INTRODUCTION: Cost-effectiveness is an important criterion in the decision to cover interventions in health insurance packages. One of the outcome measures, the quality-adjusted life year, has been... Show moreINTRODUCTION: Cost-effectiveness is an important criterion in the decision to cover interventions in health insurance packages. One of the outcome measures, the quality-adjusted life year, has been criticised on its assumptions and implications concerning life expectancy and quality of life. Several studies have been conducted that measured societal preferences concerning healthcare rationing decisions. These studies mainly focused on one attribute. To adjust quality-adjusted life year maximisation in accordance with societal preferences, the relative importance of attributes should be studied. The present study aims to measure the relative importance of age, gender, socioeconomic status, pre-intervention health state, treatment effect, chance of treatment success and number of people in need of the intervention. A secondary objective is to compare the validity of the willingness to pay method with the validity of a relatively new preference elicitation method, best-worst scaling. METHODS AND ANALYSIS: A representative sample of 2000 Dutch citizens, over 18 years of age, are recruited to complete a web-based survey containing treatment scenarios. The scenarios present different levels of attributes. Respondents are asked to select one of the four scenarios that they prefer to be covered by the Dutch standard health insurance package and one that they prefer not to be covered. They are also asked to indicate how much they are willing to pay for each treatment scenario. At the end of the survey, respondents are asked to rate every attribute on a 1-10 scale. Two versions of the questionnaire are developed which differ on the framing, that is, treatments can be added to or removed from the insurance package. The data will be analysed by means of sequential conditional logit analysis (best-worst scaling) and analysis of variance (willingness to pay). ETHICS AND DISSEMINATION: The protocol is reviewed and approved by the medical ethical committee of the University Medical Center Leiden. Show less
Akker-van Marle, M.E. van den; Chorus, A.M.J.; Vlieland, T.P.M.V.; Hout, W.B. van den 2012
Rheumatic disorders concern a broad spectrum of painful disorders affecting the musculoskeletal system, and are responsible for a considerable amount of disease burden and also a substantial... Show moreRheumatic disorders concern a broad spectrum of painful disorders affecting the musculoskeletal system, and are responsible for a considerable amount of disease burden and also a substantial economic burden. This economic burden consists of direct and indirect costs, but also the so-called intangible costs. In this study, we estimated the societal cost of rheumatic disorders in the Netherlands, including intangible costs. Data from the National Monitor on Musculoskeletal System 2010 were used to assess resource used, multiplied with standard prices for the Netherlands to obtain total costs for the 1.8 million people suffering from rheumatic disorders. These estimates were supplemented with data from secondary sources. Total societal costs of rheumatic disorders in the Netherlands amount to €4.7 million a year, that is, €2665 per person with rheumatic disorders. Rheumatic disorders have considerable costs, which justify more attention in discussing investments in facing the challenges in our ageing Western societies. Show less
Weele, G.M. van der; Waal, M.W.M. de; Hout, W.B. van den; Craen, A.J.M. de; Spinhoven, P.; Stijnen, T.; ... ; Gussekloo, J. 2012
OBJECTIVES: to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥75 years who screened positive for depressive symptoms in general practice. DESIGN: the... Show moreOBJECTIVES: to determine (cost)-effectiveness of a stepped-care intervention programme among subjects ≥75 years who screened positive for depressive symptoms in general practice. DESIGN: the pragmatic cluster-randomised controlled trial with 12-month follow-up. SETTING: sixty-seven Dutch general practices. SUBJECTS: two hundred and thirty-nine subjects ≥75 years screened positive for untreated depressive symptoms (15-item Geriatric Depression Scale ≥5). METHODS: usual care (34 practices, 118 subjects) was compared with the stepped-care intervention (33 practices, 121 subjects) consisting of three steps: individual counselling; Coping with Depression course; and-if indicated-referral back to general practitioner to discuss further treatment. Measurements included severity of depressive symptoms [Montgomery-Åsberg Depression Rating Scale (MADRS)], quality of life, mortality and costs. RESULTS: at baseline subjects mostly were mildly/moderately depressed. At 6 months MADRS scores had improved more in the usual care than the intervention group (-2.9 versus -1.1 points, P = 0.032), but not at 12 months (-3.1 versus -4.6, P = 0.084). No significant differences were found within two separate age groups (75-79 years and ≥80 years). In intervention practices, 83% accepted referral to the stepped-care programme, and 19% accepted course participation. The control group appeared to have received more psychological care. CONCLUSIONS: among older subjects who screened positive for depressive symptoms, an offered stepped-care intervention programme was not (cost)-effective compared with usual care, possibly due to a low uptake of the course offer.Trial registration: www.controlled-trials.com/ISRCTN 71142851v. Show less
Hofstede, S.N.; Marang-van de Mheen, P.J.; Assendelft, W.J.J.; Vleggeert-Lankamp, C.L.A.; Stiggelbout, A.M.; Vroomen, P.C.A.J.; ... ; DISC Study Grp 2012
BACKGROUND: Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with... Show moreBACKGROUND: Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM). However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients. METHODS: The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (para)medical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons). In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel. DISCUSSION: Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas multiple disciplines are involved in SDM among sciatica patients. The results of this study can be used as an example for implementing SDM in other patient groups receiving multidisciplinary complex care (e.g., elderly) and can be generalized to other countries with similar context, thereby contributing to a worldwide increase of SDM in preference sensitive choices. Show less
