Collection and use of EQ-5D for follow-up, decision-making, and quality improvement in health care - the case of the Swedish National Quality Registries

Background: The Swedish National Quality Registries (NQRs) contain individual-level health care data for specific patient populations, or patients receiving specific interventions. Approximately 90% of the 105 Swedish NQRs include any patient-reported outcome measure, with EQ-5D being the most common. As there has been no general overview of EQ-5D data within the NQRs, this study fills a knowledge gap by reporting how the data are collected, presented, and used at different levels of the Swedish health care system. Methods: All 46 NQRs with a license for the use of EQ-5D were included. Information was retrieved from the registries’ annual reports or from websites, using a template that was subsequently sent to eac

Buttock pain after sacrospinous hysteropexy: reply to Wallner

We greatly appreciate the comment by Dr. Wallner [1] on the new insight into the positioning of the pudendal and levator ani nerves in relation to the complaint of buttock pain after sacrospinous hysteropexy [2]

Is centralization of ovarian cancer care warranted? A cost-effectiveness analysis

Objective. To evaluate the cost-effectiveness of tertiary referral care for ovarian cancer patients in the Netherlands. Methods. We collected clinical and registry data on 1077 newly diagnosed ovarian cancer patients treated from 1996-2003 in a random sample of Dutch hospitals. Decision modelling was used to compare the cost-effectiveness of treatment in general hospitals, semi-specialized hospitals, and tertiary care centers. The actual direct medical costs of ovarian cancer treatment were evaluated. Long-term outcomes in terms of costs, quality-adjusted life-years (QALYs). and incremental costs per QALY gained were estimated. To assess uncertainty, multivariable sensitivity analyses and scenario analyses were performed. Results. Treatment of ovarian cancer patients in semi-specialized hospitals costs on average (sic)882 more than in general hospitals (95% confidence interval -720 to 2462) and yields 0.12 additional QALYs (95% CI 0.02 to 0.22), resulting in an incremental cost-effectiveness ratio (ICER) of (sic)7135. Patients treated in tertiary care centers incurred again higher costs ((sic)10,591, 95% CI 8757 to 12,480) and also higher QALYs (0.10, 95% CI 0 to 0.21), resulting in an ICER of (sic)102,642 compared to semi-specialized hospitals. If the optimal debulking rate in tertiary care centers would increase to 70%, costs could drop below (sic)30,000 per QALY. Conclusion. Current treatment of ovarian cancer patients in semi-specialized hospital settings is a cost-effective strategy, while treatment in tertiary care centers becomes only cost-effective when better surgical results would be achieved. (C) 2008 Elsevier Inc. All rights reserved

The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse

The objective of this study was to assess the effectiveness of sacrospinous ligament fixation of the uterus as a primary treatment of uterovaginal prolapse. In this observational study, 133 women underwent a sacrospinous hysteropexy. Data were obtained from their medical records, and standardized questionnaires about urogenital symptoms and quality of life were used. All women were invited for gynecological examination, using the Pelvic Organ Prolapse Quantification score. Ninety-nine women responded by returning the questionnaire (mean age, 59.2 and follow-up time, 22.5 months); 60 of these women underwent gynecologic examination. Eighty-four percent of women were highly satisfied about the outcome of the procedure. Serious complications were rare. The recurrence rate of descensus uteri that needed surgical treatment was 2.3%. The recurrence of cystoceles after surgery was 35%, but there were no differences in urogenital symptoms between women with or without a cystocele