Societal burden and quality of life in patients with Lisfranc Injuries.

BACKGROUND: The incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. MATERIALS AND METHODS: This study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. RESULTS: 214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. CONCLUSION: The total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.

Economic evaluations in fracture research an introduction with examples of foot fractures.

INTRODUCTION: The incidence of foot fractures is increasing. These types of fractures represent the most expensive group of diagnoses in the emergency department. Next to this, the need for economic evaluation studies is growing fast. The aim of this article is to provide healthcare professionals with an introduction to economic evaluation studies in the field of foot fractures. TYPES OF ECONOMIC EVALUATION STUDIES: Four types of economic evaluation studies exist: cost-minimization analysis (CMA), cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), and cost-utility analysis (CUA). An economic evaluation study can be either trial- or model-based. COST ASSESSMENT: When assessing costs in an economic evaluation study, three steps need to be made: identification of costs, measurement of costs, and valuation of costs. PERSPECTIVE OF ANALYSIS: Two main perspectives exist in economic evaluation studies. When using a healthcare perspective, only the potential costs and benefits of an intervention for the healthcare sector are included. The societal perspective includes all potential costs, including societal costs. SYNTHESIS OF COSTS AND EFFECTS AND UNCERTAINTY ANALYSIS: The level of cost-effectiveness can be objectively expressed using the incremental cost-effectiveness ratio (ICER). This measure can be plotted in a cost-effectiveness plane and can be compared with existing regional ceiling ratios. CONCLUSION: Although this article is not a guideline for economic evaluations, we do want to present five tips to consider when performing an economic evaluation. Firstly, when measuring resource use, consult the Database of Instruments for Resource Use Measurements (DIRUM) to find an appropriate instrument. Secondly, when measuring utility values, use the EuroQol questionnaire if possible. Thirdly, when setting up an economic evaluation study, consult the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) database for the appropriate pharmacoeconomic guidelines. Fourthly, consult international guidelines to decide which study design is most appropriate. Finally, when performing an economic evaluation, consult a heath technology assessment (HTA) specialist from the start to ensure methodological quality.

[Addiction and recidivism in forensic psychiatry]. / Verslaving als risicofactor in de forensische psychiatrie.

BACKGROUND: The prevalence of addiction in forensic psychiatric patients (adolescents and adults) is unknown. Published figures are nearly always based on estimates or on old or select samples. AIM: To determine the importance of addiction as a risk factor for recidivism in forensic psychiatric patients in the Netherlands and to determine the prevalence of addiction in this group and the prevalence of drug intoxication in group-members at the time they committed the offence. METHOD: We analysed one database relating to forensic psychiatric adolescents and two sets of data relating to tbs-patients (tbs='detained at her Majesty's pleasure'). RESULTS: The prevalence of addiction among forensic psychiatric patients could only be given approximately, but it was certainly high (more than 60%). Substance abuse or addiction often played a major role (in more than 30% of cases) at the time the offence was committed for which the detention order was issued. CONCLUSION: Because substance abuse often played a role in the delinquent behaviour that led to the detention order, it may also be a risk factor for recidivism. More research is needed so that we can increase our knowledge about the most effective ways of treating substance abuse.

Effectiveness of a drug-free detention treatment program in a Dutch prison.

Several Dutch penitentiaries, which have relatively severe drug-use related problems, experimented with drug-free detention treatment programs (DVA). These programs aim at controlling drug use by offering a therapeutic atmosphere and serve as linkage to detention posttreatment. In a Rotterdam jail (335 cells), ca. 10% were the DVA. Information was gathered from 86 male inmates who volunteered to enter the program, and 42 from other wings. After 1 year the drug-free detention group more actively searched and accepted treatment. No differences were found in drug use, recidivism, or physical, social, and psychological problems.

Enrollment in a drug-free detention program: the prediction of successful behavior change of drug-using inmates.

Factors predicting the behavior change of drug-using detainees were investigated in detainees in two penitentiaries in The Netherlands. Subjects attended either a standard program or a Drug-Free Detention Program (DFDP) and were assessed at the beginning of detention, at release/transfer, and at 2 years after the end of detention. Predictors of postprogram contact with treatment agencies and changes in criminal recidivism, substance abuse, and psychosocial functioning were investigated using regression analysis. Detainees who started drug use early, without previous DFDP detention, and who frequently expressed self-esteem and who had many family problems realized meetings with drug treatment agencies more often. Those with a legal source of income showed decreases in addiction severity and in the number of days in which hard drugs were used. Comparison of the normal program and the DFDP showed that only for the normal wing could changes in substance use and psychosocial functioning be predicted. Results show the value of multiple-outcome criteria in criminal recidivism research and call for more studies investigating change processes.