Expansion in markets with decreasing demand-for-profits in the German hospital industry.

Over the last 20 years, acute-care hospitals in most OECD countries have built up costly overcapacities. From the perspective of economic policy, it is desirable to know how hospitals of different ownership forms respond to changes in demand and are probably best suited to deal with existing overcapacities. This article examines ownership-specific differences in the responsiveness to changes in demand for hospital services in Germany between 1996 and 2006.

Using threshold values for cost per quality-adjusted life-year gained in healthcare decisions.

Background: In many countries, the incremental cost-effectiveness ratio (ICER) is used to assess whether an intervention is worth its costs. At the same time, policy makers often feel uncomfortable with refusing reimbursement of any intervention purely on the basis of the fact that the ICER exceeds a specific threshold value. Reluctance to define a single threshold value for the ICER seems to have been stronger in social security systems than in national healthcare services systems.

Challenges in physician supply planning: the case of Belgium.

Introduction: Planning human resources for health (HRH) is a complex process for policy-makers and, as a result, many countries worldwide swing from surplus to shortage. In-depth case studies can help appraising the challenges encountered and the solutions implemented. This paper has two objectives: to identify the key challenges in HRH planning in Belgium and to formulate recommendations for an effective HRH planning, on the basis of the Belgian case study and lessons drawn from an international benchmarking.

Does tiotropium lower exacerbation and hospitalization frequency in COPD patients: results of a meta-analysis.

Background: International guidelines recommend long-acting bronchodilators in patients who remain symptomatic despite adequate treatment with short-acting bronchodilators. The purpose of this study is to estimate the effect of tiotropium, a long-acting anticholinergic inhalant, on exacerbation and hospitalisation frequency.

Methods: Electronic databases (Medline, Embase, INAHTA, CRD databases, and the Cochrane Library) were searched for randomised controlled trials, comparing tiotropium to placebo, or other bronchodilators.

Tiotropium's cost-effectiveness for the treatment of COPD: a cost-utility analysis under real-world conditions.

Background: Tiotropium is reimbursed since March 2004 in Belgium for the treatment of Chronic Obstructive Pulmonary Disease (COPD). Questions however remain on this product's value for money. The purpose of this study is to calculate tiotropium's cost-effectiveness under real-world conditions.

Belgian methodological guidelines for pharmacoeconomic evaluations: toward standardization of drug reimbursement requests.

Objective: To develop methodological guidelines for pharmacoeconomic evaluation (PE) submitted to the Belgian Drug Reimbursement Committee as part of a drug reimbursement request.

Methods: In 2006, preliminary pharmacoeconomic guidelines were developed by a multidisciplinary research team. Their feasibility was tested and discussed with all stakeholders.

Cost-effectiveness of human papillomavirus vaccination in Belgium: do not forget about cervical cancer screening.

Objectives: The cost-effectiveness of adding a human papillomavirus (HPV) vaccination program in 12-year-old females to the recommended cervical cancer screening in Belgium is examined. Moreover, the health and economic consequences of a potential decline in screening uptake after initiation of a HPV vaccination program are investigated.

Methods: A static Markov model is developed to estimate the direct effect of vaccination on precancerous lesions and cervical cancers.

Cost-effectiveness of statins in the primary prevention of cardiovascular disease: a systematic review and economic analysis for Belgium.

Objectives: 8% of total drug spending by the Belgian government goes to statins. The aim of this study is to determine the cost-effectiveness of statins for the primary prevention of cardiovascular disease (CVD) in middle-aged Belgian populations.

Methods And Results: Economic evaluations were identified in a systematic literature search and were critically appraised.

Measuring appropriate use of antibiotics in pyelonephritis in Belgian hospitals.

Inappropriate use of antibiotics can induce antibiotic resistance, treatment failure, increased costs and even mortality. We developed a methodology for measuring guideline compliance of hospital antibiotic prescriptions in community-acquired acute pyelonephritis in Belgium. The claims and clinical data of all Belgian hospitalizations for community-acquired acute pyelonephritis were extracted from a nationwide administrative database.

Cost-effectiveness analyses of drug eluting stents versus bare metal stents: a systematic review of the literature.

Objectives: Drug eluting stents (DES) used to treat coronary lesions reduce rates of in-stent restenosis and therefore the need for repeat revascularization compared to bare metal stents (BMS). DES, however, are considerably more expensive than BMS. We evaluated whether DES are a cost-effective alternative for BMS.

Methodology for calculating a country's need for positron emission tomography scanners.

Objectives: The aim of this study was to develop a methodology for calculating the need for positron emission tomography (PET) scanners in a country and illustrate this methodology for Belgium.

Methods: First, levels of evidence were assigned to PET in different indications according to a standard hierarchical classification system. The level reached depends on whether there is evidence on diagnostic accuracy, impact on diagnostic thinking, therapeutic impact, impact on patient outcomes, or cost-effectiveness.

Trastuzumab in early stage breast cancer: a cost-effectiveness analysis for Belgium.

Objectives: Although trastuzumab is traditionally used in metastatic breast cancer treatment, studies reported on the efficacy and safety of trastuzumab in adjuvant setting for the treatment of early stage breast cancer in HER2+ tumors. We estimated the cost-effectiveness and budget impact of reimbursing trastuzumab in this indication from a payer's perspective.

Methods: We constructed a health economic model.

Measuring patient-reported outcomes in solid organ transplant recipients: an overview of instruments developed to date.

Improvements in organ preservation methods, immunosuppressive regimens and general post-transplant care have resulted in an increased life expectancy and a continually decreasing morbidity after solid organ transplantation. As attention gradually moves towards improving subjective patient outcomes, the use of patient-reported outcome measures (PROs) thus becomes increasingly important in post-transplant patient management. This paper provides a brief systematic overview of the transplant-specific PRO measures, and their psychometric properties, developed and used in solid organ transplant recipients to date.

More is not better in the early care of acute myocardial infarction: a prospective cohort analysis on administrative databases.

Aims: To assess the outcome and costs of patients with acute myocardial infarction (AMI) after initial admission to hospitals with or without catheterization facilities in Belgium.

Methods And Results: From a nationwide hospital register, we retrieved the data of 34 961 patients discharged during 1999-2001 with a principal diagnosis of AMI. They were initially admitted to hospitals without catheterization facilities (A), with diagnostic (B1) or interventional catheterization facilities (B2).