M Hoogendoorn

Is INTERdisciplinary COMmunity-based COPD management (INTERCOM) cost-effective?

The study aimed to estimate the cost-effectiveness of interdisciplinary community-based chronic obstructive pulmonary disease (COPD) management in patients with COPD. We conducted a cost-effectiveness analysis alongside a 2-yr randomised controlled trial, in which 199 patients with less advanced airflow obstruction and impaired exercise capacity were assigned to the INTERCOM programme or usual care. The INTERCOM programme consisted of exercise training, education, nutritional therapy and smoking cessation counselling offered by community-based physiotherapists and dieticians and hospital-based respiratory nurses. All-cause resource use during 2 yrs was obtained by self-report and from hospital and pharmacy records. Health outcomes were the St Georges Respiratory Questionnaire (SGRQ), exacerbations and quality-adjusted life years (QALYs). The INTERCOM group had 30% (95% CI 3–56%) more patients with a clinically relevant improvement in SGRQ total score, 0.08 (95% CI -0.01–0.18) more QALYs per patient, but a higher mean number of exacerbations, 0.84 (95% CI -0.07–1.78). Mean total 2-yr costs were €2,751 (95% CI -€632–€6,372) higher for INTERCOM than for usual care, which resulted in an incremental cost-effectiveness ratio of €9,078 per additional patient with a relevant improvement in SGRQ or €32,425 per QALY. INTERCOM significantly improved disease-specific quality of life, but did not affect exacerbation rate. The cost per QALY ratio was moderate, but within the range of that generally considered to be acceptable.

Cost effectiveness of preventive interventions in type 2 diabetes mellitus: a systematic literature review.

A systematic review of the literature was conducted to give an overview of economic evaluations of preventive interventions in type 2 diabetes mellitus. The interventions were sorted by type of preventive intervention (primary, secondary or tertiary) and by category (e.g. education, medication for hypertension). Several databases were searched for studies published between January 1990 and May 2004 on the three types of preventive intervention. For each study selected, inclusion of specific components from a standardised list of items, including quality, was recorded in a database. Summary tables were generated based on the database.A number of conclusions were drawn from this review. The most important was that strict blood pressure control was a more cost-effective intervention than less strict control, as shown by six studies reporting cost savings to very low costs per life-year gained. Primary and secondary prevention of type 2 diabetes were also highly cost effective, but these results were based on very few studies. Medications to reduce weight and hyperglycaemia together were cost effective compared with conventional interventions. Finally, the separate results regarding medications to reduce weight, hyperglycaemia and hypercholesterolaemia varied enormously, thus no conclusion could be drawn and further economic analysis is required.

Costs and effects of prenatal screening methods for Down syndrome and neural tube defects.

Objectives: To evaluate prenatal screening methods for Down syndrome and neural tube defects (NTD) with regard to costs per detected case and the number of screening-related miscarriages. Methods: The screening methods compared were risk assessment tests, i.e. serum tests and nuchal translucency measurement (NT), and invasive testing through chorionic villus sampling (CVS) or amniocentesis. Costs, the number of cases detected and screening-related miscarriages were calculated using a decision tree model. Results: The costs per detected case of Down syndrome ranged from EUR 98,000 for the first-trimester (serum) double test to EUR 191,000 for invasive testing. If NTD detection was included, the (serum) triple test had the lowest costs, EUR 73,000, per detected case of Down syndrome or NTD. The number of screening-related miscarriages due to invasive diagnostic tests varied from 13 per 100,000 women for the (serum) first- and second-trimester combined test to 914 per 100,000 women for invasive testing. Conclusions: Considering screening for both Down syndrome and NTD favors the triple test in terms of costs per detected case. Compared to invasive testing, risk assessment tests in general substantially lower screening-related miscarriages, which raises the question of whether invasive testing should still be offered in a screening program for Down syndrome.

PMC7 SELF-REPORT VERSUS CAREGIVER REPORT OF HEALTH CARE UTILIZATION: IMPACT ON COST AND COST-EFFECTIVENESS

countries and across time. The average STP rate for the 167 countries in the sample is 6.8% and the standard deviation 3.9%. The figures ranged from -6.8% for Equatorial Guinea to 18.6% for Armenia. For Brazil, STP rates display a decreasing profile across time, with an average rate of 4.7%. Computed figures vary from 3.6% to 5.5%. CONCLUSIONS: The standardisation of the use and estimation of discount rates in the economic evaluation of health care programmes (EEHCP) is a core quest, especially with the increase of EEHCP as a tool for decision making. The variation of STR rate results indicate the need for country-specific discount rate estimation.

Contents Vol. 11, 2008

L. Al-Gazali, Al-Ain A.H. Bittles, Perth A. Cao, Cagliari E.E. Castilla, Rio de Janeiro A.L. Christianson, Johannesburg A. de la Chapelle, Columbus, Ohio C.J. Epstein, San Francisco, Calif. E. Haimes, Newcastle upon Tyne P.S. Harper, Cardiff H. Harris, Manchester A. Kent, London B.M. Knoppers, Montreal M.J. Khoury, Atlanta, Ga. U. Kristoff ersson, Lund S. Metcalfe, Parkville A.G. Motulsky, Seattle, Wash. G. Neri, Rome I. Nippert, Münster C.N. Rotimi, Washington, D.C. P. Schroeder, Bielefeld Associate Editors

PRS10 PROJECTING THE FUTURE COSTS OF ASTHMA AND COPD IN THE NETHERLANDS

RESULTS: The strategy based on initial treatment with fluticazone propionate nasal drops resulted with treatment cost of PLN 768, while early polypectomy resulted with cost of PLN 1251. When surgery was performed in outpatients’ settings the mean treatment costs were PLN 586 for initial fluticazone and PLN 751 for early polypectomy. Sensitivity analysis revealed that FPND is less costly therapy unless no computed tomography is performed prior to polypectomy and the cost of surgical procedure falls below PLN 170. CONCLUSIONS: Treatment strategy based on fluticasone propionate nasal drops is effective in bilateral nasal polyposis and results in short-term cost savings.

Cost-effectiveness of preventive interventions in Diabetes Mellitus and its (macrovascular) complications: A systematic literature review

PDB30 COST-EFFECTIVENESS OF PREVENTIVE INTERVENTIONS IN DIABETES MELLITUS AND ITS (MACROVASCULAR)COMPLICATIONS: A SYSTEMATIC LITERATURE REVIEW Vijgen SMC, Hoogendoorn M, Baan C, de Wit A, Limburg W, Feenstra TL National Institute for Public Health and the Environment, Bilthoven, The Netherlands INTRODUCTION: Diabetes Mellitus is one of the major chronic diseases in Western societies, causing considerable comorbidity of cardiovascular diseases and premature death. Because of the variety of risk factors for diabetes mellitus and different macrovascular complications, the set of potentially interesting interventions is quite large. For policy makers with limited budgets, the question thus arises in what area of diabetes prevention, health care money is spent most effectively. OBJECTIVE: The aim of the present study was to review the literature on economic evaluation of interventions for prevention of diabetes Type-2 or its macrovascular complications, to describe their results and to identify the interventions that require additional research. METHODS: A systematic review of the literature was conducted. The interventions were classified by type of prevention. The characteristics of the selected studies (with life years gained or quality adjusted life years as an outcome measure) were described in a database, to generate summary tables. To be included, studies had to give a full economic evaluation of effects of the intervention. All studies were scored for quality using the BMJ checklist. RESULTS: In total 23 studies with life years gained or quality adjusted life years as an outcome measure were selected. Two studies focused on primary prevention, one on screening, and 20 studies evaluated interventions for the prevention of macrovascular complications. CONCLUSIONS: Tight blood pressure control is a cost effective intervention compared to less tight control. Medication to reduce both overweight and hyperglycemia was found to be cost saving to moderately cost-effective. Primary prevention of Type-2 diabetes also appeared to be cost-effective and cost saving, but further research is needed because only two studies were available. The results of medication interventions to reduce overweight, to reduce hyperglycemia, and to reduce dyslipidemia vary considerably, warranting further economic analysis to identify costeffective strategies.