When Time is Not on Your Side: Patient Experiences with Waiting for Home Care and Admission to a Nursing or Residential Home.

Background: Waiting for care is common in many countries as a result of supply-side rationing. The effects that waiting has on patients and their environment have not received much attention thus far. We discuss the literature and present the results of a study on patient experiences with waiting for home care or admission to a nursing or residential home.

Cost-effectiveness of varenicline compared with bupropion, NRT, and nortriptyline for smoking cessation in the Netherlands.

Objective: To examine the cost-effectiveness of varenicline, a new pharmacotherapy to support smoking cessation, compared with the currently available pharmacologic alternatives in the Netherlands.

Methods: The BENESCO-model was used to estimate the long-term health and economic benefits of smoking cessation for a cohort of smokers making a one-time quit attempt. The cohort represented the population of Dutch smokers with respect to gender, age, and prevalence of the smoking-related diseases included in the model: COPD, lung cancer, CHD, stroke, and asthma exacerbations.

Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD).

Background: The impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown.

Objective: The aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers.

Study Design: We selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD.

Cost consequences of implementing an electronic decision support system for ordering laboratory tests in primary care: evidence from a controlled prospective study in the Netherlands.

Background: The economic consequences of interventions to promote rational, evidence-based use of laboratory tests by physicians are not yet fully understood. We evaluated the cost consequences of a computer-based, guideline-driven decision-support system (CDSS) for ordering blood tests in primary care.

Methods: We installed the CDSS in 118 practices [159 general practitioners (GPs)] throughout The Netherlands and calculated the costs of the intervention in this group.

Does quality of life of COPD patients as measured by the generic EuroQol five-dimension questionnaire differentiate between COPD severity stages?

Objective: To assess the discriminative properties of the EuroQol five-dimension questionnaire (EQ-5D) with respect to COPD severity according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria in a large multinational study.

Methods: Baseline EQ-5D visual analog scale (VAS) scores, EQ-5D utility scores, and St. George Respiratory Questionnaire scores were obtained from a subset of patients in the Understanding the Potential Long-term Impact on Function with Tiotropium trial, which was a 4-year placebo-controlled trial designed to assess the effect of tiotropium on the rate of decline in FEV(1) in COPD patients aged > or = 40 years, an FEV(1) of < 70% predicted, an FEV(1)/FVC ratio of < or = 70%, and a smoking history of >/= 10 pack-years.

"Everyone dies, so you might as well have fun!" Attitudes of Dutch youths about their health lifestyle.

Most Western societies seem to have embarked on a runaway weight-gain train, equipped with too many accelerators and not enough brakes. Adolescents have been identified as a public health risk group in this area. To uncover youths' attitudes about their health lifestyle, with a focus on overweightness, we conducted a discourse analysis using Q-methodology.

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.

Cost-effectiveness analyses of diagnostic strategies: a literature survey using the NHS Economic Evaluation Database.

The aim of this study was to examine the methods used in published cost-effectiveness analyses of diagnostic strategies and to explore possible changes in methodology over time. A literature survey was conducted by identifying cost-effectiveness analyses found in the UK NHS Economic Evaluation Database. Only full economic evaluations involving diagnostic strategies as the type of intervention were included.

Respite care--an explorative study of demand and use in Dutch informal caregivers.

Recently, there has been increasing concern for the well-being of informal caregivers. Attention is directed at the development of respite care programs that provide support and relief by (temporarily) easing the burden for the caregiver. Yet, little is known about caregivers' needs, desires and use of respite care facilities.

Medical consumption and costs during a one-year follow-up of patients with LUTS suggestive of BPH in six european countries: report of the TRIUMPH study.

Objective: To determine the medical consumption and associated treatment costs of patients with LUTS suggestive of BPH.

Methods: A prospective, cross-sectional, observational survey in six European countries: France, Germany, Italy, Poland, Spain and the United Kingdom, with a one-year follow-up of incident and prevalent patients.

Results: Treatment costs were estimated for 5,057 patients with a mean age of 66 years and a mean IPSS score at inclusion of 11.

Cost effectiveness analysis of strategies for tuberculosis control in developing countries.

Objective: To assess the costs and health effects of tuberculosis control interventions in Africa and South East Asia in the context of the millennium development goals.

Design: Cost effectiveness analysis based on an epidemiological model.

Setting: Analyses undertaken for two regions classified by WHO according to their epidemiological grouping-Afr-E, countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, countries in South East Asia with high adult and high child mortality.

Equity in health care prioritisation: an empirical inquiry into social value.

The value of QALY gains for different patients may be recalculated using equity weights, but it is unclear which interpretation of equity should be used: severity of illness, fair innings or proportional shortfall. We set up an experiment to analyze which of these equity concepts best reflects people's distributional preferences. Sixty respondents assigned a priority rank to the treatment of 10 conditions using the paired comparison technique.

A dynamic population model of disease progression in COPD.

To contribute to evidence-based policy making, a dynamic Dutch population model of chronic obstructive pulmonary disease (COPD) progression was developed. The model projects incidence, prevalence, mortality, progression and costs of diagnosed COPD by the Global Initiative for Chronic Obstructive Lung Disease-severity stage for 2000-2025, taking into account population dynamics and changes in smoking prevalence over time. It was estimated that of all diagnosed COPD patients in 2000, 27% had mild, 55% moderate, 15% severe and 3% very severe COPD.

Cost-effectiveness of integrated stroke services.

Background: Randomized trials have shown that integrating services for acute stroke care may lead to organizational improvements, higher efficiency and better patient outcomes in the acute phase.

Aim: To compare the costs and effects of stroke services in an experimental group of patients compared to a group of patients receiving conventional care.

Design: Prospective non-randomized controlled trial.

PRODISQ: a modular questionnaire on productivity and disease for economic evaluation studies.

Productivity costs are often an important cost component in economic evaluations of healthcare programs. However, there still remains a low degree of consensus on the exact measurement and valuation of these productivity costs. The development and testing of valid measurement instruments in patient and worker populations may give researchers better tools to perform economic evaluations.

Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden.

Objective: To compare the feasibility, convergent and clinical validity of three commonly used burden scales: Caregiver Strain Index (CSI), Caregiver Reaction Assessment (CRA) and Sense of Competence Questionnaire (SCQ), with a self-developed single question on self-rated burden (SRB).

Subjects: Stroke patients receiving support from an informal caregiver (n = 148) and their caregivers were followed up to six months after stroke.

Intervention: Feasibility was assessed with several measures of missing values.

Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services.

BACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care.

['Necessity' determined on the basis of disease severity when prioritising health care interventions].

In the Netherlands, the Priorities in Healthcare [Keuzen in de Zorg] Committee proposed that the prioritisation of healthcare interventions should in part be based on the criterion 'necessity'. However, this criterion has hardly ever been used. It was proposed that 'necessity' should be defined in terms of disease severity.

The cost-effectiveness of treatment for congenital diaphragmatic hernia.

Background/purpose: The cost-effectiveness of medical interventions is becoming an important issue for decision makers. Until recently, evidence of the cost-effectiveness of neonatal surgery was largely lacking. The authors analyzed the cost-effectiveness of neonatal surgery and subsequent treatment for congenital diaphragmatic hernia (CDH).

Resource consumption and costs in Dutch patients with type 2 diabetes mellitus. Results from 29 general practices.

Aims: The aims of this study were to estimate the costs incurred by Dutch patients with Type 2 diabetes, examine which patient and/or treatment characteristics are associated with costs, and estimate the medical and non-medical costs of patients with Type 2 diabetes in The Netherlands.

Methods: Twenty-nine Dutch general practitioners provided information on all Type 2 diabetes patients in their practice (n = 1371), information on demography, clinical characteristics, treatment type, the presence of complications and the type and amount of medical consumption during the previous 6 months. Medical costs were analysed using multivariate linear regression.

Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes.

Objective: To estimate the health-related quality of life (HRQOL) and treatment satisfaction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associated with quality of life and treatment satisfaction.

Research Design And Methods: For a sample of 1,348 type 2 diabetes patients, recruited by 29 general practitioners, we collected data regarding HRQOL. This study was performed as part of a larger European study (Cost of Diabetes in Europe - Type 2 [CODE-2]).

The cost-effectiveness of neonatal surgery and subsequent treatment for congenital anorectal malformations.

Background/purpose: The progress made in all fields of medicine, including neonatal surgery, has contributed to the rise in healthcare costs. Although neonatal surgery may provide survival gains, these could be at the expense of worse quality of life caused by impairment after surgery. For example, congenital anorectal malformations (CAM) are complex anomalies, and the surgical techniques available have their limitations in achieving continence.

Performance of the EuroQol in children with imperforate anus.

Objective: To investigate the feasibility and validity of a proxy version of the EuroQol in children treated for imperforate anus.

Methods: Patients included were between 1 and 51 years of age. Instruments included were the EuroQol, the TACQOL and a disease specific questionnaire, the Langemeijer Stool Questionnaire.

[Model of costs of care for dementia: community-dwelling vs. institutionalization].

This article describes a model of costs for Alzheimer's Disease. The cost of institutionalization and the cost of living at home for patients with Alzheimer's Disease are calculated and compared. The average yearly cost of living at home is 10,810 Dutch guilders for male patients and 12,771 Dutch guilders for female patients (prices of 1996).

Estimating parametric relationships between health description and health valuation with an application to the EuroQol EQ-5D.

Generic health status measures classify patients into different health states. For example, the EQ-5D descriptive system developed by the EuroQol Group classifies patients into 243 health states. Empirical values for the health states are available for only a selection (mostly 12 to 45) of these health states.