L. Hakkaart-van Roijen

Quality of life and clinical outcome in psoriasis patients using intermittent cyclosporin

Background Psoriasis causes considerable patient morbidity and can seriously affect a patient’s quality of life (QoL).

Comparing methodologies for the cost estimation of hospital services

The aim of the study was to determine whether the total cost estimate of a hospital service remains reliable when the cost components of bottom-up microcosting were replaced by the cost components of top-down microcosting or gross costing. Total cost estimates were determined in representative general hospitals in the Netherlands for appendectomy, normal delivery, stroke and acute myocardial infarction for 2005. It was concluded that restricting the use of bottom-up microcosting to those cost components that have a great impact on the total costs (i.e., labour and inpatient stay) would likely result in reliable cost estimates.

Prevalence of bipolar disorder in the general population: a Reappraisal Study of the Netherlands Mental Health Survey and Incidence Study

Objective:  The Netherlands Mental Health Survey and Incidence Study (NEMESIS) is a Dutch population study using a fully structured interview (Composite International Diagnostic Interview, CIDI), administered by trained interviewers. Based on all three assessments of NEMESIS, 2.4% of the respondents were identified with lifetime bipolar disorder (DSM‐III‐R).

The cost of atopic dermatitis in the Netherlands: an international comparison.

Summary Background Only a few international studies have assessed the economic burden of atopic dermatitis (AD), and no costs‐of‐illness study for AD has been done for the Netherlands.

Societal costs and quality of life of children suffering from attention deficient hyperactivity disorder (ADHD)

BackgroundThe impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown.ObjectiveThe aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers.Study designWe selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD. For comparison’s sake, we also included a non-matched group of 35 children with behaviour problems and 60 children with no behaviour problem from a large school population-based study on the detection of ADHD. We collected information on the health care utilisation of the children applying the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness’ (TiC-P). Their health related quality of life was collected by using the Dutch 50-item parent version of the Child Health Questionnaire (CHQ PF-50). Measurements were at baseline and at 6 months. Subsequently, we collected data on the health utilisation of the mothers and their production losses due to absence from work and reduced efficiency.ResultsThe mean direct medical costs per ADHD patient per year were €2040 or €1173 when leaving out one patient with a long-term hospital admission, compared to €288 for the group of children with behaviour problems and €177 for the group of children with no behaviour problems. The direct medical costs for children who had psychiatric co-morbidities were significantly higher compared to children with ADHD alone. The mean medical costs per year for the mothers of the ADHD patients were significantly higher than for the mothers of the children with behaviour problems and the mothers of children with no behaviour problems respectively €728, €202 and €154. The physical summary score showed no significant differences between the groups. However, the score on the Psychosocial Summary Score dimension was significantly lower for ADHD patients compared to the scores of the children in the two other samples. The mean annual indirect costs due to absence from work and reduced efficiency at work were €2243 for the mothers of the ADHD patients compared to €408 for the mothers of children with behaviour problems and €674 for the mothers of children with no behaviour problems.ConclusionOur study showed that the direct medical costs of ADHD patients were relatively high. Additionally, our study indicated that ADHD appears to be accompanied by higher (mental) health care costs for the mothers of ADHD patients and by increased indirect costs for this group.

The societal costs and quality of life of patients suffering from bipolar disorder in the Netherlands

Objective:  To assess the societal costs and quality of life of patients suffering from bipolar disorder in the Netherlands.

More co‐morbid depression in patients with Type 2 diabetes with multiple complications. An observational study at a specialized outpatient clinic

Diabet. Med. 28, 86–89 (2011)

A microcosting study of diagnostic tests for the detection of coronary artery disease in the Netherlands

OBJECTIVE The primary aim of the present study was to calculate the actual costs of four diagnostic tests for the detection of coronary artery disease in the Netherlands using a microcosting methodology. As a secondary objective, the cost effectiveness of eight diagnostic strategies was examined, using microcosting and reimbursement fees subsequently as the cost estimate. DESIGN A multicenter, retrospective cost analysis from a hospital perspective. SETTING The study was conducted in three general hospitals in the Netherlands for 2006. INTERVENTIONS Exercise electrocardiography (exECG), stress echocardiography (sECHO), single-photon emission computed tomography (SPECT) and coronary angiography (CA). RESULTS The actual costs of exECG, sECHO, SPECT and CA were 33, 216, 614 and 1300 euro respectively. For all diagnostic tests, labour and indirect cost components (overheads and capital) together accounted for over 75% of the total costs. Consumables played a relatively important role in SPECT (14%). Hotel and nutrition were only applicable to SPECT and CA. Diagnostic services were solely performed for CA, but their costs were negligible (2%). Using microcosting estimates, exECG-sECHO-SPECT-CA was the most and CA the least cost effective strategy (397 and 1302 euro per accurately diagnosed patient). Using reimbursement fees, exECG-sECHO-CA was most and SPECT-CA least cost effective (147 and 567 euro per accurately diagnosed patient). CONCLUSIONS The use of microcosting estimates instead of reimbursement fees led to different conclusions regarding the relative cost effectiveness of alternative strategies.

Health-related quality of life and productivity losses in patients with depression and anxiety disorders.

Objectives: To assess the explanatory power of disease severity and health-related quality of life (HRQOL) on absenteeism and presenteeism in a working population suffering from depression and/or anxiety disorders. Methods: We used data of a large, multicenter, randomized trial (n = 644). Pearson chi-squared tests, analysis of variance, and multinomial logistic regression analyses were performed to explore associations of the type of the disorder and HRQOL with different types of productivity losses. Multivariate regression analyses were performed to assess associations with the duration of absenteeism. Results: The type of the disorder, disease severity, and HRQOL were associated with different types of productivity losses. Health-related quality of life and age were significantly associated with the duration of absenteeism. Conclusions: Our findings indicate that HRQOL may significantly explain the type of productivity loss as well as the duration of absenteeism.

Cost-effectiveness of multidimensional family therapy compared to cognitive behavioral therapy for adolescents with a cannabis use disorder: Data from a randomized controlled trial

OBJECTIVE To evaluate the cost-effectiveness of Multidimensional Family Therapy (MDFT) for adolescents with a cannabis use disorder, compared to Cognitive Behavioural Therapy (CBT). METHODS A parallel-group randomized controlled trial was performed. 109 adolescents with a DSM-IV cannabis use disorder (CBT n=54; MDFT n=55) were included. Assessments were conducted at baseline, and 3, 6, 9 and 12 months post-baseline, and included measures on cannabis and other substance use, delinquency, health care utilization, and general health related quality of life. RESULTS Excluding those with missing cost-data, 96 participants (MDFT n=49; CBT n=47) were included. From a health care perspective, the average annual direct medical costs in the CBT group were €2015 (95%C.I. 1397-2714), compared to €5446 (95%C.I. 4159-7092) in the MDFT group. The average quality-adjusted life years (QALYs) gained were 0.06 QALY higher for the MDFT group, which led to an incremental cost-effectiveness ratio (ICER) of 54,308 Euro/QALY or €43,405 per recovered patient. Taking the costs of delinquency into account, the costs increased to €21,330 (95%C.I. 12,389-32,894) for the CBT group and to €21,915 (95%C.I. 16,273-28,181) for the MDFT group, which lead to an ICER of 9266 Euro/QALY or a cost per recovered patient of €7491. CONCLUSIONS This is the first comprehensive CEA of MDFT compared to CBT and it demonstrated that when costs of delinquency were included, the ICERS were modest. The results underline the importance of adopting a broader perspective regarding cost effectiveness analyses in mental health care.