BACKGROUND & AIMS: Telemedicine can be used to monitor determinants and outcomes of patients with chronic diseases, possibly increasing the quality and value of care. Telemedicine was found to... Show moreBACKGROUND & AIMS: Telemedicine can be used to monitor determinants and outcomes of patients with chronic diseases, possibly increasing the quality and value of care. Telemedicine was found to reduce outpatient visits and hospital admissions for patients with inflammatory bowel diseases (IBD). We performed a full economic evaluation of telemedicine interventions in patients with IBD, comparing the cost-utility of telemedicine vs standard care.METHODS: We performed a randomized trial of 909 patients with IBD at 2 academic and 2 non-academic hospitals in The Netherlands. Patients were randomly assigned to groups that received telemedicine (myIBDcoach; n = 465) or standard outpatient care (n = 444) and followed for 12 months. Costs were measured from a societal perspective. Direct healthcare costs were based on actual resource use. Indirect costs comprised self-reported hours sick leave from work, intervention costs (annual license fee of (sic)40 per patient [$45]), and utility costs (assessed using EQ5D). Cost-utility and uncertainty were estimated using the non-parametric bootstrapping method.RESULTS: Telemedicine resulted in lower mean annual costs of (sic)547/patient [$612] (95% CI, (sic)1029-2143 [$1150-2393]; mean costs of (sic)9481 [$10,587] for standard care and (sic)8924 [$9965] for telemedicine) without changing quality adjusted life years. At the Dutch threshold of (sic)80,000 [$89,335] per quality adjusted life year, the intervention had increased incremental cost-effectiveness over standard care in 83% of replications and an incremental net monetary benefit of (sic)707/patient [$790] (95% CI, (sic)1241-2544 [$1386-2841]).CONCLUSIONS: Telemedicine with myIBDcoach is cost saving and has a high probability of being cost effective for patients with IBD. This self-management tool enables continuous registration of quality indicators and (patient-reported) outcomes and might help reorganize IBD care toward value-based healthcare. Show less
The study focuses on prophecy as a historical phenomenon by offering a comparison between parts of First Isaiah and the Assyrian prophecies. In the first part of the study the material from First... Show moreThe study focuses on prophecy as a historical phenomenon by offering a comparison between parts of First Isaiah and the Assyrian prophecies. In the first part of the study the material from First Isaiah and from seventh-century Assyria is investigated in its own right. The second part is a comparison of the Isaiah tradition in its earliest shape on the one hand and the prophetic material from seventh-century Assyria on the other. The comparison contains three aspects: the interrelation of prophetic oracles and historical events; the functions of the prophets; and the literary development of prophecy. The main conclusion of the study is that the earliest stages of the Isaiah tradition - i.e. the prophetic material from the eighth century and its earliest revision in the seventh century - to a great extent correspond with the prophetic material of seventh-century Assyria. Based on this conclusion, the hypothesis that prophecy as a historical phenomenon in ancient Israel was much more in conformity with prophecy in the ancient Near East in general than the biblical sources at face value suggest, gains further support. Show less
