The evaluation of lifestyle interventions in the Netherlands

2012 ◽  
Vol 7 (2) ◽  
pp. 243-261 ◽  
Author(s):  
David R. Rappange ◽  
Werner B. F. Brouwer
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
The Netherlands ◽  
Population Health ◽  
Lifestyle Interventions ◽  
Preventive Interventions ◽  
Unhealthy Behaviour ◽  
Decision Making Framework ◽  
Healthcare Interventions ◽  
Benefits Package

AbstractCurrent investments in preventive lifestyle interventions are relatively low, despite the significant impact of unhealthy behaviour on population health. This raises the question of whether the criteria used in reimbursement decisions about healthcare interventions put preventive interventions at a disadvantage. In this paper, we highlight the decision-making framework used in the Netherlands to delineate the basic benefits package. Important criteria in that framework are ‘necessity’ and ‘cost-effectiveness’. Several normative choices need to be made, and these choices can have an important impact on the evaluation of lifestyle interventions, especially when making these criteria operational and quantifiable. Moreover, the implementation of the decision-making framework may prove to be difficult for lifestyle interventions. Improvements of the decision-making framework in the Netherlands are required to guarantee sound evaluations of lifestyle interventions aimed at improving health.

scholarly journals Health-promoting and preventive interventions for community-dwelling older people published from inception to 2019: a scoping review to guide decision making in a Swedish municipality context

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Saranda Bajraktari ◽  
Marlene Sandlund ◽  
Magnus Zingmark
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
Older People ◽  
Nordic Countries ◽  
Community Dwelling ◽  
Preventive Interventions ◽  
Positive Effects ◽  
Scoping Reviews ◽  
Health Promoting ◽  
Community Dwelling Older People

Abstract Background Despite the promising evidence of health-promoting and preventive interventions for maintaining health among older people, not all interventions can be implemented due to limited resources. Due to the variation of content in the interventions and the breadth of outcomes used to evaluate effects in such interventions, comparisons are difficult and the choice of which interventions to implement is challenging. Therefore, more information, beyond effects, is needed to guide decision-makers. The aim of this review was to investigate, to what degree factors important for decision-making have been reported in the existing health-promoting and preventive interventions literature for community-dwelling older people in the Nordic countries. Methods This review was guided by the PRISMA-ScR checklist (Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews), the methodological steps for scoping reviews described in the Arksey and O′Malley’s framework, and the Medical Research Council’s (MRC) guidance on complex interventions. Eligible studies for inclusion were randomised controlled trials (RCTs) concerning health promotion or primary prevention for community-dwelling older people implemented in the Nordic countries. Additionally, all included RCTs were searched for related papers that were reporting on additional factors. Eligible studies were searched in seven databases: PubMed, SCOPUS, CINAHL, Academic Search Elite, PsycINFO, SocINDEX, and SPORTDiscus. Results Eighty-two studies met the inclusion criteria (twenty-seven unique studies and fifty-five related studies). Twelve studies focused on fall prevention, eleven had a health-promoting approach, and four studies focused on preventing disability. All interventions, besides one, reported positive effects on at least one health outcome. Three studies reported data on cost-effectiveness, three on experiences of participants and two conducted feasibility studies. Only one intervention, reported information on all seven factors. Conclusions All identified studies on health-promoting and preventive interventions for older people evaluated in the Nordic countries report positive effects although the magnitude of effects and number of follow-ups differed substantially. Overall, there was a general lack of studies on feasibility, cost-effectiveness, and experiences of participants, thus, limiting the basis for decision making. Considering all reported factors, promising candidates to be recommended for implementation in a Nordic municipality context are ‘Senior meetings’, ‘preventive home visits’ and ‘exercise interventions’ on its own or combined with other components.

Economic Evaluation of CAM Use

2017 ◽  
pp. 232-271
Author(s):  
Li-Chia Chen ◽  
Mayuree Tangkiatkumjai
Keyword(s):  
Decision Making ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Conventional Medicine ◽  
Kidney Diseases ◽  
Developed Countries ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Healthcare Interventions

Economic evaluation (EE) of health care interventions has been used to inform and affect policy decision-making by considering both costs and outcomes of the interventions. National guidelines in many countries consider cost-effectiveness evidence for making recommendations of healthcare interventions. In such case, EE of complementary and alternative medicine (CAM) is crucial to guide reimbursement decision-making. However, there is currently a lack of cost-effectiveness evidence of using CAM for kidney diseases. There are three types of full EEs, including a cost-benefit, cost-effectiveness, and cost-utility analysis, of which, results of cost-utility analysis is preferred and widely used by healthcare authorities in several developed countries. General approaches for EE of conventional medicine are likely to be applied to assess economic outcomes of CAM for kidney diseases. This chapter depicts the overall principles of EEs, interpretations of economic results and summaries the currently available EE for CAM.

SIMILARITIES AND DIFFERENCES BETWEEN FIVE EUROPEAN DRUG REIMBURSEMENT SYSTEMS

2012 ◽  
Vol 28 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Margreet Franken ◽  
Maïté le Polain ◽  
Irina Cleemput ◽  
Marc Koopmanschap
Keyword(s):  
Decision Making ◽  
Cost Effectiveness ◽  
The Netherlands ◽  
Risk Sharing ◽  
Added Value ◽  
Decision Making Process ◽  
Discretionary Power ◽  
Drug Reimbursement ◽  
Similarities And Differences ◽  
System Sustainability

Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations.Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant stakeholders.Results: All systems aim to balance three main objectives: system sustainability, equity and quality of care. System impact, however, is mainly assessed by drug expenditure. A national reimbursement agency evaluates reimbursement requests on a case-by-case basis. The minister has discretionary power to alter the reimbursement advice in Belgium, France, and the Netherlands. All systems make efforts to increase transparency in the decision-making process but none uses formal hierarchical reimbursement criteria nor applies a cost-effectiveness threshold value. Policies to deal with uncertainty vary: financial risk-sharing by price/volume contracts (France, Belgium) versus coverage with evidence development (Sweden, the Netherlands). Although case-by-case revisions are embedded in some systems for specific groups of drugs, systematic (group) revisions are limited.Conclusions: As shared strengths, all systems have clear objectives reflected in reimbursement criteria and all are prepared to pay for drugs with sufficient added value. However, all systems could improve the transparency of the decision-making process; especially appraisal lacks transparency. Systems could increase the use of (systematic) revisions and could make better use of HTA (among others cost-effectiveness) to obtain value for money and ensure system sustainability.

THE INTEGRAL INDEX OF PROBLEMS IN THE EVALUATION OF THE HEALTH STATE

2018 ◽  
pp. 12-14
Author(s):  
A.E. Vlasenko ◽  
N.M. Zhilina ◽  
A.A. Kozhevnikov ◽  
G.I. Chechenin
Keyword(s):  
Decision Making ◽  
Population Health ◽  
Economic Indicators ◽  
Health State ◽  
Integral Index ◽  
Municipal District ◽  
Risk Areas

The article presents the algorithm for calculating the integral index of problems in the evaluation of indicators of population health and identifying risk areas. The integral indices for Novokuznetsk municipal district were calculated. The index can be used by specialists of various levels and regions in assessing the level of health, environmental and socio-economic indicators for appropriate decision-making.

A BIM-based decision-making framework for optimal seismic retrofit of existing buildings

2021 ◽  
Vol 242 ◽  
pp. 112544
Author(s):  
Nicola Caterino ◽  
Iolanda Nuzzo ◽  
Antonio Ianniello ◽  
Giorgio Varchetta ◽  
Edoardo Cosenza
Keyword(s):  
Decision Making ◽  
Seismic Retrofit ◽  
Existing Buildings ◽  
Decision Making Framework

scholarly journals A referral aid for smoking cessation interventions in primary care: study protocol for a randomized controlled trial

2021 ◽  
Vol 22 ◽  
Author(s):  
Daniëlle N. Zijlstra ◽  
Jean W.M. Muris ◽  
Catherine Bolman ◽  
J. Mathis Elling ◽  
Vera E.R.A. Knapen ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Structural Equation ◽  
Controlled Trial ◽  
Linear Regression Analysis ◽  
Informed Decision ◽  
Equation Modeling ◽  
Informed Decision Making

Abstract Background: To expedite the use of evidence-based smoking cessation interventions (EBSCIs) in primary care and to thereby increase the number of successful quit attempts, a referral aid was developed. This aid aims to optimize the referral to and use of EBSCIs in primary care and to increase adherence to Dutch guidelines for smoking cessation. Methods: Practice nurses (PNs) will be randomly allocated to an experimental condition or control condition, and will then recruit smoking patients who show a willingness to quit smoking within six months. PNs allocated to the experimental condition will provide smoking cessation guidance in accordance with the referral aid. Patients from both conditions will receive questionnaires at baseline and after six months. Cessation effectiveness will be tested via multilevel logistic regression analyses. Multiple imputations as well as intention to treat analysis will be performed. Intervention appreciation and level of informed decision-making will be compared using analysis of (co)variance. Predictors for appreciation and informed decision-making will be assessed using multiple linear regression analysis and/or structural equation modeling. Finally, a cost-effectiveness study will be conducted. Discussion: This paper describes the study design for the development and evaluation of an information and decision tool to support PNs in their guidance of smoking patients and their referral to EBSCIs. The study aims to provide insight into the (cost) effectiveness of an intervention aimed at expediting the use of EBSCIs in primary care.

scholarly journals Cost per DALY averted in low, middle- and high-income countries: evidence from the global burden of disease study to estimate the cost-effectiveness thresholds

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rajabali Daroudi ◽  
Ali Akbari Sari ◽  
Azin Nahvijou ◽  
Ahmad Faramarzi
Keyword(s):  
Cost Effectiveness ◽  
Inverse Correlation ◽  
Gdp Per Capita ◽  
Middle Income ◽  
Capita Health Expenditure ◽  
Per Capita ◽  
Healthcare Interventions ◽  
Disease Study ◽  
The Cost ◽  
Very High

Abstract Background Determining the cost-effectiveness thresholds for healthcare interventions has been a severe challenge for policymakers, especially in low- and middle-income countries. This study aimed to estimate the cost per disability-adjusted life-year (DALY) averted for countries with different levels of Human Development Index (HDI) and Gross Domestic Product (GDP). Methods The data about DALYs, per capita health expenditure (HE), HDI, and GDP per capita were extracted for 176 countries during the years 2000 to 2016. Then we examined the trends on these variables. Panel regression analysis was performed to explore the correlation between DALY and HE per capita. The results of the regression models were used to calculate the cost per DALY averted for each country. Results Age-standardized rate (ASR) DALY (DALY per 100,000 population) had a nonlinear inverse correlation with HE per capita and a linear inverse correlation with HDI. One percent increase in HE per capita was associated with an average of 0.28, 0.24, 0.18, and 0.27% decrease on the ASR DALY in low HDI, medium HDI, high HDI, and very high HDI countries, respectively. The estimated cost per DALY averted was $998, $6522, $23,782, and $69,499 in low HDI, medium HDI, high HDI, and very high HDI countries. On average, the cost per DALY averted was 0.34 times the GDP per capita in low HDI countries. While in medium HDI, high HDI, and very high HDI countries, it was 0.67, 1.22, and 1.46 times the GDP per capita, respectively. Conclusions This study suggests that the cost-effectiveness thresholds might be less than a GDP per capita in low and medium HDI countries and between one and two GDP per capita in high and very high HDI countries.

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