Gezondheidseconomie: de sleutel tot gepaste zorg The Impact of economic evaluation on healthcare decision-making

Afscheidscollege Professor Frans Rutten op 4 oktober 2012. Gezondheidseconomie, ofwel ‘health economics’, is een fascinerend deel - terrein van de economie dat gemakkelijk 40 jaar lang kan boeien. Dat geldt zeker als je, zoals ik, bij de start en ontwikkeling ervan nauw betrokken bent geweest. Het vakgebied is in deze 40 jaar gegroeid van een onbeduidend wetenschapsgebied tot een belangrijke en relevante subdiscipline van de economie, gemeten naar zowel wetenschappelijke output als maatschappelijke impact (Wagstaff en Culyer 2012). De onderwerpen, die in de loop der tijd door gezondheidseconomen onder de loep zijn genomen, variëren van macro-vraagstukken over de ordening van de zorg tot de bepaling van de kosten en baten van individuele programma’s, en van vraagstukken in Europa en de VS tot die m.b.t. de zorg Afrika en Azië. Op al die terreinen spelen we in Rotterdam een voortrekkersrol, zoals ook blijkt uit het feit dat wij gemeten naar wetenschappelijke output het 11e instituut in de wereld zijn en het 2e in Europa

Kosten en effecten van esomeprazol in de behandeling van reflux ziekte

Doel. Het bepalen van de kosten-effectiviteit van esomeprazol (Nexium(r)) ten opzichte van alle andere in Nederland geregistreerde protonpomp remmers in de behandeling van reflux ziekte. Voor de effectiviteit vormt het hebben van voldoende controle over de symptomen het uitgangspunt. Perspectief. De studie is uitgevoerd zowel vanuit het perspectief van de verzekeraars als vanuit het maatschappelijk perspectief. Methoden. Gegevens met betrekking tot effectiviteit zijn afgeleid uit een systematische analyse van de literatuur. Gegevens omtrent zorgconsumptie zijn afkomstig uit interviews met huisartsen en gastro-enterologen. Een model is ontwikkeld, dat de gegevens over effectiviteit en kosten van behandeling bijeen brengt. De structuur van het model is vervolgens bediscussieerd met een panel van deskundigen. Tenslotte zijn de berekeningen uitgevoerd met het aangepaste model. Resultaten. Behandeling met esomeprazol 40 mg is dominant ten opzichte van de andere protonpomp remmers: 96,4% van de patiënten heeft na 8 weken voldoende controle over de klachten, tegen totale kosten van EUR 89 (maatschappelijk;m) / EUR 83 (verzekeraar;v). Na esomeprazol 40 mg is omeprazol 40 mg het meest effectief (95,2%), gevolgd door esomeprazol 20 mg (94%)

Economic appraisal of asthma and COPD care: A literature review 1980–1991

Despite the considerable burden and costs of illness and despite the increasing need to set priorities on the basis of efficiency considerations, only 20 economic appraisals of asthma and COPD care have been published during the past 11 years. This paper provides a detailed summary of the cost-effectiveness ‘evidence’ given by these studies and a discussion of relevant methodological issues. The studies comparing programme costs of delivery methods for oxygen and for aerosol bronchodilator drugs, provide the most straightforward evidence in favour of the concentrator and the metered dose inhaler respectively. There also seems to be evidence in favour of hospital-based home care programmes as compared to community-based home care programs. Health education, especially directed at asthmatic children seems to reduce health care costs and improve attitude, compliance behaviour and self-management skills. Information on the cost-effectiveness of pharmacotherapy and diagnostic technologies, both important interventions in asthma and COPD, was found to be totally lacking

Cost analysis and substitution of conventional treatment by autologous bone marrow transplantation for patients with (non) Hodgkin's lymphoma or acute myeloid leukemia

In a retrospective study we calculated the costs of introducing autologous BMT in the treatment of patients with malignant lymphoma and acute leukaemia in The Netherlands. The cost analysis has been performed in five university hospitals and one cancer centre, in a series of patients with intermediate and high grade non-Hodgkin's lymphoma (NHL) and patients with AML. Conventional treatment consisted of chemotherapy. The average costs of the conventional NHL treatment varied from US$3120 to U$12,900. The costs of autologous BMT amounted to US$40,220. In the AML group the costs of conventional treatment amounted to about US$11,040, as only 50% of the patients were treated further. The costs of autologous BMT including a follow-up period of 2 years, amounted to US$55,440. In The Netherlands the total number of autologous BMTs per year in these patient groups was estimated at 230; 180 in the NHL group and 50 in the AML group. The costs of introducing autologous BMT to the NHL group will vary between 4.93 and 6.68 million dollars and for the AML group these costs were estimated at 2.22 million dollars. As a result, the total extra costs of introducing autologous BMTs are expected to be between 7.15 and 8.9 million dollars

Integration of economic appraisal and health care policy in a health insurance system; The Dutch case

This article discusses the role of economic appraisal in insurance based health care systems, taking the case of the Netherlands as an example. The public health insurance system in this country is governed by the Health Insurance Executive Board, which policies are firmly based on the results of economic appraisal. Furthermore, reimbursement policies regarding pharmaceutical products are described, emphasizing again the position of information from economic appraisal in these policies. The article concludes with the identification of some trends in health policy and in the way it is supported by economic appraisal studies

Peripheral blood progenitor cell transplantation mobilised by r-metHuG-CSF (filgrastim); a less costly alternative to autologous bone marrow transplantation

In a retrospective study, we calculated the treatment costs of 63 patients who received either autologous bone marrow transplantation (ABMT) with recombinant human granulocyte colony-stimulating factor (r-metHuG-CSF) (filgrastim) (n=13) or without r-metHuG-CSF (n=22) or altenatively, peripheral blood progenitor cell (PBPC) transplantation mobilised by r-metHuG-CSF (n=28). The recovery of granulocytes, platelets and reticulocytes after PBPC was markedly accelerated as compared with ABMT with or without r-metHuG-CSF. The accelerated haematopoietic recovery was associated with a reduction in platelets and red blood cell transfusion requirements, with a reduction in episodes of fever and with earlier discharge from the hospital. This resulted in the average cost per treatment of the PBPC group being almost 30% lower than the treatment costs in the ABMT groups

Cost-effectiveness of DNA-diagnosis for four monogenic diseases

In this paper the costs and benefits associated with DNA-diagnosis of individuals who are at risk of a child with a monogenic disease and who seek genetic counselling because of their reproductive plans are predicted under various assumptions using a mathematical model. Four monogenic diseases have been considered: cystic fibrosis, Duchenne muscular dystrophy, myotonic dystrophy and fragile X syndrome. Counselling (triggered by prior information) on the basis of DNA-diagnosis is compared to the situation that only risk evaluation based on pedigree analysis is possible. The results show for each disease that with DNA-diagnosis couples can be more confident in choosing (further) offspring leading to the birth of more healthy children while the number of affected children is reduced. The costs minus savings within the health care sector depend on the prior risks and to the future burden of the monogenic illness considered. DNA-diagnosis of relative "low" prior risks of a child with CF (e.g. 1:180, 1:240 and 1:480) leads to costs in stead of savings. For higher prior risks of CF and for the three other diseases DNA-diagnosis induces considerable savings. This result remains valid when assumptions regarding behaviour regarding reproduction and receiving DNA-diagnosis under different circumstances are varied

Changes in costs and effects after the implementation of disease management programs in the Netherlands: Variability and determinants

__Abstract __ Objectives The aim of the study was to investigate the changes in costs and outcomes after the implementation of various disease management programs (DMPs), to identify their potential determinants, and to compare the costs and outcomes of different DMPs. Methods We investigated the 1-year changes in costs and effects of 1,322 patients in 16 DMPs for cardiovascular risk (CVR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DMII) in the Netherlands. We also explored the within-DMP predictors of these changes. Finally