In the Netherlands, the healthcare expenditures have increased rapidly over the last decades. The care for mental disorders and hospital care account for most of the healthcare expenditures. It is essential that policy makers reimburse interventions that maximize health gain at the lowest possible costs because the resources in healthcare are limited. Consequently, choices between treatment alternatives have to be made.
This thesis explores the utilization of Health Technology Assessment (HTA) in the field of injury, mental healthcare and prevention with the aim of investigating the cost-effectiveness of interventions and improving the methodology of health-related quality of life (HRQOL) measurement in these fields.
The focus of the first part of the thesis was the systematic collection and quality appraisal of cost-effectiveness evidence for interventions in (preventive) healthcare. We aimed to review the cost-effectiveness of interventions for anxiety disorders and falls prevention and to assess the methodological quality of the studies. We showed that combining the available health-economic evidence provided by individual studies helps identifying which type of interventions for anxiety disorders and falls prevention are the most cost-effective. Considerable methodological variation existed between the published cost-effectiveness studies within these fields, which hampered comparison of the results. We therefore showed the importance of designing, conducting, and reporting cost-effectiveness studies in conformity with the current health-economic guidelines in order to increase the quality of the health-economic evidence and the comparability between studies.
In the second part of the thesis, we used health-economic modeling techniques to calculate the cost-effectiveness of different preventive interventions and to examine and value the uncertainty surrounding the cost-effectiveness estimates. The financial risk of choosing an intervention given the current decision uncertainty was quantified using value of information analysis. These values strongly depended on the perspective of the cost-effectiveness analysis.
In the third part of the thesis the value of alternative approaches for measuring HRQOL in injury patients by means of the EQ-5D-3L questionnaire was investigated. We showed that the addition of the cognition dimension increased the explanatory power of the EQ-5D-3L among injury patients. Although the increase in explanatory power was relatively small after the cognition dimension was added, the decrease of HRQOL (measured with the EQ-VAS) resulting from cognitive problems was comparable to the decreases resulting from other EQ-5D dimensions. More research is needed to justify the addition of a cognitive dimension to the EQ-5D-3L questionnaire among injury patients.This thesis explores the utilization of HTA in the field of injury, mental healthcare and prevention with the aim of i
