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Pouwels XGLV, Kroeze K, van der Linden N, Kip MMA, Koffijberg H. Validating health economic models with the Probabilistic Analysis Check dashBOARD (PACBOARD). Value Health 2024:S1098-3015(24)02340-4. [PMID: 38641056 DOI: 10.1016/j.jval.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES Health economic (HE) models are often considered as "black boxes" because they are not publicly available and lack transparency, which prevents independent scrutiny of HE models. Additionally, validation efforts and validation status of HE models are not systematically reported. Methods to validate HE models in absence of their full underlying code are therefore urgently needed to improve health policy making.This study aimed to develop and test a generic dashboard to systematically explore the workings of HE models and validate their model parameters and outcomes. METHODS The Probabilistic Analysis Check dashBOARD (PACBOARD) was developed using insights from literature, health economists, and a data scientist.Functionalities of PACBOARD are 1) exploring and validating model parameters and outcomes using standardised validation tests and interactive plots, 2) visualising and investigating the relationship between model parameters and outcomes using metamodelling, and 3) predicting health economic outcomes using the fitted metamodel.To test PACBOARD, two mock HE models were developed and errors were introduced in these models, e.g. negative costs inputs, utility values exceeding 1. PACBOARD metamodelling predictions of incremental net monetary benefit were validated against the original model's outcomes. RESULTS PACBOARD automatically identified all errors introduced in the erroneous HE models. Metamodel predictions were accurate compared to the original model outcomes. CONCLUSIONS PACBOARD is a unique dashboard aiming at improving the feasibility and transparency of validation efforts of HE models. PACBOARD allows users to explore the working of HE models using metamodelling based on HE models' parameters and outcomes.
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Affiliation(s)
- Xavier G L V Pouwels
- Section of Health Technology & Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, the Netherlands, Overijssel, Enschede.
| | - Karel Kroeze
- Behavioural Data Science incubator, Faculty of Behavioural, Management, and Social Sciences, University of Twente, the Netherlands, Overijssel, Enschede
| | - Naomi van der Linden
- Section of Health Technology & Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, the Netherlands, Overijssel, Enschede; Institute for Health Systems Science, Faculty of Technology, Policy and Management, Delft University of Technology, the Netherlands, South Holland, Delft
| | - Michelle M A Kip
- Section of Health Technology & Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, the Netherlands, Overijssel, Enschede
| | - Hendrik Koffijberg
- Section of Health Technology & Services Research, Technical Medical Centre, Faculty of Behavioural, Management, and Social Sciences, University of Twente, the Netherlands, Overijssel, Enschede
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Florax AA, Doeleman MJH, de Roock S, van der Linden N, Schatorjé E, Currie G, Marshall DA, IJzerman MJ, Yeung RSM, Benseler SM, Vastert SJ, Wulffraat NM, Swart JF, Kip MMA. Quantifying hospital-associated costs, and accompanying travel costs and productivity losses, before and after withdrawing tumour necrosis factor-alfa inhibitors in juvenile idiopathic arthritis. Rheumatology (Oxford) 2023:kead688. [PMID: 38123516 DOI: 10.1093/rheumatology/kead688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To quantify differences in hospital-associated costs, and accompanying travel costs and productivity losses, before and after withdrawing TNFi in JIA patients. METHODS Retrospective analysis of prospectively collected data from electronic medical records of paediatric JIA patients treated with TNFi, which were either immediately discontinued, spaced (increased treatment interval) or tapered (reduced subsequent doses). Costs of hospital-associated resource use (consultations, medication, radiology procedures, laboratory testing, procedures under general anaesthesia, hospitalisation) and associated travel costs and productivity losses were quantified during clinically inactive disease until TNFi withdrawal (pre-withdrawal period) and compared with costs during the first and second year after withdrawal initiation (first and second year post-withdrawal). RESULTS Fifty-six patients were included of whom 26 immediately discontinued TNFi, 30 spaced and zero tapered. Mean annual costs were €9,165/patient on active treatment (pre-withdrawal) and decreased significantly to €5,063/patient (-44.8%) and €6,569/patient (-28.3%) in the first and second year post-withdrawal, respectively (p< 0.05). Of these total annual costs, travel costs plus productivity losses were €834/patient, €1,180/patient, and €1,320/patient, in the three periods respectively. Medication comprised 80.7%, 61.5% and 72.4% of total annual costs in the pre-withdrawal, first, and second year post-withdrawal period, respectively. CONCLUSION In the first two years after initiating withdrawal, the total annual costs are decreased compared with the pre-withdrawal period. However, cost reductions were lower in the second year compared with the first year post-withdrawal, primarily due to restarting or intensifying biologics. To support biologic withdraw decisions, future research should assess the full long-term societal cost impacts, and include all biologics.
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Affiliation(s)
- Anna A Florax
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Martijn J H Doeleman
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sytze de Roock
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Naomi van der Linden
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Ellen Schatorjé
- Department of Paediatric Rheumatology, St Maartenskliniek, Nijmegen, The Netherlands
- Department of Paediatric Rheumatology and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gillian Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rae S M Yeung
- Division of Rheumatology, The Hospital for Sick Children, Department of Paediatrics, Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Division of Rheumatology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sebastiaan J Vastert
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- European Reference Network RITA (rare immunodeficiency autoinflammatory and autoimmune diseases network)
| | - Nico M Wulffraat
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- European Reference Network RITA (rare immunodeficiency autoinflammatory and autoimmune diseases network)
| | - Joost F Swart
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- European Reference Network RITA (rare immunodeficiency autoinflammatory and autoimmune diseases network)
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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van Nieuwkerk JL, van der Linden MC, Verheul RJ, Gaalen MVLV, Janmaat M, van der Linden N. The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial. World J Emerg Med 2023; 14:257-264. [PMID: 37425086 PMCID: PMC10323509 DOI: 10.5847/wjem.j.1920-8642.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/01/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND In patients with chest pain who arrive at the emergency department (ED) by ambulance, venous access is frequently established prehospital, and could be utilized to sample blood. Prehospital blood sampling may save time in the diagnostic process. In this study, the association of prehospital blood draw with blood sample arrival times, troponin turnaround times, and ED length of stay (LOS), number of blood sample mix-ups and blood sample quality were assessed. METHODS The study was conducted from October 1, 2019 to February 29, 2020. In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome (ACS), outcomes were compared between cases, in whom prehospital blood draw was performed, and controls, in whom blood was drawn at the ED. Regression analyses were used to assess the association of prehospital blood draw with the time intervals. RESULTS Prehospital blood draw was performed in 100 patients. In 406 patients, blood draw was performed at the ED. Prehospital blood draw was independently associated with shorter blood sample arrival times, shorter troponin turnaround times and decreased LOS (P<0.001). No differences in the number of blood sample mix-ups and quality were observed (P>0.05). CONCLUSION For patients with acute chest pain with low suspicion for ACS, prehospital blood sampling is associated with shorter time intervals, while there were no significant differences between the two groups in the validity of the blood samples.
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Affiliation(s)
- Johan L. van Nieuwkerk
- Emergency Department, Haaglanden Medical Centre & Emergency Medical Services Haaglanden, the Hague 2501 CB, the Netherlands
| | | | - Rolf J. Verheul
- Laboratory Services, Haaglanden Medical Centre, the Hague 2501 CK, the Netherlands
| | | | - Marije Janmaat
- Faculty of Health, University of Applied Sciences Leiden, Leiden 2300 AJ, the Netherlands
| | - Naomi van der Linden
- Faculty of Technology, Policy and Management, Delft University of Technology, Delft 2628 BX, the Netherlands
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Campbell M, van der Linden N, Gardner K, Dickinson H, Agostino J, Dowden M, O’Meara I, Scolyer M, Woerle H, Viney R, van Gool K. Health care cost of crusted scabies in Aboriginal communities in the Northern Territory, Australia. PLoS Negl Trop Dis 2022; 16:e0010288. [PMID: 35344551 PMCID: PMC8989313 DOI: 10.1371/journal.pntd.0010288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 04/07/2022] [Accepted: 02/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background Crusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world. Objective To estimate the health system costs associated with diagnosing, treating and managing crusted scabies. Methods A disease pathway model was developed to identify the major phases of managing crusted scabies. In recognition of the higher resource use required to treat more severe cases, the pathway differentiates between crusted scabies severity grades. The disease pathway model was populated with data from a clinical audit of 42 crusted scabies patients diagnosed in the Top-End of Australia’s Northern Territory between July 1, 2016 and May 1, 2018. These data were combined with standard Australian unit costs to calculate the expected costs per patient over a 12-month period, as well as the overall population cost for treating crusted scabies. Findings The expected health care cost per patient diagnosed with crusted scabies is $35,418 Australian dollars (AUD) (95% CI: $27,000 to $43,800), resulting in an overall cost of $1,558,392AUD (95% CI: $1,188,000 to $1,927,200) for managing all patients diagnosed in the Northern Territory in a given year (2018). By far, the biggest component of the health care costs falls on the hospital system. Discussion This is the first cost-of-illness analysis for treating crusted scabies. Such analysis will be of value to policy makers and researchers by informing future evaluations of crusted scabies prevention programs and resource allocation decisions. Further research is needed on the wider costs of crusted scabies including non-financial impacts such as the loss in quality of life as well as the burden of care and loss of well-being for patients, families and communities. Crusted scabies is characterised by thick skin crusting and fissuring and can lead to serious secondary infections and death from complications. Rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are among the highest in the world. Efforts are on the way in Australia to prevent, if not eliminate, crusted scabies. We use data from a clinical audit of 42 patients diagnosed with crusted scabies in the Top-End of the NT to estimate the health system costs associated with diagnosing, treating and managing crusted scabies for patients and their households. This cost of illness study can provide a valuable starting point for policy makers and evaluators in estimating the potential economic impact of crusted scabies prevention programs on health care service use and costs.
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Affiliation(s)
- Margaret Campbell
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Naomi van der Linden
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Karen Gardner
- Public Service Research Group, School of Business, UNSW Canberra, Canberra, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business, UNSW Canberra, Canberra, Australia
| | - Jason Agostino
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | | | | | | | | | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
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van der Linden MC, van den Wijngaard IR, van der Linden S, van der Linden N. Night-time confusion in an elderly woman post-stroke. BMJ Case Rep 2020; 13:13/5/e230693. [PMID: 32444438 DOI: 10.1136/bcr-2019-230693] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a complex and vulnerable phase in the patient's journey. Elderly are particularly vulnerable to the stressors caused by hospitalisation. Recently hospitalised patients are not only recovering from their acute illness; they also experience a period of generalised risk for a range of adverse events. At the same time, elderly generally prefer living in their own homes and should be discharged from the hospital and return home as quickly as possible. Both premature and delayed discharge are potential threats to patient well-being. We present a 90-year-old patient who underwent successful thrombectomy but suffered from night-time confusion at the hospital and discuss the transition process from hospital to home.
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Affiliation(s)
| | | | | | - Naomi van der Linden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Wolff HB, Alberts L, van der Linden N, Bongers ML, Verstegen NE, Lagerwaard FJ, Hofman FN, Uyl-de Groot CA, Senan S, El Sharouni SY, Kastelijn EA, Schramel FMNH, Coupé VMH. Cost-effectiveness of stereotactic body radiation therapy versus video assisted thoracic surgery in medically operable stage I non-small cell lung cancer: A modeling study. Lung Cancer 2020; 141:89-96. [PMID: 31982640 DOI: 10.1016/j.lungcan.2020.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/13/2019] [Accepted: 01/11/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Stage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC. MATERIALS AND METHODS Patient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis. Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses. RESULTS Patients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were €29,269 versus €21,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations. CONCLUSION Using a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.
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Affiliation(s)
- Henri B Wolff
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Leonie Alberts
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Naomi van der Linden
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Mathilda L Bongers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Naomi E Verstegen
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Carin A Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sherif Y El Sharouni
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | | | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands
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Saing S, van der Linden N, Hayward C, Goodall S. Why is There Discordance between the Reimbursement of High-Cost 'Life-Extending' Pharmaceuticals and Medical Devices? The Funding of Ventricular Assist Devices in Australia. Appl Health Econ Health Policy 2019; 17:421-431. [PMID: 30906972 DOI: 10.1007/s40258-019-00470-x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New health technologies often yield health benefits, but often at a high cost. In Australia, the processes for public reimbursement of high-cost pharmaceuticals and medical devices are different, potentially resulting in inequity in support for new therapies. We explore how reimbursement is different for medical devices compared with pharmaceuticals, including whether higher cost-effectiveness thresholds are accepted for pharmaceuticals. A literature review identified the challenges of economic evaluations for medical devices compared with pharmaceuticals. We used the ventricular assist device as a case study to highlight specific features of medical device funding in Australia. We used existing guidelines to evaluate whether ventricular assist devices would fulfil the requirements for the "Life-Saving Drugs Program", which is usually reserved for expensive life-extending pharmaceutical treatments of serious and rare medical conditions. The challenges in conducting economic evaluations of medical devices include limited data to support effectiveness, device-operator interaction (surgical experience) and incremental innovations (miniaturisation). However, whilst high-cost pharmaceuticals may be funded by a single source (federal government), the funding of high-cost devices is complex and may be funded via a combination of federal, state and private health insurance. Based on the Life-Saving Drugs Program criteria, we found that ventricular assist devices could be funded by a similar mechanism to that which funds high-cost life-extending pharmaceuticals. This article highlights the complexities of medical device reimbursement. Whilst differences in available evidence affect the evaluation process, differences in funding methods contribute to inequitable reimbursement decisions between medical devices and pharmaceuticals.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Naomi van der Linden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Christopher Hayward
- Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Saing S, Haywood P, van der Linden N, Manipis K, Meshcheriakova E, Goodall S. Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia. Appl Health Econ Health Policy 2019; 17:243-254. [PMID: 30617458 DOI: 10.1007/s40258-018-00454-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14-49 NTDs each year. OBJECTIVE Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. METHODS We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. RESULTS We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. CONCLUSIONS This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Phil Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Naomi van der Linden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Kathleen Manipis
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Elena Meshcheriakova
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
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van der Linden N, van Gool K, Gardner K, Dickinson H, Agostino J, Regan DG, Dowden M, Viney R. A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions. PLoS Negl Trop Dis 2019; 13:e0007182. [PMID: 30849124 PMCID: PMC6426261 DOI: 10.1371/journal.pntd.0007182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/20/2019] [Accepted: 01/23/2019] [Indexed: 01/12/2023] Open
Abstract
Background Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. Methods Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. Findings Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. Discussion Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies. Scabies is a neglected tropical disease affecting more than 130 million people, with major costs on health care systems worldwide. While effective treatments exist, it is unknown which treatment strategies result in the best outcomes against the lowest costs, and to what extent this differs between communities. Health economic modelling can help answer these questions, but has rarely been used in this disease area. This review discusses all available scabies transmission models (n = 4), and uses them to create a new, comprehensive modelling framework. This framework can be used as aid for creating a scabies transmission model, the details of which will be determined by the context (population) and the question being addressed. The current paper also reviews the data that is needed to inform scabies modelling: on scabies biology, quality of life and resource use. Unfortunately, available data is limited and particularly data on crusted scabies (associated with high morbidity and mortality rates) is rare. With this review, we hope to assist researchers and policy makers to predict and/or evaluate the cost-effectiveness of interventions against scabies in their population(s) of interest. To tackle scabies, it is key to use effective treatment strategies in a cost-effective and sustainable way. The models and data described in this review, may help researchers, clinicians and funding bodies to facilitate this.
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Affiliation(s)
- Naomi van der Linden
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | - Kees van Gool
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Karen Gardner
- Public Service Research Group, School of Business UNSW Canberra, Canberra, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business UNSW Canberra, Canberra, Australia
| | - Jason Agostino
- Academic Unit of General Practice, Australian National University, Canberra, Australia
| | | | | | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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Holleman MS, Uyl-de Groot CA, Goodall S, van der Linden N. Determining the Comparative Value of Pharmaceutical Risk-Sharing Policies in Non-Small Cell Lung Cancer Using Real-World Data. Value Health 2019; 22:322-331. [PMID: 30832970 DOI: 10.1016/j.jval.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Risk-sharing arrangements (RSAs) can be used to mitigate uncertainty about the value of a drug by sharing the financial risk between payer and pharmaceutical company. We evaluated the projected impact of alternative RSAs for non-small cell lung cancer (NSCLC) therapies based on real-world data. METHODS Data on treatment patterns of Dutch NSCLC patients from four different hospitals were used to perform "what-if" analyses, evaluating the costs and benefits likely associated with various RSAs. In the scenarios, drug costs or refunds were based on response evaluation criteria in solid tumors (RECIST) response, survival compared to the pivotal trial, treatment duration, or a fixed cost per patient. Analyses were done for erlotinib, gemcitabine/cisplatin, and pemetrexed/platinum for metastatic NSCLC, and gemcitabine/cisplatin, pemetrexed/cisplatin, and vinorelbine/cisplatin for nonmetastatic NSCLC. RESULTS Money-back guarantees led to moderate cost reductions to the payer. For conditional treatment continuation schemes, costs and outcomes associated with the different treatments were dispersed. When price was linked to the outcome, the payer's drug costs reduced by 2.5% to 26.7%. Discounted treatment initiation schemes yielded large cost reductions. Utilization caps mainly reduced the costs of erlotinib treatment (by 16%). Given a fixed cost per patient based on projected average use of the drug, risk sharing was unfavorable to the payer because of the lower than projected use. The impact of RSAs on a national scale was dispersed. CONCLUSIONS For erlotinib and pemetrexed/platinum, large cost reductions were observed with risk sharing. RSAs can mitigate uncertainty around the incremental cost-effectiveness or budget impact of drugs, but only when the type of arrangement matches the setting and type of uncertainty.
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Affiliation(s)
- Marscha S Holleman
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Stephen Goodall
- Center for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Naomi van der Linden
- Center for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
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van der Linden N, Bongers ML, Coupé VM, Smit EF, Groen HJ, Welling A, Schramel FM, Uyl-de Groot CA. Treatment Patterns and Differences in Survival of Non-Small Cell Lung Cancer Patients Between Academic and Non-Academic Hospitals in the Netherlands. Clin Lung Cancer 2017; 18:e341-e347. [DOI: 10.1016/j.cllc.2015.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
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de Groot S, van der Linden N, Franken MG, Blommestein HM, Leeneman B, van Rooijen E, Koos van der Hoeven JJM, Wouters MW, Westgeest HM, Uyl-de Groot CA. Balancing the Optimal and the Feasible: A Practical Guide for Setting Up Patient Registries for the Collection of Real-World Data for Health Care Decision Making Based on Dutch Experiences. Value Health 2017; 20:627-636. [PMID: 28408005 DOI: 10.1016/j.jval.2016.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this article was to provide practical guidance in setting up patient registries to facilitate real-world data collection for health care decision making. METHODS This guidance was based on our experiences and involvement in setting up patient registries in oncology in the Netherlands. All aspects were structured according to 1) mission and goals ("the Why"), 2) stakeholders and funding ("the Who"), 3) type and content ("the What"), and 4) identification and recruitment of patients, data handling, and pharmacovigilance ("the How"). RESULTS The mission of most patient registries is improving patient health by improving the quality of patient care; monitoring and evaluating patient care is often the primary goal ("the Why"). It is important to align the objectives of the registry and agree on a clear and functional governance structure with all stakeholders ("the Who"). There is often a trade off between reliability, validity, and specificity of data elements and feasibility of data collection ("the What"). Patient privacy should be carefully protected, and address (inter-)national and local regulations. Patient registries can reveal unique safety information, but it can be challenging to comply with pharmacovigilance guidelines ("the How"). CONCLUSIONS It is crucial to set up an efficient patient registry that serves its aims by collecting the right data of the right patient in the right way. It can be expected that patient registries will become the new standard alongside randomized controlled trials due to their unique value.
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Affiliation(s)
- Saskia de Groot
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Naomi van der Linden
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Margreet G Franken
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hedwig M Blommestein
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Brenda Leeneman
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ellen van Rooijen
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Michel W Wouters
- Dutch Institute for Clinical Auditing (DICA), Leiden, The Netherlands; Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hans M Westgeest
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Oncology, Amphia Hospital, Breda, The Netherlands
| | - Carin A Uyl-de Groot
- Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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van der Linden N, Buter J, Pescott CP, Lalisang RI, de Boer JP, de Graeff A, van Herpen CML, Baatenburg de Jong RJ, Uyl-de Groot CA. Treatments and costs for recurrent and/or metastatic squamous cell carcinoma of the head and neck in the Netherlands. Eur Arch Otorhinolaryngol 2016; 273:455-64. [PMID: 25876000 PMCID: PMC4733133 DOI: 10.1007/s00405-015-3495-y] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/01/2015] [Indexed: 11/27/2022]
Abstract
For patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), chemotherapy can prolong life and alleviate symptoms. However, expected gains may be small, not necessarily outweighing considerable toxicity and high costs. Treatment choice is to a large extent dependent on preferences of doctors and patients and data on these choices are scarce. The purpose of this study is to obtain real-world information on palliative systemic treatment and costs of R/M SCCHN in the Netherlands. In six Dutch head and neck treatment centers, data were collected on patient and tumor characteristics, treatment patterns, disease progression, survival, adverse events, and resource use for R/M SCCHN, between 2006 and 2013. 125 (14 %) out of 893 R/M SCCHN patients received palliative, non-trial first-line systemic treatment, mainly platinum + 5FU + cetuximab (32 %), other platinum-based combination therapy (13 %), methotrexate monotherapy (27 %) and capecitabine monotherapy (14 %). Median progression-free survival and overall survival were 3.4 and 6.0 months, respectively. 34 (27 %) patients experienced severe adverse events. Mean total hospital costs ranged from € 10,075 (± € 9,891) (methotrexate monotherapy) to € 39,459 (± € 21,149) (platinum + 5FU + cetuximab). Primary cost drivers were hospital stays and anticancer drug treatments. Major health care utilization and costs are involved in systemically treating R/M SCCHN patients with a limited survival.
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Affiliation(s)
- Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Woudestein location (J5-51), P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Jan Buter
- VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Chris P Pescott
- Merck KGaA, Frankfurter Str. 250, F135/101, 64293, Darmstadt, Germany.
| | - Roy I Lalisang
- Division of Medical Oncology, Department of Internal Medicine, GROW, School of Oncology and Developmental Biology, Maastricht University Medical Center, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Jan Paul de Boer
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, P.O. Box 90203, 1006 BE, Amsterdam, The Netherlands.
| | - Alexander de Graeff
- University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Carla M L van Herpen
- Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | | | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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van der Linden N, Smit EF, Uyl-de Groot CA. Real-world costs of laboratory tests for non-small cell lung cancer. ACTA ACUST UNITED AC 2015; 53:e187-9. [DOI: 10.1515/cclm-2014-1262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
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van der Linden MC, Lindeboom R, van der Linden N, van den Brand CL, Lam RC, Lucas C, de Haan R, Goslings JC. Self-referring patients at the emergency department: appropriateness of ED use and motives for self-referral. Int J Emerg Med 2014; 7:28. [PMID: 25097670 PMCID: PMC4110705 DOI: 10.1186/s12245-014-0028-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nearly all Dutch citizens have a general practitioner (GP), acting as a gatekeeper to secondary care. Some patients bypass the GP and present to the emergency department (ED). To make best use of existing emergency care, Dutch health policy makers and insurance companies have proposed the integration of EDs and GP cooperatives (GPCs) into one facility. In this study, we examined ED use and assessed the characteristics of self-referrals and non-self-referrals, their need for hospital emergency care and self-referrals' motives for presenting at the ED. METHODS A descriptive cohort study was conducted in a Dutch level 1 trauma centre. Differences in patient characteristics, time of presentation and need for hospital emergency care were analysed using χ (2) tests and t tests. A patient was considered to need hospital emergency care when he/she was admitted to the hospital, had an extremity fracture and/or when diagnostic tests were performed. Main determinants of self-referral were identified via logistic regression. RESULTS Of the 5,003 consecutive ED patients registering within the 5-week study period, 3,028 (60.5%) were self-referrals. Thirty-nine percent of the self-referrals had urgent acuity levels, as opposed to 65% of the non-self-referrals. Self-referrals more often suffered from injuries (49 vs. 20%). One third of the self-referrals presented during office hours. Of all self-referrals, 51% needed hospital emergency care. Younger age; non-urgent acuity level; chest pain, ear, nose or throat problems; and injuries were independent predictors for self-referral. Most cited motives for self-referring were 'accessibility and convenience' and perceived 'medical necessity'. CONCLUSIONS A substantial part of the self-referrals needed hospital emergency care. The 49% self-referrals who were eligible for GP care presented during out-of-hours as well as during office hours. This calls for an integrative approach to this health care problem.
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Affiliation(s)
| | - Robert Lindeboom
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, The Netherlands
| | - Crispijn L van den Brand
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Rianne C Lam
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Cees Lucas
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Rob de Haan
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, J1b-118, Amsterdam 1100 DD, The Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
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van der Linden MC, Lindeboom R, de Haan R, van der Linden N, de Deckere ER, Lucas C, Rhemrev SJ, Goslings JC. Unscheduled return visits to a Dutch inner-city emergency department. Int J Emerg Med 2014; 7:23. [PMID: 25045407 PMCID: PMC4100563 DOI: 10.1186/s12245-014-0023-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unscheduled return visits to the emergency department (ED) may reflect shortcomings in care. This study characterized ED return visits with respect to incidence, risk factors, reasons and post-ED disposition. We hypothesized that risk factors for unscheduled return and reasons for returning would differ from previous studies, due to differences in health care systems. METHODS All unscheduled return visits occurring within 1 week and related to the initial ED visit were selected. Multivariable logistic regression was conducted to determine independent factors associated with unscheduled return, using patient information available at the initial visit. Reasons for returning unscheduled were categorized into illness-, patient- or physician-related. Post-ED disposition was compared between patients with unscheduled return visits and the patients who did not return. RESULTS Five percent (n = 2,492) of total ED visits (n = 49,341) were unscheduled return visits. Patients with an urgent triage level, patients presenting during the night shift, with a wound or local infection, abdominal pain or urinary problems were more likely to return unscheduled. Reasons to revisit unscheduled were mostly illness-related (49%) or patient-related (41%). Admission rates for returning patients (16%) were the same as for the patients who did not return (17%). CONCLUSIONS Apart from abdominal complaints, risk factors for unscheduled return differ from previous studies. Short-term follow-up at the outpatient clinic or general practitioner for patients with urgent triage levels and suffering from wounds or local infections, abdominal pain or urinary problem might prevent unscheduled return.
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Affiliation(s)
| | - Robert Lindeboom
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Rob de Haan
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, J1b-118, Amsterdam 1100 DD, The Netherlands
| | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam 3000 DR, The Netherlands
| | - Ernie Rjt de Deckere
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - Cees Lucas
- Division of Clinical Methods and Public Health, Master Evidence Based Practice, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
| | - Steven J Rhemrev
- Accident and Emergency Department, Medical Centre Haaglanden, The Hague 2501 CK, The Netherlands
| | - J Carel Goslings
- Department of Surgery, Trauma Unit, Academic Medical Centre, University of Amsterdam, Amsterdam 1100 DD, The Netherlands
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van den Brand CL, van der Linden MC, van der Linden N, Rhemrev SJ. Fracture prevalence during an unusual period of snow and ice in the Netherlands. Int J Emerg Med 2014; 7:17. [PMID: 24872860 PMCID: PMC4017960 DOI: 10.1186/1865-1380-7-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background The objective of the current study was to assess the effect of an unusual 10-day snow and ice period on the prevalence of fractures in an emergency department (ED) in the Netherlands. Furthermore, patients with fractures during the snow and ice period were compared to those in the control period with respect to gender, age, location of accident, length of stay, disposition, and anatomical site of the injury. Methods Fracture prevalence during a 10-day study period with snow and ice (January 14, 2013 until January 23, 2013) was compared to a similar 10-day control period without snow or ice (January 16, 2012 until January 25, 2012). The records of all patients with a fracture were manually selected. Besides this, basic demographics, type of fracture, and location of the accident (inside or outside) were compared. Results A total of 1,785 patients visited the ED during the study period and 1,974 during the control period. A fracture was found in 224 patients during the study period and in 109 patients during the control period (P <0.01). More fractures sustained outside account for this difference. No differences were found in gender, mean age, and length of ED stay. However, during the snow and ice period the percentage of fractures in the middle-aged (31–60 yrs) was significantly higher than in the control period (P <0.01). Conclusions The number of fractures sustained more than doubled during a period with snow and ice as compared to the control period. In contrast to other studies outside the Netherlands, not the elderly, but the middle-aged were most affected by the slippery conditions.
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Affiliation(s)
- Crispijn L van den Brand
- Emergency Department, Medical Centre Haaglanden, P.O. box 432, 2501 CK The Hague, The Netherlands
| | | | - Naomi van der Linden
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Steven J Rhemrev
- Department of Trauma Surgery, Medical Centre Haaglanden, P.O. box 432, 2501 CK The Hague, The Netherlands
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van der Linden MC, van den Brand CL, van der Linden N, Rambach AH, Brumsen C. Rate, characteristics, and factors associated with high emergency department utilization. Int J Emerg Med 2014; 7:9. [PMID: 24499684 PMCID: PMC3931321 DOI: 10.1186/1865-1380-7-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/29/2014] [Indexed: 11/30/2022] Open
Abstract
Background Patients with high emergency department (ED) utilization account for a disproportionate number of ED visits. The existing research on high ED utilization has raised doubts about the homogeneity of the frequent ED user. Attention to differences among the subgroups of frequent visitors (FV) and highly frequent visitors (HFV) is necessary in order to plan more effective interventions. In the Netherlands, the incidence of high ED utilization is unknown. The purpose of this study was to investigate if the well-documented international high ED utilization also exists in the Netherlands and if so, to characterize these patients. Therefore, we assessed the proportion of FV and HFV; compared age, sex, and visit outcomes between patients with high ED utilization and patients with single ED visits; and explored the factors associated with high ED utilization. Methods A 1-year retrospective descriptive correlational study was performed in two Dutch EDs, using thresholds of 7 to 17 visits for frequent ED use, and greater than or equal to 18 visits for highly frequent ED use. Results FV and HFV (together accounting for 0.5% of total ED patients) attended the ED 2,338 times (3.3% of the total number of ED visits). FV and HFV were equally likely to be male or female, were less likely to be self-referred, and they suffered from urgent complaints more often compared to patients with single visits. FV were significantly older than patients with single visits and more often admitted than patients with single visits. Several chief complaints were indicative for frequent and highly frequent ED use, such as shortness of breath and a psychiatric disorder. Conclusions Based on this study, high ED utilization in the Netherlands seems to be less a problem than outlined in international literature. No major differences were found between FV and HFV, they presented with the same, often serious, problems. Our study supports the notion that most patients with high ED utilization visit the ED for significant medical problems.
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van der Linden N, van Gils CWM, Pescott CP, Buter J, Uyl-de Groot CA. Cetuximab in locally advanced squamous cell carcinoma of the head and neck: generalizability of EMR 062202-006 trial results. Eur Arch Otorhinolaryngol 2013; 271:1673-8. [PMID: 23907370 DOI: 10.1007/s00405-013-2646-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
In a randomized controlled trial in patients with locally advanced squamous cell carcinoma of the head and neck (LA SCCHN), treatment with RT plus cetuximab resulted in improved survival compared to treatment with RT alone. Uncertainty exists about the generalizability of the trial results for the Dutch healthcare setting due to possible discrepancies in treatment allocation. Retrospective patient chart review was performed for 141 patients treated with first line RT plus cetuximab or RT alone, diagnosed in 2007-2010 in two head and neck treatment centers. Combined with aggregated population-based data from the Netherlands Cancer Registry and patient level clinical trial data, use of cetuximab in Dutch daily practice was assessed through comparison of patient characteristics, treatment characteristics and treatment outcomes between trial and daily practice. 61 daily practice patients fulfilled the selection criteria. In line with Dutch guidelines, RT plus cetuximab is prescribed in patients requiring combined therapy unfit to receive traditional platinum-based chemotherapeutics. These patients have unfavorable baseline characteristics, due to selection on--amongst others--high age of the patients. Beyond 1 year after treatment start, patients treated with RT plus cetuximab in daily practice died earlier than patients treated with RT plus cetuximab in the trial. Selective treatment allocation in daily practice limits generalizability of EMR 062202-006 trial results. Evidence is needed about the effectiveness of RT plus cetuximab compared to other treatments for patients with unfavorable clinical baseline characteristics.
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Affiliation(s)
- Naomi van der Linden
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Woudestein, J5-51, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands,
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van der Linden C, Lindeboom R, van der Linden N, Lucas C. Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners. Int Emerg Nurs 2012; 20:52-7. [DOI: 10.1016/j.ienj.2011.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/27/2011] [Accepted: 06/04/2011] [Indexed: 11/28/2022]
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van der Linden C, Lucas C, van der Linden N, Lindeboom R. Evaluation of a flexible acute admission unit: effects on transfers to other hospitals and patient throughput times. J Emerg Nurs 2012; 39:340-5. [PMID: 22244548 DOI: 10.1016/j.jen.2011.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 09/05/2011] [Accepted: 09/07/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION To prevent overcrowding of the emergency department, a flexible acute admission unit (FAAU) was created, consisting of 15 inpatient regular beds located in different departments. We expected the FAAU to result in fewer transfers to other hospitals and in a lower length of stay (LOS) of patients needing hospital admission. METHODS A before-and-after interventional study was performed in a level 1 trauma center in the Netherlands. Number of transfers and LOS of admitted ED patients in a 4-month period in 2008 (control period) and a 4-month period in 2009 (intervention period) were analyzed. RESULTS Of 1,619 regular admission patients, 768 were admitted in the control period and 851 in the intervention period. The number of transfers decreased from 80 (10.42%) to 54 (6.35%) (P = .0037). The mean ED LOS of both the non-admitted patients and the admitted patients needing special care significantly increased (105 minutes vs 117 minutes [P = .022] and 176 minutes vs 191 minutes [P < .001], respectively). However, the mean LOS of FAAU-admissible patients was unaltered (226 minutes vs 225 minutes, P = .865). CONCLUSIONS The FAAU reduced the number of transfers of admitted patients to other hospitals. The increase in LOS for special care patients and non-admitted patients was not observed for regular, FAAU-admissible patients. Flexible bed management might be useful in preventing overcrowding.
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Abstract
This article reports on the implementation of an adapted version of the Manchester triage system (Mackway-Jones et al 1997) in a Dutch hospital to allow trained nurse practitioners to treat patients with minor injuries or illnesses, and to assess, treat and discharge patients autonomously. The project has helped to prevent long waits in emergency departments for patients with less urgent conditions.
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Abstract
The Haaglanden Medical Centre, the Hague, Netherlands, has opened a 'virtual' acute admission unit (VAAU) to increase throughput of acute patients. The VAAU consists of 15 inpatient beds located on different wards that are set aside for patients from the emergency department (ED) when all of the beds on specialty wards are being used. A qualitative evaluation of the VAAU has revealed that it has reduced emergency nurses' workload and allowed them more time to see and treat patients. This suggests that the introduction of VAAUs may address similar problems of ED throughput in the U.K.
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