Cost-utility analysis of expanding the colorectal cancer screening policy in Flanders.

OBJECTIVE: Since 2013, Flanders has introduced a screening programme for colorectal cancer for all citizens aged between 50 and 74 years. The objective of this study was to assess the cost-utility of an expansion of the colorectal cancer screening policy in Flanders (Belgium) and to place these findings in the international context. METHODS: Cost-utility analysis using high-detail data about screening participation, screening results, and epidemiological data, a Markov cohort model has been constructed to study long-term costs and effects. A cost-utility analysis was performed as a three-way comparison between current, expanded (from age 45 years), and no screening scenarios, from a societal and healthcare perspective. Robustness was assessed by both one-way and probabilistic sensitivity analyses. RESULTS: Analyses show that both current and expanded screening result in quality-adjusted life years (QALY) gains and are mostly cost-saving. Overall, 97.5% of Incremental Cost-Effectiveness Ratios (ICERs) remained well below € 2000 per QALY for all comparisons. Parameters related to the colonoscopy that follows a positive test result such as compliance and cost are especially impactful on the cost-effectiveness. CONCLUSIONS: Screening participation and screening costs have remained comparatively stable, making colorectal cancer screening a cost-effective (dominant) policy. Expanding the screen age to 45 years is also cost-effective (dominant) compared with current screening, albeit with a slimmer margin.

Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective: a cross-sectional study.

BACKGROUND: Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective. METHODS: Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness. RESULTS: The mean monthly cost of care for a community-dwelling person with dementia was estimated at € 2339 (95% CI € 2133 - € 2545) per person from a societal perspective and at € 968 (95% CI € 825 - € 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective. CONCLUSIONS: Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care. TRIAL REGISTRATION: Clinicaltrials.gov NCT02630446, December 15, 2015.

Osteopathic care for low back pain and neck pain: A cost-utility analysis.

OBJECTIVES: The aim was to examine the health and economic consequences of osteopathic care for low back pain and neck pain in addition to usual care compared to usual care alone. DESIGN: A decision tree model considering a one-year time horizon was applied. The analysis occurred from a health insurance perspective only considering direct medical costs. The health effects were expressed as quality-adjusted life years (QALYs). MAIN OUTCOMES: The main outcome was the incremental cost-effectiveness ratio (ICER). The uncertainty around key input parameters was addressed applying one-way and probabilistic sensitivity analyses (5000 simulations). RESULTS: For low back pain, osteopathy resulted in cost savings (€385.1 vs €501.8/patient) at improved QALYs (0.666 vs. 0.614) compared to usual care. For neck pain, osteopathy resulted in additional costs (€577.3 vs. €521.0) and improved QALYs (0.639 vs. 0.609) resulting in an ICER of €1,870/QALY. The one-way sensitivity analysis identified the hospitalization cost (back) and osteopathy cost (neck) as major cost drivers. The probabilistic sensitivity analysis resulted in an average net saving of €163 (95%CI-€260, -€49.1) and a QALY gain of 0.06 (95%CI -0.06, 0.17) for low back pain and an average additional cost of €55.1 (95%CI €20.9, €129) and improved QALY gain of 0.03 (95%CI-0.06, 0.12) for neck pain. CONCLUSIONS: Osteopathy was found to be a 'dominant' (low back pain) and cost-effective strategy (neck pain) compared to usual care. Further health economic evaluation studies considering a broader range of cost items and longer time horizon are required.

Health-related costs in a sample of premenopausal non-diabetic overweight or obese females in Antwerp region: a cost-of-illness analysis.

BACKGROUND: People with overweight or obesity are at increased risk for disease later in life which cause important health costs.The aim of this study was to estimate the health status and the corresponding costs in a sample of females with overweight or obesity which were participating in a Randomized Controlled Trial (RCT) exploring the effect of lifestyle habits changes on ectopic adipose tissue. METHODS: Sixty-two non-diabetic premenopausal females without major comorbidities of overweight and obesity were recruited among patients visiting endocrinologists at the obesity clinic of the University Hospital of Antwerp and the University of Antwerp.A RCT-embedded cost-of-illness approach with societal perspective, based on self-reported questionnaires and cost diaries (3 months recall) was applied to estimate the prevalence of different comorbidities and the related direct and indirect costs in this sample of overweight or obese females. The European Quality-of-Life-5D questionnaire was used to define the health state and the corresponding utility index of the participants. RESULTS: The average direct health costs and health utilities observed in this sample were comparable with the general Flemish female population. This may partially be explained by the strict inclusion criteria of the RCT (i.e. overweight or obesity without diabetes type 2 or cardiovascular diseases). However, 15% of the participants had five or more comorbidities resulting in higher average costs and lower average health utility as compared to the general population, only 3 participants were diagnozed with the metabolic syndrome. In this subsample productivity was low due to high average absenteeism, yielding important total costs for the society. CONCLUSION: Secondary prevention to avoid health deterioration in overweight or obese females without major comorbidies is needed to contain health care costs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02831621, approval of the ethics committee of the University Hospital of Antwerp (number: 14/17/205 -ref: 7543075363).

Economic evaluation of S. boulardii CNCM I-745 for prevention of antibioticassociated diarrhoea in hospitalized patients.

Interest in administration of probiotics to prevent antibiotic-associated diarrhoea (AAD) in hospitalized patients is increasing. We determined the cost of antibiotic-associated diarrhoea in hospital settings for non-complicated and Clostridium difficile (C.diff) complicated AAD, and performed a health-economic analysis of AAD prevention with S. boulardii CNCM I-745 (S. boulardii) from data collected in 1 university and 3 regional hospitals in Flanders. Using a decision tree analytic model, costs and effects of S. boulardii for AAD prevention are calculated. Incremental costs due to AAD, including increased length of hospitalization, were calculated using bottom-up and top-down costing approaches from a hospital, healthcare payer (HCP) and societal perspective. Model robustness was tested using sensitivity analyses. Additional costs per hospitalized patient range from € 277.4 (hospital) to € 2,150.3 (societal) for non-complicated and from € 588.8 (hospital) to € 2,239.1 (societal) for C. diff. complicated AAD. Using S. boulardii as AAD prevention results in cost savings between € 50.3 (bottom-up) and € 28.1 (topdown) per patient treated with antibiotics from the HCP perspective; and € 95.2 and € 14.7 per patient from the societal and hospital perspectives. Our analysis shows the potential for using S. boulardii as AAD prophylactic treatment in hospitalized patients. Based on 831,655 hospitalizations with antibiotic administration in 2014 and € 50.3 cost saving per patient on antibiotics, generalized use of S. boulardii could result in total annual savings up to € 41.8 million for the Belgian HCP.

The insights of health and welfare professionals on hurdles that impede economic evaluations of welfare interventions.

BACKGROUND: Four hurdles associated with economic evaluations in welfare interventions were identified and discussed in a previous published literature review. These hurdles include (i) 'Ignoring the impact of condition-specific outcomes', (ii) 'Ignoring the impact of QoL externalities', (iii) 'Calculation of costs from a too narrow perspective' and (iv) 'The lack of well-described & standardized interventions'. This study aims to determine how healthcare providers and social workers experience and deal with these hurdles in practice and what solutions or new insights they would suggest. METHODS: Twenty-two professionals of welfare interventions carried out in Flanders, were interviewed about the four described hurdles using a semi-structured interview. A thematic framework was developed to enable the qualitative analysis. The analysis of the semi-structured interviews was facilitated through the use of the software program QRS NVivo 10. RESULTS: The interviews revealed a clear need to tackle these hurdles. The interviewees confirmed that further study of condition-specific outcomes in economic evaluations are needed, especially in the field of mental health and stress. The proposed dimensions for the condition-specific questionnaires varied however between the groups of interviewees (i.e. general practitioners vs social workers). With respect to QoL externalities, the interviewees confirmed that welfare interventions have an impact on the social environment of the patient (friends and family). There was however no consensus on how this impact of QoL externalities should be taken into account in welfare interventions. Professionals also suggested that besides health care costs, the impact of welfare interventions on work productivity, the patients' social life and other items should be incorporated. Standardization appears to be of limited added value for most of the interviewees because they need a certain degree of freedom to interpret the intervention. Furthermore, the target population of the interventions is diverse which requires a tailor-made approach. CONCLUSION: This qualitative research demonstrated that these hurdles occur in practice. The proposed solutions for these hurdles can contribute to the improvement of the methodological quality of economic evaluations of welfare interventions.

Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial.

BACKGROUND: Despite advances in diagnosis and treatment of type 2 diabetes, suboptimal metabolic control persists. Patient education in diabetes has been proved to enhance self-efficacy and guideline-driven treatment, however many people with type 2 diabetes do not have access to or do not participate in self-management support programmes. Tele-education and telecoaching have the potential to improve accessibility and efficiency of care, but there is a slow uptake in Europe. Patient and provider acceptance in a local context is an important pre-condition for implementation. The aim of the study was to explore the perceptions of patients, nurses and general practitioners (GPs) regarding telecoaching in type 2 diabetes. METHODS: Mixed-method study embedded in a clinical trial, in which a nurse-led target-driven telecoaching programme consisting of 5 monthly telephone sessions of +/- 30 min was offered to 287 people with type 2 diabetes in Belgian primary care. Intervention attendance and satisfaction about the programme were analysed along with qualitative data obtained during post-trial semi-structured interviews with a purposive sample of patients, general practitioners (GPs) and nurses. The perceptions of patients and care providers about the intervention were coded and the themes interpreted as barriers or facilitators for adoption. RESULTS: Of 252 patients available for a follow-up analysis, 97.5 % reported being satisfied. Interviews were held with 16 patients, 17 general practitioners (GPs) and all nurses involved (n = 6). Themes associated with adoption facilitation were: 1) improved diabetes control; 2) need for more tailored patient education programmes offered from the moment of diagnosis; 3) comfort and flexibility; 4) evidence-based nature of the programme; 5) established cooperation between GPs and diabetes educators; and 6) efficiency gains. Most potential barriers were derived from the provider views: 1) poor patient motivation and suboptimal compliance with "faceless" advice; 2) GPs' reluctance in the area of patient referral and information sharing; 3) lack of legal, organisational and financial framework for telecare. CONCLUSIONS: Nurse-led telecoaching of people with type 2 diabetes was well-accepted by patients and providers, with providers being in general more critical in their reflections. With increasing patient demand for mobile and remote services in healthcare, the findings of this study should support professionals involved in healthcare policy and innovation. TRIAL REGISTRATION: NCT01612520 , registered prior to recruitment on 4th June 2012.

Cost-effectiveness and budget impact analysis of a population-based screening program for colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer mortality in Belgium. In Flanders (Belgium), a population-based screening program with a biennial immunochemical faecal occult blood test (iFOBT) in women and men aged 56-74 has been organised since 2013. This study assessed the cost-effectiveness and budget impact of the colorectal population-based screening program in Flanders (Belgium). METHODS: A health economic model was conducted, consisting of a decision tree simulating the screening process and a Markov model, with a time horizon of 20years, simulating natural progression. Predicted mortality and incidence, total costs, and quality-adjusted life-years (QALYs) with and without the screening program were calculated in order to determine the incremental cost-effectiveness ratio of CRC screening. Deterministic and probabilistic sensitivity analyses were conducted, taking into account uncertainty of the model parameters. RESULTS: Mortality and incidence were predicted to decrease over 20years. The colorectal screening program in Flanders is found to be cost-effective with an ICER of 1681/QALY (95% CI -1317 to 6601) in males and €4,484/QALY (95% CI -3254 to 18,163). The probability of being cost-effective given a threshold of €35,000/QALY was 100% and 97.3%, respectively. The budget impact analysis showed the extra cost for the health care payer to be limited. CONCLUSION: This health economic analysis has shown that despite the possible adverse effects of screening and the extra costs for the health care payer and the patient, the population-based screening program for CRC in Flanders is cost-effective and should therefore be maintained.

The potential health and economic effect of a Body Mass Index decrease in the overweight and obese population in Belgium.

OBJECTIVES: The aim of the study was to examine the health and economic consequences of a Body Mass Index decrease in the Belgian overweight and obese population over a 20-year time period. STUDY DESIGN: Health economic evaluation study. METHODS: A Markov decision-analytic model using a societal perspective was applied, projecting the one-year results of a one unit Body Mass Index decrease over a time horizon of 20 years. Scenario analysis was applied evaluating the effects on the results of an alternative modelling assumption. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the effects on the findings of varying key input parameters. RESULTS: A one unit Body Mass Index decrease resulted in improved health outcomes and cost savings/patient (overweight women: 785€, obese women: 1039€, overweight men: 613€, obese men: 864€). For the total overweight and obese population, a cost saving of 2.8 billion euros was estimated. Considering the economic value of the health impact would result in a total economic benefit of about 15.9 billion euros for the Belgian society over a 20 year time period. CONCLUSIONS: A one unit Body Mass Index reduction in the overweight and obese population in Belgium was found to be associated with improved health outcomes and cost savings. The evidence of such research can assist regulatory bodies in the allocation of healthcare budgets in a more efficient way.

Optimizing diabetes control in people with Type 2 diabetes through nurse-led telecoaching.

AIMS: To study the effect of a target-driven telecoaching intervention on HbA1c and other modifiable risk factors in people with Type 2 diabetes. METHODS: We conducted a randomized controlled trial in patients receiving hypoglycaemic agents. The primary outcome was HbA1c level at 6 months in the entire sample and in a subgroup with HbA1c levels ≥ 53 mmol/mol (7%) at baseline. Secondary outcomes were HbA1c at 18 months; total cholesterol, LDL, HDL, triglycerides, blood pressure, BMI and proportion of people who had achieved guideline-recommended targets at 6 and 18 months. RESULTS: A total of 287 participants were randomized to telecoaching and 287 to usual care. The mean (sd) baseline HbA1c level was 53 (11) mmol/mol [7.0 (1.0)%] overall and 63 (10) mmol/mol [7.9 (0.9)%] in the elevated HbA1c subgroup. At 6 months, the between-group differences in favour of telecoaching were: HbA1c -2 (95% CI -4; -1) mmol/mol [-0.2 (95% CI -0.3;-0.1)%; P=0.003] overall and -4 (95% CI -7; -2) mmol/mol [-0.4 (95% CI -0.7; -0.2)%; P=0.001] in the elevated HbA1c subgroup; BMI -0.4 kg/m(2) (95% CI -0.6; -0.1; P=0.003); total cholesterol -6 mg/dl (95% CI -11; -1, P=0.012). The proportion of participants on target for the composite of HbA1c , LDL and blood pressure increased by 8.9% in the intervention group and decreased by 1.3% in the control group (P=0.011). At 18 months, the difference in HbA1c was: -2 (95% CI -3;-0) mmol/mol [-0.2 (95% CI -0.3; -0.0)%; P=0.046] overall and -4 (-7; -1) mmol/mol [-0.4 (95% CI -0.7; -0.1)%; P=0.023] in the elevated HbA1c subgroup. CONCLUSION: Nurse-led telecoaching improved glycaemic control, total cholesterol levels and BMI in people with Type 2 diabetes. Twelve months after the intervention completion, there were sustained improvements in glycaemic control.

Establishing a method to estimate the cost-effectiveness of a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study.

Overweight and obesity in children are recognized as a major health problem. The ToyBox-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the ToyBox-intervention. In order to estimate the long-term impact of the ToyBox-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the ToyBox-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the ToyBox-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers.

[Illicit drug use among employees in Belgium: an initial estimate of the costs borne by employers]. / La consommation de drogues illicites chez les employés en Belgique: une première estimation des coûts supportés par les employeurs .

INTRODUCTION: The use of illicit drug can affect workplace absenteeism, accidents, job turnover and worker productivity. The magnitude of the cost borne by employers has not yet been calculated. OBJECTIVES: Assessing the perception corporate directors in Belgium on illicit drug use and costs that the company has to bear because of this consumption. METHOD: An online survey on alcohol and other drugs was conducted in 2005 with 216 employers in Belgium, based on a stratified random sample of companies with 50 employees or more. Data on the costs related to illicit drugs incurred by the company were collected from 17 companies in the sample. The survey results were supplemented by data from a literature review. RESULTS: Employers have little data on the impact of illicit drugs on the company. A very small sample of companies has given us enough information for a first estimate of the cost incurred by the use of illegal substances in the workplace. Their estimates are still very close to the estimates found in the few articles from the literature. Reduced productivity is seen as the most important cost. CONCLUSION: The productivity of employees who use drugs was estimated reduced by 30%. Employers perceive the reduced productivity of drug users as the most important cost, rather than absenteeism, accidents and staff turnover.

Hospital-acquired infections in Belgian acute-care hospitals: financial burden of disease and potential cost savings.

INTRODUCTION: Hospital Acquired Infections (HAIs) are considered to be one of the most serious patient safety issues in healthcare today. It has been shown that HAIs contribute significantly not only to morbidity and mortality, but also to excessive costs for the health care system and for hospitalized patients. Since possibilities of prevention and control exist, hospital quality can be improved while simultaneously the cost of care is reduced. The objectives of this study were to examine the prevalence and the excess costs associated with HAIs. METHODS: A retrospective observational study was performed to estimate costs associated with hospital-acquired infections in Belgian hospitals, both in procedural admissions and in medical admissions. Hospital, diagnosis-related group, age and gender were used as matching factors to compare stays associated with HAIs and stays without HAIs. Data were obtained from the Minimum Basic Data Set 2008 used by Belgian hospitals to register case-mix data for each admission to obtain reimbursement from the authorities. Data included information from 45 hospitals representing 16,141 beds and 2,467,698 patient stays. Using the 2008 national feedback programme of the Belgian government, cost data were collected (prolonged length of stay, additional pharmaceuticals and procedures) and subsequently linked to the data set. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of HAIs in hospitals having a higher rate of hospital-acquired infections in comparison to other hospitals would be realized. RESULTS: In our sample 5.9% of the hospital stays were associated with a hospital-acquired infection. In the procedural admission subset this was the case for 4.7% of the hospital stays. The additional mean cost of the hospital-acquired infection was Euro 2,576 for all stays (P < 0.001) and Euro 3,776 for procedural stays (P < 0.001). The total burden of disease in Belgium is estimated at Euro 533,076,110 for all admissions and Euro 235,667,880 for the subset of procedural admissions. The excess length of stay varied between hospitals from 2.52 up to 8.06 days (Md 4.58, SD 1.01), representing an associated cost of Euro 355,060,174 (66.61% of the total cost). The cost of additional medical procedures and additional pharmaceutical products was estimated at Euro 62,864,544 (11.97%) and Euro 115,151,939 (21.60%) respectively. Overall, our results showed that considerable variability between hospitals regarding the incidence of HAIs (3.77-9.78%) for all hospital stays is present, indicating a potential for improvement. We provide a full overview of the potential monetary savings when reductions in HAIs are realized by applying different thresholds. For instance, if all Belgian hospitals having a higher rate of hospital-acquired infections improve their rate to the level of the hospital corresponding to percentile 75 (= 7.5% HAL) savings would be Euro 17,799,326. CONCLUSION: HALs are associated with important additional healthcare costs. Although not all hospital-acquired infections can be prevented, an opportunity to increase cost-effectiveness of hospital care delivery presents itself. This study is the first to estimate the annual economic burden of HALs for Belgium at a national level, incorporating all associated hospital costs. Apart from the fact that the cost of prolonged length of stay is of major importance, we have also shown that the cost of additional procedures and pharmaceutical products cannot be neglected when estimating the financial burden of HAIs.

Longitudinal economic consequences of colorectal cancer in a university hospital setting.

BACKGROUND: Colorectal cancer is an important cause of morbidity and mortality in Europe. Medical interventions improve health outcomes, but may come at a considerable cost for the health care system and for patients. There is a need for so called incidence-based cost-analyses, in order to better understand the potential impact of new types of prevention and treatment. AIM: The objective of this study was to map--both from the patient and the health insurance perspective--the longitudinal costs of colorectal cancer in a university hospital setting. In addition, the average monthly cost per patient and the costs during the last year of life were investigated. METHODS: The incidence-based analysis was conducted on data from 539 patients, who were treated for colorectal cancer in the Ghent University Hospital between July 1989 and August 2008. Data were obtained from all identified invoices and analysed from the perspective of both the health insurance and the patient. The costs were split in three major categories: drugs, hospital stay and fees. The follow-up period was divided into three periods: before recurrence, between recurrence and metastatic disease, and from metastatic disease until death. RESULTS: The total cumulative cost for an average follow-up of 3 years and 3 months was Euro37,696.2, the cost for rectal cancer and colon cancer being similar (Euro38,058 versus Euro37,268 respectively). Patients pay on average 10% of the cost, whereby medical fees are the main contributor to this cost. The total cost for patients who died during followup is higher (p = 0.297) compared to the cost in those who were still alive at the end of the follow-up period. The costs are highest during the last year of life. There was a significant difference (p = 0.049) in costs between patients with (Euro41,256.4) and without (Euro35,525.4) involved Lymph Nodes (LN) at the time of diagnosis. CONCLUSION: This study provides insight in the total longitudinal costs of colorectal cancer, and on the drivers of these costs within pre-defined periods in the progress of the disease. Taking into consideration some inherent limitations of our data and methods, such data are relevant and informative to health care policy makers and should be investigated more frequently.

Long-term outcomes and quality of life in critically ill patients with hematological or solid malignancies: a single center study.

PURPOSE: Data concerning long-term outcomes and quality of life (QOL) in critically ill cancer patients are scarce. The aims of this study were to assess long-term outcomes and QOL in critically ill patients with hematological (HM) or solid malignancies (SM) 3 months and 1 year after intensive care unit (ICU) discharge, to compare these with QOL before ICU admission, and to identify prognostic indicators of long-term QOL. METHODS: During a 1 year prospective observational cohort analysis, consecutive patients with HM or SM admitted to the medical or surgical ICU of a university hospital were screened for inclusion. Cancer data, demographics, co-morbidity, severity of illness, organ failures, and outcomes were collected. The QOL before ICU admission, 3 months, and 1 year after ICU discharge was assessed using standardized questionnaires (EuroQoL-5D, Medical Outcomes Study 36-item Short Form Health Survey). Statistical significance was attained at P < 0.05. RESULTS: There were 483 patients (85 HM, 398 SM) (64% men) with a median age of 62 years included. Mortality rates of HM compared to SM were, respectively: hospital (34 vs. 13%), 3 months (42 vs. 17%), and 1 year (66 vs. 36%) (P < 0.001). QOL declined at 3 months, but improved at 1 year although it remained under baseline QOL, particularly in HM. Older age (P = 0.007), severe comorbidity (P = 0.035), and HM (P = 0.041) were independently associated with poorer QOL at 1 year. CONCLUSIONS: Long-term outcomes and QOL were poor, particularly in HM. Long-term expectations should play a larger role during multidisciplinary triage decisions upon referral to the ICU.

Costs associated with readmissions in Belgian acute-care hospitals.

INTRODUCTION: Internationally, hospital readmissions have a great appeal as an indicator of hospital quality. Since possibilities in prevention and control exist, reducing rates of hospital readmission has attracted attention of policymakers as a way to improve quality of care while simultaneously reducing costs. Therefore reducing the number of readmissions is considered to be a pillar of more cost-effective hospital care. The goal of this study was to estimate the cost of hospital readmissions at a national level, describe differences in readmission rates between hospitals and to calculate the potential monetary savings of reducing excess readmissions. METHODS: Stays data were obtained from the Minimum Basic Data Set 2008 in a sample of 45 hospitals representing 16,141 beds. Readmissions were identified as a second admission for the same patient with the same APR-DRG code within 1 month or 3 months after discharge. Hospital type, diagnosis-related group, age and gender were used as matching factors in comparing readmission rates. Specific types of readmissions that occur naturally in each other's proximity due to the repeating nature of the therapy were excluded from the analysis. The costs per readmission were then calculated by linking the stays data with the cost data per APR-DRG and per severity index using the 2008 national feedback. The results of our sample were then extrapolated to all Belgian hospitals in order to calculate the total cost of readmissions. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of readmissions in hospitals having a higher readmission rate in comparison to other hospitals would be realized. RESULTS: In our sample 1.5% readmissions within 1 month after discharge and 2.1% within 3 months after discharge were identified. The additional weighted mean cost of these readmissions was Euro 3,495.58 within 1 month and Euro 3,572.20 within 3 months. The total financial burden, as extrapolated to the Belgian setting, is estimated at Euro 280,091,471.The wide variability between hospitals in incidence of readmissions (1.17-6.40%) indicates a potential for improvement. For instance, if all Belgian hospitals having a higher readmission rate improve their rate to the level of the hospital corresponding to percentile 75 (= 2.4% readmissions) savings would amount to Euro 14,118,509. CONCLUSION: The observed incidence of readmissions is associated with important additional healthcare costs. Although not all readmissions can be prevented, there is clearly a potential to increase cost-effectiveness of hosp tal care delivery.