De eetbuistoornis is de meest voorkomende eetstoornis en komt in vergelijking met anorexia en boulima veel meer onder alle lagen van de bevolking voor. Wereldwijd is er een gebrek aan kennis over... Show moreDe eetbuistoornis is de meest voorkomende eetstoornis en komt in vergelijking met anorexia en boulima veel meer onder alle lagen van de bevolking voor. Wereldwijd is er een gebrek aan kennis over de eetbuistoornis. Door gebrekkige (h)erkenning krijgen individuen met een eetbuistoornis vaak verkeerde zorg, waardoor de eetbuien juist toenemen. Daarnaast zijn er lange wachttijden voor specialistische behandeling en heeft niet iedereen toegang tot behandeling. Deze these is tweeledig: er wordt onderzoek gedaan naar risicofactoren van de eetbuistoornis in Arabische landen en twee diagnostische vragenlijsten worden gevalideerd. In Nederland wordt de werkzaamheid van een traditionele en een digitale begeleide zelfhulp behandeling onderzocht. In Arabische landen bleken een hoog BMI en lichaamsontevredenheid geassocieerd te zijn met eetstoornispathologie. De eating disorder examination questionnaire meet accuraat eetstoornisklachten en de body shape questionnaire lichaamsontevredenheid. In Nederland blijkt cognitive behavioral therapy een werkzame behandeling voor de eetbuistoornis, zowel op de traditionale manier, als digitaal aangeboden. De digitale variant vergroot de toegang tot specialistische zorg en kan mogelijk de lange wachttijden voor behandeling verkorten. Show less
BackgroundCardiovascular diseases and especially Acute Coronary Syndrome (ACS) constitute a major health issue impacting millions of patients worldwide. Being a leading cause of death and hospital... Show moreBackgroundCardiovascular diseases and especially Acute Coronary Syndrome (ACS) constitute a major health issue impacting millions of patients worldwide. Being a leading cause of death and hospital admissions in many European countries including Spain, it accounts for enormous amounts of healthcare expenditures for its management. Clopidogrel is one of the oldest antiplatelet medications used as standard of care in ACS.MethodsIn this study, we performed an economic evaluation study to estimate whether a genome-guided clopidogrel treatment is cost-effective compared to conventional one in a large cohort of 243 individuals of Spanish origin suffering from ACS and treated with clopidogrel. Data were derived from the U-PGx PREPARE clinical trial. Effectiveness was measured as survival of individuals while study data on safety and efficacy, as well as on resource utilization associated with each adverse drug reaction were used to measure costs to treat these adverse drug reactions. A generalized linear regression model was used to estimate cost differences for both study groups.ResultsBased on our findings, PGx-guided treatment group is cost-effective. PGx-guided treatment demonstrated to have 50% less hospital admissions, reduced emergency visits and almost 13% less ADRs compared to the non-PGx approach with mean QALY 1.07 (95% CI, 1.04-1.10) versus 1.06 (95% CI, 1.03-1.09) for the control group, while life years for both groups were 1.24 (95% CI, 1.20-1.26) and 1.23 (95% CI, 1.19-1.26), respectively. The mean total cost of PGx-guided treatment was 50% less expensive than conventional therapy with clopidogrel [euro883 (95% UI, euro316-euro1582), compared to euro1,755 (95% UI, euro765-euro2949)].ConclusionThese findings suggest that PGx-guided clopidogrel treatment represents a cost-effective option for patients suffering from ACS in the Spanish healthcare setting. Show less
Gerven, P. van; Dongen, J.M. van; Rubinstein, S.M.; Termaat, M.F.; Moumni, M. el; Zuidema, W.P.; ... ; WARRIOR Study Grp 2020
Background: To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures.Methods: We performed an economic evaluation... Show moreBackground: To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures.Methods: We performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. Participants were randomised to a reduced imaging follow-up protocol (i.e. radiographs at week 6 and 12 follow-up obtained on clinical indication) or usual care (i.e. routine radiography at weeks 6 and 12). The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation was used for missing data, and data were analysed using seemingly unrelated regression analysis and bootstrapping.Results: In total, 246 patients had data available for analysis (reduced imaging = 118; usual care = 128). Fewer radiographs were obtained in the reduced imaging group (median = 4) compared with the usual-care group (median = 5). Functional outcome was comparable in both groups. The difference in QALYs was - 0.008 (95% CI:-0.06 to 0.04) and the difference in OMAS was 0.73 (95% CI:-5.29 to 6.76). Imaging costs were lower in the reduced imaging group (-(sic)48; 95% CI:- (sic)72 to -(sic)25). All other cost categories did not statistically differ between the groups. The probability of the reduced imaging protocol being cost-effectiveness was 0.45 at a wiliness-to-pay of (sic)20,000 per QALY.Conclusions: Reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care, and may result in reduced costs. Show less
Background The present study aims to assess the cost-effectiveness of an influenza vaccination program for children in the Netherlands. This requires an evaluation of the long-term impact of such a... Show moreBackground The present study aims to assess the cost-effectiveness of an influenza vaccination program for children in the Netherlands. This requires an evaluation of the long-term impact of such a program on the burden of influenza across all age groups, using a transmission model that accounts for the seasonal variability in vaccine effectiveness and the shorter duration of protection following vaccination as compared to natural infection. Methods We performed a cost-effectiveness analysis based on a stochastic dynamic transmission model that has been calibrated to reported GP visits with influenza-like illness in the Netherlands over 11 seasons (2003/2004 to 2014/2015). We analyzed the costs and effects of extending the current program with vaccination of children aged 2-16 years at 50% coverage over 20 consecutive seasons. We measured the effects in quality-adjusted life-years (QALYs) and we adopted a societal perspective. Results The childhood vaccination program is estimated to have an average incremental cost-effectiveness ratio (ICER) of euro3944 per QALY gained and is cost-effective in the general population (across 1000 simulations; conventional Dutch threshold of euro20,000 per QALY gained). The childhood vaccination program is not estimated to be cost-effective for the target-group itself with an average ICER of euro57,054 per QALY gained. Uncertainty analyses reveal that these ICERs hide a wide range of outcomes. Even though introduction of a childhood vaccination program decreases the number of infections, it tends to lead to larger epidemics: in 23.3% of 1000 simulations, the childhood vaccination program results in an increase in seasons with a symptomatic attack rate larger than 5%, which is expected to cause serious strain on the health care system. In 6.4% of 1000 simulations, the childhood vaccination program leads to a net loss of QALYs. These findings are robust across different targeted age groups and vaccination coverages. Conclusions Modeling indicates that childhood influenza vaccination is cost-effective in the Netherlands. However, childhood influenza vaccination is not cost-effective when only outcomes for the children themselves are considered. In approximately a quarter of the simulations, the introduction of a childhood vaccination program increases the frequency of seasons with a symptomatic attack rate larger than 5%. The possibility of an overall health loss cannot be excluded. Show less
Luenen, S. van; Kraaij, V.; Garnefski, N.; Spinhoven, P.; Akker-van Marie, M.E. van den 2019
Objective: The aim of this study was to evaluate the cost-utility of a guided Internet-based intervention for people living with HIV and depressive symptoms, compared to attention only (control... Show moreObjective: The aim of this study was to evaluate the cost-utility of a guided Internet-based intervention for people living with HIV and depressive symptoms, compared to attention only (control condition). It was previously found that the intervention was effective in decreasing depressive symptoms, compared to the control group.Methods: This economic evaluation was conducted alongside a randomized controlled trial. The control group received attention only and was put on a waiting list. Quality adjusted life years were calculated over six months. The study was conducted from a societal perspective and included intervention costs, healthcare costs, and non healthcare costs. Participants completed a pretest, a post-test after two to three months, and a second post-test after six months. Cost-utility acceptability curves were constructed and two sensitivity analyses were conducted.Results: No differences between the intervention and the control group were found in quality adjusted life years and total societal costs. The results indicate that the intervention is likely to be cost-effective, compared to attention only. The findings of the sensitivity analyses point in the same direction.Conclusion: More research with larger samples is necessary to confirm the findings. The outcomes of this study may inform policy makers to decide which interventions will be included in policies. The guided Internet intervention may improve psychological care for people living with HIV and depressive symptoms, against low costs. Show less
Lier, L.I. van; Bosmans, J.E.; Hout, H.P.J. van; Mokkink, L.B.; Hout, W.B. van den; Wit, G.A. de; ... ; Roest, H.G. van der 2018
Urinary tract infections (UTI) are among the most frequently reported infections among older persons. UTI not only causes several days of illness but may have more severe consequences, such as a... Show moreUrinary tract infections (UTI) are among the most frequently reported infections among older persons. UTI not only causes several days of illness but may have more severe consequences, such as a decline in functioning, as well as delirium, dehydration, urosepsis, hospitalization, or even death. Annually, 20% of all older persons visit their general practitioner for a UTI and about 50% of the residents in long-term care facilities (LTCF) get a UTI. This thesis describes the possibilities for and the effects of the prevention of UTI in vulnerable very old persons. The first part of this thesis investigates the effect of infections on functioning and explores which vulnerable very old persons would benefit most from UTI prevention. The second part of this thesis describes the results of the CRANBERRY study. A double-blind randomized placebo-controlled multicentre trial in LTCF. This study investigates the effectiveness and costs of cranberry capsule use in the prevention of clinical UTI. Show less
