Who contextualises clinical epidemiological evidence? A political analysis of the problem of evidence-based medicine in the layered Dutch healthcare system.

We critically examine the discussion on the role of evidence-based medicine (EBM) in healthcare governance. We take the institutionally layered Dutch healthcare system as our case study. Here, different actors are involved in the regulation, provision and financing of healthcare services.

Validation of the Dutch version of the DN4 diagnostic questionnaire for neuropathic pain.

Difficulties in diagnosing neuropathic pain in routine clinical practice support the need for validated and easy-to-use diagnostic tools. The DN4 neuropathic pain diagnostic questionnaire aims to discriminate neuropathic pain from nociceptive pain, but needs clinical validation. A total of 269 patients with chronic pain in three pain clinics were included in the study of which 248 had analyzable data.

Cholesterol level goal attainment with statins: clinical management guideline recommendations versus management in actual clinical practice.

Study Objectives: To compare the cholesterol level goal attainment rates in patients receiving simvastatin doses recommended in clinical practice guidelines and simvastatin doses most frequently prescribed in clinical practice versus other statins at various dose levels, and to assess statin adherence rates in patients receiving all statins.

Design: Retrospective cohort study.

Data Source: PHARMO database, which contains linked prescription drug information, hospitalization records, and laboratory test results of over 1 million patients in the Netherlands.

Antihypertensive drugs: a perspective on pharmaceutical price erosion and its impact on cost-effectiveness.

Objective: When comparators' prices decrease due to market competition and loss of exclusivity, the incremental clinical effectiveness required for a new technology to be cost-effective is expected to increase; and/or the minimum price at which it will be funded will tend to decrease. This may be, however, either unattainable physiologically or financially unviable for drug development. The objective of this study is to provide an empirical basis for this discussion by estimating the potential for price decreases to impact on the cost-effectiveness of new therapies in hypertension.

Evaluation of smoking cessation drug use and outcomes in the Netherlands.

Objective: Several pharmacological therapies are available to help smokers quit. The aim was to investigate the utilisation and effectiveness of smoking cessation drugs in daily practice in the Netherlands.

Methods: Subjects aged ≥18 years with a pharmacy prescription of varenicline, bupropion, nicotine replacement therapy (NRT) or nortriptyline between March 2007 and September 2008 were identified from the PHARMO data warehouse, which includes drug dispensing, hospitalisation and other data from approximately 2.

How adequate are emergency department home and leisure injury surveillance systems for cross-country comparisons in Europe?

The objective of this study was to assess whether the emergency department (ED) injury surveillance systems in Europe are suitable for cross-country comparisons. For this, the ED injury surveillance systems in Austria, Denmark, Greece, Ireland, the Netherlands, Norway and the UK (England, Wales) were considered. Standardised injury incidence and healthcare utilisation indices were calculated and the influence of measurement bias due to data collection and sampling differences, as well as trauma policy and health systems characteristics were assessed.

Social time preferences for health and money elicited with a choice experiment.

Objectives: In economic evaluations future health and monetary outcomes are commonly discounted at equal and constant rates. The theoretical foundation of this practice is being debated and appropriate discount rates for costs and health effects are sought. Here, we have derived social discount rates for health, money, and environmental benefits by means of a choice experiment.

Determination of non-treatment with statins of high risk patients in The Netherlands.

Objective: To determine in the Netherlands what proportions of high risk patients with established cardiovascular disease (CVD) or diabetes mellitus type 2 (DM2) who were not treated with statins on 1 January 2007 and which characteristics were associated with non-treatment.

Methods: From the IPCI GP database patients were selected who were registered with a GP on 1 January 2007 who had a history of either CVD (CVD patients), DM2 (diabetics) or both (diabetics with CVD). The proportion of patients using statins around 1 January 2007 was determined.

Preferences of GPs and patients for preventive osteoporosis drug treatment: a discrete-choice experiment.

Background: Osteoporotic fractures have a serious economic impact on society and on the quality of life of patients. Differences in opinions on the desirability of preventive treatment initiation may hamper the process and outcome of shared decision making between physician and patient.

Objective: To evaluate and compare preferences of GPs and patients for preventive osteoporosis drug treatment.

International variation in clinical injury incidence: exploring the performance of indicators based on health care, anatomical and outcome criteria.

Objective: To analyse international variation in clinical injury incidence, and explore the performance of different injury indicators in cross-country comparisons.

Methods: Hospital discharge data of seven European countries (Austria, Denmark, Ireland, Netherlands, Norway, England and Wales) were analysed. We tested existing and newly developed indicators based on (a) health care use, (b) anatomical criteria, or (c) expected health outcome: admissions excluding day-cases (a), hospital stay 4+ (a) and 7+ days (a), (serious) long-bone fractures (b), selected radiological verifiable fractures 'SRVFs' (b), and indicators based on international (Global Burden of Disease) and Dutch disability weights).

Towards a comprehensive estimate of national spending on prevention.

Background: Comprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts.

Methods: National spending on health-related primary and secondary preventive activities was examined by funding source with the use of national statistics, government reports, sector reports, and data from individual health associations and corporations, public services, occupational health services, and personal prevention.

Human papillomavirus triage of women with persistent borderline or mildly dyskaryotic smears: Comparison of costs and side effects of three alternative strategies.

The conventional direct referral to colposcopy of persistent borderline or mildly dyskaryotic (BMD) smears in cervical cancer screening leads to considerable unnecessary referrals and associated anxiety and costs. This may be improved by including testing for oncogenic human papillomavirus (HPV) in the triage. We assessed costs and side effects (referrals, treatments and time in follow-up) for 3 possible HPV triage strategies (immediate HPV testing, a 6-month delay in HPV testing, a 2-stage combination of both) and compared them with the conventional strategy.

Individual differences in the use of the response scale determine valuations of hypothetical health states: an empirical study.

Background: The effects of socio-demographic characteristics of the respondent, including age, on valuation scores of hypothetical health states remain inconclusive. Therefore, we analyzed data from a study designed to discriminate between the effects of respondents' age and time preference on valuations of health states to gain insight in the contribution of individual response patterns to the variance in valuation scores.

Methods: A total of 212 respondents from three age groups valued the same six hypothetical health states using three different methods: a Visual Analogue Scale (VAS) and two variants of the Time trade-off (TTO).

Effectiveness of a back pain prevention program: a cluster randomized controlled trial in an occupational setting.

Study Design: A cluster randomized controlled trial and economic evaluation with a 12-month follow-up and with work department as the unit of randomization.

Objective: To evaluate the effectiveness of a prevention program for low back pain (LBP) in an occupational setting with an economic evaluation.

Summary Of Background Data: LBP accounts for high economic costs in Western societies.

Guidelines for the conduction of follow-up studies measuring injury-related disability.

Background: Scientific knowledge on functional outcome after injury is limited. During the past decade, a variety of measures have been used at various moments in different study populations. Guidelines are needed to increase comparability between studies.

Assessing the burden of injury in six European countries.

Objective: To assess injury-related mortality, disability and disability-adjusted life years (DALYs) in six European countries.

Methods: Epidemiological data (hospital discharge registers, emergency department registers, mortality databases) were obtained for Austria, Denmark, Ireland, Netherlands, Norway, and the United Kingdom (England and Wales). For each country, the burden of injury was estimated in years lost due to premature mortality (YLL), years lived with disability (YLD), and DALYs (per 1000 persons).

Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands.

Background: The collection of empirical data on the frequency, severity, and duration of functioning is a prerequisite to identify patient groups with long term or permanent disability.

Methods: We fielded postal questionnaires in a stratified sample of 8,564 injury patients aged 15 years and older, who had visited an emergency department in the Netherlands. Measurements were at 2.

Incidence and costs of injuries in The Netherlands.

Background: Injuries are a major and persistent public health problem, but a comprehensive and detailed overview of the economic burden is missing. We therefore estimated the number of emergency department (ED) attendances and health care costs as a result of injury.

Methods: We estimated lifetime health care costs of injuries occurring in The Netherlands in the year 1999.

Cost estimation of injury-related hospital admissions in 10 European countries.

Background: Injuries are a major cause of total health care costs. Cost estimations may help identify injuries and high risk-groups to be considered for potential intervention.

Methods: Hospital discharge registers of 10 European countries were used to estimate injury incidence.

Prevalence and prognostic factors of disability after childhood injury.

Objective: To assess the prevalence and the prognostic factors of disabilities after minor and major childhood injuries and to analyze which sociodemographic and injury-related factors are predictive for suboptimal functioning in the long term.

Method: We conducted a patient follow-up study in a stratified sample of 1221 injured children who were aged 5 to 14 years and had visited an emergency department in The Netherlands. Our study sample was stratified so that severe, less common injuries were overrepresented.

Reduced productivity after sickness absence due to musculoskeletal disorders and its relation to health outcomes.

Objectives: This prospective cohort study quantified the reduced productivity of workers on full duty after sickness absence from a musculoskeletal disorder and determined the effect of health parameters such as perceived pain, functional disability, and general health on reduced productivity.

Methods: Workers were included who were returning to work from 2- to 6-week sickness absence due to a musculoskeletal disorder. Self-administered questionnaires at baseline, after return to work, and at a 12-month follow-up were used to collect information on productivity and health status.

Societal discounting of health effects in cost-effectiveness analyses: the influence of life expectancy.

Background: Increasing life expectancy and decreasing marginal valuation of additional QALYs over time may serve as a basis for discounting future health effects from a societal perspective. Therefore, we tested the hypothesis that societal time preference for health is related to perceived future life expectancy.

Methods: A sample of 223 people from the general population prioritised healthcare programmes with differential timing of health benefits and costs from a societal perspective.

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.

A cross-national perspective on cost of illness: a comparison of studies from The Netherlands, Australia, Canada, Germany, United Kingdom, and Sweden.

All Western health systems are in search of efficiency. Cost of illness (COI) studies can contribute to the efficiency debate by elucidating the relation between health expenditure and health status and population demography. Since the purpose of COI data being summarized in the OECD Health Data publications is to facilitate cross-national comparisons, it is important to assess the comparability.

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.