Holistic preferences for 1-year health profiles describing fluctuations in health: the case of chronic obstructive pulmonary disease.

Background: There are few empirical studies on the valuation of health profiles that describe the short-term fluctuations of chronic diseases.

Objective: This study aimed to value chronic obstructive pulmonary disease (COPD) health profiles, which describe the health of these patients over the course of 1 year from a societal perspective.

Methods: We developed 16 COPD health profiles.

Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme: a report from the EORTC 26981/22981 NCI-C CE3 Intergroup Study.

Background: The study aimed to compare the cost-effectiveness of concomitant and adjuvant temozolomide (TMZ) for the treatment of newly diagnosed glioblastoma multiforme versus initial radiotherapy alone from a public health care perspective.

Methods: The economic evaluation was performed alongside a randomized, multicenter, phase 3 trial. The primary endpoint of the trial was overall survival.

On the assessment of preferences for health and duration: maximal endurable time and better than dead preferences.

Background: Several studies revealed difficulties with the valuation and analysis of health states deemed worse than dead. These problems may be linked to maximal endurable time (MET) preferences, the phenomenon that for severe states better than dead (BTD), shorter durations are often preferred to longer durations.

Objective: To test the association between the duration of health states and their valuation.

Cost-effectiveness of physical therapy and general practitioner care for sciatica.

Study Design: An economic evaluation alongside a randomized clinical trial in primary care. A total of 135 patients were randomly allocated to physical therapy added to general practitioners' care (n = 67) or to general practitioners' care alone (n = 68).

Objective: To evaluate the cost-effectiveness of physical therapy and general practitioner care for patients with an acute lumbosacral radicular syndrome (LRS, also called sciatica) compared with general practitioner care only.

The use of disease-specific outcome measures in cost-utility analysis: the development of Dutch societal preference weights for the FACT-L scale.

Introduction: The Functional Assessment of Cancer Therapy-Lung (FACT-L) is a validated, sensitive and reliable patient questionnaire that evaluates and quantifies quality of life (QOL) across several domains, including lung cancer-related symptoms. The FACT-L was not designed for use in economic evaluation and does not incorporate preferences into its scoring system.

Objective: To derive a set of Dutch preference weights for FACT-L health states that can be used to convert FACT-L into a single value that can be used in cost-utility analyses.

The transformation of utilities for health states worse than death: consequences for the estimation of EQ-5D value sets.

Background: Utilities for health are measured on an interval scale, where 1 refers to full health and 0 refers to death. No theoretical lower boundary on the utilities for states worse than death exists. As a consequence, negative values receive greater weight in the calculation of mean utilities.

Gender and health care utilization: the role of mental distress and help-seeking propensity.

Many studies report higher levels of health care utilization among women. Understanding how gender influences health care utilization is still unresolved. We developed a model that could explain these gender-related differences.

Testing the interval-level measurement property of multi-item visual analogue scales.

Background: Conditions were studied that may invalidate health-state values derived from the visual analogue scale (VAS).

Methods: Respondents were asked to place cards with descriptions of EQ-5D health states on a 20 cm EuroQol VAS and modified versions of it, positioning them such that the distances between the states reflect their valuation for these states. Anchor-point bias was examined using the standard EuroQol VAS (n = 212) and a modified version (n = 97) with a different lower anchor.

Is the impact of depressive complaints on the use of general health care services dependent on severity of somatic morbidity?

Objective: The aim of this study was to examine the effects of depressive complaints and chronic medical illnesses on prospective somatic health care utilization and the possible heterogeneity of the effect of depressive complaints across levels of medical illness severity.

Methods: Data from a community-based sample of adults (n=9428) were used, of whom a health survey and claims data, indicating health care use, were available. Assessments of depressive complaints and somatic illnesses were based on self-report.

Inconsistencies in TTO and VAS values for EQ-5D health states.

Background: Most EQ-5D health states can be ordered logically. When people assign values to different health states, they may violate this logical order, which can be seen as inconsistencies.

Objective: The aim of this study was to assess the effect of inconsistently valued EQ-5D health states on mean visual analog scale (VAS) and time trade-off (TTO) values.

Assessing the construct validity of three indicators of psychological distress in relation to perceived health and physical illness.

Objectives: The aim of this study is to compare three indicators of psychological distress (PD) on the strength of their association with subjective (or perceived) health and to analyse to what extent these associations will change after adjusting for physical illness measures and other possible confounding variables.

Methods: Data were used from a community-based sample of adults (N=9,428). Psychological distress was measured using three different instruments: the Negative Affect Scale of Bradburn, a nervousness scale, and a self-reported depressive complaints.

The relationship between productivity and health-related quality of life: an empirical exploration in persons with low back pain.

Objective: In economic evaluation of health care programmes normally health-related quality of life is part of measurement of a programme's effectiveness and productivity part of its costs. In this paper the relationship between quality of life and productivity is highlighted and empirically assessed in persons suffering from low back pain.

Methods: A secondary analysis was performed on data from a sample of 483 patients treated for low back pain.

The relationship between productivity and health-related QOL: an exploration.

In economic evaluation of healthcare programmes both QOL and productivity of patients are aspects to be studied. Normally, the former is part of the measurement of the effectiveness of the programme and the latter is part of the measurement of its costs. In this paper we highlight the relationship between QOL and productivity.

The gap effect: discontinuities of preferences around dead.

Background: The assessment of health states considered to be worse than dead is a controversial issue.

Objective: To investigate how health states are valued when they are close to dead. Differences between adjacent states are compared with the differences between the first positive/first negative state with death.

Health-adjusted premium subsidies in the Netherlands.

The Dutch government has decided to proceed with managed competition in health care. In this paper we report on progress made with health-based risk adjustment, a key issue in managed competition. In 2004 both Diagnostic Cost Groups (DCGs) computed from hospital diagnoses only and Pharmacy-based Cost Groups (PCGs) computed from out-patient prescription drugs are used to set the premium subsidies for competing risk-bearing sickness funds.

The Pharmacy-based Cost Group model: validating and adjusting the classification of medications for chronic conditions to the Dutch situation.

In 2002, the Dutch government implemented a Pharmacy-based Cost Group (PCG) model in the social health insurance sector. This model uses specific types of medication prescribed to individuals in a base year as markers for chronic conditions, which are then employed to adjust capitation payments to their sickness fund in the subsequent year. In this study, a classification of prescribed medication is derived for 22 chronic conditions, based on an assessment of the relation between prescribed medication and diagnoses indicated by physicians on their prescriptions.

Risk-adjusted capitation payment systems for health insurance plans in a competitive market.

Adequate risk-adjustment is critical to the success of market-oriented healthcare reforms in many countries. Regulated competition among insurers and providers is often a crucial element in these reforms. Consumers may then choose among competing health insurance plans, which are largely financed through premium-replacing risk-adjusted capitation payments.

Risk adjustment and risk selection on the sickness fund insurance market in five European countries.

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund.

Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands.

As part of a market-oriented health care reform, in 1991 risk adjusted premium subsidies were introduced in the Dutch social health insurance sector. Currently the premium subsidies are primarily based on demographic variables. To mitigate the obvious inadequacy of these risk adjusters, the system of risk adjustment is supplemented with a system of risk sharing.

Comparing patients with depressive complaints and patients with chronic medical conditions on their functioning and medical consumption.

BACKGROUND: Several studies have found that depressive complaints are associated with limitations in functioning that are at least comparable with those of chronic medical conditions, such as diabetes or lung diseases. However, the consequences of these associations for the utilization of general health care services are not known, certainly not for health care settings outside the United States. AIMS OF THE STUDY: To investigate the association of depressive complaints with functioning and health care utilization, comparing this with the association of chronic medical conditions with functioning and health care utilization.