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 prohibition of anti-competitive unilateral conduct by firms with market power is not absolute, but allows for derogation. For the purposes of EU law, the ECJ has accepted that a so-called ... Show moreThe prohibition of anti-competitive unilateral conduct by firms with market power is not absolute, but allows for derogation. For the purposes of EU law, the ECJ has accepted that a so-called ‘objective justification’ plea may be invoked in the case of a prima facie abuse of dominance. Even though this is long-standing case law, many uncertainties remain as to its interpretation. This thesis contains a detailed examination of this concept of ‘(objective) justification’, focusing in particular on its scope and the applicable legal conditions. The thesis submits that this concept is highly important, as it can steer Article 102 TFEU away from a formalistic approach and give ample weight to the prevalent context. Although the thesis focuses on EU law, it also seeks inspiration from the approach in other jurisdictions. A comparative study includes relevant cases from various EU Member States (France, Germany, Ireland, Luxembourg, the Netherlands, Spain and the UK) and non-EU jurisdictions (Australia, Canada, Hong Kong, Singapore, South Africa and the US). The study reveals that these jurisdictions have accepted the availability of a justification plea, and have dealt with the concept in strikingly similar ways. Show less
Thijssing, L.; Heijden, J.P. van der; Chavannes, N.H.; Melissant, C.F.; Jaspers, M.W.M.; Witkamp, L. 2014
The author addresses a recent force employment concept called effects-based operations, which first appeared during the 1991 war against Iraq. The attributes of effects-based operations can be... Show moreThe author addresses a recent force employment concept called effects-based operations, which first appeared during the 1991 war against Iraq. The attributes of effects-based operations can be grouped around three common, but interrelated elements such as effects focus, advanced technology, and systems thinking. However, the characteristics upon which the common elements are built, such as causality/deduction for effects focus, intangibles/control for advanced technology, and categorisation/analysis for systems thinking bear dangerous simplifications regarding the nature of war. These characterictics are in sharp contrast with war__s frictional nature as outlined by Clausewitz, who stated that effects in war cannot be traced back to single causes, as several concurrent causes are normally at work. Novelty must always be expected in war as friction dims expectations in terms of causality and the ability to achieve desired effects. The author suggests an organic approach to address the challenge posed by war. According to him the emphasis must shift towards learning and adaptation, instead of planning for desired effects. Friction indicates that often it is more important in war how we do things than what things we do, which has a clear practical limitation for the concept of effects-based operations. Show less
