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BackgroundThe risk of contracting rabies is low for travellers. However, the number of Dutch travellers potentially exposed abroad following an animal-associated injury and needing post-exposure prophylaxis (PEP) has increased, resulting in increased costs.AimHere, we evaluated the costs and the cost-effectiveness of different pre- and post-exposure interventions in the Netherlands, taking into account the 2018 World Health Organization (WHO) recommendations for the prevention of rabies.MethodsA decision tree-based economic model was constructed. We calculated and compared the cost of different WHO pre-exposure prophylaxis (PrEP) recommendations, intramuscular vs intradermal vaccination and PEP subsequent to increased vaccination coverage in risk groups. We estimated cost-effectiveness, expressed as incremental costs per rabies immunoglobulin (RIG) administration averted, using a societal perspective. Statistical uncertainty regarding number of travellers and vaccination coverage was assessed.ResultsTotal costs at the national level were highest using previous WHO recommendations from 2012, estimated at EUR 15.4 million annually. Intradermal vaccinations in combination with the current recommendations led to the lowest costs, estimated at EUR 10.3 million. Higher vaccination uptake resulted in higher overall costs. The incremental costs per RIG administration averted varied from EUR 21,300-46,800.ConclusionsThe change in rabies PrEP and PEP recommendations in 2018 reduced total costs. Strategies with increased pre-travel vaccination uptake led to fewer RIG administrations and fewer vaccinations after exposure but also to higher total costs. Although larger scale intradermal administration of rabies vaccine can reduce total costs of PrEP and can positively influence vaccination uptake, it remains a costly intervention.
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Profilaxis Posexposición/economía , Profilaxis Pre-Exposición/economía , Vacunas Antirrábicas/administración & dosificación , Vacunas Antirrábicas/economía , Virus de la Rabia/inmunología , Rabia/prevención & control , Animales , Análisis Costo-Beneficio , Humanos , Modelos Económicos , Profilaxis Posexposición/estadística & datos numéricos , Profilaxis Pre-Exposición/estadística & datos numéricos , Rabia/inmunología , Vacunación/economía , Vacunación/métodosRESUMEN
Observed multiple adverse effects of livestock production have led to increasing calls for more sustainable livestock production. Quantitative analysis of adverse effects, which can guide public debate and policy development in this area, is limited and generally scattered across environmental, human health, and other science domains. The aim of this study was to bring together and, where possible, quantify and aggregate the effects of national-scale livestock production on 17 impact categories, ranging from impacts of particulate matter, emerging infectious diseases and odor annoyance to airborne nitrogen deposition on terrestrial nature areas and greenhouse gas emissions. Effects were estimated and scaled to total Dutch livestock production, with system boundaries including feed production, manure management and transport, but excluding slaughtering, retail and consumption. Effects were expressed using eight indicators that directly express Impact in the sense of the Drivers-Pressures-State-Impact-Response framework, while the remaining 14 express Pressures or States. Results show that livestock production may contribute both positively and negatively to human health with a human disease burden (expressed in disability-adjusted life years) of up to 4% for three different health effects: those related to particulate matter, zoonoses, and occupational accidents. The contribution to environmental impact ranges from 2% for consumptive water use in the Netherlands to 95% for phosphorus transfer to soils, and extends beyond Dutch borders. While some aggregation across impact categories was possible, notably for burden of disease estimates, further aggregation of disparate indicators would require normative value judgement. Despite difficulty of aggregation, the assessment shows that impacts receive a different contribution of different animal sectors. While some of our results are country-specific, the overall approach is generic and can be adapted and tuned according to specific contexts and information needs in other regions, to allow informed decision making across a broad range of impact categories.
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Ganado , Estiércol , Animales , Ambiente , Humanos , Países Bajos , SueloRESUMEN
OBJECTIVE: Influenza virus infections cause a high disease and economic burden during seasonal epidemics. However, there is still a need for reliable disease burden estimates to provide a more detailed picture of the impact of influenza. Therefore, the objectives of this study is to estimate the incidence of hospitalisation for influenza virus infection and associated hospitalisation costs in adult patients in the Netherlands during two consecutive influenza seasons. METHODS: We conducted a retrospective study in adult patients with a laboratory confirmed influenza virus infection in three Dutch hospitals during respiratory seasons 2014-2015 and 2015-2016. Incidence was calculated as the weekly number of hospitalised influenza patients divided by the total population in the catchment populations of the three hospitals. Arithmetic mean hospitalisation costs per patient were estimated and included costs for emergency department consultation, diagnostics, general ward and/or intensive care unit admission, isolation, antibiotic and/or antiviral treatment. These hospitalisation costs were extrapolated to national level and expressed in 2017 euros. RESULTS: The study population consisted of 380 hospitalised adult influenza patients. The seasonal cumulative incidence was 3.5 cases per 10,000 persons in respiratory season 2014-2015, compared to 1.8 cases per 10,000 persons in 2015-2016. The arithmetic mean hospitalisation cost per influenza patient was 6128 (95% CI 4934-7737) per patient in 2014-2015 and 8280 (95% CI 6254-10,665) in 2015-2016, potentially reaching total hospitalisation costs of 28 million in 2014-2015 and 20 million in 2015-2016. CONCLUSIONS: Influenza virus infections lead to 1.8-3.5 hospitalised patients per 10,000 persons, with mean hospitalisation costs of 6100-8300 per adult patient, resulting in 20-28 million euros annually in The Netherlands. The highest arithmetic mean hospitalisation costs per patient were found in the 45-64 year age group. These influenza burden estimates could be used for future influenza cost-effectiveness and impact studies.
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Costos de Hospital/estadística & datos numéricos , Hospitalización/economía , Gripe Humana/economía , Gripe Humana/epidemiología , Adolescente , Adulto , Anciano , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Virus de la Influenza A/aislamiento & purificación , Gripe Humana/enzimología , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios Retrospectivos , Adulto JovenRESUMEN
In the Netherlands, toxoplasmosis ranks second in disease burden among foodborne pathogens with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at 45 million annually. Therefore, effective and preferably cost-effective preventive interventions are warranted. Freezing meat intended for raw or undercooked consumption and improving biosecurity in pig farms are promising interventions to prevent Toxoplasma gondii infections in humans. Putting these interventions into practice would expectedly reduce the number of infections; however, the net benefits for society are unknown. Stakeholders bearing the costs for these interventions will not necessary coincide with the ones having the benefits. We performed a Social Cost-Benefit Analysis to evaluate the net value of two potential interventions for the Dutch society. We assessed the costs and benefits of the two interventions and compared them with the current practice of education, especially during pregnancy. A 'minimum scenario' and a 'maximum scenario' was assumed, using input parameters with least benefits to society and input parameters with most benefits to society, respectively. For both interventions, we performed different scenario analyses. The freezing meat intervention was far more effective than the biosecurity intervention. Despite high freezing costs, freezing two meat products: steak tartare and mutton leg yielded net social benefits in both the minimum and maximum scenario, ranging from 10.6 million to 31 million for steak tartare and 0.6 million to 1.5 million for mutton leg. The biosecurity intervention would result in net costs in all scenarios ranging from 1 million to 2.5 million, due to high intervention costs and limited benefits. From a public health perspective (i.e. reducing the burden of toxoplasmosis) and the societal perspective (i.e. a net benefit for the Dutch society) freezing steak tartare and leg of mutton is to be considered.
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Productos de la Carne/parasitología , Toxoplasmosis/prevención & control , Animales , Costo de Enfermedad , Análisis Costo-Beneficio , Parasitología de Alimentos , Calidad de los Alimentos , Almacenamiento de Alimentos , Humanos , Países Bajos/epidemiologíaRESUMEN
This study aimed at estimating gastroenteritis (GE) incidence in all age groups of the Netherlands' general population, with special emphasis on the role of children in GE burden, and the associated costs. Monthly from November 2014 to November 2016, a random sample of 2000 residents in the Netherlands was invited to complete a questionnaire on household characteristics and health complaints. We calculated GE incidence rates standardized to the Dutch population and used multivariable logistic regression models to identify potential risk factors. We calculated the costs related to resources used within the healthcare sector, the resources used by patients and their families, and productivity losses (paid worktime) due to GE. The overall standardized incidence rate was 0.81 GE episodes/person-year, with the highest rate in children ≤4 years (1.96 episodes/person-year). GE was observed more often in households with children (≤17 years), especially if children attended out-of-home childcare services, and among individuals with non-native Dutch ethnic background. Less GE was observed among employed persons aged 25-64 years, compared with those unemployed, but the opposite was observed in persons ≥65 years. The average costs per GE episode was 191, resulting in 945 million annual total costs for GE in the Netherlands (55 per inhabitant). The majority of costs (55%) were attributable to productivity losses of the ill or their caregivers. In conclusion, GE still poses a significant burden, particularly in preschool children and adults living in households with children. Similar to other industrialized countries, the major factor driving the costs due to GE was the loss of productivity. This study also provides up-to-date baseline GE incidence rates and associated societal costs to better contextualize the burden of the disease in support of policy making.
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Infecciones Comunitarias Adquiridas/economía , Infecciones Comunitarias Adquiridas/epidemiología , Gastroenteritis/economía , Gastroenteritis/epidemiología , Adolescente , Adulto , Anciano , Cuidadores , Niño , Preescolar , Costo de Enfermedad , Composición Familiar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Factores de Riesgo , Encuestas y Cuestionarios , Adulto JovenRESUMEN
IntroductionEstimating burden of disease (BoD) is an essential first step in the decision-making process on introducing new vaccines into national immunisation programmes (NIPs). For varicella, a common vaccine-preventable disease, BoD in the Netherlands was unknown.AimTo assess national varicella BoD and compare it to BoD of other vaccine-preventable diseases before their introduction in the NIP.MethodsIn this health estimates reporting study, BoD was expressed in disability-adjusted life years (DALYs) using methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project. As no parameters/disease model for varicella (including herpes zoster) were available in the BCoDE toolkit, incidence, disease progression model and parameters were derived from seroprevalence, healthcare registries and published data. For most other diseases, BoD was estimated with existing BCoDE-parameters, adapted to the Netherlands if needed.ResultsIn 2017, the estimated BoD of varicella in the Netherlands was 1,800 (95% uncertainty interval (UI): 1,800-1,900) DALYs. Herpes zoster mainly contributed to this BoD (1,600 DALYs; 91%), which was generally lower than the BoD of most current NIP diseases in the year before their introduction into the NIP. However, BoD for varicella was higher than for rotavirus gastroenteritis (1,100; 95%UI: 440-2,200 DALYs) and meningococcal B disease (620; 95%UI: 490-770 DALYs), two other potential NIP candidates.ConclusionsWhen considering the introduction of a new vaccine in the NIP, BoD is usually estimated in isolation. The current approach assesses BoD in relation to other vaccine-preventable diseases' BoD, which may help national advisory committees on immunisation and policymakers to set vaccination priorities.
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Varicela/epidemiología , Programas de Inmunización , Programas Nacionales de Salud , Distribución por Edad , Varicela/prevención & control , Enfermedades Transmisibles/epidemiología , Difteria/mortalidad , Evaluación de la Discapacidad , Progresión de la Enfermedad , Femenino , Gastroenteritis/epidemiología , Gastroenteritis/virología , Herpes Zóster/epidemiología , Humanos , Incidencia , Sarampión/mortalidad , Países Bajos/epidemiología , Poliomielitis/mortalidad , Desarrollo de Programa , Infecciones por Rotavirus/epidemiología , Distribución por Sexo , Tétanos/mortalidad , Neoplasias del Cuello Uterino/epidemiologíaRESUMEN
OBJECTIVES: To assess the cost-effectiveness of increased consistent HIV testing among MSM in the Netherlands. METHODS: Among MSM testing at sexually transmitted infection clinics in the Netherlands in 2014-2015, approximately 20% tested consistently every 6 months. We examined four scenarios with increased percentage of MSM testing every 6 months: a small and a moderate increase among all MSM; a small and a moderate increase only among MSM with at least 10 partners in the preceding 6 months. We used an agent-based model to calculate numbers of HIV infections and AIDS cases prevented with increased HIV testing. These numbers were used in an economic model to calculate costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) due to increased testing, over 2018-2027, taking a healthcare payer perspective. RESULTS: A small increase in the percentage testing every 6 months among all MSM resulted in 490 averted HIV infections and an average ICER of &OV0556;27â900/QALY gained. A moderate increase among all MSM, resulted in 1380 averted HIV infections and an average ICER of &OV0556;36â700/QALY gained. Both were not cost-effective, with a &OV0556;20â000 willingness-to-pay threshold. Increasing the percentage testing every 6 months only among MSM with at least 10 partners in the preceding 6 months resulted in less averted HIV infections than increased testing among all MSM, but was on average cost-saving. CONCLUSION: Increased HIV testing can prevent considerable numbers of new HIV infections among MSM, but may be cost-effective only if targeted at high-risk individuals, such as those with many partners.
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Análisis Costo-Beneficio , Pruebas Diagnósticas de Rutina/métodos , Transmisión de Enfermedad Infecciosa/economía , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Utilización de Procedimientos y Técnicas/economía , Adolescente , Adulto , Pruebas Diagnósticas de Rutina/economía , Transmisión de Enfermedad Infecciosa/prevención & control , Infecciones por VIH/economía , Infecciones por VIH/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Países Bajos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Burden of disease (BoD) estimations are increasingly used to prioritize public health interventions. Previous Cryptosporidium BoD models accounted only for acute episodes, while there is increasing evidence of long-term manifestations. Our objective was to update Cryptosporidium BoD and cost-of-illness (COI) models and to estimate BoD and COI for the Netherlands in years 2013-2017. METHODS: We performed a scoping literature review and drew an outcome tree including long-term manifestations for which sufficient evidence was found, such as recurrent diarrhea and joint pain. We chose the Disability-Adjusted Life Year (DALY) metric to synthesize years of life lost due mortality (YLLs) and years lived with disability due to non-fatal outcomes (YLDs). For the costs, we adopted a societal perspective accounting for direct healthcare costs, patient costs and productivity losses. Uncertainty was managed using Latin Hypercube sampling (30,000 iterations). RESULTS: In the Netherlands in 2017, we estimated 50,000 Cryptosporidium cases (95% uncertainty interval (UI): 15,000-102,000), 7,000 GP visits, 300 hospitalizations and 3 deaths, resulting in 137 DALYs (95%UI: 54-255) and 19.2 million COI (95%UI: 7.2 million- 36.2 million). Estimates were highest for 2016 (218 DALYs and 31.1 million in COI), and lowest in 2013 (100 DALYs and 13.8 million in COI). Most of the BoD was attributable to YLD (≈80% of DALYs). The most important cost was productivity losses (≈90% of total COI). Long-term manifestations, including recurring diarrhea and joint pain, accounted for 9% of the total DALYs and 7% of the total COI. CONCLUSION: Current evidence supports the inclusion of long-term manifestations in Cryptosporidium models, which contribute close to 10% of the total DALYs and costs. This may be an underestimation, as we were conservative in our assumptions. Cryptosporidium should be considered a priority organism with respect to public health surveillance, even in industrialized countries with high hygiene standards.
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Costo de Enfermedad , Criptosporidiosis/economía , Criptosporidiosis/epidemiología , Criptosporidiosis/patología , Bases de Datos Factuales , Diarrea/etiología , Humanos , Países Bajos/epidemiología , Dolor/etiología , Salud Pública , Años de Vida Ajustados por Calidad de VidaRESUMEN
OBJECTIVE: To assess the cost-effectiveness of three testing strategies with or without light microscopic Gram-stained smear (GSS) evaluation for the detection of anogenital gonorrhoea among men who have sex with men (MSM) at the Amsterdam STI clinic using a healthcare payer perspective. METHODS: Three testing strategies for MSM were compared: (1) GSS in symptomatic MSM only (currently practised strategy), (2) no GSS and (3) GSS in symptomatic and asymptomatic MSM. The three testing protocols include testing with nucleic acid amplification test to verify the GSS results in (1) and (3), or as the only test in (2). A transmission model was employed to calculate the influence of the testing strategies on the prevalence of anogenital gonorrhoea over 10 years. An economic model combined cost data on medical consultations, tests and treatment and utility data to estimate the number of epididymitis cases and quality-adjusted life years (QALY) associated with gonorrhoea. Incremental cost-effectiveness ratios (ICERs) for the testing scenarios were estimated. Uncertainty and sensitivity analyses were performed. RESULTS: No GSS testing compared with GSS in symptomatic MSM only (current strategy) resulted in nine extra epididymitis cases (95% uncertainty interval (UI): 2-22), 72 QALYs lost (95% UI: 59-187) and 7300 additional costs (95% UI: -185 000 (i.e.cost-saving) to 407 000) over 10 years. GSS testing in both symptomatic and asymptomatic MSM compared with GSS in symptomatic MSM only resulted in one prevented epididymitis case (95% UI: 0-2), 1.1 QALY gained (95% UI: 0.1-3.3), 148 000 additional costs (95% UI: 86 000 to-217 000) and an ICER of 177 000 (95% UI: 67 000-to 705 000) per QALY gained over 10 years. The results were robust in sensitivity analyses. CONCLUSIONS: GSS for symptomatic MSM only is cost-effective compared with no GSS for MSM and with GSS for both symptomatic and asymptomatic MSM.
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Gonorrea/diagnóstico , Técnicas de Amplificación de Ácido Nucleico/economía , Proctitis/diagnóstico , Minorías Sexuales y de Género , Coloración y Etiquetado/economía , Uretritis/diagnóstico , Infecciones Asintomáticas , Análisis Costo-Beneficio , Epididimitis/epidemiología , Epididimitis/etiología , Violeta de Genciana , Gonorrea/complicaciones , Gonorrea/patología , Humanos , Masculino , Microscopía , Modelos Económicos , Países Bajos , Fenazinas , Proctitis/complicaciones , Proctitis/patología , Años de Vida Ajustados por Calidad de Vida , Uretritis/complicaciones , Uretritis/patologíaRESUMEN
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.
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Comportamiento del Consumidor , Congelación , Carne/parasitología , Toxoplasmosis/prevención & control , Adulto , Anciano , Animales , Bovinos , Femenino , Inocuidad de los Alimentos , Humanos , Masculino , Productos de la Carne/parasitología , Persona de Mediana Edad , Países Bajos , Oveja Doméstica , Porcinos , ToxoplasmaRESUMEN
BACKGROUND: Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective. METHODS: The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed. RESULTS: For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from 4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to 9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of ≥0.41% and ≥0.22%, with ICERs below the Dutch cost-effectiveness reference value of 20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections. CONCLUSIONS: For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants.
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Análisis Costo-Beneficio , Emigrantes e Inmigrantes/estadística & datos numéricos , Hepatitis B Crónica/diagnóstico , Hepatitis C Crónica/diagnóstico , Hepatitis B Crónica/economía , Hepatitis B Crónica/epidemiología , Hepatitis C Crónica/economía , Hepatitis C Crónica/epidemiología , Humanos , Cadenas de Markov , Países Bajos/epidemiología , Prevalencia , Años de Vida Ajustados por Calidad de VidaRESUMEN
Background and aimsThe Burden of Communicable Diseases in Europe (BCoDE) study aimed to calculate disability-adjusted life years (DALYs) for 31 selected diseases in the European Union (EU) and European Economic Area (EEA). Methods: DALYs were estimated using an incidence-based and pathogen-based approach. Incidence was estimated through assessment of data availability and quality, and a correction was applied for under-estimation. Calculation of DALYs was performed with the BCoDE software toolkit without applying time discounting and age-weighting. Results: We estimated that one in 14 inhabitants experienced an infectious disease episode for a total burden of 1.38 million DALYs (95% uncertainty interval (UI): 1.25-1.5) between 2009 and 2013; 76% of which was related to the acute phase of the infection and its short-term complications. Influenza had the highest burden (30% of the total burden), followed by tuberculosis, human immunodeficiency virus (HIV) infection/AIDS and invasive pneumococcal disease (IPD). Men had the highest burden measured in DALYs (60% of the total), adults 65 years of age and over had 24% and children less than 5 years of age had 11%. Age group-specific burden showed that infants (less than 1 year of age) and elderly people (80 years of age and over) experienced the highest burden. Conclusions: These results provide baseline estimates for evaluating infectious disease prevention and control strategies. The study promotes an evidence-based approach to describing population health and assessing surveillance data availability and quality, and provides information for the planning and prioritisation of limited resources in infectious disease prevention and control.
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Enfermedades Transmisibles/epidemiología , Costo de Enfermedad , Salud Poblacional , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Personas con Discapacidad/estadística & datos numéricos , Europa (Continente)/epidemiología , Unión Europea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Lactante , Esperanza de Vida , Masculino , Modelos EstadísticosRESUMEN
Background: The understanding of gender differences in inflammatory bowel disease (IBD) patients is an important step towards tailored treatment for the individual patient. The aim of this study was to compare disease phenotype, clinical manifestations, disease activity, and healthcare utilization between men and women with Crohn's disease (CD) and ulcerative colitis (UC). Methods: Two multicenter observational cohort studies with a prospective design were used to explore the differences between men and women regarding demographic and phenotypic characteristics and healthcare utilization. Detailed data on IBD-phenotype was mainly available from the Dutch IBD Biobank, while the COIN cohort provided healthcare utilization data. Results: In the Dutch IBD Biobank study, 2118 CD patients and 1269 UC patients were analyzed. Female CD patients were more often current smokers, and male UC patients were more often previous smokers. Early onset CD (<16 years) was more frequently encountered in males than in females (20% versus 12%, P < 0.01). Male CD patients were more often diagnosed with ileal disease (28% versus 20%, P < 0.01) and underwent more often small bowel and ileocecal resection. Extraintestinal manifestations (EIMs) were more often encountered in female IBD patients. In the COIN study, 1139 CD patients and 1213 UC patients were analyzed. Male CD patients used prednisone more often and suffered more often from osteopenia. IBD-specific healthcare costs did not differ between male and female IBD patients. Conclusions: Sex differences in patients with IBD include age of onset, disease location, and EIM prevalence. No large differences in therapeutic management of IBD were observed between men and women with IBD. 10.1093/ibd/izy004_video1izy004_Video_15786481854001.
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Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Factores Sexuales , Adulto , Colitis Ulcerosa/terapia , Enfermedad de Crohn/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
The recent epidemic of Ebola virus disease (EVD) resulted in countries worldwide to prepare for the possibility of having an EVD patient. In this study, we estimate the costs of Ebola preparedness and response borne by the Dutch health system. An activity-based costing method was used, in which the cost of staff time spent in preparedness and response activities was calculated based on a time-recording system and interviews with key professionals at the healthcare organizations involved. In addition, the organizations provided cost information on patient days of hospitalization, laboratory tests, personal protective equipment (PPE), as well as the additional cleaning and disinfection required. The estimated total costs averaged 12.6 million, ranging from 6.7 to 22.5 million. The main cost drivers were PPE expenditures and preparedness activities of personnel, especially those associated with ambulance services and hospitals. There were 13 possible cases clinically evaluated and one confirmed case admitted to hospital. The estimated total cost of EVD preparedness and response in the Netherlands was substantial. Future costs might be reduced and efficiency increased by designating one ambulance service for transportation and fewer hospitals for the assessment of possible patients with a highly infectious disease of high consequences.
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Defensa Civil/economía , Costos de la Atención en Salud , Fiebre Hemorrágica Ebola/terapia , Hospitalización , Epidemias , Fiebre Hemorrágica Ebola/epidemiología , Hospitales , Humanos , Países BajosRESUMEN
BACKGROUND: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD. METHODS: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient- and disease-related factors predictive of nonadherence 3 months after the assessment of predictors. RESULTS: In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating-characteristics curve of 0.74. CONCLUSIONS: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.
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Colitis Ulcerosa/psicología , Enfermedad de Crohn/psicología , Fármacos Gastrointestinales/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Edad de Inicio , Ansiedad/psicología , Área Bajo la Curva , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/patología , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/patología , Depresión/psicología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Curva ROC , Factores de Riesgo , Índice de Severidad de la Enfermedad , Brote de los SíntomasRESUMEN
PURPOSE: To evaluate the cost effectiveness of corneal collagen crosslinking (CXL) for progressive keratoconus from the healthcare payer's perspective. DESIGN: A probabilistic Markov-type model using data from published clinical trials and cohort studies. PARTICIPANTS: Two identical cohorts, each comprising 1000 virtual patients with progressive bilateral keratoconus, were modeled; one cohort underwent CXL and the other cohort received no intervention. METHODS: Both cohorts were modeled and evaluated annually over a lifetime. Quality-adjusted life years (QALYs), total cost, disease progression, and the probability of corneal transplantation, graft failure, or both were calculated based on data from published trials and cohort studies. These outcomes were compared between the 2 cohorts. In our base scenario, the stabilizing effect of CXL was assumed to be 10 years; however, longer durations also were analyzed. One-way sensitivity analyses were performed to test the robustness of the outcomes. MAIN OUTCOME MEASURE: Incremental cost-effectiveness ratio (ICER), defined as euros per QALY. RESULTS: Assuming a 10-year effect of CXL, the ICER was 54 384/QALY ($59 822/QALY). When we adjusted the effect of CXL to a lifelong stabilizing effect, the ICER decreased to 10 149/QALY ($11 163/QALY). Other sensitivity and scenario analyses that had a relevant impact on ICER included the discount rate, visual acuity before CXL, and healthcare costs. CONCLUSIONS: Corneal collagen crosslinking for progressive keratoconus is cost effective at a willingness-to-pay threshold of 3 times the current gross domestic product (GDP) per capita. Moreover, a longer stabilizing effect of CXL increases cost effectiveness. If CXL had a stabilizing effect on keratoconus of 15 years or longer, then the ICER would be less than the 1 × GDP per capita threshold and thus very cost effective.
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Colágeno/metabolismo , Sustancia Propia/metabolismo , Análisis Costo-Beneficio , Reactivos de Enlaces Cruzados/economía , Queratocono/economía , Fotoquimioterapia/economía , Fármacos Fotosensibilizantes/economía , Adulto , Trasplante de Córnea , Progresión de la Enfermedad , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Queratocono/tratamiento farmacológico , Queratocono/metabolismo , Cadenas de Markov , Persona de Mediana Edad , Años de Vida Ajustados por Calidad de Vida , Riboflavina/economía , Rayos Ultravioleta , Agudeza Visual/fisiología , Adulto JovenRESUMEN
Background: Lyme borreliosis (LB) is the most frequently reported tick-borne infection in Europe and North America. The aim of this study was to estimate the cost-of-illness of LB in the Netherlands. We used available incidence estimates from 2010 for tick bite consultations and three symptomatic LB outcomes: erythema migrans (EM), disseminated LB and Lyme-related persisting symptoms. The cost was estimated using these incidences and the average cost per patient as derived from a patient questionnaire. We estimated the cost from a societal perspective, including healthcare cost, patient cost and production loss, using the friction cost method and a 4% annual discount rate. Tick bites and LB in 2010 led to a societal cost of 19.3 million (95% CI 15.6-23.4; 16.6 million population) for the Netherlands. Healthcare cost and production loss each constituted 48% of the total cost (9.3 and 9.2 million/year), and patient cost 4% (0.8 million/year). Of the total cost, 37% was related to disseminated LB, followed by 27% for persisting symptoms, 22% for tick bites and 14% for EM. Per outcome, for an individual case the mean cost of disseminated LB and Lyme-related persisting symptoms was both around 5700; for EM and GP consultations for tick bites this was 122 and 53. As an alternative to the friction cost method, the human capital method resulted in a total cost of 23.5 million/year. LB leads to a substantial societal cost. Further research should therefore focus on additional preventive interventions.
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Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Enfermedad de Lyme/economía , Humanos , Incidencia , Enfermedad de Lyme/epidemiología , Países Bajos/epidemiología , Encuestas y Cuestionarios , Mordeduras de Garrapatas/economía , Mordeduras de Garrapatas/epidemiologíaRESUMEN
BACKGROUND: The sustained health-related quality-of-life of patients surviving community-acquired pneumonia has not been accurately quantified. The aim of the current study was to quantify differences in health-related quality-of-life of community-dwelling elderly with and without community-acquired pneumonia during a 12-month follow-up period. METHODS: In a matched cohort study design, nested in a prospective randomized double-blind placebo-controlled trial on the efficacy of the 13-valent pneumococcal vaccine in community-dwelling persons of ≥65 years, health-related quality-of-life was assessed in 562 subjects hospitalized with suspected community-acquired pneumonia (i.e. diseased cohort) and 1145 unaffected persons (i.e. non-diseased cohort) matched to pneumonia cases on age, sex, and health status (EQ-5D-3L-index). Health-related quality-of-life was determined 1-2 weeks after hospital discharge/inclusion and 1, 6 and 12 months thereafter, using Euroqol EQ-5D-3L and Short Form-36 Health survey questionnaires. One-year quality-adjusted life years (QALY) were estimated for both diseased and non-diseased cohorts. Separate analyses were performed for pneumonia cases with and without radiologically confirmed community-acquired pneumonia. RESULTS: The one-year excess QALY loss attributed to community-acquired pneumonia was 0.13. Mortality in the post-discharge follow-up year was 8.4% in community-acquired pneumonia patients and 1.2% in non-diseased persons (p < 0.001). During follow-up health-related quality-of-life was persistently lower in community-acquired pneumonia patients, compared to non-diseased persons, but differences in health-related quality-of-life between radiologically confirmed and non-confirmed community-acquired pneumonia cases were not statistically significant. CONCLUSIONS: Community-acquired pneumonia was associated with a six-fold increased mortality and 16% lower quality-of-life in the post-discharge year among patients surviving hospitalization for community-acquired pneumonia, compared to non-diseased persons. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00812084 .
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Infecciones Comunitarias Adquiridas/psicología , Hospitalización/estadística & datos numéricos , Neumonía/psicología , Calidad de Vida , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/mortalidad , Femenino , Estado de Salud , Humanos , Masculino , Países Bajos/epidemiología , Neumonía/mortalidad , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
BACKGROUND: To determine the cost-effectiveness of strategies of preferred antibiotic treatment with beta-lactam/macrolide combination or fluoroquinolone monotherapy compared to beta-lactam monotherapy. METHODS: Costs and effects were estimated using data from a cluster-randomized cross-over trial of antibiotic treatment strategies, primarily from the reduced third payer perspective (i.e. hospital admission costs). Cost-minimization analysis (CMA) and cost-effectiveness analysis (CEA) were performed using linear mixed models. CMA results were expressed as difference in costs per patient. CEA results were expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per prevented death. RESULTS: A total of 2,283 patients were included. Crude average costs within 90 days from the reduced third payer perspective were 4,294, 4,392, and 4,002 per patient for the beta-lactam monotherapy, beta-lactam/macrolide combination, and fluoroquinolone monotherapy strategy, respectively. CMA results were 106 (95% CI -697 to 754) for the beta-lactam/macrolide combination strategy and -278 (95%CI -991 to 396) for the fluoroquinolone monotherapy strategy, both compared to the beta-lactam monotherapy strategy. The ICER was not statistically significantly different between the strategies. Other perspectives yielded similar results. CONCLUSIONS: There were no significant differences in cost-effectiveness of strategies of preferred antibiotic treatment of CAP on non-ICU wards with either beta-lactam monotherapy, beta-lactam/macrolide combination therapy, or fluoroquinolone monotherapy. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01660204 , on May 2nd, 2012.
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Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Neumonía Bacteriana/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Antibacterianos/economía , Infecciones Comunitarias Adquiridas/economía , Análisis Costo-Beneficio , Estudios Cruzados , Quimioterapia Combinada , Femenino , Fluoroquinolonas/economía , Fluoroquinolonas/uso terapéutico , Hospitalización , Humanos , Macrólidos/economía , Macrólidos/uso terapéutico , Masculino , Persona de Mediana Edad , Países Bajos , Neumonía Bacteriana/economía , beta-Lactamas/economía , beta-Lactamas/uso terapéuticoRESUMEN
BACKGROUND: We aimed to evaluate health status and associated factors in community-dwelling elderly in the Netherlands. METHODS: Participants from a placebo-controlled double-blind randomized controlled trial conducted in the Netherlands were invited at the time of enrolment to participate in this study. Data were collected on comorbidities, socio-demographic background and health status, using EQ-5D-3L instrument. EQ-5D-3L summary index values (EQ-5D-indices) was derived using Dutch tariff. Regression analysis was conducted to identify factors associated with EQ-5D-indices and visual analogue scale (EQ-VAS). RESULTS: 48,634 elderly (≥65 years) were included. The most frequently reported complaint was pain/discomfort (29.4%), but for the elder elderly (i.e. ≥85 years) it was mobility (52.9%). The proportion of persons reporting (multiple) problems increased with age from 31.5% for 65-69 years old subjects to 65.9% for elder elderly. The mean EQ-5D-indices and EQ-VAS decreased with age from 0.94 and 84, respectively in those 65 to 69 years old to 0.86 and 76, respectively, in ≥85 years old subjects. Increasing age, female gender, low education, geographic factors and comorbidities were associated with impaired health status. CONCLUSIONS: Within community-dwelling elderly large differences in health status exist. Impairment increases rapidly with age, but health status is also associated with socio-demographic variables and comorbidities. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00812084 .