Overview of important cervical cancer screening process values in European Union (EU) countries, and tentative predictions of the corresponding effectiveness and cost-effectiveness.

The objective was the evaluation of the (cost-)effectiveness of cervical cancer screening in the European Union (EU) countries. Data were collected on recommended screening age ranges and intervals, coverage, proportion of non-negative smears and smear use. Estimates reported by representatives of each participating Member State were compared, and used as input for model based on (using the MISCAN simulation model for cancer screening) effectiveness and cost-effectiveness calculations. Differences in coverage from below 50 to 82% resulted in more or less proportional differences in expected percentage life-years lost reduction, almost regardless of differences in 7-50+ smears recommended in a lifetime. Differences in screening intensity (resulting from the recommended number of smears per lifetime and the number of excess smears on top of these recommendations) resulted in more than 2-fold difference in the expected number of smears per percentage life-years lost reduction. (Cost-)effectiveness predictions would have greatly improved if estimates of long-term coverage had also been available. To conclude, estimates for a restricted set of well defined parameters - a few for short and long-term coverage and one for the total number of smears - are quite useful for country-specific (cost-)effectiveness evaluations. The main, and to some extent, unsolvable problem for further improvement of the analysis is the lack of reliable country-specific estimates for the background risk of cervical cancer in women eligible for screening in the near future.

Cost of care of patients with cystic fibrosis in The Netherlands in 1990-1.

BACKGROUND: Research on the cost of care of patients with cystic fibrosis is scarce. The aim of this study was to estimate the costs using age-specific medical consumption from real patient data. METHODS: The age-specific medical consumption of patients with cystic fibrosis in The Netherlands in 1991 was estimated from a survey of medical records and a patient questionnaire. A distinction was made between costs of hospital care, hospital and non-hospital medication, and home care. Costs per year were obtained by multiplying the yearly amount of care and the costs per unit. RESULTS: On average the annual cost of a patient with cystic fibrosis in 1991 was 10,908 pounds (hospital care 42%, medication 37%, home care 20%). The cost of care of cystic fibrosis in The Netherlands, with approximately 1000 patients, is estimated at 10.9 million pounds per year, which is 0.07% of the total health care budget. The cost of care of a patient up to the age of 35 is estimated at 614,587 pounds. When year-to-year survival is taken into account and future costs are discounted to the year of birth with a yearly discount rate of 5%, the cost of care of a patient with cystic fibrosis is estimated at 164,365 pounds for 1991. This estimate will be used in a prospective evaluation of screening for cystic fibrosis carriers. CONCLUSIONS: The cost of care of patients with cystic fibrosis estimated by age-specific medical consumption of real patients is higher than that estimated by non-age-specific medical consumption and/or expert opinions.

Follow-up after colorectal cancer: current practice in The Netherlands.

OBJECTIVE: To assess the current practice of follow-up after operations for colorectal cancer in The Netherlands in comparison with other countries. DESIGN: Postal survey. SETTING: All surgical departments in The Netherlands. MAIN OUTCOME MEASURES: Attitudes of surgeons towards detection and treatment of recurrences after colorectal cancer. RESULTS: Of the 139 questionnaires sent out, 136 (98%) were returned. History taking, physical examination, and colonoscopy for local recurrence and metachronous tumours were used by 90% of the hospitals. Attitudes towards screening for hepatic and pulmonary metastases and regional recurrence varied considerably between hospitals. Similar findings were found in seven surveys from other countries. CONCLUSION: There is no consensus among surgeons regarding the follow-up of patients with colorectal cancer. Randomised controlled trials comparing different follow-up strategies and cost-effectiveness analyses are needed to identify groups of patients that will benefit most from follow-up. Identification of these patients may lead to more agreement between surgeons.