bonten MJM. Rapid diagnostic testing of methicillin-resistant Staphylococcus aureus carriage at different anatomical sites: costs and benefits of less extensive screening regimens. Clin Microbiol Infect 2011; 17:1704-10. [PMID: 21595786 DOI: 10.1111/j.1469-0691.2011.03502.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Multiple body site screening and pre-emptive isolation of patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) carriage are considered essential for control of nosocomial spread. The relative importance of extranasal screening when using rapid diagnostic testing (RDT) is unknown. Using data from a multicentre study evaluating BD GeneOhm™ MRSA PCR (IDI), Xpert MRSA (GeneXpert) and chromogenic agar, added to conventional cultures, we determined cost-effectiveness assuming isolation measures would have been based on RDT results of different hypothetical screening regimes. Costs per isolation day avoided were calculated for regimes with single or less extensive multiple site RDT, regimes without conventional back-up cultures and when PCR would have been performed with pooling of swabs. Among 1764 patients at risk, MRSA prevalence was 3.3% (n = 59). In all scenarios the negative predictive value is above 98.4%. With back-up cultures of all sites as a reference, the costs per isolation day avoided were €15.19, €30.83 and €45.37 with 'nares only' screening using chromogenic agar, IDI and GeneXpert, respectively, as compared with €19.95, €95.77 and €125.43 per isolation day avoided when all body sites had been screened. Without back-up cultures costs per isolation day avoided using chromogenic agar would range from €9.24 to €76.18 when costs per false-negative RDT range from €5000 up to €50 000; costs for molecular screening methods would be higher in all scenarios evaluated. In conclusion, in a low endemic setting chromogenic agar screening added to multiple site conventional cultures is the most cost-effective MRSA screening strategy.
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Affiliation(s)
- M W M Wassenberg
- Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands.
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Abstract
OBJECTIVE To assess the cost-effectiveness of low dose statins for primary prevention of vascular disease, incorporating current prices, non-adherence (reduced clinical efficacy while maintaining healthcare costs), and the results of the recently published JUPITER trial. DESIGN Cost-effectiveness analysis using a Markov model. Sensitivity analyses and Monte Carlo simulation evaluated the robustness of the results. SETTING Primary care in The Netherlands. PARTICIPANTS Hypothetical populations of men and women aged 45 to 75 years without a history of vascular disease at different levels of risk for vascular disease (myocardial infarction and stroke) over 10 years. INTERVENTIONS Low dose statin treatment daily versus no treatment for 10 years. MAIN OUTCOME MEASURES Number of fatal and nonfatal vascular events prevented, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios over 10 years. RESULTS Over a 10-year period, statin treatment cost €35 000 (£30 000, $49 000) per QALY gained for men aged 55 years with a 10-year vascular risk of 10%. The incremental cost-effectiveness ratio improved as risk for vascular disease increased. The cost per QALY ranged from approximately €5000 to €125 000 when the 10-year vascular risk for men aged 55 years was varied from 25% to 5%. The incremental cost-effectiveness ratio slightly decreased with age after the level of vascular risk was specified. Results were sensitive to the costs of statin treatment, statin effectiveness, non-adherence, disutility of taking medication daily, and the time horizon of the model. CONCLUSIONS In daily practice, statin treatment seemed not to be cost-effective for primary prevention in populations at low risk of vascular disease, despite low costs of generic drug pills. Adherence to statin treatment needs to be improved to enhance the cost-effectiveness of the use of statins for primary prevention.
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Affiliation(s)
- J P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Netherlands.
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Mazairac AHA, de Wit GA, Grooteman MPC, Penne EL, van der Weerd NC, van den Dorpel MA, Nube MJ, Levesque R, ter Wee PM, Bots ML, Blankestijn PJ. A composite score of protein-energy nutritional status predicts mortality in haemodialysis patients no better than its individual components. Nephrol Dial Transplant 2010; 26:1962-7. [DOI: 10.1093/ndt/gfq643] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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van den Berg M, de Wit GA, Vijgen SMC, Busch MCM, Schuit AJ. [Cost-effectiveness of prevention: opportunities for public health policy in the Netherlands]. Ned Tijdschr Geneeskd 2008; 152:1329-1334. [PMID: 18661860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To gain insight into the cost-effectiveness of new preventive interventions. DESIGN Systematic review and interviews. METHOD Based on literature search, a search of the project database of ZonMw and interviews with experts, the National Institute for Public Health and the Environment drew up a long list of preventive interventions that are potentially cost-effective but are not yet systematically carried out in the Netherlands. From this long list, 21 interventions were selected for each of which, at least 3 economic evaluations were available that indicate favourable cost-effectiveness (< Euro 20,000,--per QALY gained). RESULTS The majority of the interventions concerned vaccination and screening programmes (7 and 5 respectively). Only a small minority concerned health promotion or health protection (1 respectively 3). There was strong evidence that 5 interventions were both cost-effective, and feasible. These were: screening for Chlamydia, screening for diabetic retinopathy in type 2 diabetes, screening for neonatal group beta streptococcal infections through a combination strategy, prevention of recurrent myocardial infarction through heart habilitation, and prevention of head injuries by wearing of bicycle helmets by children. CONCLUSION Before implementation of preventive interventions, it is necessary to investigate whether these interventions are also cost-effective in the Dutch context.
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Affiliation(s)
- M van den Berg
- Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven.
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Vijgen SMC, van Baal PHM, Hoogenveen RT, de Wit GA, Feenstra TL. Cost-effectiveness analyses of health promotion programs: a case study of smoking prevention and cessation among Dutch students. Health Educ Res 2008; 23:310-8. [PMID: 17675649 DOI: 10.1093/her/cym024] [Citation(s) in RCA: 17] [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: 05/16/2023]
Abstract
Little research has been done to connect health promotion programs to outcomes in terms of life expectancy, health care costs and cost-effectiveness. For a policy maker, economic evaluation may be an important tool to support decisions on how to allocate the health care budget. The aim of this paper was to determine the cost-effectiveness of a Dutch school-based smoking education program. The incremental cost-effectiveness ratio of the school program was estimated at euro19 900 per quality adjusted life year gained. For a complete analysis, not only intervention costs but also savings for smoking-related diseases and differences in total health care costs should be taken into account. As several assumptions had to be made in order to estimate cost-effectiveness, the study outcomes should be interpreted with caution. Main problem in estimating the cost-effectiveness was the lack of proper effectiveness data on daily smokers among adolescents. Absence of specific effectiveness data often is an obstacle in the economic evaluation of public health interventions. While some problems may be the result of insufficient sample size or follow-up, another possible explanation might be the different basic principles of analysis of health promoters and economists.
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Affiliation(s)
- S M C Vijgen
- Centre for Prevention.ealth Services Research, National Institute of Public Health and the Environment, 3720 BA Bilthoven, the Netherlands
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Abstract
A mathematical model that takes transmission by sexual contact and vertical transmission into account was employed to describe the transmission dynamics of hepatitis B virus (HBV) and vaccination against it. The model is an extension of a model by Williams et al. (Epidemiol Infect 1996: 116; 71-89) in that it takes immigration of hepatitis B carriers from countries with higher prevalence into account. Model parameters were estimated from data from The Netherlands where available. The main results were that, given the estimates for the parameters describing sexual behaviour in The Netherlands, the basic reproduction number R0 is smaller than 1 in the heterosexual population. As a consequence, the immigration of carriers into the population largely determines the prevalence of HBV carriage and therefore limits the possible success of universal vaccination. Taking into account the prevalence of hepatitis B carriage among immigrants and an age-dependent probability of becoming a carrier after infection, we estimate that a fraction of between 5 and 10% of carrier states could be prevented by universal vaccination.
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Affiliation(s)
- M Kretzschmar
- Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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de Wit GA, Merkus MP, Krediet RT, de Charro FT. A comparison of quality of life of patients on automated and continuous ambulatory peritoneal dialysis. Perit Dial Int 2001; 21:306-12. [PMID: 11475348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE Data on health-related quality of life (HRQOL) of automated peritoneal dialysis (APD) patients are scarce. The objectives of this study were (1) to explore HRQOL of APD patients and compare it with HRQOL of continuous ambulatory peritoneal dialysis (CAPD) patients and a general population sample, and (2) to study the relationship between HROOL assessment outcomes and background variables. DESIGN Home interviews of APD and CAPD patients. HRQOL, social-demographic, clinical, and treatment-related background data were collected at the interview and from patient charts. Multiple regression analysis and logistic regression analysis were used to study the relationship of HRQOL assessment outcomes with background variables. SETTING Sixteen Dutch dialysis centers. PATIENTS Convenience sample of 37 APD patients and 59 CAPD patients matched for total time on dialysis. MAIN OUTCOME MEASURES Four HRQOL instruments: Short-Form 36, EuroQol EQ-5D, Standard Gamble, and Time Trade Off. RESULTS Physical functioning of both APD and CAPD patients was impaired compared with the general population; mental functioning was not different. In multivariate analyses, the mental health of APD patients was found to be better than that of CAPD patients. In addition, APD patients were less anxious and depressed than CAPD patients. With respect to physical aspects of HRQOL and role-functioning, no differences were observed between APD and CAPD patients. Other variables to explain HRQOL assessment outcomes were age, the number of comorbid diseases, and primary kidney disease. CONCLUSIONS HRQOL of APD patients is at least equal to HRQOL of CAPD patients.
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Affiliation(s)
- G A de Wit
- Sanders Institute, Erasmus University, Rotterdam, The Netherlands.
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Abstract
This paper examines the cost-effectiveness of end stage renal disease (ESRD) treatments. Empirical data on costs of treatment modalities and quality of life of patients were gathered alongside a clinical trial and combined with data on patient and technique survival from the Dutch Renal Replacement Registry. A Markov-chain model, based on the actual Dutch ESRD program as of January 1st 1997, predicted the cost-effectiveness and cost-utility of dialysis and transplantation over the 5-year period 1997-2001. Total annual costs amounted to DFL 650 million (1.1% of the health care budget). Centre Haemodialysis was found to be the least cost-effective treatment, while transplantation and Continuous Ambulatory Peritoneal Dialysis (CAPD) were the most cost-effective treatments. The Markov-chain model was used to study the influence of substitutive policies on the overall cost-effectiveness of the ESRD treatment program. The influence of such policies was found to be modest in the Dutch context, where a high percentage of patients is already being treated with more cost-effective treatment modalities. In countries where Centre Haemodialysis is still the only or the major treatment option for ESRD patients, substitutive policies might have a more substantial impact on cost-effectiveness of ESRD treatment.
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Affiliation(s)
- G A de Wit
- Centre for Health Policy and Law, Erasmus University Rotterdam, The Netherlands.
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