Context: Throughout Europe, the financial risks of health and long-term care are covered to varying degrees through models of national (health) insurance. Such insurance draws upon the principle of ...solidarity. Much is unknown on the solidarity-effects of reforms in national insurance schemes. Objective: To present an empirical analysis of the effects of recent reforms in national health insurance on solidarity in one country. Methods: We conducted a comparative analysis of the 2006 health care insurance reform and the 2015 long-term care insurance reform in the Netherlands. A multidimensional analytical framework of solidarity was developed to study the solidarity-effects of both reforms. Findings: Reforms of health care and long-term care insurance in the Netherlands had some solidarity effects, but they should not be overstated. We found evidence for increased and decreased solidarity. Health care insurance seems more ‘immune’ to reductions in solidarity than long-term care insurance. Limitations: The present case study involves reforms in the Netherlands. The solidarity framework is specifically designed for the study of solidarity-effects of reforms on national health and long-term care insurance. Effects on informal arrangements for care are beyond the scope of this study. More detailed and quantitative research is required to investigate how the reforms played out for specific groups, for instance the frail elderly, people with a disability and people with rare conditions. Similarly, long-term effects require further investigation. Implications: Given the limited scope of our analysis, more comparative research (including on an international scale) is required to develop systematic insight into the solidarity-effects of reforms in national health and long-term care insurance.
There has rarely been any reporting on health-related quality of life (HRQOL) of patients with HIV/AIDS in developing countries.
To estimate the health utilities of people with HIV/AIDS in Bogotá, ...Columbia.
A cross-sectional survey was conducted for 181 patients receiving antiretroviral therapy from an outpatient HIV/AIDS clinic in Bogotá. The five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-VAS) were used to estimate HRQOL scores. To derive utilities on the basis of the EQ-5D-5L, the Spanish value set was used. Subgroup analyses were performed according to sex, age, the Centers for Disease Control and Prevention classification, and CD4 cell count.
The mean utility of the EQ-5D-5L was estimated at 0.85 ± 0.21 and the EQ-VAS score was estimated at 84 ± 14. Pain/discomfort and anxiety/depression were the two EQ-5D-5L dimensions associated with the poorer outcomes. Subgroup analyses revealed significantly higher utilities (using the EQ-5D-5L) for men than for women (0.88 vs. 0.76; P = 0.002) and lower utilities for patients with severe HIV (0.83 for CD4 < 200 vs. 0.87 for CD4 ≥ 500; P = 0.024).
The HRQOL scores of patients with HIV/AIDS receiving antiretroviral therapy were relatively high in Bogotá, Colombia, using the EuroQol questionnaire. The utility data could be useful, in combination with cost data, for future economic evaluations.
Abstract Objective One of the existing methods to assess the transferability of economic evaluations is the model of Welte, which is a decision-chart method that includes general and specific ...knockout criteria and a transferability checklist. This study aims to test Welte's model with the help of a case study. Methods In this study, foreign studies were transferred to The Netherlands and then compared with a Dutch reference study. In the case study, the cost-effectiveness of physiotherapy was compared with a multidisciplinary treatment. With the help of a systematic search, several foreign studies could be identified. Based on these foreign studies, two different predictions were produced for The Netherlands. In the “all studies prediction,” all foreign studies were used. In the “Welte's model prediction,” only the foreign studies were used, which passed the general and specific knockout criteria. Both predictions were compared with the Dutch reference case. Results A total of 14 non-Dutch studies were identified. Seven studies did not pass the general knockout criteria and one study did not pass the specific knockout criteria. As a result, 14 studies were included in the “all studies prediction” and 6 studies in the “Welte's model prediction.” The predictions yielded different results and the “Welte's model prediction” proved better on costs than the “all studies prediction.” Discussion The application of Welte's model does influence cost and effects estimates when transferring economic data between countries. However, more cases should be subjected to the Welte transferability model before a final conclusion can be drawn.
Objectives: In a randomized controlled trial brief sex counselling (BSC), intensive sexual healthcare (ISH) and no treatment (NT) for adolescents with a sexual dysfunction were compared. The aim of ...this study was to assess the cost-effectiveness and cost-utility of BSC versus ISH and NT from a societal perspective. Methods: Costs, sexual functioning and quality of life were measured during 6 months. Primary outcome measures were measured with the Female Sexual Functional Index, the International Index of Erectile Function and the utilities reflecting Quality of Life based on the SF-36. Uncertainty was dealt with by using bootstrap replications and sensitivity analyses. Results: Results show that the societal costs were the highest for ISH followed by NT and BSC. The difference in costs between ISH compared to NT and BSC was significant. Furthermore, there were no significant group differences in sexual functioning or quality of life. With respect to the cost-effectiveness and cost-utility, BSC can be considered to be a suitable treatment for adolescents with a sexual dysfunction. Conclusions: Due to the lack of a significant difference in clinical effect, it can be concluded that BSC is the cheapest treatment option when implementing the intention-to-treat, besides a no treatment option, for adolescents with a sexual dysfunction.
To systematically identify and critically appraise all published full economic evaluations assessing the cost-effectiveness of non-pharmacological interventions for patient with drug-resistant ...epilepsy.
PICOS was used to design search strategies for the identification and selection of relevant studies. Literature search was performed using MEDLINE (via PubMed), EMBASE, INAHTA, EHS EED, and CEA Registry databases to identify articles published between January 2000 to May 2023. Web of Science was additionally used to perform forward and backward referencing. Title-, abstract- and full-text screening was performed by two independent researchers. The Consensus Health Economic Criteria (CHEC) checklist and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 were applied for quality assessment.
A total of 4,470 studies were identified of which 18 met our inclusion criteria. Twelve of the studies conducted model-based economic evaluation and others were trial-based. Three studies showed that epilepsy surgery was cost-effective in adults, while this remained inconclusive for children (two positive, three negative). Three studies showed negative economic outcome for ketogenic diet in children. One out of four studies showed positive results for self-management. For vagus nerve stimulation, one study showed positive results in adults and another one negative result in children. One recent study showed cost-effectiveness of RNS in adults. Finally, one study shows promising but inconclusive results for deep brain stimulation. Mean risk of bias assessment score (based on CHEC) was 95.3% and 80.9% for reporting quality (CHEERS 2022).
This review identified studies that assessed the cost-effectiveness of non-pharmacological treatments in both adults and children with drug-resistant epilepsy, suggesting that in adults, epilepsy surgery, VNS and RNS are cost-effective, and that DBS and self-management appear to be promising. In children, epilepsy surgery seems to be cost-effective. Contrary, the use of ketogenic diet was shown not to be cost-effective. However, limited long-term data was available for newer interventions (i.e., ketogenic diet, DBS, and RNS).
Rationale and objective In budget‐constrained health systems, decision makers need to consider both the costs and effects of introducing and actively implementing clinical guidance. We aim to ...demonstrate how, as an alternative to conventional methods, a total net benefit approach to economic evaluation can be used to inform decision making about guidelines and specific implementation strategies, like education or financial incentives.
Methods Aside from providing more detail on the decision framework, we describe how to collect and analyse the relevant data for calculating the total net benefit of guideline use and the value of implementation. We illustrate the process of decision analysis for a stylized example on improving diabetes care in the UK. For the analysis, economic evidence on intensified glycemic control and that on audit and feedback to promote control is combined with information on diabetes practice.
Results Our illustration demonstrates that the total net benefit of guideline use and the value of implementation can vary substantially, depending on the clinical intervention chosen, the health system being studied and the specific implementation strategies. This also holds for the threshold value for cost‐effectiveness, the duration of guideline usage or validity, the size of the patient population served, and the trends and ceiling rates in the implementation of clinical guidance.
Conclusions In comparison with conventional methods for health economic evaluation, a total net benefit approach allows for the explicit consideration of the current (or future) use of guidelines or guideline recommendations, the cost of implementation and the scope of clinical practice. Decisions made on the basis of the total net benefit of all plausible combinations of clinical guidance and implementation strategies provide optimal patient care and an efficient use of resources.
BACKGROUND: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity ...function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. OBJECTIVE: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-) effectiveness compared with care as usual. METHODS: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n= 48) receiving care as usual and of an intervention group (optimized provision process) (n= 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.
In 2014, 0.3% of the total population in Colombia was living with HIV/AIDS. The data currently available regarding the costs of these patients are very limited.
To estimate the societal costs of ...patients with HIV/AIDS in Bogotá, Colombia.
This study is a quantitative, cross-sectional cost-of-illness study. Costs were assessed with a prevalence-based, bottom-up approach. The data of 124 patients were collected from their medical records in a Bogotá hospital and a questionnaire was developed to measure other health care costs, as well as patient and family costs. Subgroup analyses were performed according to sex, age, Centers for Disease Control and Prevention classification, and CD4 count (cluster of differentiation 4).
The mean annual cost per patient with HIV/AIDS was estimated at $11,505 ± 18,658 (2014 US dollars). The larger part was attributable to drug costs (a mean annual cost of $8,616, 75% of the total), whereas productivity costs represented a mean annual cost of $1,044 (10%). Total costs per patient were estimated for a CD4 count of 500 or more, 200 to 499, and less than 200 cells/µl at $13,116, $9,077, and $10,741, respectively (all values in 2014 US dollars).
HIV/AIDS represents a high societal burden in Colombia. In comparison with the gross domestic product per capita of $7,904 in 2014, the mean annual cost per patient with HIV/AIDS was 40% higher, estimated at $11,505. The largest part of the HIV/AIDS costs was attributed to drugs, followed by productivity costs. Using extrapolation, the total cost of HIV/AIDS for the Colombian society would be $1.431 billion.
As the incidence of stroke has increased, its impact on society has increased accordingly, while it continues to have a major impact on the individual. New strategies to further improve the quality, ...efficiency and logistics of stroke services are necessary. Early discharge from hospital to a nursing home with an adequate rehabilitation programme could help to optimise integrated care for stroke patients.The objective is to describe the design of a non-randomised comparative study evaluating early admission to a nursing home, with multidisciplinary assessment, for stroke patients. The study is comprised of an effect evaluation, an economic evaluation and a process evaluation.
The design involves a non-randomised comparative trial for two groups. Participants are followed for 6 months from the time of stroke. The intervention consists of a redesigned care pathway for stroke patients. In this care pathway, patients are discharged from hospital to a nursing home within 5 days, in comparison with 12 days in the usual situation. In the nursing home a structured assessment takes place, aimed at planning adequate rehabilitation. People in the control group receive the usual care. The main outcome measures of the effect evaluation are quality of life and daily functioning. In addition, an economic evaluation will be performed from a societal perspective. A process evaluation will be carried out to evaluate the feasibility of the intervention as well as the experiences and opinions of patients and professionals.
The results of this study will provide information about the cost effectiveness of the intervention and its effects on clinical outcomes and quality of life. Relevant strengths and weaknesses of the study are addressed in this article.
Current Controlled Trails ISRCTN58135104.
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