Cost of illness in the Netherlands

Health care professionals, policy makers and politicians have urgent needs for systematic information about national health care expenditure. The study Cost of Illness in the Netherlands has been performed for the third time and presents information about the relationship between health care use, measured as costs, and what matters most: the health of the population. Previous studies reported cost of illness estimates for the years 1988 en 1994. This study provides a comprehensive overview of Dutch health care costs in 1999. Total health care costs were attributed to health care sectors and providers, diseases, age groups and gender. The results of this analysis can be used for answering questions such as: 'On what type of health care do we spend our money?' And: 'how are these costs distributed among various illnesses and diseases?' But also: 'how much money do we need for healthcare in the future and for resolving waiting lists?' Researchers and policy makers may use the information of this study as a tool to explore the desired future characteristics and volumes of the Dutch health care system.In Nederland werd in 1999 ongeveer 36 miljard euro aan gezondheidszorg uitgegeven. Dat bedrag zal de komende jaren stijgen onder invloed van toenemende medische mogelijkheden en de vergrijzing van de bevolking. Om vast te stellen of al dat geld zo goed mogelijk wordt besteed, moet eerst bekend zijn waar dat geld precies aan wordt besteed. Dit rapport geeft een antwoord op die laatste vraag. Beschreven wordt hoe het zorggebruik van de Nederlandse gezondheidszorg in 1999 was verdeeld over ziekten, mannen en vrouwen, verschillende leeftijdsgroepen en zorgsectoren. Ook wordt beschreven hoe de kosten van de gezondheidszorg zich in de afgelopen jaren hebben ontwikkeld, en hoe zij zich in de toekomst naar verwachting zullen ontwikkelen. In dit rapport wordt tevens een eerste aanzet gegeven om de kosten ook te verdelen naar risicofactoren achter de ziekten. Verder wordt een vergelijking gemaakt met andere kosten van ziektenstudies uit binnen- en buitenland. Voor de interpretatie van verschillen tussen KVZ-cijfers wordt een algemene checklist van 10 punten gepresenteerd. Tenslotte worden de uitkomsten in een breder perspectief geplaatst door een vergelijking van de kosten met andere gevolgen van ziekte zoals sterfte, ziekteverzuim en arbeidsongeschiktheid

Принципи управління персоналом сільськогосподарських підприємств (на прикладі Луганської області)

У статті проаналізовано сучасний стан сільськогосподарського виробництва в Луганській області та здійснена оцінка перспектив реформування управління персоналом на підприємствах АПК. Регресійним аналізом оцінено ступінь впливу деяких факторів на рентабельність персоналу. Рекомендується використання SWOT-аналізу для дослідження й формування раціонального управління персоналом підприємств АПК.Performed analysis of the current state of agriculture in the Luhansk region, evaluated the prospects for personnel resources reforming for the agricultural enterprises. The degree of factors influencing on profitability of personnel is appraised by the regressive analysis. SWOT-analysis is recommended for research and forming of agrarian enterprises rational management of a personnel

Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design: The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term. Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion: We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration: ISRCTN: ISRCTN5871969

The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998–1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by €4040 in women, and by €4100 in men. Of these, €660 in women, and €890 in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately €4000. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications

Effect of anticoagulants on 162 circulating immune related proteins in healthy subjects

Diagnosis of complex disease and response to treatment is often associated with multiple indicators, both clinical and laboratorial. With the use of biomarkers, various mechanisms have been unraveled which can lead to better and faster diagnosis, predicting and monitoring of response to treatment and new drug development. With the introduction of multiplex technology for immunoassays and the growing awareness of the role of immune-monitoring during new therapeutic interventions it is now possible to test large numbers of soluble mediators in small sample volumes. However, standardization of sample collection and laboratory assessments remains suboptimal. We developed a multiplex immunoassay for detection of 162 immune related proteins in human serum and plasma. The assay was split in panels depending on natural occurring concentrations with a maximum of 60 proteins. The aim of this study was to evaluate precision, accuracy, reproducibility and stability of proteins when repeated freeze-thaw cycles are performed of this in-house developed panel, as well as assessing the protein signature in plasma and serum using various anticoagulants. Intra-assay variance of each mediator was <10%. Inter-assay variance ranged between 1.6 and 37% with an average of 12.2%. Recoveries were similar for all mediators (mean 99.8 ± 2.6%) with a range between 89-107%. Next we measured all mediators in serum, EDTA plasma and sodium heparin plasma of 43 healthy control donors. Of these markers only 19 showed similar expression profiles in the 3 different matrixes. Only 5 mediators were effected by multiple freeze-thawing cycles. Principal component analysis revealed different coagulants cluster separately and that sodium heparin shows the most consistent profile

The effect of comorbidity on health-related quality of life for injury patients in the first year following injury: comparison of three comorbidity adjustment approaches

Background: Three approaches exist to deal with the impact of comorbidity in burden of disease studies - the maximum limit approach, the additive approach, and the multiplicative approach. The aim of this study was to compare the three comorbidity approaches in patients with temporary injury consequences as well as comorbid chronic conditions with nontrivial health impacts.Methods: Disability weights were assessed using data from the EQ-5D instrument developed by the EuroQol Group and derived from a postal survey among 2,295 injury patients at 2.5 and 9 months after being treated at an emergency department. We compared the observed and predicted EQ-5D disability weights in comorbid case

The importance of job control for workers with decreased work ability to remain productive at work

Purpose: Workers with decreased work ability are at greater risk of reduced productivity at work. We hypothesized that work-related characteristics play an important role in supporting workers to remain productive despite decreased work ability. Methods: The study population consisted of 10,542 workers in 49 different companies in the Netherlands in 2005-2009. Productivity loss at work was defined on a 10-point scale by asking how much work was actually performed during regular hours on the last regular workday when compared with normal. Independent variables in the logistic regression analysis were individual characteristics, work-related factors, and the work ability index. Additive interactions between work-related factors and decreased work ability were evaluated by the relative excess risk due to interaction (RERI). Results: The odds ratios and 95% confidence intervals (CI) for the likelihood of productivity loss at work were 2.03 (1.85-2.22), 3.50 (3.10-3.95), and 5.54 (4.37-7.03) for a good, moderate, and poor work ability, compared with an excellent work ability (reference group). Productivity loss at work was associated with lack of job control, poor skill discretion, and high work demands. There was a significant interaction between decreased work ability and lack of job control (RERI = 0.63 95% CI 0.11-1.16) with productivity loss at work. Conclusion: The negative effects on work performance of decreased work ability may be partly counterbalanced by increased job control. This suggests that interventions among workers with (chronic) disease that cause a decreased work ability should include enlargement of possibilities to plan and pace their own activities at work