Michel van Agthoven

Unit Costs of Inpatient Hospital Days

AbstractBackground: Costs of inpatient days in hospitals are frequently the main drivers of total treatment costs, and their unit cost can markedly affect the outcomes of an economic evaluation. In many countries, the availability of unit cost data is limited and unit costs are often based on data from hospitals participating in clinical trials. Objective: To provide data about unit costs of inpatient hospital days in The Netherlands from a healthcare provider’s perspective and to give an insight into the extent to which cost categories and total costs differ between hospitals. Design: Unit costs were collected from 22 wards and 11 intensive care units (ICUs) of general and university hospitals involved in clinical trials with ‘piggy-backed’ economic evaluations. Direct costs, such as costs of nursing and medical materials, were calculated by dividing the annual cost per category of the nursing department by the annual number of inpatient days. Indirect costs, such as overheads and accommodation, were allocated to the nursing departments by applying direct allocation. All costs were expressed in 1998 euros (EUR). Results: The mean costs per inpatient day were EUR230 (range: EUR154–EUR311) in general hospitals and EUR323 (range: EUR209–EUR400) in university hospitals. The mean costs per inpatient day in an ICU were EUR1125 (EUR919–EUR1560). Between 38–48% of the total costs were made up of nursing costs. All cost categories showed wide variations between hospitals. Conclusions: The results of this study were used to develop standard costs for inpatient days in The Netherlands and may contribute to the comparability and generalisability of economic evaluations.

Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: Costs, local control, survival, quality of life, and voice quality

The clinical results of radiotherapy and endoscopic cordectomy for T1a glottic carcinoma are reported to be similar, but costs of both treatments may differ. Therefore, we retrospectively evaluated the costs, voice quality, quality of life, and clinical results of both treatments.

Long-Acting Methylphenidate-OROS in Youths with Attention-Deficit Hyperactivity Disorder Suboptimally Controlled with Immediate-Release Methylphenidate. A study of cost effectiveness in The Netherlands.

AbstractBackground: Attention-deficit hyperactivity disorder (ADHD) is the most common mental health disorder in youths. Stimulants are the drugs of first choice in the treatment of ADHD. It has been suggested that full costs associated with the treatment of ADHD may be reduced by once-daily administration regimens of stimulants. Objectives: To estimate the cost effectiveness of treatment with long-acting methylphenidate osmotic release oral system (OROS) [Concerta®] for youths with ADHD for whom treatment with immediate-release (IR) methylphenidate is suboptimal. Study design: We developed a Markov model to obtain an incremental cost-effectiveness ratio (ICER). The analysis covered 10 years, with a Markov cycle of 1 day. Costs (in 2005 euros [€]) included medication, consultations and treatment interventions, and additional costs for attending special education. Quality-adjusted life-years (QALYs) were used as the effectiveness measure. Outcome probabilities were taken from the medical literature and an expert panel of five child psychiatrists and paediatricians. Univariate sensitivity analyses were performed to assess the robustness of the base-case estimate. Multivariate sensitivity analysis was used to estimate a worst- and best-case ICER. Results: The ICER of methylphenidate-OROS treatment in youths with ADHD for whom treatment with IR methylphenidate is suboptimal was €2004 per QALY. Total costs after 10 years were €15 739 for the IR methylphenidate pathway and €16 015 for the methylphenidate-OROS pathway. In the univariate sensitivity analysis, the ICER was sensitive to changes in resource use and the robability of stopping stimulant treatment in favour of IR methylphenidate. An ICER of 0 was reached with a 6.2% price reduction of methylphenidate-OROS. Conclusion: Methylphenidate-OROS is a cost-effective treatment for youths with ADHD for whom treatment with IR methylphenidate is suboptimal. Higher medication costs of methylphenidate-OROS were compensated for by savings on resource use, yielding similar 10-year costs compared with treatment with IR methylphenidate. Our analysis is sensitive to both clinical parameters and (differences in) resource utilization and costs between the groups modelled, warranting further research within clinical trials and observational databases, and into the full scope of costs.

Predictors and impact of non-adherence in adults with attention-deficit/hyperactivity disorder receiving OROS methylphenidate: results from a randomized, placebo-controlled trial

BackgroundMedication non-adherence has an important impact on treatment efficacy and healthcare burden across a range of conditions and therapeutic areas. The aim of this analysis was to determine predictors of non-adherence and impact of non-adherence on treatment response in adults with attention-deficit/hyperactivity disorder (ADHD).MethodsPost-hoc analysis of a 13-week randomized, double-blind placebo-controlled study of OROS methylphenidate (MPH) 54 and 72 mg/day. Primary efficacy variable was the Conners’ Adult ADHD Rating Scale – Screening Version (CAARS:O-SV). Daily adherence was calculated as average daily adherence (100 × capsules taken/2), with overall adherence calculated as the average daily adherence. Predictors of adherence were assessed using mixed-effects logistic regression. Descriptive statistics were generated for change in CAARS:O-SV score for adherent (> 95% adherence) and non-adherent subjects. Predictors of change were analyzed using a mixed model.ResultsSubjects were allocated to OROS MPH (54 mg, n = 87; 72 mg, n = 92) or placebo (n = 97). Mean adherence was 92.6% and 93.3% (OROS MPH 54 and 72 mg/day, respectively), versus 97.5% (placebo). Adherence was higher and less variable in completers. Factors significantly associated with non-adherence included female sex, shorter time since ADHD diagnosis, higher education level (completion of university) and score on the Drug Use Screening Inventory psychiatric disorders subscale. Improvements from baseline in CAARS:O-SV score were numerically greater in subjects defined as adherent than in those who were non-adherent. Significant predictors of CAARS:O-SV change in patients who completed the study included percentage adherence up to the point of assessment (p < 0.0001), baseline score (p < 0.0001) and family history of ADHD (p = 0.0003).ConclusionThe results of this analysis suggest that newly diagnosed patients, those with a high score on the DUSI-R psychiatric disorder scale, women, and subjects with high educational degrees may be at increased risk of non-adherence. Clinicians and policymakers should therefore pay special attention to these individuals, as non-adherence is a significant predictor of reduced response to treatment.Trial registrationEudraCT #: 2007-002111-82

Chemotherapy and high-dose-rate brachytherapy in the management of advanced cancers of the nasopharynx: clinical impact of high technology--is it worth the cost?

PURPOSE The aim of this study was to calculate the costs of chemotherapy and high-dose-rate brachytherapy in advanced-stage nasopharyngeal cancer. It is argued whether the effect of chemotherapy and this type of high-dose, high-precision radiation therapy is worth the costs. METHODS AND MATERIALS Clinical results of Stage III-IVB nasopharyngeal cancer in patients treated between 1991 and 2000 are reported. Treatment was broken down into five categories: workup, chemotherapy, preparation of radiation therapy, and application of radiation. For each category, costs were computed. Nasopharyngeal cancer treatment costs were compared with costs previously reported on patients treated for cancers of the oral cavity, larynx, and oropharynx. RESULTS With the addition of neoadjuvant chemotherapy and high cumulative doses of radiation (77-81 Gy) with brachytherapy, disease-free survival increased from 48% to 74% (p=0.002), and overall survival increased from 35% to 72% (p=0.005). The Rotterdam protocol has been implemented stepwise: as of 1991, costs per patient increased from 4521 Euros (US

Diffusion of a New Drug: A Comparative Analysis of Adoption, Treatment Complexity, and Persistence of Risperidone Long-Acting Injectable Therapy in the Netherlands

5023; 2001 exchange rate [December]: 1 Euro approximately 0.88 US

Economic assessment in the management of non-Hodgkin's lymphoma

) for conventional external beam radiation therapy to 13,728 Euros (US

Economic assessment on the management of chronic lymphocytic leukaemia

15,253) in 2000 for combinations of chemotherapy, conventional external beam radiation therapy, and brachytherapy. In case of stereotactic radiotherapy, the cost was 14,516 Euros (US

Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed?

16,495). CONCLUSIONS Costs for cancer in the nasopharynx vary from 14,528 Euros (US

What should we know about the person behind a TTO

16,509) to 15,316 Euros (US