Centrale database voor diertransporten; Voor- en nadelen in de praktijk

EL&I heeft aan het LEI gevraagd inzicht te geven in de voor- en nadelen van het centraal vastleggen van gegevens over het transport van dieren volgens transportondernemers en andere betrokken marktpartijen. De Tweede Kamer dringt aan op een strengere handhaving van de huidige regelgeving met de inzet van moderne hulpmiddelen. Bij het vaststellen van de voor- en nadelen is gekeken naar de administratieve lasten voor transportbedrijven en de overheid, het toezicht door de overheid, de aansluiting met de I&R-regeling en de aansluiting met private kwaliteitssystemen zoals QLL voor transport van levende dieren. Vooral met telefonische enquêtes is aanvullend informatie verzameld bij transportbedrijven, hun brancheorganisaties, slachterijen, boeren en de NVWA

The effect of Food Assistance on Adherence to Antiretroviral Therapy among HIV/AIDS Patients in Sofala Province, in Mozambique: A Retrospective Study

Contains fulltext : 117779.pdf (publisher's version ) (Open Access

UK Public Sector Information and Re-use Policy – A 2008 Analysis

INTRODUCTION: Earlier antiretroviral therapy (ART) initiation reduces HIV-1 incidence. This benefit may be offset by increased transmitted drug resistance (TDR), which could limit future HIV treatment options. We analyze the epidemiological impact and cost-effectiveness of strategies to reduce TDR. METHODS: We develop a deterministic mathematical model representing Kampala, Uganda, to predict the prevalence of TDR over a 10-year period. We then compare the impact on TDR and cost-effectiveness of: (1) introduction of pre-therapy genotyping; (2) doubling use of second-line treatment to 80% (50-90%) of patients with confirmed virological failure on first-line ART; and (3) increasing viral load monitoring from yearly to twice yearly. An intervention can be considered cost-effective if it costs less than three times the gross domestic product per capita per quality adjusted life year (QALY) gained, or less than $3420 in Uganda. RESULTS: The prevalence of TDR is predicted to rise from 6.7$1612 to $2234 (IQR$450-dominated) per QALY gained. CONCLUSIONS: While earlier treatment initiation will result in a predicted increase in the proportion of patients infected with drug-resistant HIV, the absolute numbers of patients infected with drug-resistant HIV is predicted to decrease. Increasing use of second-line treatment to all patients with confirmed failure on first-line therapy is a cost-effective approach to reduce TDR. Improving access to second-line ART is therefore a major priority

Costs of providing food assistance to HIV/AIDS patients in Sofala province, Mozambique: a retrospective analysis

Contains fulltext : 125290.pdf (publisher's version ) (Open Access)BACKGROUND: As care and antiretroviral treatment (ART) for people living with HIV/AIDS become widely available, the number of people accessing these resources also increases. Despite this exceptional progress, the estimated coverage in low- and middle-income countries is still less than half of all people who need treatment. In addition, treatment discontinuation and non-adherence are still concerns for ART programs. Governments and partner institutions have sought to implement a variety of interventions addressing the main reasons behind the low coverage of, discontinuation of, and non-adherence to ART. Food assistance is one of those interventions; increasing evidence suggests that this type of intervention has the potential to improve ART outcomes. However, to our knowledge, no study has estimated its costs in detail. The objective of this study was to assess the costs of a program providing food assistance to HIV/AIDS patients in Sofala province, Mozambique, in 2009. METHODS: We performed a retrospective analysis of the costs of providing food assistance, based on financial and economic costs. We used the ingredients approach to estimate costs, which involved multiplying the total estimated quantities of goods and services actually employed in providing the intervention by their respective unit prices. RESULTS: In 2009, the cost of providing food assistance to HIV/AIDS patients was $2.27 million, with capital and recurrent costs accounting for 1$288 over 3 months. CONCLUSION: The food distribution program carries significant costs. To assess whether it provides value for money, the present study results should be interpreted in conjunction with the program's impact, and in comparison with other programs that aim to improve adherence to ART. Our costing analysis revealed important management information, indicating that the program incurred relatively large overhead costs. This result raises questions regarding the efficiency of implementing this food distribution program

Cost effectiveness of strategies to combat vision and hearing loss in sub-Saharan Africa and South East Asia: mathematical modelling study.

OBJECTIVE: To determine the relative costs, effects, and cost effectiveness of selected interventions to control cataract, trachoma, refractive error, hearing loss, meningitis and chronic otitis media. DESIGN: Cost effectiveness analysis of or combined strategies for controlling vision and hearing loss by means of a lifetime population model. SETTING: Two World Health Organization sub-regions of the world where vision and hearing loss are major burdens: sub-Saharan Africa and South East Asia. DATA SOURCES: Biological and behavioural parameters from clinical and observational studies and population based surveys. Intervention effects and resource inputs based on published reports, expert opinion, and the WHO-CHOICE database. MAIN OUTCOME MEASURES: Cost per disability adjusted life year (DALY) averted, expressed in international dollars ($Int) for the year 2005. RESULTS : Treatment of chronic otitis media, extracapsular cataract surgery, trichiasis surgery, treatment for meningitis, and annual screening of schoolchildren for refractive error are among the most cost effective interventions to control hearing and vision impairment, with the cost per DALY averted <$Int285 in both regions. Screening of both schoolchildren (annually) and adults (every five years) for hearing loss costs around $Int1000 per DALY averted. These interventions can be considered highly cost effective. Mass treatment with azithromycin to control trachoma can be considered cost effective in the African but not the South East Asian sub-region. CONCLUSIONS : Vision and hearing impairment control interventions are generally cost effective. To decide whether substantial investments in these interventions is warranted, this finding should be considered in relation to the economic attractiveness of other, existing or new, interventions in health

Costs of providing food assistance to HIV/AIDS patients in Sofala province, Mozambique: a retrospective analysis

BACKGROUND: As care and antiretroviral treatment (ART) for people living with HIV/AIDS become widely available, the number of people accessing these resources also increases. Despite this exceptional progress, the estimated coverage in low- and middle-income countries is still less than half of all people who need treatment. In addition, treatment discontinuation and non-adherence are still concerns for ART programs. Governments and partner institutions have sought to implement a variety of interventions addressing the main reasons behind the low coverage of, discontinuation of, and non-adherence to ART. Food assistance is one of those interventions; increasing evidence suggests that this type of intervention has the potential to improve ART outcomes. However, to our knowledge, no study has estimated its costs in detail. The objective of this study was to assess the costs of a program providing food assistance to HIV/AIDS patients in Sofala province, Mozambique, in 2009. METHODS: We performed a retrospective analysis of the costs of providing food assistance, based on financial and economic costs. We used the ingredients approach to estimate costs, which involved multiplying the total estimated quantities of goods and services actually employed in providing the intervention by their respective unit prices. RESULTS: In 2009, the cost of providing food assistance to HIV/AIDS patients was $2.27 million, with capital and recurrent costs accounting for 1$288 over 3 months. CONCLUSION: The food distribution program carries significant costs. To assess whether it provides value for money, the present study results should be interpreted in conjunction with the program's impact, and in comparison with other programs that aim to improve adherence to ART. Our costing analysis revealed important management information, indicating that the program incurred relatively large overhead costs. This result raises questions regarding the efficiency of implementing this food distribution program

The Household Costs of Visceral Leishmaniasis Care in South-eastern Nepal

Contains fulltext : 117747.pdf (publisher's version ) (Open Access)BACKGROUND AND OBJECTIVES: Visceral leishmaniasis (VL) is an important public health problem in south-eastern Nepal affecting very poor rural communities. Since 2005, Nepal is involved in a regional initiative to eliminate VL. This study assessed the economic impact of VL on households and examined whether the intensified VL control efforts induced by the government resulted in a decrease in household costs. METHODS: Between August and September 2010, a household survey was conducted among 168 patients that had been treated for VL within 12 months prior to the survey in five districts in south-eastern Nepal. We collected data on health-seeking behaviour, direct and indirect costs and coping strategies. RESULTS: The median total cost of one episode of VL was US$ 165 or 11% of annual household income. The median delay between the onset of symptoms and presentation to a qualified provider was 25 days. Once the patient presented to a qualified provider, the delay to correct diagnosis was minimal (median 3 days). Direct and indirect costs (income losses) represented 47% and 53% of total costs respectively. Households used multiple strategies to cope with the cost of illness, mainly mobilizing cash/savings (71%) or taking a loan (56%). CONCLUSIONS: The provision of free VL diagnosis and drugs by the Nepalese control programme has been an important policy measure to reduce the cost of VL to households. But despite the free VL drugs, the economic burden is still important for households. More effort should be put into reducing indirect costs, in particular the length of treatment, and preventing the transmission of VL through vector control

Implementing evidence-informed deliberative processes in health technology assessment: a low income country perspective

Contains fulltext : 218280.pdf (Publisher’s version ) (Open Access)The purpose of this paper is to discuss the potential feasibility and utility of evidence-informed deliberative processes (EPDs) in low income country (LIC) contexts. EDPs are implemented in high and middle income countries and thought to improve the quality, consistency, and transparency of decisions informed by health technology assessment (HTA). Together these would ultimately improve the legitimacy of any decision making process. We argue-based on our previous work and in light of the priority setting literature-that EDPs are relevant and feasible within LICs. The extreme lack of resources necessitates making tough decisions which may mean depriving populations of potentially valuable health technologies. It is critical that the decisions and the decision making bodies are perceived as fair and legitimate by the people that are most affected by the decisions. EDPs are well aligned with the political infrastructure in some LICs, which encourages public participation in decision making. Furthermore, many countries are committed to evidence-informed decision making. However, the application of EDPs may be hampered by the limited availability of evidence of good quality, lack of interest in transparency and accountability (in some LICs), limited capacity to conduct HTA, as well as limited time and financial resources to invest in a deliberative process. While EDPs would potentially benefit many LICs, mitigating the identified potential barriers would strengthen their applicability. We believe that implementation studies in LICs, documenting the contextualized enablers and barriers will facilitate the development of context specific improvement strategies for EDPs

The impact of health insurance in Africa and Asia: a systematic review.

Contains fulltext : 109845.pdf (publisher's version ) (Open Access)OBJECTIVE: To evaluate the impact of health insurance on resource mobilization, financial protection, service utilization, quality of care, social inclusion and community empowerment in low- and lower-middle-income countries in Africa and Asia. METHODS: A systematic search for randomized controlled trials, quasi-experimental and observational studies published before the end of 2011 was conducted in 20 literature databases, reference lists of relevant studies, web sites and the grey literature. Study quality was assessed with a quality grading protocol. FINDINGS: Inclusion criteria were met by 159 studies - 68 in Africa and 91 in Asia. Most African studies reported on community-based health insurance (CBHI) and were of relatively high quality; social health insurance (SHI) studies were mostly Asian and of medium quality. Only one Asian study dealt with private health insurance (PHI). Most studies were observational; four had randomized controls and 20 had a quasi-experimental design. Financial protection, utilization and social inclusion were far more common subjects than resource mobilization, quality of care or community empowerment. Strong evidence shows that CBHI and SHI improve service utilization and protect members financially by reducing their out-of-pocket expenditure, and that CBHI improves resource mobilization too. Weak evidence points to a positive effect of both SHI and CBHI on quality of care and social inclusion. The effect of SHI and CBHI on community empowerment is inconclusive. Findings for PHI are inconclusive in all domains because of insufficient studies. CONCLUSION: Health insurance offers some protection against the detrimental effects of user fees and a promising avenue towards universal health-care coverage

The Dutch Citizen Forum on Public Reimbursement of Healthcare: A Qualitative Analysis of Opinion Change

BACKGROUND: A deliberative Citizen Forum 'Choices in healthcare' was held in the Netherlands to obtain insight into the criteria informed citizens would propose for the public reimbursement of healthcare. During 3 weekends, 24 citizens participated in evidence-informed deliberation on the basis of 8 case studies. The aim of this study was to assess how the opinions of 8 participants in the deliberative Citizens Forum changed and if so, why participants themselves believe their opinions have changed, whether participation influenced their perceived reasonableness of other participants in the forum and whether it influenced their opinions about involvement of citizens in decision-making. METHODS: Semi-structured interviews were held with 8 participants before and after their participation in the Citizen Forum. Using the method of reconstructing interpretive frames opinions about the public reimbursement of healthcare were reconstructed. RESULTS: Participants' opinions changed over time; they became more aware of the complexity of decision-making and came to accept that there are limits to the available resources and accept cost as a criterion for reimbursement decisionmaking. Participants report that exchanging arguments and personal experiences with other participants made them change their initial opinions. Participants ascribed increases in the perceived reasonableness of other participants' opinions to feelings of group-bonding and becoming more familiar with each other's personal circumstances. Participants further believe that citizens represent an additional opinion to that of other stakeholders and believe their opinions should be considered in relation to those of other stakeholders, given they are provided with opportunities for critical discussion. CONCLUSION: Organized deliberation should allow for the exchange of arguments and the sharing of personal experiences which is linked to learning. On the one hand this is reflected in the uptake of new arguments and on the other hand in the revision, specification or expansion of personal argumentation. Providing opportunities for critical deliberation is key to prevent citizens from adhering to initial emotional reactions that remain unchallenged and which may no longer be supported after deliberation