12 research outputs found
Economic evaluation of end-stage renal disease treatment
One of the main functions of the human kidney is the clarification of blood from human
waste products, such as ureum and creatinine. Failure of functioning of the kidneys may
ultimately lead to death. When the stage of very limited kidney functioning (5 to 10% of
norm-al) is reached, renal replacement therapy becomes essential to survive. Chronic renal
replacement therapy has been available since the 1960s. At present, three major types of
renal :replacement therapy are available: haemodialysis, peritoneal dialysis and kidney transplantation.
With haemodialysis, the body is connected to an extracorporeal filter or dialyser, consisting
of a semipermeable membrane to which blood is taken and returned. This requires a
permanent artificial access to the body (a shunt, fistula or synthetic graft), that usually is created
in the forearm. Dialysis fluid, resembling blood plasma, is passed in the opposite direction
across the outside of the membrane. Waste products and excess water from the blood
diffuse into this dialysis fluid. Several forms of haemodialysis are available in the
Netherlands. Most patients receive full care centre haemodialysis which requires the patient
to travel to a dialysis centre, usually 3 times a week. The patient is attached to a dialysis
machine for 3-4 hours. Limited care or active centre haemodialysis is similar to full care centre
haemodialysis, but the patient takes active responsibility for the treatment, implying that
the majority of the (nursing) tasks involved are performed by the patient him/herself.
Another modality is home haemodialysis whereby the patient has all the necessary equipment
at home and takes active responsibility for the treatment; some help from a partner,
family member or nursing assistant is usually necessary
Chronically ill patients' preferences for a financial incentive in a lifestyle intervention. Results of a discrete choice experiment
Background
The preferences of diabetes type 2 patients and cardiovascular disease patients for a financial incentive added to a specified combined lifestyle intervention were investigated.
Methods
A discrete choice experiment questionnaire was filled out by 290 diabetes type 2 patients
(response rate 29.9%). Panel-mixed-logit models were used to estimate the preferences for
a financial incentive. Potential uptake rates of different financial incentives and relative
importance scores of the included attributes were estimated. Included attributes and levels
were: form of the incentive (cash money and different types of vouchers), value of the incentive (ranging from 15 to 100 euros), moment the incentive is received (start, halfway, after
finishing the intervention) and prerequisite for receiving the incentive (registration, attendance or results at group or individual level).
Results
Prerequisites for receiving the financial incentive were the most important attribute, according to the respondents. Potential uptake rates for different financial incentives ranged
between 37.9% and 58.8%. The latter uptake rate was associated with a financial incentive
consisting of cash money with a value of €100 that is handed out after completing the lifestyle program with the prerequisite that the participant attended at least 75% of the scheduled meetings.
Conclusions
The potential uptake of the different financial incentives varied between 37.9% and 58.8%.
The value of the incentive does not significantly influence the potential uptake. However, the potential uptake and associated potential effect of the financial incentive is influenced by the
type of financial incentive. The preferred type of incentive is €100 in cash money, awarded
after completing the lifestyle program if the participant attended at least 75% of the scheduled meetings
Valuing Healthcare Goods and Services: A Systematic Review and Meta-Analysis on the WTA-WTP Disparity
Objective: The objective of this systematic review was to review the available evidence on the disparity between willingness to accept (WTA) and willingness to pay (WTP) for healthcare goods and services. Methods: A tiered approach consisting of (1) a systematic review, (2) an aggregate data meta-analysis, and (3) an individual participant data meta-analysis was used. MEDLINE, EMBASE, Scopus, Scisearch, and Econlit were searched for articles reporting both WTA and WTP for healthcare goods and services. Individual participant data were requested from the authors of the included studies. Results: Thirteen papers, reporting WTA and WTP from 19 experiments/subgroups, were included in the review. The WTA/WTP ratios reported in these papers, varied from 0.60 to 4.01, with means of 1.73 (median 1.31) for 15 estimates of the mean and 1.58 (median 1.00) for nine estimates of the median. Individual data obtained from six papers, covering 71.2% of the subjects included in the review, yielded an unadjusted WTA/WTP ratio of 1.86 (95% confidence interval 1.52–2.28) and a WTA/WTP ratio adjusted for age, sex, and income of 1.70 (95% confidence interval 1.42–2.02). Income category and age had a statistically significant effect on the WTA/WTP ratio. The approach to handling zero WTA and WTP values has a considerable impact on the WTA/WTP ratio found. Conclusions and Implications: The results of this study imply that losses in healthcare goods and services are valued differently from gains (ratio > 1), but that the degree of disparity found depends on the method used to obtain the WTA/WTP ratio, including the approach to zero responses. Irrespective of the method used, the ratios found in our meta-analysis are smaller than the ratios found in previous meta-analyses
The effect of including an opt-out option in discrete choice experiments
Objective: to determine to what extent the inclusion of an opt-out option in a DCE may have an effect on choice behaviour and therefore might influence the attribute level estimates, the relative importance of the attributes and calculated tradeoffs.
Methods: 781 Dutch Type 2 Diabetes Mellitus patients completed a questionnaire containing nine choice tasks with an optout option and nice forced choice tasks. Mixed-logit models were used to estimate the relative importance of the five lifestyle program related attributes that were included. Willingness to pay (WTP) values were calculated and it was tested whether result
Consumers' preferences for freezing of meat to prevent toxoplasmosis- A stated preference approach.
Consumption of raw or undercooked meat increases the risk of infection with Toxoplasma gondii. Freezing meat
products can eliminate this risk. Freezing of meat may affect consumers' valuation of meat products in two
different ways: it may be valued positively because of increased food safety or valued negatively because of
(perceived) loss of quality. In a Discrete Choice Experiment on four different meat products we studied the
difference in willingness to pay for frozen and non-frozen meat products in the Netherlands. Analyses revealed
that most Dutch consumer groups prefer non-frozen meat. Price was important in consumer decisions, whereas
the meat being frozen appeared to play a minor role in the decision to purchase meat products.
Even though it may seem obvious that people would prefer safe food to unsafe food, in a context where
consumers presume food being safe, many consumers appear unwilling to pay for freezing of meat as additional
measure to reduce the risk of food borne infections such as toxoplasmosis
Exploring how individuals complete the choice tasks in a discrete choice experiment: An interview study
Background: To be able to make valid inferences on stated preference data from a Discrete Choice Experiment (DCE) it is essential that researchers know if participants were acti
Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates
Background: A large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008-2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16-29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future. Methods and Findings: We used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run. Conclusions: Decreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited
Age-related difference in health care use and costs of patients with chronic kidney disease and matched controls
_Background_ The financial burden of chronic kidney disease (CKD) is increasing due to the ageing population and increased prevalence of comorbid diseases. Our aim was to evaluate age-related differences in health care use and costs in Stage G4/G5 CKD without renal replacement therapy (RRT), dialysis and kidney transplant patients and compare them to the general population.
_Methods_ Using Dutch health care claims, we identified CKD patients and divided them into three groups: CKD Stage G4/G5 without RRT, dialysis and kidney transplantation. We matched them with two controls per patient. Total health care costs and hospital costs unrelated to CKD treatment are presented in four age categories (19–44, 45–64, 65–74 and ≥75 years).
_Results_ Overall, health care costs of CKD patients ≥75 years of age were lower than costs of patients 65–74 years of age. In dialysis patients, costs were highest in patients 45–64 years of age. Since costs of controls increased gradually with age, the cost ratio of patients versus controls was highest in young patients (19–44 years). CKD patients were in greater need of additional specialist care than the general population, which was already evident in young patients.
_Conclusion_ Already at a young age and in the earlier stages of CKD, patients are in need of additional care with corresponding health care costs far exceeding those of the general population. In contrast to the general population, the oldest patients (≥75 years) of all CKD patient groups have lower costs than patients 65–74 years of age, which is largely explained by lower hospital and medication costs
Healthcare costs of patients on different renal replacement modalities – Analysis of Dutch health insurance claims data
Background The aim of this study is to present average annual healthcare costs for Dutch renal replacement therapy (RRT) patients for 7 treatment modalities. Methods Health insurance claims data from 2012–2014 were used. All patients with a 2014 claim for dialysis or kidney transplantation were selected. The RRT related and RRT unrelated average annual healthcare costs were analysed for 5 dialysis modalities (in-centre haemodialysis (CHD), home haemodialysis (HHD), continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD) and multiple dialysis modalities in a year (Mix group)) and 2 transplant modalities (kidney from living and deceased donor, respectively). Results The total average annual healthcare costs in 2014 ranged from €77,566 (SD = €27,237) for CAPD patients to €105,833 (SD = €30,239) for patients in the Mix group. For all dialysis modalities, the vast majority (72–84%) of costs was RRT related. Patients on haemodialysis 4x/week had significantly higher average annual costs compared to those dialyzing 3x/ week (Δ€19,122). Costs for kidney transplant recipients were €85,127 (SD = €39,679) in the year of transplantation and rapidly declined in the first and second year after successful transplantation (resp. €29,612 (SD = €34,099) and €15,018 (SD = €16,186)). Transplantation with a deceased donor kidney resulted in higher costs (€99,450, SD = €36,036)) in the year of transplantation compared to a living donor kidney transplantation (€73,376, SD = €38,666). Conclusions CAPD patients have the lowest costs compared to other dialysis modalities. Costs in the year of transplantation are 25% lower for patients with kidneys from living vs. deceased donor. After successful transplantation, annual costs decline substantially to a level that is approximately 14–19% of annual dialysis costs
Health profiles and health preferences of dialysis patients
BACKGROUND: Health-related quality of life (HRQOL) of haemodialysis (HD)
and peritoneal dialysis (PD) patients has been assessed with health
profiles and health preferences methods. Few studies have used both types
of HRQOL instruments. The main objective of this study was to assess the
relationship between information from the two types of HRQOL instruments
in dialysis patients. METHODS: We interviewed 135 patients, using two
health profiles (Short Form 36 and EuroQol/EQ-5D) and two health
preferences methods (Standard Gamble and Time Trade Off).
Socio-demographic, clinical, and treatment-related background data were
collected from patient charts and during the interview. Relationships
between the outcome measures were assessed with Pearson correlation
coefficients. Multiple regression models were used to study the
relationship of HRQOL outcomes to background variables. RESULTS: The HRQOL
of dialysis patients as measured with health profiles was severely
impaired. The health preferences scores were higher (0.82-0.89) than
scores previously reported in the literature. Correlations between health
profiles and health preferences were poor to modest. HRQOL outcomes were
poorly explained by background characteristics. Differences between HD and
PD groups could not be demonstrated. CONCLUSIONS: Health profiles and
health preferences represent different aspects of HRQOL. An impaired
health status may not be reflected in the preference scores. Coping
strategies and other attitudes towards health may affect the preference
scores more than they influence health profile outcomes. The added value
of health preferences methods in clinical research is limited