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van den Boom NAC, van den Hurk AA, Evers SMAA, Poeze M. Societal burden and quality of life in patients with Lisfranc Injuries. Injury 2023; 54:110913. [PMID: 37536004 DOI: 10.1016/j.injury.2023.110913] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. MATERIALS AND METHODS This study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. RESULTS 214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. CONCLUSION The total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.
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Affiliation(s)
- N A C van den Boom
- Maastricht University Medical Centre, Dept. of Trauma Surgery, P. Debyelaan 25, 6229, HX Maastricht, The Netherlands; Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - A A van den Hurk
- Maastricht University, Faculty of Health, Medicine, and Life Sciences (FHML), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - S M A A Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine, and Life Sciences (FHML), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health, and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
| | - M Poeze
- Maastricht University Medical Centre, Dept. of Trauma Surgery, P. Debyelaan 25, 6229, HX Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
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Janssen LMM, Pokhilenko I, Drost RMWA, Paulus ATG, Thorn J, Hollingworth W, Noble S, Berger M, Simon J, Evers SMAA. Methods for think-aloud interviews in health-related resource-use research: the PECUNIA RUM instrument. Expert Rev Pharmacoecon Outcomes Res 2023; 23:383-389. [PMID: 36880336 DOI: 10.1080/14737167.2023.2187379] [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] [Indexed: 03/08/2023]
Abstract
BACKGROUND The think-aloud (TA) approach is a qualitative research method that allows for gaining insight into thoughts and cognitive processes. It can be used to incorporate a respondent's perspective when developing resource-use measurement (RUM) instruments. Currently, the application of TA methods in RUM research is limited, and so is the guidance on how to use them. Transparent publication of TA methods for RUM in health economics studies, which is the aim of this paper, can contribute to reducing the aforementioned gap. METHODS Methods for conducting TA interviews were iteratively developed by a multi-national working group of health economists and additional qualitative research expertise was sought. TA interviews were conducted in four countries to support this process. A ten-step process was outlined in three parts: Part A 'before the interview' (including translation, recruitment, training), Part B 'during the interview' (including setting, opening, completing the instrument, open-ended questions, closing), and part C 'after the interview' (including transcription and data analysis, trustworthiness). CONCLUSIONS This manuscript describes the step-by-step approach for conducting multi-national TA interviews with potential respondents of the PECUNIA RUM instrument. It increases the methodological transparency in RUM development and reduces the knowledge gap of using qualitative research methods in health economics.
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Affiliation(s)
- L M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - I Pokhilenko
- Institute of Applied Health Research Edgbaston, Centre for Economics of Obesity, University of Birmingham, Birmingham, The United Kingdom
| | - R M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - A T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - J Thorn
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, the United Kingdom
| | - W Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, the United Kingdom
| | - S Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, the United Kingdom
| | - M Berger
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, the United Kingdom
| | - J Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,Trimbos Institute National Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Willems D, Sayed CJ, Van der Zee HH, Ingram JR, Hinzpeter E, Beaudart C, Evers SMAA, Hiligsmann M. A discrete-choice experiment to elicit the treatment preferences of patients with hidradenitis suppurativa in the United States. J Med Econ 2023; 26:503-508. [PMID: 36951399 DOI: 10.1080/13696998.2023.2194804] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- D Willems
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - H H Van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK
| | - E Hinzpeter
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C Beaudart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Trimbos Institute Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Leijdesdorff SMJ, Huijs CEM, Klaassen RMC, Popma A, van Amelsvoort TAMJ, Evers SMAA. Burden of mental health problems: quality of life and cost-of-illness in youth consulting Dutch walk-in youth health centres. J Ment Health 2023; 32:150-157. [PMID: 33086874 DOI: 10.1080/09638237.2020.1836555] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the burden of (sub-threshold) mental health problems in youth. AIM To examine the burden of mental health problems in terms of health-related quality of life (HRQoL) and cost-of-illness, for first visitors of the Dutch youth walk-in centres (@ease). METHOD A bottom-up, prevalence-based burden of disease study from a societal perspective. HRQoL was assessed through the EuroQoL (EQ-5D-5L), and cost-of-illness via items about truancy and health care utilization. RESULTS Participants (N = 80) showed a decreased HRQoL compared to the general population of Dutch youth. In the three months prior to their 1st attendance, participants skipped on average 4.11 days of school and had 1.03 health care visits, leading to total costs of €512.64 per person. Females had significantly higher health care costs and lower HRQoL. Health care use was lower in those not speaking the Dutch language. Living alone was a significant predictor of truancy (costs), and therefore total costs. CONCLUSIONS Mental health problems in youth consulting @ease have a considerable impact on the individual's HRQoL, and an economic impact on society, yet almost 75% is not receiving care. A lack of interventions in this critical period in life may have major lifelong consequences.
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Affiliation(s)
- S M J Leijdesdorff
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MNeNS) Maastricht University, Maastricht, The Netherlands
| | - C E M Huijs
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - R M C Klaassen
- Department of Child and Adolescent Psychiatry, Duivendrecht, The Netherlands
| | - A Popma
- Department of Child and Adolescent Psychiatry, Duivendrecht, The Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - T A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MNeNS) Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Trimbos Institute Centre for Economic Evaluation and Machine Learning, Utrecht, the Netherlands
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Pokhilenko I, Kast T, Janssen LMM, Evers SMAA, Paulus ATG, Simon J, Mayer S, Berger M, Konnopka A, Muntendorf L, Brodszky V, García-Pérez L, Park A, Salvador-Carulla L, Drost RMWA. International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project). Expert Rev Pharmacoecon Outcomes Res 2023; 23:135-141. [PMID: 36472303 DOI: 10.1080/14737167.2023.2152331] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. METHODS The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. RESULTS The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. DISCUSSION The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.
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Affiliation(s)
- I Pokhilenko
- Centre for Economics of Obesity, Health Economics Unit, Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, Birmingham, The United Kingdom
| | - T Kast
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - L M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,Centre of Economic Evaluation & Machine Learning, Trimbos Institute, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - A T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - J Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Mayer
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - M Berger
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Muntendorf
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - L García-Pérez
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Spain
| | - A Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - L Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, Australia
| | - R M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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van den Boom NAC, Douwes I, Poeze M, Evers SMAA. Patient experiences and preferences during treatment and recovery of Lisfranc fractures: A qualitative interview study. Injury 2022; 53:4152-4158. [PMID: 36273922 DOI: 10.1016/j.injury.2022.10.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/25/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
AIM To determine from a patient perspective what improves the quality of care and patient satisfaction during the treatment and recovery process of Lisfranc fractures and to reveal possible points for improvement in this process. METHODS We performed a qualitative study based on semi-structured interviews with patients treated for a Lisfranc fracture-dislocation in the Netherlands with either open reduction and internal fixation or primary arthrodesis, until data saturation was reached, focusing on the quality of care during treatment and recovery, from a patient perspective. RESULTS Data saturation was reached after interviewing 10 patients. The main themes emerging from the analysis were expectation management regarding the recovery period; communication with and between health care providers; information provided during consultations; and support during the recovery period. Participants expressed a need for improved provision of information about the different treatment options, the different kinds of pain that can arise, the expected duration of the recovery period, education on strong pain killers, likelihood of a second surgery, risks of osteoarthritis, risks of the surgery itself, allied health care and patient experiences. Participants mentioned the importance of good allied health care and a preference for starting allied health care as soon as possible. Insoles and compression socks were also appreciated by various participants. Finally, multiple patients saw a positive attitude on the part of the health care providers towards the recovery period as a key factor in recovery. CONCLUSION This study found that patients value more tailored approaches to the pre-and post-operative care program, more guidance regarding allied health care (physiotherapy), and a broader scope of available references and information for patients, both oral (during consultations and in informative videos) and written, such as brochures or evidence-based web pages and mobile platforms, which may be offered during consultations or when being discharged from the hospital.
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Affiliation(s)
- N A C van den Boom
- Maastricht University Medical Centre, Dept. of Trauma Surgery. P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Maastricht University, Care and Public Health Research Institute (CAPHRI). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University. Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - I Douwes
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - M Poeze
- Maastricht University Medical Centre, Dept. of Trauma Surgery. P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University. Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - S M A A Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands; Maastricht University, Dept of Health Services Research. Duboisdomein 30, 6229 GT Maastricht, The Netherlands
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Hoving M, Jongen PJ, Evers SMAA, Edens MA, Zeinstra EMPE. MSmonitor-plus program and video calling care (MPVC) for multidisciplinary care and self-management in multiple sclerosis: study protocol of a single-center randomized, parallel-group, open label, non-inferiority trial. BMC Neurol 2022; 22:423. [DOI: 10.1186/s12883-022-02948-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
We designed a new multi-modal version of the MSmonitor, called the MSmonitor-Plus and Video calling Care (MPVC), a self-management and education program with e-health interventions that combines frequent use of specific questionnaires with video calling in treating multiple sclerosis (MS) patients.
Objective
To assess the effectiveness, cost-effectiveness and feasibility of MPVC compared to care as usual (CAU), with the goal of achieving equal or better quality of life for MS patients and their partners/informal caregivers.
Our hypothesis is that by using MPVC, monitoring will become more efficient, that patients’ self-efficacy, quality of life, and adherence to treatment will improve, and that they will be able to live their lives more autonomously.
Methods
A randomized, parallel-group, open label, non-inferiority trial will be conducted to compare MPVC with CAU in MS patients and their partners/informal caregivers. A total of 208 patients will be included with follow-up measurements for 2 years (at baseline and every 3 months). One hundred four patients will be randomized to MPVC and 104 patients to CAU. Partners/informal caregivers of both groups will be asked to participate.
The study will consist of three parts: 1) a clinical effectiveness study, 2) an economic evaluation, and 3) a process evaluation. The primary outcome relates to equal or improved disease-specific physical and mental quality of life of the MS patients. Secondary outcomes relate to self-efficacy, efficiency, cost-effectiveness, autonomy, satisfaction with the care provided, and quality of life of partners/informal caregivers.
Discussion
The idea behind using MPVC is that MS patients will gain more insight into the individual course of the disease and get a better grip on their symptoms. This knowledge should increase their autonomy, give patients more control of their condition and enable them to better and proactively interact with health care professionals.
As the consulting process becomes more efficient with the use of MPVC, MS-related problems could be detected earlier, enabling earlier multidisciplinary care, treatment or modification of the treatment. This could have a positive effect on the quality of life for both the MS patient and his/her partner/informal caregiver, reducing health and social costs.
Trial registration
NCT05242731 Clinical Trials.gov. Date of registration: 16 February 2022 retrospectively registered.
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Schuermans VNE, Smeets AYJM, Boselie AFM, Zarrouk O, Hermans SMM, Droeghaag R, Curfs I, Evers SMAA, van Santbrink H. Cost-effectiveness of anterior surgical decompression surgery for cervical degenerative disk disease: a systematic review of economic evaluations. Eur Spine J 2022; 31:1206-1218. [PMID: 35224672 DOI: 10.1007/s00586-022-07137-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/06/2021] [Accepted: 01/26/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE No clear consensus exists on which anterior surgical technique is most cost-effective for treating cervical degenerative disk disease (CDDD). One of the most common treatment options is anterior cervical discectomy with fusion (ACDF). Anterior cervical discectomy with arthroplasty (ACDA) was developed in an effort to reduce the incidence of clinical adjacent segment pathology and associated additional surgeries by preserving motion. This systematic review aims to evaluate the evidence regarding the cost-effectiveness of anterior surgical decompression techniques used to treat radiculopathy and/or myelopathy caused by CDDD. METHODS The search was conducted in PubMed, EMBASE, Web of Science, CINAHL, EconLit, NHS-EED and the Cochrane Library. Studies were included if healthcare costs and utility or effectivity measurements were mentioned. RESULTS A total of 23 studies were included out of the 1327 identified studies. In 9 of the 13 studies directly comparing ACDA and ACDF, ACDA was the most cost-effective technique, with an incremental cost effectiveness ratio ranging from $2.900/QALY to $98.475/QALY. There was great heterogeneity between the costs of due to different in- and exclusion criteria of costs and charges, cost perspective, baseline characteristics, and calculation methods. The methodological quality of the included studies was moderate. CONCLUSION The majority of studies report ACDA to be a more cost-effective technique in comparison with ACDF. The lack of uniform literature impedes any solid conclusions to be drawn. There is a need for high-quality cost-effectiveness research and uniformity in the conduct, design and reporting of economic evaluations concerning the treatment of CDDD. TRIAL REGISTRATION PROSPERO Registration: CRD42020207553 (04.10.2020).
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Affiliation(s)
- V N E Schuermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - A Y J M Smeets
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - A F M Boselie
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - O Zarrouk
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - S M M Hermans
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - R Droeghaag
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - I Curfs
- Department of Orthopedic Surgery and Traumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - S M A A Evers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research, Focusing on Value-Based Care and Ageing and Department of Family Medicine, Maastricht University, Maastricht, The Netherlands.,Center of Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - H van Santbrink
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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9
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van den Boom NAC, Stollenwerck GANL, Evers SMAA, Poeze M. Effectiveness and cost-effectiveness of primary arthrodesis versus open reduction and internal fixation in patients with Lisfranc fracture instability (The BFF Study) study protocol for a multicenter randomized controlled trial. BMC Surg 2021; 21:323. [PMID: 34384419 PMCID: PMC8359057 DOI: 10.1186/s12893-021-01320-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background The Lisfranc injury is a complex injury of the midfoot. It can result in persistent pain and functional impairment if treated inappropriately. In Lisfranc fracture dislocation, treatment options are primary arthrodesis of the midfoot joints or open reduction and internal fixation. The purpose of the proposed study is to define the optimal treatment for the Lisfranc fracture dislocation, either primary arthrodesis or open reduction and internal fixation, in regard to quality of life, complications, functional outcomes, and cost effectiveness. Methods Study design: A prospective multicenter RCT. Study population: All patients of 18 years and older with an acute (< 6 weeks) traumatic fracture dislocation in the Lisfranc midfoot joints, displaced on static radiographic evaluation or unstable with dynamic evaluation, weight bearing radiographs or fluoroscopic stress testing under anesthesia, and eligible for either one of the surgical procedures. In total, this study will include n = 112 patients with Lisfranc fracture dislocation. Interventions: Patients with Lisfranc fracture dislocation will be randomly allocated to treatment in “The Better to Fix or Fuse Study” (The BFF Study) with either PA or ORIF. Main study parameters/endpoints: Primary outcome parameter: the quality of life. Secondary outcomes: complications, functional outcomes, secondary surgical interventions and cost effectiveness. Nature and extent of the burden: PA is expected to have a better outcome, however both treatments are accepted for this injury with a similar low risk of complications. Follow up is standardized and therefore this study will not add extra burden to the patient. Discussion This study protocol provides a comprehensive overview of the aims and methods of the attached clinical study. Limitations of this study are the absence of patient blinding since it is impossible in surgical intervention, and the outcome measure (AOFAS) that has limited validity not for these injuries. This study will be the first with enough power to define optimal treatment for Lisfranc fracture dislocations. This is necessary since current literature is unclear on this topic. Trial registration Current controlled Trial: NCT04519242 with registration date: 08/13/2020. Retrospectively registered; Protocol date and version: Version 4 05/06/2020 Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01320-1.
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Affiliation(s)
- N A C van den Boom
- Dept. of Trauma Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. .,Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - G A N L Stollenwerck
- Dept. of Surgery-Trauma Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
| | - S M A A Evers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
| | - M Poeze
- Dept. of Trauma Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
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10
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Kremer IEH, Jongen PJ, Evers SMAA, Hoogervorst ELJ, Verhagen WIM, Hiligsmann M. Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development. BMC Med Inform Decis Mak 2021; 21:123. [PMID: 33836742 PMCID: PMC8033667 DOI: 10.1186/s12911-021-01479-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 01/20/2023] Open
Abstract
Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01479-w.
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Affiliation(s)
- I E H Kremer
- Department of Health Services Research, School CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - P J Jongen
- MS4 Research Institute, Nijmegen, The Netherlands.,Department of Community and Occupational Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, School CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - E L J Hoogervorst
- Department of Neurology, St. Antonius Hospital, Utrecht, The Netherlands
| | - W I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, School CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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11
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Slenders JPL, Van den Berg-Vos RM, van Heugten CM, Visser-Meily JMA, Evers SMAA, de Haan RJ, de Man-van Ginkel JM, Kwa VIH. Screening and patient-tailored care for emotional and cognitive problems compared to care as usual in patients discharged home after ischemic stroke (ECO-stroke): a protocol for a multicenter, patient-blinded, cluster randomized controlled trial. BMC Health Serv Res 2020; 20:1049. [PMID: 33203405 PMCID: PMC7670662 DOI: 10.1186/s12913-020-05902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background Ischemic stroke patients with a good outcome in terms of motor functioning and communication are likely to be discharged home without further rehabilitation. A significant number of these patients experience cognitive and emotional problems resulting in lower quality of life and decreased participation in society. This paper presents the protocol of a study examining the clinical effectiveness, cost-effectiveness and implementation of an intervention focused on screening and patient-tailored care for cognitive and emotional problems as compared to usual care in patients discharged home after ischemic stroke. Methods / design A multicenter, patient-blinded, cluster randomized controlled trial will be performed. Centers will be randomized (1:1) to the intervention group or the usual care group. Patients (> 18 years old) with a neurological confirmed diagnosis of ischemic stroke who can be discharged home without follow-up treatment at an outpatient rehabilitation clinic will be included. In the intervention group, patients will receive a short, individualized, semi-structured consultation by specialized nurses in addition to usual care. This consultation includes 1) screening for cognitive and emotional problems, 2) screening for restrictions in participation, 3) promotion of self-management strategies and 4) a decision tool for referral to rehabilitation services. The intervention will be performed approximately 6 weeks after the stroke at the neurology outpatient clinics and will take approximately 60 min. The control group will receive care as usual. Both groups will be followed-up at 6 weeks, 3 months and 12 months after stroke. The primary outcome will be the level of participation measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation on the level of Participation (USER-Participation-R) at 12 months. A cost-effectiveness analysis and process evaluation will be performed alongside. Discussion This trial is the first to evaluate clinical effectiveness, cost-effectiveness and implementation of screening and patient-tailored care for cognitive and emotional problems compared to care as usual in patients discharged home after ischemic stroke. Potentially, this will improve the outcomes for patients with frequently occurring cognitive and emotional problems after stroke. Trial registration Netherlands Trial Register: NL7295, registered 25 September 2018
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Affiliation(s)
- J P L Slenders
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands. .,Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - R M Van den Berg-Vos
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - C M van Heugten
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, the Netherlands.,School for Mental Health & Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - S M A A Evers
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI) of the Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - R J de Haan
- Clinical Research Unit, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Science and Primary Care & UMC Utrecht Brain Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - V I H Kwa
- Department of Neurology, OLVG, Amsterdam, the Netherlands
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12
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Janssen LMM, Hiligsmann M, Elissen AMJ, Joore MA, Schaper NC, Bosma JHA, Stehouwer CDA, Sep SJS, Koster A, Schram MT, Evers SMAA. Burden of disease of type 2 diabetes mellitus: cost of illness and quality of life estimated using the Maastricht Study. Diabet Med 2020; 37:1759-1765. [PMID: 32112462 PMCID: PMC7539911 DOI: 10.1111/dme.14285] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the societal costs and quality of life of people with type 2 diabetes and to compare these results with those of people with normal glucose tolerance or prediabetes. METHODS Data from 2915 individuals from the population-based Maastricht Study were included. Costs were assessed through a resource-use questionnaire completed by the participants; cost prices were based on Dutch costing guidelines. Quality of life was expressed in utilities using the Dutch EuroQol 5D-3L questionnaire and the SF-36 health survey. Based on normal fasting glucose and 2-h plasma glucose values, participants were classified into three groups: normal glucose tolerance (n = 1701); prediabetes (n = 446); or type 2 diabetes (n = 768). RESULTS Participants with type 2 diabetes had on average 2.2 times higher societal costs than those with normal glucose tolerance (€3,006 and €1,377 per 6 months, respectively) and had lower utilities (0.77 and 0.81, respectively). No significant differences were found between participants with normal glucose tolerance and those with prediabetes. Subgroup analyses showed that higher age, being female and having two or more diabetes-related complications resulted in higher costs (P < 0.05) and lower utilities. CONCLUSIONS This study showed that people with type 2 diabetes have substantially higher societal costs and lower quality of life than people with normal glucose tolerance. The results provide important input for future model-based economic evaluations and for policy decision-making.
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Grants
- NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, The Netherlands)
- Sanofi-Aventis Netherlands B.V. (Gouda, The Netherlands)
- Stichting Annadal (Maastricht, The Netherlands)
- (grant 31O.041) European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs
- CAPHRI Care and Public Health Research Institute (Maastricht, The Netherlands)
- the Pearl String Initiative Diabetes (Amsterdam, The Netherlands)
- Novo Nordisk Farma B.V. (Alphen aan den Rijn, The Netherlands)
- CARIM School for Cardiovascular Diseases (Maastricht, The Netherlands)
- Health Foundation Limburg (Maastricht, The Netherlands)
- Stichting De Weijerhorst (Maastricht, The Netherlands)
- the Cardiovascular Center (CVC, Maastricht, the Netherlands)
- Janssen-Cilag B.V. (Tilburg, The Netherlands)
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Affiliation(s)
- L. M. M. Janssen
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. Hiligsmann
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - A. M. J. Elissen
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - N. C. Schaper
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - J. H. A. Bosma
- Department of Social MedicineMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - C. D. A. Stehouwer
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - S. J. S. Sep
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
- Adelante Centre of Expertise in Rehabilitation and AudiologyHoensbroekThe Netherlands
| | - A. Koster
- Department of Social MedicineMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. T. Schram
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
| | - S. M. A. A. Evers
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Trimbos Institute Centre for Mental Health and Economic EvaluationUtrechtThe Netherlands
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13
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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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14
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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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15
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Pattamatta M, Smeets BJJ, Evers SMAA, Peters EG, Luyer MDP, Hiligsmann M. Quality of life and costs of patients prior to colorectal surgery. Expert Rev Pharmacoecon Outcomes Res 2019; 20:193-198. [PMID: 31190575 DOI: 10.1080/14737167.2019.1628641] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To assess the quality of life and societal costs of patients prior to colorectal surgery in the Netherlands.Methods: This study is embedded in a previous randomized controlled trial (SANICS II). The quality of life was measured using EQ-5D-5L questionnaires. The iMTA medical consumption questionnaire (iMCQ) and the iMTA productivity costs questionnaire (iPCQ) were used to identify and measure healthcare and productivity costs. Subgroup analyses were performed based on age and gender.Results: A total of 178 patients were included in the cost analysis and a total of 161 patients in the quality of life analysis. The three-month mean societal cost per patient amounted to €3,211 of which €1,459 was due to productivity losses. The mean utility was 0.88 per patient. Gender was an important predictor in quality of life with men scoring significantly higher than women (0.92 versus 0.82) at p < 0.0001.Conclusion: Colorectal cancer represents a high economic burden in the Netherlands. Further research with repeated cost and quality of life measurements would be needed to explore the change over time and the effects of surgery.
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Affiliation(s)
- M Pattamatta
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - B J J Smeets
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,GROW school of oncology and developmental biology, Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Center for Economic Evaluations, Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - E G Peters
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,Tytgat Institute of Liver and Intestinal Research, University of Amsterdam, Amsterdam, The Netherlands
| | - M D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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16
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Hanssen I, Huijbers MJ, Lochmann-van Bennekom MWH, Regeer EJ, Stevens AWMM, Evers SMAA, Wensing M, Kupka RW, Speckens AEM. Study protocol of a multicenter randomized controlled trial of mindfulness-based cognitive therapy and treatment as usual in bipolar disorder. BMC Psychiatry 2019; 19:130. [PMID: 31039765 PMCID: PMC6492313 DOI: 10.1186/s12888-019-2115-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite multiple pharmacological interventions, many people with bipolar disorder (BD) experience substantial residual mood symptoms, even in the absence of severe mood episodes, which have a negative impact on the course of illness and quality of life. Limited data are available on how to optimize treatment for BD, especially for those who suffer from persistent and residual depressive symptoms. Preliminary evidence suggests Mindfulness-Based Cognitive Therapy (MBCT) as a psychological treatment option for BD. This study aims to investigate whether adding MBCT to treatment as usual (TAU) will result in symptomatic and functional improvements in adults with BD compared to TAU alone. METHODS/DESIGN This study is a prospective, evaluator blinded, multicenter, randomized controlled trial of MBCT + TAU and TAU alone in 160 adults with bipolar type I and type II. Assessments will be conducted at baseline (T0), mid-treatment (Tmid), and at 3 (T1), 6 (T2), 9 (T3), 12 (T4), and 15 (T5) months follow-up. Primary outcome is post-treatment severity of depressive symptoms (Inventory of Depressive Symptomatology- Clinician administered). Secondary outcomes are severity of (hypo) manic symptoms, anxiety, relapse rates, overall functioning, positive mental health, and cost-effectiveness. As possible mediators will be assessed rumination of negative affect, dampening and rumination of positive affect, mindfulness skills, and self-compassion. DISCUSSION This study will provide valuable insight into the (cost-)effectiveness of MBCT on clinician- and self-rated symptoms of BD, relapse rates, positive mental health, and overall functioning. TRIAL REGISTRATION NCT03507647 . Registered 25th of April 2018.
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Affiliation(s)
- I. Hanssen
- 0000 0004 0444 9382grid.10417.33Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands ,0000000122931605grid.5590.9Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - M. J. Huijbers
- 0000 0004 0444 9382grid.10417.33Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - M. W. H. Lochmann-van Bennekom
- 0000 0004 0466 1666grid.491369.0Department of Mood Disorders, Pro Persona, Mental Health Care, Tarweweg 2, 6534 AM Nijmegen, The Netherlands
| | - E. J. Regeer
- grid.413664.2Altrecht, Institute for Mental Health Care, Outpatient clinic for Bipolar Disorders, Nieuwe Houtenseweg 12, 3524 SH Utrecht, the Netherlands
| | - A. W. M. M. Stevens
- Dimence Mental Health, Center for Bipolar Disorders, Pikeursbaan 3, 7411 GT Deventer, The Netherlands
| | | | - M. Wensing
- 0000 0004 0444 9382grid.10417.33Radboud University Medical Centre, Institute for Quality in Health Care, Postbus 9101, 6500 HB Nijmegen, the Netherlands
| | - R. W. Kupka
- grid.413664.2Altrecht, Institute for Mental Health Care, Outpatient clinic for Bipolar Disorders, Nieuwe Houtenseweg 12, 3524 SH Utrecht, the Netherlands ,Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands
| | - A. E. M. Speckens
- 0000 0004 0444 9382grid.10417.33Department of Psychiatry, Centre for Mindfulness, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands ,0000000122931605grid.5590.9Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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17
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Majoie HJM, van Gaalen J, Verstegen DML, van Mastrigt GAPG, Kleijnen J, Alonso-Coello P, Gartlehner G, Ritchie K, Service D, Leone M, Evers SMAA. Cost-conscious high-quality care and guideline development education: a strange contradiction or simple solution? Eur J Neurol 2019; 26:e48-e49. [PMID: 30829458 DOI: 10.1111/ene.13855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- H J M Majoie
- Academic Center of Epileptology Kempenhaeghe Maastricht UMC+, Kempenhaeghe, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), University of Maastricht, Maastricht, The Netherlands
| | - J van Gaalen
- Department of Neurology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.,Dutch Association for Neurology Residents (VAAN), Nijmegen, The Netherlands
| | - D M L Verstegen
- Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), University of Maastricht, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands
| | - J Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK
| | - P Alonso-Coello
- Department Centro Cochrane Iberoamericano - Servicio de Epidemiología, Clínica y Salud Pública Instituto de Investigación Biomédica (IIB Sant Pau-CIBERESP), Sant Pau, Spain
| | | | - K Ritchie
- Healthcare Improvement Scotland, Edinburgh, UK
| | - D Service
- Healthcare Improvement Scotland, Edinburgh, UK
| | - M Leone
- Guideline Production Group of European Academy of Neurology (EAN): Fondazione IRCCS Casa Sollievo della Sofferenza, UO Neurologia, San Giovanni Rotondo, Italy
| | - S M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), University of Maastricht, Maastricht, The Netherlands
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Mijnarends DM, Luiking YC, Halfens RJG, Evers SMAA, Lenaerts ELA, Verlaan S, Wallace M, Schols JMGA, Meijers JMM. Muscle, Health and Costs: A Glance at their Relationship. J Nutr Health Aging 2018; 22:766-773. [PMID: 30080217 PMCID: PMC6061527 DOI: 10.1007/s12603-018-1058-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [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: 08/30/2017] [Accepted: 11/15/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs. DESIGN Cross-sectional Maastricht Sarcopenia Study (MaSS). SETTING Community-dwelling, assisted-living, residential living facility. PARTICIPANTS 227 adults aged 65 and older. MEASUREMENTS Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months. RESULTS Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs). CONCLUSION Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.
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Affiliation(s)
- D M Mijnarends
- Jos Schols, School CAPHRI, Department of Family Medicine, Maastricht University, P.O Box 616, 6200 MD, Maastricht, the Netherlands,
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19
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Rizk R, Karavetian M, Hiligsmann M, Evers SMAA. Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial. J Hum Nutr Diet 2017; 30:554-562. [DOI: 10.1111/jhn.12472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Rizk
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - M. Karavetian
- Department of Natural Sciences in Public Health; College of Natural and Health Sciences; Zayed University; Dubai United Arab Emirates
| | - M. Hiligsmann
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - S. M. A. A. Evers
- Department of Health Services Research; CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
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20
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van Eeden M, van Mastrigt GAPG, Evers SMAA, van Raak EPM, Driessen GAM, van Heugten CM. The economic impact of mental healthcare consumption before and after stroke in a cohort of stroke patients in the Netherlands: a record linkage study. BMC Health Serv Res 2016; 16:688. [PMID: 27964721 PMCID: PMC5155378 DOI: 10.1186/s12913-016-1915-3] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022] Open
Abstract
Background Post-stroke healthcare consumption is strongly associated with a mental health diagnosis. This study aimed to identify stroke patients who utilised mental healthcare facilities, explored their mental healthcare consumption pre-stroke and post-stroke, and examined possible predictors of costs incurred by mental healthcare consumption post-stroke. Methods Three databases were integrated, namely the Maastricht University Medical Centre (MUMC) Medical Administration, the Stroke Registry from the Department of Neurology at MUMC, and the Psychiatric Case Registry South-Limburg. Patients from the MUMC who suffered their first-ever stroke between January 1 2000 and December 31 2004 were included and their records were analysed for mental healthcare consumption from 5 years preceding to 5 years following their stroke (1995–2009). Regression analysis was conducted to identify possible predictors of mental healthcare consumption costs. Results A total of 1385 patients were included and 357 (25.8%) received services from a mental healthcare facility during the 10-year reference period around their stroke. The costs of mental healthcare usage increased over time and peaked 1 year post-stroke (€7057; 22% of total mental healthcare costs). The number of hospitalisation days and mental healthcare consumption pre-stroke were significant predictors of mental healthcare costs. Explained variances of these models (costs during the 5 years post-stroke: R2 = 15.5%, costs across a 10 year reference period: R2 = 4.6%,) were low. Conclusion Stroke patients have a significant level of mental healthcare comorbidity leading to relatively high mental healthcare costs. There is a relationship between stroke and mental healthcare consumption costs, but results concerning the underlying factors responsible for these costs are inconclusive.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - E P M van Raak
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G A M Driessen
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
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Thielen FW, Van Mastrigt GAPG, Burgers LT, Bramer WM, Majoie HJM, Evers SMAA, Kleijnen J. How to prepare a systematic review of economic evaluations for clinical practice guidelines: database selection and search strategy development (part 2/3). Expert Rev Pharmacoecon Outcomes Res 2016; 16:705-721. [DOI: 10.1080/14737167.2016.1246962] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- FW Thielen
- Institute for Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - GAPG Van Mastrigt
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - LT Burgers
- Institute for Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - WM Bramer
- Medical Library, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | - HJM Majoie
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
- Department of Neurology, Academic Centre for Epileptology, Epilepsy Centre Kempenhaeghe and Maastricht University Medical Centre, Heeze and Maastricht, The Netherlands
- School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - SMAA Evers
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Research and Development, Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands
- Public Mental Health, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - J Kleijnen
- CAPHRI, School for Public Health and Primary Care, Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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22
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van den Brand FA, Nagelhout GE, Winkens B, Evers SMAA, Kotz D, Chavannes NH, van Schayck CP. The effect of financial incentives on top of behavioral support on quit rates in tobacco smoking employees: study protocol of a cluster-randomized trial. BMC Public Health 2016; 16:1056. [PMID: 27716132 PMCID: PMC5053183 DOI: 10.1186/s12889-016-3729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stimulating successful tobacco cessation among employees has multiple benefits. Employees who quit tobacco are healthier, more productive, less absent from work, and longer employable than employees who continue to use tobacco. Despite the evidence for these benefits of tobacco cessation, a successful method to stimulate employees to quit tobacco is lacking. The aim of this study is to evaluate whether adding a financial incentive to behavioral support (compared with no additional incentive) is effective and cost-effective in increasing abstinence rates in tobacco smoking employees participating in a smoking cessation group training. METHODS/DESIGN In this cluster-randomized trial employees in the intervention and control group both participate in a smoking cessation group training consisting of seven weekly counseling sessions of ninety minutes each. In addition to the training, employees in the intervention group receive a voucher as an incentive for being abstinent from smoking at the end of the training (€50), after three months (€50), after six months (€50), and after one year (€200). The control group does not receive any incentive. The primary outcome is carbon monoxide validated 12-month continuous abstinence from smoking (Russel's standard). Additionally, an economic evaluation is performed from a societal and an employer perspective. DISCUSSION The present paper describes the methods and design of this cluster-randomized trial in detail. We hypothesize that the financial incentive for abstinence in the form of vouchers increases abstinence rates over and above the group training. The results of this study can provide important recommendations for enhancement of employee tobacco cessation. TRIAL REGISTRATION Dutch Trial Register: NTR5657 . First received 27-01-2016.
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Affiliation(s)
- F. A. van den Brand
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - G. E. Nagelhout
- Department of Health Promotion/Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - B. Winkens
- Department of Methodology and Statistics, Maastricht University, P. Debyeplein 1, 6229 HA Maastricht, Netherlands
| | - S. M. A. A. Evers
- Department of Health Services Research, Maastricht University (CAPHRI), Duboisdomein 30, 6229 GT Maastricht, Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluations, Utrecht, Netherlands
| | - D. Kotz
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
- Department of Institute of General Practice, Heinrich-Heine University, P.O. Box 101007, 40001 Düsseldorf, Germany
| | - N. H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333 ZD Leiden, Netherlands
| | - C. P. van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), P. Debyeplein 1, 6229 HA Maastricht, Netherlands
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Paulus ATG, Drost RMWA, Ruwaard D, Evers SMAA. [Inter-sectoral costs and benefits arising from mental health (disorders)]. Tijdschr Psychiatr 2016; 58:688-694. [PMID: 27779284] [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: 06/06/2023]
Abstract
Mental health disorders may bring costs and benefits to areas and sectors lying outside the health care system. However, little is known about these inter-sectoral costs and benefits (ICBs) in spite of the increasing interest in societal cost-benefit analyses (SCBA) that attempt to quantify all costs and benefits involved.<br/> AIM: To present a first inventory of ICBs relating to mental health care and to describe the relation between ICBs and SCBA.<br/> METHOD: We reviewed the literature and conducted a secondary analysis of the results of a previous study.<br/> RESULTS: We found that at least eight mental health disorders were reported to have a (financial) impact on at least three sectors outside the health care system. <br/> CONCLUSION: Further research into ICBs is needed so that future inter-sectoral policy can be better directed and targeted more efficiently.
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van Eeden M, Kootker JA, Evers SMAA, van Heugten CM, Geurts ACH, van Mastrigt GAPG. An economic evaluation of an augmented cognitive behavioural intervention vs. computerized cognitive training for post-stroke depressive symptoms. BMC Neurol 2015; 15:266. [PMID: 26715040 PMCID: PMC4696099 DOI: 10.1186/s12883-015-0522-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022] Open
Abstract
Background Stroke survivors encounter emotional problems in the chronic phase after stroke. Post-stroke depressive symptoms have major impact on health-related quality of life (HRQol) and lead to increased hospitalization and therefore substantial healthcare costs. We present a cost-effectiveness and cost-utility evaluation of a cognitive behavioural therapy augmented with occupational and movement therapy to support patients with a stroke with depressive symptoms in goal-setting and goal attainment (augmented CBT) in comparison with a computerized cognitive training program (CogniPlus) as a control intervention. Methods A trial-based economic evaluation was conducted from a societal perspective with a time horizon of 12 months. Stroke patients (aged 18+ years) with signs of depression (Hospital Anxiety and Depression Scale (HADS) – subscale depression > 7) were eligible to participate. Primary outcomes were the HADS and Quality Adjusted Life Years (QALYs) based on the three-level five-dimensional EuroQol (EQ-5D-3 L). Missing data were handled through mean imputation (costs) and multiple imputation (HADS and EuroQol), and costs were bootstrapped. Sensitivity analyses were performed to test robustness of baseline assumptions. Results Sixty-one patients were included. The average total societal costs were not significantly different between the control group (€9,998.3) and the augmented CBT group (€8,063.7), with a 95 % confidence interval (−5,284, 1,796). The augmented CBT intervention was less costly and less effective from a societal perspective on the HADS, and less costly and slightly more effective in QALYs, in comparison with the control treatment. The cost-effectiveness and cost-utility analyses provided greater effects and fewer costs for the augmented CBT group, and fewer effects and costs for the HADS. Based on a willingness to pay (WTP) level of €40,000 per QALY, the augmented CBT intervention had a 76 % chance of being cost-effective. Sensitivity analyses showed robustness of results. Conclusion The stroke-specific augmented CBT intervention did not show convincing cost-effectiveness results. In addition to other literature, this study provided new insights into the potential cost-effectiveness of an adjusted cognitive behavioural therapy intervention. However, as our study showed a 76 % chance of being cost-effective for one outcome measure (QALY) and did not provide convincing cost-effectiveness results on the HADS we recommend further research in a larger population.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - J A Kootker
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience; Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A C H Geurts
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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van Eeden M, van Heugten C, van Mastrigt GAPG, van Mierlo M, Visser-Meily JMA, Evers SMAA. The burden of stroke in the Netherlands: estimating quality of life and costs for 1 year poststroke. BMJ Open 2015; 5:e008220. [PMID: 26614618 PMCID: PMC4663410 DOI: 10.1136/bmjopen-2015-008220] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess and explore over 1 year poststroke (1) the societal costs, (2) changes in costs and quality of life (QoL) and (3) the relation between costs and QoL. DESIGN The current study is a burden of disease study focusing on the cost-of-illness (in Euros) and QoL (in utilities) after stroke. SETTING Adult patients with stroke were recruited from stroke units in hospitals and followed for 1 year. PARTICIPANTS Data were collected from 395 patients with stroke. MAIN OUTCOME MEASURES Costs and QoL expressed in utilities. METHODS Cost categories were identified through a bottom-up method. The Dutch 3-level 5-dimensional EuroQol (EQ-5D-3L) was used to calculate utilities. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs and QoL. Robustness of results was tested via sensitivity analyses. RESULTS The total societal costs for 1 year poststroke were €29 484 (n=352) of which 74% were in the first 6 months. QoL remained stable over time. The discharge location was a significant predictor for cost and QoL; men had a significantly higher QoL than women and younger patients (<65) had significantly more costs than older patients (>65). Ceiling effects appear on all dimension of the EQ-5D-3L. Costs and QoL show a weak correlation (r=-0.29). Sensitivity analyses showed robustness of results. CONCLUSIONS We found lower patient costs and higher QoL than expected. This may be explained by the good state of health of our study population and by change in the Dutch healthcare system, which has led to considerable shorter hospitalisation poststroke. Future research must question the use of the EQ-5D-3L in a similar population due to ceiling effects. TRIAL REGISTRATION NUMBER NTR3051.
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Affiliation(s)
- M van Eeden
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Faculty of Health, Medicine & Life Sciences MHeNS, Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - C van Heugten
- Faculty of Health, Medicine & Life Sciences MHeNS, Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
- Faculty of Psychology & Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - M van Mierlo
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - S M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Public Mental Healthcare, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Rondas AALM, Schols JMG, Halfens RJG, Hull HR, Stobberingh EE, Evers SMAA. Cost analysis of one of the first outpatient wound clinics in the Netherlands. J Wound Care 2015; 24:426-36. [PMID: 26349024 DOI: 10.12968/jowc.2015.24.9.426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To perform, from an insurance perspective, a cost analysis of one of the outpatient community wound care clinics in the Netherlands, the Knowledge Centre in Wound Care (KCWC) at Venray. METHOD This study involved a cost analysis based on an observational cohort study with a one-year pre-admission and a one-year post-admission comparison of costs. Patients were included when they first consulted the outpatient wound care clinic. Participants were all insured by the same health insurance company, Coöperatie Volksgezondheidszorg (VGZ). A standard six-step procedure for performing cost studies was used to calculate the costs. Given the skewed cost data, non-parametric bootstrapping was used to test for statistical differences. RESULTS There were 172 patients included in this study. The difference in costs related to wound care between the year before and the year after initial admission to the wound clinic amounted to an average reduction of €2621 (£1873) per patient in the base case analysis. The categories 'general practitioner', 'hospital care', 'mental health care' and 'transport' scored lower, indicating lower costs, in the year after admission to the wound clinic. CONCLUSION In this study, only the reimbursement data of patients of one health insurance company, and specifically only those made under the 2006 Dutch Health Insurance Act, were available. Because of the observational design, definitive conclusions cannot be made regarding a demonstrated reduction of costs in the year post admission. Nevertheless, this study is a first attempt of a cost analysis of an equipped outpatient wound clinic as an innovative way of responding to the increasing number of chronic wounds in the Netherlands. The calculations show that savings in wound care are possible. DECLARATION OF INTEREST A possible conflict of interest should be mentioned. First author AALM Rondas, PhD student at Maastricht University, is working at the KCWC wound clinic at Venray in the Netherlands as a physician. However, the research data were provided externally by Coöperatie Volksgezondheidszorg (VGZ) and checked by the academic co-authors, none of whom have a conflict of interest. The authors have no financial or commercial interest to declare.
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Affiliation(s)
- A A L M Rondas
- De Zorggroep, Knowledge Centre of Wound Care, Venlo, the Netherlands.,Maastricht University, Caphri-School of Public Health and Primary Care, Department of Family Medicine, Maastricht
| | - J M G Schols
- Maastricht University, Caphri-School for Public Health and Primary Care,, the Netherlands
| | - R J G Halfens
- Maastricht University, Caphri-School for Public Health and Primary Care,, the Netherlands
| | - H R Hull
- Health insurance company, Coöperatie Volksgezondheidszorg (VGZ), the Netherlands
| | - E E Stobberingh
- Centre for Infectious Disease Research, Diagnostics and Screening (RIVM), the Netherlands
| | - S M A A Evers
- Maastricht University, Caphri-School for Public Health and Primary Care,, the Netherlands
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Wijnen BFM, de Kinderen RJA, Colon AJ, Dirksen CD, Essers BAB, Hiligsmann M, Leijten FSS, Ossenblok PPW, Evers SMAA. Eliciting patients' preferences for epilepsy diagnostics: a discrete choice experiment. Epilepsy Behav 2014; 31:102-9. [PMID: 24389020 DOI: 10.1016/j.yebeh.2013.11.029] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diagnosing epilepsy is a lengthy and burdensome process for patients and their family. Although the need for a more patient-centered approach in clinical practice is widely acknowledged, empirical evidence regarding patient preferences for diagnostic modalities in epilepsy is missing. The objectives of this study were 1) to identify to what extent important attributes of diagnostic procedures in epilepsy affect preferences for a procedure, 2) to determine the relative importance of these attributes, and 3) to calculate overall utility scores for routine electroencephalography (EEG) and magnetoencephalography (MEG) recordings. METHODS A discrete choice experiment was performed to determine patients' preferences, which involved presentation of pairwise choice tasks regarding hypothetical scenarios. Scenarios varied along six attributes: "way of measuring brain activity", "duration", "freedom of movement", "travel time", "type of additional examination", and "chance of additional examination". Choice tasks were constructed using a statistically efficient design, and the questionnaire contained 15 unique unlabeled choice tasks. Mixed multinomial logistic regression was used to estimate patients' preferences. RESULTS A total of 289 questionnaires were included in the analysis. McFadden's pseudo R(2) showed a model fit of 0.28, and all attributes were statistically significant. Heterogeneity in preferences was present for all attributes. "Freedom of movement" and "Chance of additional examination" were perceived as the most important attributes. Overall utility scores did not substantially differ between routine EEG and MEG. CONCLUSION This study suggests that the identified attributes are important in determining patients' preference for epilepsy diagnostics. It can be concluded that MEG is not necessarily more patient-friendly than a routine EEG in primary diagnostics and, regarding additional diagnostics, patients have a strong preference for long-term 24-h EEG over EEG after sleep deprivation. Furthermore, barring substantial heterogeneity within the parameters in mind, our study suggests that it is important to take individual preferences into account in medical decision-making.
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Affiliation(s)
- B F M Wijnen
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - R J A de Kinderen
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Research & Development, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - A J Colon
- Department of Clinical Neurophysiology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands; Department of Neurology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - C D Dirksen
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - B A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - M Hiligsmann
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - F S S Leijten
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Centre Utrecht, 3584 CG Utrecht, The Netherlands.
| | - P P W Ossenblok
- Department of Neurology, Epilepsy Centre Kempenhaeghe, PO Box 61, 5590 AB Heeze, The Netherlands.
| | - S M A A Evers
- CAPHRI, Research School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Knies S, Boonen A, Candel MJJM, Evers SMAA, Severens JL. Compensation mechanisms for lost productivity: a comparison between four European countries. Value Health 2013; 16:740-4. [PMID: 23947966 DOI: 10.1016/j.jval.2013.03.1624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 05/05/2023]
Abstract
OBJECTIVE Productivity costs are usually estimated by multiplying the wage with the period absent. This can lead to an overestimation if compensation mechanisms occur. Until now only Dutch data are available on the influence of compensation mechanisms on lost productivity, but between-country differences in frequency and type of compensation mechanisms can be expected. The objective of this study was to understand whether compensation mechanisms for days absent from paid work differ in type and frequency across countries and to explore whether this would result in between-country differences in relevant lost productivity. METHODS Data from a cross-sectional survey among respondents with rheumatic disorders from four countries were the basis for this study. Analyses focused on respondents with paid employment who reported absence in the last 3 months. The different compensation mechanisms are described and the resulting lost productivity in terms of days absent was calculated with and without taking compensation mechanisms into account. Logistic regression analyses were performed to examine which variables influence compensation mechanisms leading to relevant lost productivity. RESULTS The results indicate that compensation mechanisms occur and are relevant in all four countries. Between-country differences in the type and frequency of compensation mechanisms and relevant lost productivity were observed. The logistic regression analyses indicate that, correcting for other variables, this is also the case for the use of compensation mechanisms leading to relevant lost productivity. CONCLUSIONS Between-country differences in compensation mechanisms in case of absenteeism exist and could vary to such an extent that foreign relevant lost productivity data should be used with caution.
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Affiliation(s)
- S Knies
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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Wyers CE, Reijven PLM, Evers SMAA, Willems PC, Heyligers IC, Verburg AD, van Helden S, Dagnelie PC. Cost-effectiveness of nutritional intervention in elderly subjects after hip fracture. A randomized controlled trial. Osteoporos Int 2013; 24:151-62. [PMID: 22638708 PMCID: PMC3536976 DOI: 10.1007/s00198-012-2009-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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] [Received: 01/23/2012] [Accepted: 04/19/2012] [Indexed: 12/01/2022]
Abstract
UNLABELLED Hip fracture patients can benefit from nutritional supplementation during their recovery. Up to now, cost-effectiveness evaluation of nutritional intervention in these patients has not been performed. Costs of nutritional intervention are relatively low as compared with medical costs. Cost-effectiveness evaluation shows that nutritional intervention is likely to be cost-effective. INTRODUCTION Previous research on the effect of nutritional intervention on clinical outcome in hip fracture patients yielded contradictory results. Cost-effectiveness of nutritional intervention in these patients remains unknown. The aim of this study was to evaluate cost-effectiveness of nutritional intervention in elderly subjects after hip fracture from a societal perspective. METHODS Open-label, multi-centre randomized controlled trial investigating cost-effectiveness of intensive nutritional intervention comprising regular dietetic counseling and oral nutritional supplementation for 3 months postoperatively. Patients allocated to the control group received care as usual. Costs, weight and quality of life were measured at baseline and at 3 and 6 months postoperatively. Incremental cost-effectiveness ratios (ICERs) were calculated for weight at 3 months and quality adjusted life years (QALYs) at 6 months postoperatively. RESULTS Of 152 patients enrolled, 73 were randomized to the intervention group and 79 to the control group. Mean costs of the nutritional intervention was 613 Euro. Total costs and subcategories of costs were not significantly different between both groups. Based on bootstrapping of ICERs, the nutritional intervention was likely to be cost-effective for weight as outcome over the 3-month intervention period, regardless of nutritional status at baseline. With QALYs as outcome, the probability for the nutritional intervention being cost-effective was relatively low, except in subjects aged below 75 years. CONCLUSION Intensive nutritional intervention in elderly hip fracture patients is likely to be cost-effective for weight but not for QALYs. Future cost-effectiveness studies should incorporate outcome measures appropriate for elderly patients, such as functional limitations and other relevant outcome parameters for elderly.
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Affiliation(s)
- C E Wyers
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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Gerhards SAH, Abma TA, Arntz A, de Graaf LE, Evers SMAA, Huibers MJH, Widdershoven GAM. Improving adherence and effectiveness of computerised cognitive behavioural therapy without support for depression: a qualitative study on patient experiences. J Affect Disord 2011; 129:117-25. [PMID: 20889214 DOI: 10.1016/j.jad.2010.09.012] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have evaluated the efficacy and effectiveness of computerized cognitive behavioural therapy (CCBT) for depression, but research on the patient perspective is limited. AIMS To gain knowledge on patient experiences with the online self-help CCBT program Colour Your Life (CYL) for depression, and find explanations for the low treatment adherence and effectiveness. METHOD Qualitative data were collected through semi-structured interviews with 18 patients. Interviewees were selected from a CCBT trial. An inductive, content analysis of the interviews was performed. RESULTS The main theme throughout the interviews concerns barriers and motivators experienced with CCBT. The most important barriers included experiences of a lack of identification with and applicability of CCBT-CYL, lack of support to adhere with the program or to gain deeper understanding, and inadequate computer/Internet skills, equipment, or location. Confusion between CCBT and Internet questionnaires resulted in no CCBT uptake of some study participants. Motivators included experiencing self-identification and improvement through CCBT-CYL, participating in a scientific study, and the freedom and anonymity associated with online computer self-help. The addition of support to CCBT was suggested as an improvement towards adherence and the course content. CONCLUSION The CCBT program CYL in its current form does not work for a large group of people with depressive symptoms. More tailoring, the provision of support (professional or lay) and good computer conditions could improve CCBT.
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Affiliation(s)
- S A H Gerhards
- Department of Clinical Psychological Science, Faculty of Psychology, Maastricht University, The Netherlands.
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Gerhards SAH, de Graaf LE, Jacobs LE, Severens JL, Huibers MJH, Arntz A, Riper H, Widdershoven G, Metsemakers JFM, Evers SMAA. Economic evaluation of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Br J Psychiatry 2010; 196:310-8. [PMID: 20357309 DOI: 10.1192/bjp.bp.109.065748] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence about the cost-effectiveness and cost utility of computerised cognitive-behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236). AIMS To assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU. METHOD Costs, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses. RESULTS Costs were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT. CONCLUSIONS On balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.
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Affiliation(s)
- S A H Gerhards
- Department of Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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de Graaf LE, Gerhards SAH, Arntz A, Riper H, Metsemakers JFM, Evers SMAA, Severens JL, Widdershoven G, Huibers MJH. Clinical effectiveness of online computerised cognitive-behavioural therapy without support for depression in primary care: randomised trial. Br J Psychiatry 2009; 195:73-80. [PMID: 19567900 DOI: 10.1192/bjp.bp.108.054429] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Computerised cognitive-behavioural therapy (CCBT) might offer a solution to the current undertreatment of depression. AIMS To determine the clinical effectiveness of online, unsupported CCBT for depression in primary care. METHOD Three hundred and three people with depression were randomly allocated to one of three groups: Colour Your Life; treatment as usual (TAU) by a general practitioner; or Colour Your Life and TAU combined. Colour Your Life is an online, multimedia, interactive CCBT programme. No assistance was offered. We had a 6-month follow-up period. RESULTS No significant differences in outcome between the three interventions were found in the intention-to-treat and per protocol analyses. CONCLUSIONS Online, unsupported CCBT did not outperform usual care, and the combination of both did not have additional effects. Decrease in depressive symptoms in people with moderate to severe depression was moderate in all three interventions. Online CCBT without support is not beneficial for all individuals with depression.
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Affiliation(s)
- L E de Graaf
- Erasmus Medical Centre, Department of Medical Psychology and Psychotherapy, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
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Gordeev VS, Maksymowych WP, Evers SMAA, Ament A, Schachna L, Boonen A. Role of contextual factors in health-related quality of life in ankylosing spondylitis. Ann Rheum Dis 2009; 69:108-12. [DOI: 10.1136/ard.2008.100164] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In the bio-psycho-social model of health, the role of contextual factors, either environmental or personal, is recognised.Objective:To assess the impact of a number of contextual factors on self-reported disease-specific and generic health-related quality of life in patients with ankylosing spondylitis (AS).Methods:522 patients with AS from Canada and Australia completed a postal questionnaire including sociodemographic variables, disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) function (Bath Ankylosing Spondylitis Functional Index (BASFI)) health-related quality of life (ASQoL and EQ-5D) and Rheumatoid Attitudes Index Helplessness Subscale. The contribution of contextual factors (nationality, ethnicity, marital status, education, employment and helplessness) in addition to functioning and disability (BASDAI and BASFI) to health-related quality of life was analysed using multivariate regression analyses. Interactions between contextual variables were explored.Results:Contextual factors explained 37% and 47% of the variance in EQ-5D and ASQoL, respectively. Helplessness and employment were the most important contextual factors. Their role was independent of the strong effect of disease activity (BASDAI) and functional limitations (BASFI). When ASQoL was the outcome, an interaction was seen between employment and education and when EQ-5D was the outcome, an interaction was seen between helplessness and education.Conclusions:Of the contextual factors explored in this study, helplessness and employment had an important and independent contribution to health-related quality of life. In patients with lower education, the effect of not being employed on ASQoL and the effect of helplessness on EQ-5D were stronger. Contextual factors, especially helplessness and employment, should receive more attention when interpreting data on health-related quality of life.
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Hoving MA, Evers SMAA, Ament AJHA, van Raak EPM, Vles JSH. Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis. Dev Med Child Neurol 2008; 50:450-5. [PMID: 18422682 DOI: 10.1111/j.1469-8749.2008.02059.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we conducted a cost-effectiveness analysis alongside our prospective national study. We compared the costs and health effects of CITB with those of standard treatment only, from the health care perspective for a 1-year period. Health effects were expressed in terms of a visual analogue scale for individual problems and quality-adjusted life years (QALYs). We included eight females and seven males, aged between 7 and 17 years (mean age 13y 8mo [SD 3y]). Eleven children had spastic CP and four had spastic-dyskinetic CP. One child was clsssified on the Gross Motor Function Classification System at Level III, two at Level IV, and 12 at Level V. CITB was more effective and more costly than standard treatment only. Gaining one QALY cost on average 32,737 euros. We conclude that based on the threshold-willingness to pay for one QALY in the Netherlands (80,000 euros), our results confirm the cost-effectiveness of CITB for carefully selected children with intractable spastic CP.
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Affiliation(s)
- M A Hoving
- Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands.
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Evers SMAA, Ament AJHA, Colombo GL, Konradsen HB, Reinert RR, Sauerland D, Wittrup-Jensen K, Loiseau C, Fedson DS. Cost-effectiveness of pneumococcal vaccination for prevention of invasive pneumococcal disease in the elderly: an update for 10 Western European countries. Eur J Clin Microbiol Infect Dis 2007; 26:531-40. [PMID: 17570001 DOI: 10.1007/s10096-007-0327-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pneumococcal vaccine is effective in preventing invasive pneumococcal disease in adults >or=65 years of age, but it is not widely used in Western Europe. In this study, data from an earlier (1995) cost-effectiveness study on Belgium, France, Scotland, Spain, and Sweden are updated, and data on five new countries--Denmark, the UK (specifically, England and Wales), Germany, Italy and The Netherlands--are added. Epidemiological and economic variables specific for each country were used, and it was assumed that pneumococcal and influenza vaccines would both be administered during the same physician visit. In the base-case analyses, the cost-effectiveness ratios ranged from euro 9239 to euro 23,657 per quality-adjusted life-year. Because the incidence and mortality of invasive pneumococcal disease were underestimated in most countries, a country-by-country analysis was performed, assuming an incidence of 50 cases per 100,000 population and mortality rates of 20, 30 and 40%. For a mortality of 20%, the cost-effectiveness ratios ranged from euro 4,778 to euro 17,093, and for a mortality of 30%, they ranged from euro 3,186 to euro 11,395. Pneumococcal vaccination to prevent invasive pneumococcal disease in elderly adults was very cost-effective in all 10 countries. This evidence justifies the wider use of the vaccine in Western Europe.
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Affiliation(s)
- S M A A Evers
- Department of Health, Organization, Policy and Economics, Maastricht University, PO Box 616, Maastricht, 6200, MD, The Netherlands.
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Abstract
BACKGROUND None of the randomized controlled trials (RCT) on treatment of Intracerebral haematoma (ICH), definitely shows surgery to be beneficial over conservative treatment alone. Systematic reviews that pooled these RCTs were also inconclusive. This systematic review updates previous meta-analyses, using an alternative manner of reviewing with a criteria list constructed specifically for this type of disease and related interventions. METHODS RCTs and quasi-RCTs (q-RCT) published in English were identified with a systematic literature search. They were evaluated with disease/intervention-specific criteria on comparability between intervention and control group concerning prognostic factors, co-interventions and effect measurement. The resulting selection of studies was compared with those of two earlier systematic reviews. In a meta-analysis selected studies were statistically pooled. FINDINGS The meta-analysis of surgery versus conservative treatment failed to show a statistically significant reduction in the odds of death (OR: 0.84, 95% CI: 0.67-1.07) in surgically treated patients. CONCLUSIONS Like previous reviews, our disease/intervention-specific methodological evaluation showed no reduction in mortality. Sensitivity analysis demonstrates that the manner in which studies are methodologically evaluated in a systematic review has a great impact on its conclusions.
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Affiliation(s)
- O P M Teernstra
- Department of Neurosurgery, University Hospital Maastricht, Maastricht, The Netherlands.
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Teernstra OPM, Evers SMAA, Lodder J, Leffers P, Franke CL, Blaauw G. Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator: a multicenter randomized controlled trial (SICHPA). Stroke 2003; 34:968-74. [PMID: 12649510 DOI: 10.1161/01.str.0000063367.52044.40] [Citation(s) in RCA: 232] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Treatment of intracerebral hematoma (ICH) is controversial. An advantage of neurosurgical intervention over conservative treatment of ICH has not been established. Recent reports suggest a favorable effect of stereotactic blood clot removal after liquefaction by means of a plasminogen activator. The SICHPA trial was aimed at investigating the efficacy of this treatment. METHODS A stereotactically placed catheter was used to instill urokinase to liquefy and drain the ICH in 6-hour intervals over 48 hours. From 1996 to 1999, 13 centers entered 71 patients into the study. Patients were randomized into a surgical group (n=36) and a nonsurgical group (n=35). Admission criteria were the following: age >45 years, spontaneous supratentorial ICH, Glasgow Eye Motor score ranging from 2 to 10, ICH volume >10 cm3, and treatment within 72 hours. The primary end point was death at 6 months. As secondary end points, ICH volume reduction and overall outcome measured by the modified Rankin scale were chosen. The trial was prematurely stopped as a result of slow patient accrual. RESULTS Seventy patients were analyzed. Overall mortality at day 180 after stroke was 57%; this included 20 of 36 patients (56%) in the surgical group and 20 of 34 patients (59%) in the nonsurgical group. A significant ICH volume reduction was achieved by the intervention (10% to 20%, P<0.05). Logistic regression analysis indicated the possibility of efficacy for surgical treatment (odds ratio, 0.23; 95% confidence interval, 0.05 to 1.20; P=0.08). The odds ratio of mortality combined with modified Rankin scale score 5 at 180 days was also not statistically significant (odds ratio, 0.52; 95% confidence interval, 1.2 to 2.3; P=0.38). CONCLUSIONS Stereotactic aspiration can be performed safely and in a relatively uniform manner; it leads to a modest reduction of 18 mL of hematoma reduction over 7 days when compared with control, which has a 7-mL reduction, and therefore may improve prognosis.
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Affiliation(s)
- O P M Teernstra
- Department of Neurosurgery, University Hospital Maastricht, The Netherlands.
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