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1.
Lung Cancer ; 141: 89-96, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31982640

RESUMO

OBJECTIVES: Stage I non-small cell lung cancer (NSCLC) can be treated with either Stereotactic Body Radiotherapy (SBRT) or Video Assisted Thoracic Surgery (VATS) resection. To support decision making, not only the impact on survival needs to be taken into account, but also on quality of life, costs and cost-effectiveness. Therefore, we performed a cost-effectiveness analysis comparing SBRT to VATS resection with respect to quality adjusted life years (QALY) lived and costs in operable stage I NSCLC. MATERIALS AND METHODS: Patient level and aggregate data from eight Dutch databases were used to estimate costs, health utilities, recurrence free and overall survival. Propensity score matching was used to minimize selection bias in these studies. A microsimulation model predicting lifetime outcomes after treatment in stage I NSCLC patients was used for the cost-effectiveness analysis. Model outcomes for the two treatments were overall survival, QALYs, and total costs. We used a Dutch health care perspective with 1.5 % discounting for health effects, and 4 % discounting for costs, using 2018 cost data. The impact of model parameter uncertainty was assessed with deterministic and probabilistic sensitivity analyses. RESULTS: Patients receiving either VATS resection or SBRT were estimated to live 5.81 and 5.86 discounted QALYs, respectively. Average discounted lifetime costs in the VATS group were €29,269 versus €21,175 for SBRT. Difference in 90-day excess mortality between SBRT and VATS resection was the main driver for the difference in QALYs. SBRT was dominant in at least 74 % of the probabilistic simulations. CONCLUSION: Using a microsimulation model to combine available evidence on survival, costs, and health utilities in a cost-effectiveness analysis for stage I NSCLC led to the conclusion that SBRT dominates VATS resection in the majority of simulations.

2.
Patient Prefer Adherence ; 13: 853-862, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213779

RESUMO

Background: Scarcity of prospective medication non-adherence cost measurements for the Australian population with no directly measured estimates makes determining the burden medication non-adherence places on the Australian health care system difficult. This study aims to indirectly estimate the national cost of medication non-adherence in Australia comparing the cost prior to and following a community pharmacy-led intervention. Methods: Retrospective observational study. A de-identified database of dispensing data from 20,335 patients (n=11,257 on rosuvastatin, n=6,797 on irbesartan and n=2,281 on desvenlafaxine) was analyzed and average adherence rate determined through calculation of PDC. Included patients received a pharmacist-led medication adherence intervention and had twelve months dispensing records; six months before and six months after the intervention. The national cost estimate of medication non-adherence in hypertension, dyslipidemia and depression pre- and post-intervention was determined through utilization of disease prevalence and comorbidity, non-adherence rates and per patient disease-specific adherence-related costs. Results: The total national cost of medication non-adherence across three prevalent conditions, hypertension, dyslipidemia and depression was $10.4 billion equating to $517 per adult. Following enrollment in the pharmacist-led intervention medication non-adherence costs per adult decreased $95 saving the Australian health care system and patients $1.9 billion annually. Conclusion: In the absence of a directly measured national cost of medication non-adherence, this estimate demonstrates that pharmacists are ideally placed to improve patient adherence and reduce financial burden placed on the health care system due to non-adherence. Funding of medication adherence programs should be considered by policy and decision makers to ease the current burden and improve patient health outcomes moving forward.

3.
Appl Health Econ Health Policy ; 17(4): 421-431, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30906972

RESUMO

New health technologies often yield health benefits, but often at a high cost. In Australia, the processes for public reimbursement of high-cost pharmaceuticals and medical devices are different, potentially resulting in inequity in support for new therapies. We explore how reimbursement is different for medical devices compared with pharmaceuticals, including whether higher cost-effectiveness thresholds are accepted for pharmaceuticals. A literature review identified the challenges of economic evaluations for medical devices compared with pharmaceuticals. We used the ventricular assist device as a case study to highlight specific features of medical device funding in Australia. We used existing guidelines to evaluate whether ventricular assist devices would fulfil the requirements for the "Life-Saving Drugs Program", which is usually reserved for expensive life-extending pharmaceutical treatments of serious and rare medical conditions. The challenges in conducting economic evaluations of medical devices include limited data to support effectiveness, device-operator interaction (surgical experience) and incremental innovations (miniaturisation). However, whilst high-cost pharmaceuticals may be funded by a single source (federal government), the funding of high-cost devices is complex and may be funded via a combination of federal, state and private health insurance. Based on the Life-Saving Drugs Program criteria, we found that ventricular assist devices could be funded by a similar mechanism to that which funds high-cost life-extending pharmaceuticals. This article highlights the complexities of medical device reimbursement. Whilst differences in available evidence affect the evaluation process, differences in funding methods contribute to inequitable reimbursement decisions between medical devices and pharmaceuticals.

4.
PLoS Negl Trop Dis ; 13(3): e0007182, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30849124

RESUMO

BACKGROUND: Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. OBJECTIVE: To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. METHODS: Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. FINDINGS: Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. DISCUSSION: Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies.


Assuntos
Análise Custo-Benefício , Sarcoptes scabiei/crescimento & desenvolvimento , Escabiose/economia , Escabiose/transmissão , Animais , Antiparasitários/economia , Antiparasitários/uso terapêutico , Árvores de Decisões , Humanos , Ivermectina/economia , Ivermectina/uso terapêutico , Estágios do Ciclo de Vida/efeitos dos fármacos , Estágios do Ciclo de Vida/fisiologia , Método de Monte Carlo , Anos de Vida Ajustados por Qualidade de Vida , Sarcoptes scabiei/efeitos dos fármacos , Sarcoptes scabiei/fisiologia , Escabiose/tratamento farmacológico , Escabiose/mortalidade
5.
PLoS One ; 14(3): e0214242, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921372

RESUMO

BACKGROUND: Heatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality. METHODS: Routinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define "hot days". Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between hot days and other days, and threshold regression to determine which temperature thresholds correspond to large increases in ED attendances. FINDINGS: In all regions, increases in temperature that did not coincide with time to acclimatise resulted in increases in ED attendances, and the EHIaccl performed in a similar manner. During hot days in California and The Netherlands, significantly more children ended up in the ED, while in Pakistan more elderly people attended. Hot days were associated with more patient admissions in the ages 5-11 in California, 65-74 in Karachi, and 75-84 in The Hague. During hot days in The Hague, patients with psychiatric symptoms were more likely to die. The current study did not identify a threshold temperature associated with particularly large increases in ED demand. INTERPRETATION: The association between heat and ED demand differs between regions. A limitation of the current study is that it does not consider delayed effects or influences of other environmental factors. Given the association between heat and ED use, hospitals and governmental authorities should recognise the demands that heat can place on local health care systems. These demands differ substantially between regions, with Pakistan being the most heavily affected within our study sample.


Assuntos
Mudança Climática , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Calor Extremo/efeitos adversos , Transtornos de Estresse por Calor/mortalidade , Aclimatação , Adolescente , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Botsuana/epidemiologia , California/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Paquistão/epidemiologia , Estações do Ano
6.
Value Health ; 22(3): 322-331, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832970

RESUMO

BACKGROUND: Risk-sharing arrangements (RSAs) can be used to mitigate uncertainty about the value of a drug by sharing the financial risk between payer and pharmaceutical company. We evaluated the projected impact of alternative RSAs for non-small cell lung cancer (NSCLC) therapies based on real-world data. METHODS: Data on treatment patterns of Dutch NSCLC patients from four different hospitals were used to perform "what-if" analyses, evaluating the costs and benefits likely associated with various RSAs. In the scenarios, drug costs or refunds were based on response evaluation criteria in solid tumors (RECIST) response, survival compared to the pivotal trial, treatment duration, or a fixed cost per patient. Analyses were done for erlotinib, gemcitabine/cisplatin, and pemetrexed/platinum for metastatic NSCLC, and gemcitabine/cisplatin, pemetrexed/cisplatin, and vinorelbine/cisplatin for nonmetastatic NSCLC. RESULTS: Money-back guarantees led to moderate cost reductions to the payer. For conditional treatment continuation schemes, costs and outcomes associated with the different treatments were dispersed. When price was linked to the outcome, the payer's drug costs reduced by 2.5% to 26.7%. Discounted treatment initiation schemes yielded large cost reductions. Utilization caps mainly reduced the costs of erlotinib treatment (by 16%). Given a fixed cost per patient based on projected average use of the drug, risk sharing was unfavorable to the payer because of the lower than projected use. The impact of RSAs on a national scale was dispersed. CONCLUSIONS: For erlotinib and pemetrexed/platinum, large cost reductions were observed with risk sharing. RSAs can mitigate uncertainty around the incremental cost-effectiveness or budget impact of drugs, but only when the type of arrangement matches the setting and type of uncertainty.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Custo Compartilhado de Seguro/métodos , Controle de Medicamentos e Entorpecentes/métodos , Neoplasias Pulmonares/tratamento farmacológico , Ensaios Clínicos Pragmáticos como Assunto/métodos , Idoso , Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/economia , Custo Compartilhado de Seguro/economia , Controle de Medicamentos e Entorpecentes/economia , Cloridrato de Erlotinib/economia , Cloridrato de Erlotinib/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/economia , Masculino , Pessoa de Meia-Idade , Pemetrexede/economia , Pemetrexede/uso terapêutico , Ensaios Clínicos Pragmáticos como Assunto/economia , Estudos Retrospectivos , Vinorelbina/economia , Vinorelbina/uso terapêutico
7.
Int Emerg Nurs ; 44: 14-19, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30819584

RESUMO

OBJECTIVE: To describe the numbers and length of stay (LOS) of patients with mental health (MH) problems at a Dutch emergency department (ED) and the effect of a psychiatric intervention team (PIT) on patient flow. METHODS: A longitudinal design was used to assess number of MH presentations and LOS during a 3-year period (2014-2016). In 2017, we introduced a PIT during ED peak hours, to reduce LOS for patients with MH problems. We evaluate the effects of the PIT on patients' LOS with an 18-month before and after intervention study (2017-2018). RESULTS: Total number of ED presentations increased with 4%. Total number of MH presentations increased with 23% from 2014 to 2016. LOS increased by 28 min (95 min vs. 123 min) for all presentations, while not changing for MH presentations (2014: 195 min, interquartile range (IQR) 120-293 and 2016: 190 min, IQR 116-296). In the before and after intervention study, number of MH presentations increased with 36% while LOS decreased with 46 min (p < 0.001). CONCLUSIONS: The number of MH presentations increased over the three years while LOS remained similar. In the before and after intervention study, number of presentations increased even more while LOS decreased significantly. Specialist psychiatric input reduces ED LOS.


Assuntos
Transtornos Mentais/enfermagem , Adulto , Idoso , Distribuição de Qui-Quadrado , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/enfermagem , Comportamento Autodestrutivo/psicologia , Estatísticas não Paramétricas
8.
Appl Health Econ Health Policy ; 17(2): 243-254, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30617458

RESUMO

BACKGROUND: In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14-49 NTDs each year. OBJECTIVE: Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. METHODS: We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. RESULTS: We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. CONCLUSIONS: This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.

9.
Eur J Emerg Med ; 26(1): 47-52, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28704269

RESUMO

OBJECTIVE: The aim of this study was to describe the impact of additional medical specialists, non-emergency physicians (non-EPs), performing direct supervision or a combination of direct and indirect supervision at an EP-led emergency department (ED), on patient flow and satisfaction. PATIENTS AND METHODS: An observational, cross-sectional, three-part study was carried out including staff surveys (n=379), a before and after 16-week data collection using data of visits during the peak hours (n=5270), and patient questionnaires during 1 week before the pilot and during week 5 of the pilot. Content analysis and descriptive statistics were used for analyses. RESULTS: The value of being present at the ED was acknowledged by medical specialists in 49% of their surveys and 35% of the EPs' and ED nurses' surveys, especially during busy shifts. Radiologists were most often (67.3%) convinced of their value of being on-site, which was agreed upon by the ED professionals. Perceived improved quality of care, shortening of length of stay, and enhanced peer consultation were mentioned most often.During the pilot period, length of stay of boarded patients decreased from 197 min (interquartile range: 121 min) to 181 min (interquartile range: 113 min, P=0.006), and patient recommendation scores increased from -15 to +20. CONCLUSION: Although limited by the mix of direct and indirect supervision, our results suggest a positive impact of additional medical specialists during busy shifts. Throughput of admitted patients and patient satisfaction improved during the pilot period. Whether these findings differ between direct supervision and combination of direct and indirect supervision by the medical specialists requires further investigation.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Corpo Clínico/estatística & dados numéricos , Satisfação do Paciente , Estudos Transversais , Mão de Obra em Saúde , Humanos , Tempo de Internação/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Projetos Piloto , Inquéritos e Questionários
10.
Mult Scler Relat Disord ; 25: 144-149, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30077086

RESUMO

BACKGROUND: In Australia, the Pharmaceutical Benefits Advisory Committee (PBAC) advises on the reimbursement of drugs to be subsidised through the Pharmaceutical Benefits Scheme (PBS). This study aims to provide insights into the PBAC process and key considerations regarding the reimbursement of MS drugs in Australia. METHODS: The factors considered by the PBAC and its advice on whether to reimburse a drug are documented in public summary documents (PSDs). Qualitative content analysis of PSDs was conducted for all MS drugs considered by the PBAC between January 2006 and January 2018. Key issues identified by the PBAC were extracted and categorised. Common issues were identified and compared between drugs indicated for MS. RESULTS: A total of 23 submissions were evaluated relating to 13 MS drugs. Eight were recommended for reimbursement; an approval rate of 35% per submission and 62% per drug. Approval rates were higher for disease modifying treatments (73% per drug) than for symptomatic drugs (0% for nabiximols and fampridine submissions). The most frequently discussed issues in PSDs, irrespective of PBAC decision, were: (1) the validity of the indirect comparisons formed (n = 11); (2) the validity of the approach to obtain utilities (n = 6); (3) the lack of appropriate/long-term safety data (n = 8); and (4) the time horizon used in the economic models (n = 3). CONCLUSION: A small but important number of issues have been consistently identified by the PBAC in relation to submissions for reimbursement of MS drugs. Drug developers and clinical trial investigators who are aware of these issues will be able to anticipate data requirements for reimbursement decision-making and thus potentially improve the evidence submitted for listing of MS drugs in Australia.


Assuntos
Comitês Consultivos/normas , Tomada de Decisões , Aprovação de Drogas/métodos , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla/psicologia , Comitês Consultivos/estatística & dados numéricos , Austrália/epidemiologia , Análise Custo-Benefício , Aprovação de Drogas/economia , Feminino , Humanos , Fatores Imunológicos/economia , Masculino , Estudos Retrospectivos
11.
Int Emerg Nurs ; 41: 25-30, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29880260

RESUMO

INTRODUCTION: Previous studies indicate that crowding scales may not perform well in low-volume emergency departments (EDs). In this study, face-validity of the Modified National ED OverCrowding Score (mNEDOCS) was assessed in a high-volume ED as well as in a low-volume ED. METHODS: A prospective observational cohort study was performed in the Netherlands. The correlation of the mNEDOCS with ED staff perceptions of crowding were assessed, using weighted Kappa (κ) and Pearson correlation. Subsequently, ED process measures (elapsed target times to triage, elapsed target times to treatment and patients' LOS) were described under different levels of ED crowding. RESULTS: Correlation between the categorized crowding scores was low (weighted κ 0.34 resp. 0.26). However, good correlations of 0.73 and 0.82 were found between the uncategorized mNEDOCS and ED staff's perception of crowding. Percentages of patients with elapsed target times to treatment increased simultaneously with increasingly busy periods when measured with mNEDOCS. CONCLUSIONS: The uncategorized mNEDOCS correlates well with perceived crowding, even at a low-volume ED. Determining a cut-off level at which a specific ED can be identified as crowded is important, because the predefined mNEDOCS categories may not be optimal for all EDs.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adulto , Idoso , Ambulâncias/estatística & dados numéricos , Estudos de Coortes , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Fatores de Tempo
12.
Int Emerg Nurs ; 40: 1-5, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29636284

RESUMO

INTRODUCTION: Abdominal pain has a wide range of possible causes, which may lead to difficulties in diagnosing and lengthy Emergency Department (ED) stays. In this study, bottlenecks in ED processes of patients with abdominal pain were identified. METHODS: Time-points of patients who presented to a Dutch ED with abdominal pain were observed and documented. The institutional review board approved the study. RESULTS: In total, 3015 min of patient time were observed in 54 patients. Median length of stay (LOS) was 218 min for admitted patients, and 168 min for discharged patients. For 65 patients (27.4%), LOS exceeded 4 h. Delays were found during the diagnostic process, when multiple physicians were needed in order to make a decision, and during departure. CONCLUSIONS: Our study concerning individual patients' time-points provides important insight into delays in the patient journey of patients with abdominal pain. Flow improvement can be achieved by focusing on these bottlenecks, for example by minimizing diagnostic delays and by simultaneous specialists' consultations for patients who need more than one physician. The optimization of ED flow for patients with abdominal pain depends on coordinated efforts between ED staff, medical specialists, radiology and laboratory staff, staff from inpatient units, and hospital supporting services.


Assuntos
Dor Abdominal/terapia , Aglomeração , Hospitalização/estatística & dados numéricos , Dor Abdominal/epidemiologia , Adulto , Distribuição de Qui-Quadrado , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Países Baixos , Estudos Prospectivos , Estatísticas não Paramétricas , Fatores de Tempo , Estudos de Tempo e Movimento
13.
J Neurol ; 265(3): 535-541, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29330584

RESUMO

BACKGROUND: Emergency departments (EDs) worldwide face crowding, which hampers patient flow. In this study, the impact of a dedicated neurologist present at the ED on patient flow during out-of-office hours was assessed. METHODS: A cross-sectional, mixed methods study was undertaken at a Dutch ED, including a pre-post analysis of data of patients who had a primary neurological disease (n = 458) and staff surveys (n = 152). Descriptive statistics and content analysis were used for analyses. RESULTS: Despite a 36% increase in the number of neurological patients (control period: n = 194, intervention period n = 264), a 30 min per patient decrease in ED median length of stay (LOS) was reached during the intervention period. Furthermore, the admission percentage decreased significantly (57.7% in the control period vs. 47.7% in the intervention period, p = 0.03). During half of the shifts neurologists stated that their presence had been valuable. Perceived reasons for this added value mentioned were improved quality of care, enhanced throughput of patients, and quicker consultations with other medical specialists. CONCLUSIONS: In our hypothesis-generating study, a dedicated neurologist present at the ED during out-of-office hours was associated with decreased patients' LOS and a decreased admission percentage, indicating increased decisiveness when the neurologist is present at the ED.


Assuntos
Serviço Hospitalar de Emergência , Tempo de Internação , Neurologistas , Admissão do Paciente , Adolescente , Adulto , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/terapia , Equipe de Assistência ao Paciente , Projetos Piloto , Pesquisa Qualitativa , Inquéritos e Questionários , Fatores de Tempo , Recursos Humanos , Adulto Jovem
15.
PLoS One ; 12(11): e0187477, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29121647

RESUMO

OBJECTIVES: Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version. METHODS: An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute. RESULTS: The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added. CONCLUSIONS: The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines.


Assuntos
Custos de Cuidados de Saúde , Manuais como Assunto , Assistência à Saúde , Família , Humanos , Países Baixos , Inquéritos e Questionários
16.
Int Emerg Nurs ; 35: 30-36, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28659247

RESUMO

INTRODUCTION: Emergency department (ED) crowding is a worldwide public health issue. In this study, patient flow and staff perceptions of crowding were assessed in Pakistan (Aga Khan University Hospital (AKUH)) and in the Netherlands (Haaglanden Medical Centre Westeinde (HMCW)). Bottlenecks affecting ED patient flow were identified. METHODS: First, a one-year review of patient visits was performed. Second, staff perceptions about ED crowding were collected using face-to-face interviews. Non-participant observation and document review were used to interpret the findings. RESULTS: At AKUH 58,839 (160visits/day) and at HMCW 50,802 visits (140visits/day) were registered. Length of stay (LOS) at AKUH was significantly longer than at HMCW (279min (IQR 357) vs. 100min (IQR 152)). There were major differences in patient acuities, admission and mortality rates, indicating a sicker population at AKUH. Respondents from both departments experienced hampered patient flow on a daily basis, and perceived similar causes for crowding: increased patients' complexity, long treatment times, and poor availability of inpatient beds. CONCLUSION: Despite differences in environment, demographics, and ED patient flow, respondents perceived similar bottlenecks in patient flow. Interventions should be tailored to specific ED and hospital needs. For both EDs, improving the outflow of boarded patients is essential.


Assuntos
Aglomeração , Serviço Hospitalar de Emergência/organização & administração , Pessoal de Saúde/psicologia , Percepção , Local de Trabalho/normas , Adulto , Feminino , Mortalidade Hospitalar/tendências , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos , Paquistão , Pesquisa Qualitativa , Estudos Retrospectivos , Recursos Humanos , Local de Trabalho/psicologia
17.
Value Health ; 20(4): 627-636, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28408005

RESUMO

OBJECTIVES: The aim of this article was to provide practical guidance in setting up patient registries to facilitate real-world data collection for health care decision making. METHODS: This guidance was based on our experiences and involvement in setting up patient registries in oncology in the Netherlands. All aspects were structured according to 1) mission and goals ("the Why"), 2) stakeholders and funding ("the Who"), 3) type and content ("the What"), and 4) identification and recruitment of patients, data handling, and pharmacovigilance ("the How"). RESULTS: The mission of most patient registries is improving patient health by improving the quality of patient care; monitoring and evaluating patient care is often the primary goal ("the Why"). It is important to align the objectives of the registry and agree on a clear and functional governance structure with all stakeholders ("the Who"). There is often a trade off between reliability, validity, and specificity of data elements and feasibility of data collection ("the What"). Patient privacy should be carefully protected, and address (inter-)national and local regulations. Patient registries can reveal unique safety information, but it can be challenging to comply with pharmacovigilance guidelines ("the How"). CONCLUSIONS: It is crucial to set up an efficient patient registry that serves its aims by collecting the right data of the right patient in the right way. It can be expected that patient registries will become the new standard alongside randomized controlled trials due to their unique value.


Assuntos
Coleta de Dados/métodos , Tomada de Decisões , Pesquisa sobre Serviços de Saúde/métodos , Oncologia/métodos , Formulação de Políticas , Sistema de Registros , Confidencialidade , Confiabilidade dos Dados , Coleta de Dados/economia , Coleta de Dados/normas , Fidelidade a Diretrizes , Guias como Assunto , Pesquisa sobre Serviços de Saúde/economia , Pesquisa sobre Serviços de Saúde/normas , Humanos , Oncologia/economia , Oncologia/normas , Países Baixos , Objetivos Organizacionais , Farmacovigilância , Sistema de Registros/normas , Reprodutibilidade dos Testes , Apoio à Pesquisa como Assunto
18.
Clin Lung Cancer ; 18(5): e341-e347, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28347579

RESUMO

BACKGROUND: The aims of this study are to analyze differences in survival between academic and non-academic hospitals and to provide insight into treatment patterns for non-small cell lung cancer (NSCLC). Results show the state of NSCLC survival and care in the Netherlands. METHODS: The Netherlands Cancer Registry provided data on NSCLC survival for all Dutch hospitals. We used the Kaplan-Meier estimate to calculate median survival time by hospital type and a Cox proportional hazards model to estimate the relative risk of mortality (expressed as hazard ratios) for patients diagnosed in academic versus non-academic hospitals, with adjustment for age, gender, and tumor histology, and stratifying for disease stage. Data on treatment patterns in Dutch hospitals was obtained from 4 hospitals (2 academic, 2 non-academic). A random sample of patients diagnosed with NSCLC from January 2009 until January 2011 was identified through hospital databases. Data was obtained on patient characteristics, tumor characteristics, and treatments. RESULTS: The Cox proportional hazards model shows a significantly decreased hazard ratio of mortality for patients diagnosed in academic hospitals, as opposed to patients diagnosed in non-academic hospitals. This is specifically true for primary radiotherapy patients and patients who receive systemic treatment for non-metastasized NSCLC. CONCLUSION: Patients diagnosed in academic hospitals have better median overall survival than patients diagnosed in non-academic hospitals, especially for patients treated with radiotherapy, systemic treatment, or combinations. This difference may be caused by residual confounding since the estimates were not adjusted for performance status. A wide variety of surgical, radiotherapeutic, and systemic treatments is prescribed.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/terapia , Hospitais de Ensino/estatística & dados numéricos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/secundário , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Pneumonectomia/estatística & dados numéricos , Modelos de Riscos Proporcionais , Radiocirurgia/estatística & dados numéricos , Radioterapia Adjuvante/estatística & dados numéricos , Sistema de Registros , Taxa de Sobrevida
19.
Int Emerg Nurs ; 29: 27-31, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26970907

RESUMO

INTRODUCTION: During emergency department (ED) crowding there is an imbalance between the need for emergency care and available resources. We assessed the impact of crowding on the triage process. METHODS: A 1-year health records review of 49,539 patient visits was performed. Data extracted included: occupancy ratio, ED occupancy, demographics, length of stay (LOS), time to triage, triage score, years working as a triage nurse, and triage destination. Data were analyzed using descriptive statistics and regression analyses. RESULTS: During crowding, target times to triage elapsed more often than during non-crowding (49.7% vs. 24.9%, P <0.001), and more patients were not triaged (2.2% vs. 1.6%, P <0.001). A higher ED occupancy was associated with longer waiting times for triage and longer LOS (P <0.001). There were 12,627 (25.5%) patients redirected to the general practitioner cooperative (GPC). No association between level of crowdedness and number of patients who were redirected to the GPC was found (P = 0.122). Redirection to the GPC occurred significantly more often when the triage nurse had more years working as a triage nurse (P <0.001). CONCLUSION: At this hospital, crowding affects the triage process, leading to longer waiting times to triage and longer ED LOS. Crowding did not influence triage destination.


Assuntos
Aglomeração , Tempo para o Tratamento/normas , Triagem/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Tempo para o Tratamento/tendências , Triagem/métodos , Triagem/estatística & dados numéricos
20.
Eur Arch Otorhinolaryngol ; 273(2): 455-64, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25876000

RESUMO

For patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN), chemotherapy can prolong life and alleviate symptoms. However, expected gains may be small, not necessarily outweighing considerable toxicity and high costs. Treatment choice is to a large extent dependent on preferences of doctors and patients and data on these choices are scarce. The purpose of this study is to obtain real-world information on palliative systemic treatment and costs of R/M SCCHN in the Netherlands. In six Dutch head and neck treatment centers, data were collected on patient and tumor characteristics, treatment patterns, disease progression, survival, adverse events, and resource use for R/M SCCHN, between 2006 and 2013. 125 (14 %) out of 893 R/M SCCHN patients received palliative, non-trial first-line systemic treatment, mainly platinum + 5FU + cetuximab (32 %), other platinum-based combination therapy (13 %), methotrexate monotherapy (27 %) and capecitabine monotherapy (14 %). Median progression-free survival and overall survival were 3.4 and 6.0 months, respectively. 34 (27 %) patients experienced severe adverse events. Mean total hospital costs ranged from € 10,075 (± € 9,891) (methotrexate monotherapy) to € 39,459 (± € 21,149) (platinum + 5FU + cetuximab). Primary cost drivers were hospital stays and anticancer drug treatments. Major health care utilization and costs are involved in systemically treating R/M SCCHN patients with a limited survival.


Assuntos
Carcinoma de Células Escamosas/terapia , Efeitos Psicossociais da Doença , Neoplasias de Cabeça e Pescoço/terapia , Recidiva Local de Neoplasia/terapia , Idoso , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/secundário , Terapia Combinada/economia , Custos e Análise de Custo , Progressão da Doença , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/economia , Recidiva Local de Neoplasia/epidemiologia , Países Baixos/epidemiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Taxa de Sobrevida/tendências
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