DRG systems in Europe: variations in cost accounting systems among 12 countries.

Background: Diagnosis-related group (DRG)-based hospital payment systems have gradually become the principal means of reimbursing hospitals in many European countries. Owing to the absence or inaccuracy of costs related to DRGs, these countries have started to routinely collect cost accounting data. The aim of the present article was to compare the cost accounting systems of 12 European countries.

Explaining length of stay variation of episodes of care in the Netherlands.

Objectives: Diagnosis Related Group (DRG) systems aim to classify patients into mutually exclusive groups of patients, with the patients in each group having the same expected length of stay (LOS). We examined the ability of current classification variables to explain LOS variation between DRG-like Diagnosis Treatment Combination (DBC)s for ten episodes of care in the Netherlands, including breast cancer, stroke and inguinal hernia repair. Additionally, we assessed the predictive ability of some other classification variables.

Creating patient value in glaucoma care: applying quality costing and care delivery value chain approaches--a five-year case study in the Rotterdam Eye Hospital.

Purpose: The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains.

Design/methodology/approach: In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands.

Findings: The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction.

Comparing methodologies for the allocation of overhead and capital costs to hospital services.

Background: Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming.

Objective: To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation.

Utilization and cost of diagnostic imaging and biopsies following positive screening mammography in the southern breast cancer screening region of the Netherlands, 2000-2005.

We prospectively assessed trends in utilization and costs of diagnostic services of screen-positive women in a biennial breast cancer screening program for women aged 50-75 years. All 2,062 women with suspicious findings at screening mammography in the southern region of the Netherlands between 1 January 2000 and 1 July 2005 (158,997 screens) were included. Data were collected on any diagnostic examinations, interventional procedures, and surgical consultations with two-year follow-up.

Introduction of additional double reading of mammograms by radiographers: effects on a biennial screening programme outcome.

Purpose: To determine the effect of introducing radiographer double reading, in addition to standard radiologist double reading, on screening mammography outcome.

Methods: In period A, 66,225 mammograms were read by two screening radiologists. In period B, 78,325 mammograms were read by two radiographers in addition and radiologists were blinded to the referral opinion of the radiographers.

Comparing methodologies for the cost estimation of hospital services.

The aim of the study was to determine whether the total cost estimate of a hospital service remains reliable when the cost components of bottom-up microcosting were replaced by the cost components of top-down microcosting or gross costing. Total cost estimates were determined in representative general hospitals in the Netherlands for appendectomy, normal delivery, stroke and acute myocardial infarction for 2005. It was concluded that restricting the use of bottom-up microcosting to those cost components that have a great impact on the total costs (i.

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands.

In mammography screening with double reading, different strategies can be used when the readers give discordant recommendations for referral. We investigated whether the results of the Dutch breast cancer screening programme can be optimised by replacing the standard referral strategy by consensus. Twenty-six screening radiologists independently and blinded to outcome read a test set consisting of previous screening mammograms of 250 cases (screen-detected and interval cancers) and 250 controls.

Efficiency of different systems for medication distribution in an academic children's hospital in The Netherlands.

Background: In the Sophia Children's Hospital, both a ward stock system and a decentralized, patient-orientated, ready-to-use drug distribution system (a 'satellite pharmacy system') exist. Hospital management considered expanding the concept of the satellite pharmacies. Little was known, however, about the efficiency of this drug distribution system, whereas there is increasing pressure to demonstrate the cost-effectiveness of pharmacy services.

Nationwide breast cancer screening programme fully implemented in The Netherlands.

The period 1990-1997 saw the implementation of a nationwide breast cancer screening programme in the Netherlands, which provided biennial mammography for all women aged 50-69 years (50-75 years at present). The National Evaluation Team monitors the programme annually collecting regional data on screening outcomes; regional cancer registries provide data on interval cancers and on breast cancers in unscreened women by linkage of cancer registry data to data on screened women. Of 4 million women invited, 78.

The costs of head and neck oncology: primary tumours, recurrent tumours and long-term follow-up.

We retrospectively calculated the costs of head and neck oncology for reimbursement purposes. This analysis was based on 854 head and neck cancer patients treated between 1994 and 1996 in two major Dutch university hospitals. To anticipate future care costs, costs of required improvements in the quality of care were added.

Costs of diagnosis, treatment, and follow up of patients with acute myeloid leukemia in the netherlands.

The aim of the study was to calculate the costs in various places of acute myeloid leukemia (AML). Patients less than 65 years old, who were treated for newly diagnosed AML were included. The cost analysis distinguished between diagnosis, treatment, follow-up (maximum of 2 years), and treatment of relapse.

Interval cancers in the Dutch breast cancer screening programme.

The nationwide breast cancer screening programme in The Netherlands for women aged 50-69 started in 1989. In our study we assessed the occurrence and stage distribution of interval cancers in women screened during 1990-1993. Records of 0.

An economic evaluation of Tomudex (raltitrexed) and 5-fluorouracil plus leucovorin in advanced colorectal cancer.

Our objective was to establish the balance between costs and effects of treatment with Tomudex (raltitrexed) as an alternative to treatment with 5-fluorouracil (5-FU) plus leucovorin (LV) in patients with advanced colorectal cancer. Data were used from an international, open label randomized clinical trial. Costs were calculated by multiplying resource utilization data with Dutch estimates of unit costs.

Nation-wide breast cancer screening in The Netherlands: results of initial and subsequent screening 1990-1995. National Evaluation Team for Breast Cancer Screening.

Based on an extensive cost-effectiveness analysis, the Dutch nation-wide breast cancer screening programme started in 1990, providing a biennial screen examination to women aged 50 to 69 years. The programme is monitored by the National Evaluation Team, which annually collects tabulated regional evaluation data to determine performance indicators. This study presents (trends in) the outcomes of initial and subsequent screening rounds, 1990-1995, and compares them to the predictions of the cost-effectiveness-analysis.

The friction cost method for measuring indirect costs of disease.

A new approach for estimating the indirect costs of disease, which explicitly considers economic circumstances that limit production losses due to disease, is presented (the friction cost method). For the Netherlands the short-term friction costs in 1990 amount to 1.5-2.

Nation-wide breast cancer screening in The Netherlands: support for breast-cancer mortality reduction. National Evaluation Team for Breast Cancer Screening (NETB).

The nation-wide 2-yearly breast-cancer screening programme in The Netherlands, for women aged 50-69, started around 1988, and was predicted to result eventually in a 16% reduction in breast-cancer mortality in the total female population. We present the results of screening up to January 1, 1993, and compare these with the predicted results from the cost-effectiveness analysis, on which basis this mortality reduction has been calculated. At least 550,000 women aged 50-69 were invited to screening in 1990-1992, and 75% of these participated.

How cost-effective is breast cancer screening in different EC countries?

Should the decision to start breast cancer screening in the Netherlands and in the U.K. be followed by other EC countries? This question has been addressed in an exploratory analysis of the differences in cost-effectiveness of breast cancer screening in Spain, France, the U.

Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening.

The costs of home care in the Netherlands are estimated for women with advanced breast and cervical cancer. We observe a growing role of intensive home care for the terminally ill patients. The average costs of home care are dfl 8,500 per patient for breast cancer patients and dfl 7,200 for cervical cancer patients.

Advanced breast cancer and its prevention by screening.

In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources.

Towards a new approach for estimating indirect costs of disease.

Many researchers in the field of evaluation of health care doubt the usefulness of estimates of indirect costs of disease in setting priorities in health care. This paper attempts to meet part of the criticism on the concept of indirect costs, which are defined as the value of production lost to society due to disease. Thus far in cost of illness studies and cost-effectiveness analyses the potential indirect costs of disease were calculated.

Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors.

Mammographic screening for women aged 50-70 is effective in reducing breast cancer mortality, but the impact on quality of life and the attainable mortality reduction remain to be discussed. The consequences of expanding screening programmes to include women in other age groups are uncertain. We have predicted the effects and costs for 5 popular screening variants, differing in age group and screening interval, on the basis of our analysis of the Dutch screening trials and of the reported mortality reductions in other trials.

[Efficacy of mass screening for breast cancer; reduced mortality nationally and internationally].

Breast cancer screening trials in several countries have proved to reduce breast cancer mortality. However, the trials show considerable differences in the extent of this reduction. The Swedish projects in Kopparberg/Ostergötland and Malmö are the most similar to the Dutch situation.

Breast cancer screening: its impact on clinical medicine.

Breast cancer screening is generally accepted as an effective means of reducing breast cancer mortality in post-menopausal women. In this analysis the impact of nationwide screening on clinical medicine and the effects for the women involved are quantified. Effect estimates are based on results from screening trials in Utrecht (DOM-project) and Nijmegen, and on bi-annual screening of women aged 50-70.

The cost-effectiveness of breast cancer screening.

The costs and effects of different invitation schedules of breast cancer screening are compared. The effect estimates are based on trials from the USA, Sweden and the Netherlands. The cost estimates use registration data, file studies and organization charts.