Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: a modeling study

Background: Counseling in combination with pedometer use has proven to be effective in increasing physical activity and improving health outcomes. We investigated the cost-effectiveness of this intervention targeted at one million insufficiently active adults who visit their general practitioner in the Netherlands.Methods: We used the RIVM chronic disease model to estimate the long-term effects of increased physical activity on the future health care costs and quality adjusted life years (QALY) gained, from a health care perspective.Results: The intervention resulted in almost 6000 people shifting to more favorable physical-activity levels, and in 5100 life years and 6100 QALYs gained, at an additional total cost of EUR 67.6 million. The incremental cost-effectiveness ratio (ICER) was EUR 13,200 per life year gained and EUR 11,100 per QALY gained. The intervention has a probability of 0.66 to be cost-effective if a QALY gained is valued at the Dutch informal threshold for cost-effectiveness of preventive intervention of EUR 20,000. A sensitivity analysis showed substantial uncertainty of ICER values.Conclusion: Counseling in combination with pedometer use aiming to increase physical activity may be a cost-effective intervention. However, the intervention only yields relatively small health benefits in the Netherlands

Cost of illness and disease burden in the Netherlands due to infections with Shiga toxin-producing Escherichia coli O157

Infections with Shiga toxin-producing Escherichia coli O157 (STEC O157) are associated with hemorrhagic colitis, hemolytic uremic syndrome (HUS), and end-stage renal disease (ESRD). In the present study, we extend previous estimates of the burden of disease associated with STEC O157 with estimates of the associated cost of illness in The Netherlands. A secondorder stochastic simulation model was used to calculate disease burden as disability-adjusted life years (DALYs) and cost of illness (including direct health care costs and indirect non-health care costs). Future burden and costs are presented undiscounted and discounted at annual percentages of 1.5 and 4%, respectively. Annually, approximately 2.100 persons per year experience symptoms of gastroenteritis, leading to 22 cases of HUS and 3 cases of ESRD. The disease burden at the population level was estimated at 133 DALYs (87 DALYs discounted) per year. Total annual undiscounted and discounted costs of illness due to STEC O157 infection for the Dutch society were estimated at €9.1 million and €4.5 million, respectively. Average lifetime undiscounted and discounted costs per case were both €126 for diarrheal illness, both €25,713 for HUS, and €2.76 million and €1.22 million, respectively, for ESRD. The undiscounted and discounted costs per case of diarrheal disease including sequelae were €4,132 and €2,131 , respectively. Compared with other foodborne pathogens, STEC O157 infections result in relatively low burden and low annual costs at the societal level, but the burden and costs per case are high

Infectious disease risks associated with occupational exposure: A systematic review of the literature

Employees in different types of work may be intentionally or accidentally exposed to biological agents. Improved risk assessment is needed to identify opportunities to prevent work-related infectious disease. The objective of the current study was to perform a systematic literature review of work-related infectious disease to assist in the identification of occupational infectious disease risks. A literature search of papers on work-related infectious disease published between 1999 and 2008 yielded 1239 papers of which 242 met the selection criteria and were included in the review. The results of the systematic literature review were arranged in a matrix of occupational groups and exposure pathways. Increased risk from infectious diseases appeared to be concentrated in specific professions. Healthcare workers, workers in contact with animals, laboratory workers and refuse workers seem to have the highest risk of infection by a variety of pathogens. However, pathogens reported to be associated with closely related professions were different, indicating qualitative under-reporting. Arranging the results of this systematic review on work-related infectious diseases in a matrix of occupational groups and exposure pathways allowed the reliable identification of exposure hazards for specific occupational groups beyond currently reported diseases

Khat chewing from the pharmacological point of view: an update

Khat chewing is deeply rooted in the every day life of people living in the Horn of Africa and in South Arabia, where Catha edulis is endemic. Considered little more than an exotic habit producing just mild pharmacological effects, systematic investigations on its active principles have instead lead to the isolation and chemical characterization of cathinone, a compound structurally related to amphetamine. Three decades of intense experimental and clinical research on khat have depicted a consistently clear picture of its pharmacological and toxicological effects