Cost-effectiveness of additional blood screening tests in the Netherlands

Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses—and ultimately rejects—three such arguments. According to the ‘rule of rescue’ argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will benefit from additional blood screening tests. On the ‘imposed risk’ argument, general cost-effectiveness standards do not apply when healthcare interventions impose risks on patients. This argument ignores the fact that imposing risks on patients is inevitable in healthcare and that these risks can be countered only within reasonable limits. Finally, the ‘manufacturing standard’ argument premises that general cost-effectiveness standards do not apply to procedures preventing the contamination of manufactured medical products. We contend that while this argument seems reasonable insofar as commercially manufactured medical products are concerned, publicly funded blood screening tests should respect the standards for general healthcare. We conclude that these particular arguments are unpersuasive, and we offer directions to advance the debate.

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Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

Journal of Medical Screening ◽

10.1177/096914139600300112 ◽

1996 ◽

Vol 3 (1) ◽

pp. 47-53 ◽

Cited By ~ 50

Author(s):

Afaf Girgis ◽

Philip Clarke ◽

Robert C Burton ◽

Rob W Sanson—Fisher

Keyword(s):

Cost Effectiveness ◽

Screening Programme ◽

Cost Effective ◽

Economic Assessment ◽

Screening Tests ◽

Family Practitioners ◽

Effectiveness Analysis ◽

The Cost ◽

Primary Health Care Physicians ◽

Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

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PRS30 Cost-Effectiveness of the Fixed-Dose Combination Tiotropium+Olodaterol Versus Tiotropium and Laba/Ics in Finland, Sweden and the Netherlands

Value in Health ◽

10.1016/j.jval.2020.08.1910 ◽

2020 ◽

Vol 23 ◽

pp. S722

Author(s):

M. Hoogendoorn ◽

I. Corro Ramos ◽

S. Soulard ◽

J. Cook ◽

E. Soini ◽

...

Keyword(s):

Cost Effectiveness ◽

The Netherlands ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Dose Combination

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Clip placement to prevent delayed bleeding after colonic endoscopic mucosal resection (CLIPPER): study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-020-04996-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ayla S. Turan ◽

◽

Leon M. G. Moons ◽

Ramon-Michel Schreuder ◽

Erik J. Schoon ◽

...

Keyword(s):

Cost Effectiveness ◽

The Netherlands ◽

Endoscopic Mucosal Resection ◽

Intervention Group ◽

Proximal Colon ◽

Control Group ◽

Colon Polyps ◽

Delayed Bleeding ◽

Randomized Controlled ◽

Mucosal Resection

Abstract Background Endoscopic mucosal resection (EMR) for large colorectal polyps is in most cases the preferred treatment to prevent progression to colorectal carcinoma. The most common complication after EMR is delayed bleeding, occurring in 7% overall and in approximately 10% of polyps ≥ 2 cm in the proximal colon. Previous research has suggested that prophylactic clipping of the mucosal defect after EMR may reduce the incidence of delayed bleeding in polyps with a high bleeding risk. Methods The CLIPPER trial is a multicenter, parallel-group, single blinded, randomized controlled superiority study. A total of 356 patients undergoing EMR for large (≥ 2 cm) non-pedunculated polyps in the proximal colon will be included and randomized to the clip group or the control group. Prophylactic clipping will be performed in the intervention group to close the resection defect after the EMR with a distance of < 1 cm between the clips. Primary outcome is delayed bleeding within 30 days after EMR. Secondary outcomes are recurrent or residual polyps and clip artifacts during surveillance colonoscopy after 6 months, as well as cost-effectiveness of prophylactic clipping and severity of delayed bleeding. Discussion The CLIPPER trial is a pragmatic study performed in the Netherlands and is powered to determine the real-time efficacy and cost-effectiveness of prophylactic clipping after EMR of proximal colon polyps ≥ 2 cm in the Netherlands. This study will also generate new data on the achievability of complete closure and the effects of clip placement on scar surveillance after EMR, in order to further promote the debate on the role of prophylactic clipping in everyday clinical practice. Trial registration ClinicalTrials.gov NCT03309683. Registered on 13 October 2017. Start recruitment: 05 March 2018. Planned completion of recruitment: 31 August 2021.

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Early Cost-Effectiveness of Onasemnogene Abeparvovec-xioi (Zolgensma) and Nusinersen (Spinraza) Treatment for Spinal Muscular Atrophy I in The Netherlands With Relapse Scenarios

Value in Health ◽

10.1016/j.jval.2020.09.021 ◽

2021 ◽

Author(s):

Thomas F. Broekhoff ◽

Carly C.G. Sweegers ◽

Eline M. Krijkamp ◽

Aukje K. Mantel-Teeuwisse ◽

Hubert G.M. Leufkens ◽

...

Keyword(s):

Cost Effectiveness ◽

The Netherlands ◽

Spinal Muscular Atrophy ◽

Muscular Atrophy

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Cost-effectiveness of the fixed-dose combination tiotropium/olodaterol versus tiotropium monotherapy or a fixed-dose combination of long-acting β2-agonist/inhaled corticosteroid for COPD in Finland, Sweden and the Netherlands: a model-based study

BMJ Open ◽

10.1136/bmjopen-2021-049675 ◽

2021 ◽

Vol 11 (8) ◽

pp. e049675

Author(s):

Martine Hoogendoorn ◽

Isaac Corro Ramos ◽

Stéphane Soulard ◽

Jennifer Cook ◽

Erkki Soini ◽

...

Keyword(s):

Cost Effectiveness ◽

The Netherlands ◽

Cost Effective ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Inhaled Corticosteroid ◽

Dose Combination ◽

Long Acting ◽

Β2 Agonist ◽

Country Specific

ObjectivesChronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for patients with COPD who have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-utility of the fixed dose combination of the bronchodilators tiotropium and olodaterol versus two comparators, tiotropium monotherapy and long-acting β2 agonist/inhaled corticosteroid (LABA/ICS) combinations, in three European countries: Finland, Sweden and the Netherlands.MethodsA previously published COPD patient-level discrete event simulation model was updated with most recent evidence to estimate lifetime quality-adjusted life years (QALYs) and costs for COPD patients receiving either tiotropium/olodaterol, tiotropium monotherapy or LABA/ICS. Treatment efficacy covered impact on trough forced expiratory volume in 1 s (FEV1), total and severe exacerbations and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained for each country. The country-specific analyses adhered to the Finnish, Swedish and Dutch pharmacoeconomic guidelines, respectively.ResultsTreatment with tiotropium/olodaterol gained QALYs ranging from 0.09 (Finland and Sweden) to 0.11 (the Netherlands) versus tiotropium and 0.23 (Finland and Sweden) to 0.28 (the Netherlands) versus LABA/ICS. The Finnish payer’s incremental cost-effectiveness ratio (ICER) of tiotropium/olodaterol was €11 000/QALY versus tiotropium and dominant versus LABA/ICS. The Swedish ICERs were €6200/QALY and dominant, respectively (societal perspective). The Dutch ICERs were €14 400 and €9200, respectively (societal perspective). The probability that tiotropium/olodaterol was cost-effective compared with tiotropium at the country-specific (unofficial) threshold values for the maximum willingness to pay for a QALY was 84% for Finland, 98% for Sweden and 99% for the Netherlands. Compared with LABA/ICS, this probability was 100% for all three countries.ConclusionsBased on the simulations, tiotropium/olodaterol is a cost-effective treatment option versus tiotropium or LABA/ICS in all three countries. In both Finland and Sweden, tiotropium/olodaterol is more effective and cost saving (ie, dominant) in comparison with LABA/ICS.

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