Talitha Feenstra - Academia.edu (original) (raw)

Papers by Talitha Feenstra

www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Intro... more www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Introduction ─ 21 1.2 Reading guide ─ 23 2 Blueprint: approach and intermediate results ─ 25 2.1 Introduction to methods for blueprint ─ 25 2.2 Terminology and definition ─ 26 2.3 Methods for blueprint ─ 27 2.4 Results from panel surveys ─ 32 3 Blueprint, discussion of topics and introduction of business cases ─ 41 3.1 Discussion of topics and their relation to business cases ─ 41 3.2 Blueprint for organizational and methodological issues in relation to ownership choices ─ 62 3.3 Overall summary Blueprint work ─ 69 4 Casus Diabetes Mellitus ─ 77 4.1 Introduction ─ 77 4.2 MICADO-R general outline ─ 78 4.3 Lessons learnt concerning organizational issues. ─ 80 4.4 Lessons learnt concerning methodological issues. ─ 82 4.5 Further lessons learnt from the case study in diabetes mellitus. ─ 88 4.6 Applicability and potential use ─ 88 5 Overall Discussion and conclusions ─ 91 5.1 The prospect of applying multi-use disease models, main study findings ─ 91 Supplement 1. Expert panel ─ 103 Supplement 2. Expert panel rounds 1 and 2 ─ 105 The project consisted of three tasks: 1. To build and provide access to an up-to-date disease model, by way of a model interface. 2. To investigate the methodological and organizational issues involved in using disease models for health care policy support. 3. To report on the findings. The current report is the result of task 3.

The European respiratory journal, Jun 30, 2013

Pavlovic D, Wendt M. Diaphragm pacing during prolonged mechanical ventilation of the lungs could ... more Pavlovic D, Wendt M. Diaphragm pacing during prolonged mechanical ventilation of the lungs could prevent from respiratory muscle fatigue. Med Hypotheses 2003; 60: 398-403. 6 Assouad J, Masmoudi H, Steltzlen C, et al. Minimally invasive trans-mediastinal endoscopic approach to insert phrenic stimulation electrodes in the human diaphragm: a preliminary description in cadavers. Eur J Cardiothorac Surg 2011; 40: e142-e145. 7 Finkelstein DI, Andrianakis P, Luff AR, et al. Developmental changes in hindlimb muscles and diaphragm of sheep.

Objectives: 1) To improve an existing COPD model by incorporating the distinction between mild, m... more Objectives: 1) To improve an existing COPD model by incorporating the distinction between mild, moderate, severe and very severe COPD and by quantifying the progression of COPD over these stages 2) To use the improved model to estimate the potential impact of smoking cessation programs offered to COPD patients and project their effect on the future burden of COPD. Methods: An existing population model for COPD, which is a module of the RIVM Chronic Disease model, was extended with disease progression over time. Prevalent cases in the starting year were distributed over 4 severity stages mild (28%), moderate (54%), severe (15%) and very severe (3%) (GOLD-classification). The severity distribution was based on data from GP registrations. The COPD incidence was 41% in mild, 55% in moderate and 4% in severe. Disease progression was modelled as annual decline in lung function in FEV 1 % predicted. The Lung Health Study was used to estimate gender, age, smoking and baseline FEV 1 % predicted dependent values of lung function decline and one-time increase in lung function associated with smoking cessation. A meta-analysis was done to obtain severity stage specific mortality rates.

Value in Health, Nov 1, 2006

in AMD patients versus € 1,287 in controls. Of the €12,156 per AMD patient, 9% were AMD drug cost... more in AMD patients versus € 1,287 in controls. Of the €12,156 per AMD patient, 9% were AMD drug costs, 14% were direct vision-related medical costs, 9 % were direct other medical costs, and 68% were non-medical costs. CONCLUSION: In Germany, bilateral AMD patients reported substantially worse quality of life, poorer vision-related functioning, and higher economic burden compared to controls without AMD. AMD poses significant emotional and financial burdens to the society.

Value in Health, May 1, 2005

Objectives: To estimate the cost-effectiveness of five faceto-face smoking cessation intervention... more Objectives: To estimate the cost-effectiveness of five faceto-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained. Methods: Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates. Results: Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were higher than intervention costs. For the other interventions, incremental costs per QALY gained ranged from about 1100€ for telephone counseling to 4900€ for intensive counseling with nicotine patches or gum for implementation periods of 75 years. Conclusions: All five smoking cessation interventions were cost-effective compared with current practice, and minimal GP counseling was even cost-saving.

European Respiratory Journal, Sep 1, 2013

Introduction:Smoking is the most important single risk factor for mortality in the Netherlands an... more Introduction:Smoking is the most important single risk factor for mortality in the Netherlands and has been related to 12% of the burden of disease in Western Europe. Hence the Dutch Ministry of Health has asked to assess the cost-effectiveness of interventions to enhance smoking cessation in adults. Objective:To evaluate eight interventions for smoking cessation, namely increased tobacco taxes, mass media campaigns, minimal counseling, GP support, telephone counseling, minimal counseling plus nicotine replacement therapy, intensive counseling plus nicotine replacement therapy and intensive counseling plus bupropion. Methods: Costs per smoker were estimated based on bottom-up cost analysis. Combined with effectiveness data from meta-analyses and Dutch trials this gave us costs per quitter. To estimate costs per quality adjusted life year (QALY) gained, scenarios for each intervention were compared to current practice in the Netherlands. A dynamic population model, the RIVM Chronic Disease Model, was used to project future health gains and effects on health care costs. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix, and accounts for risks of relapse and incidence of smoking related diseases that depend on time since cessation. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size and discount rates. Results: A tax increase was the most efficient intervention with zero intervention costs from the health care perspective. Additional tax revenues resulting from a 20% tax increase were about 5 billion euro. Costs per smoker for a mass media campaign were relatively low (3 euro) and costs per QALY were below 10.000 euro.The effectiveness of these two population measures was uncertain. Costs per smoker for individual cessation support varied from 5 to almost 400 euro. Although all individual interventions had proven effectiveness, the cheapest intervention had an effect that did not differ significantly from current practice cessation rates. Compared to current practice, cost-effectiveness ratios varied between about 8,800 euro for structured GP stop-advice (H-MIS) to 21,500 euro for telephone counseling for implementation periods of 5 years. Discussion and conclusions: All smoking cessation interventions were cost-effective compared to current practice. Comparison of interventions is difficult, especially for population and individual interventions, because they are often applied in combination. Taking that into account, taxes seem to provide most value for money, especially since additional tax revenues outweigh the health care costs in life years gained.

Objectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventio... more Objectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions: 1) Telephone Counseling (TC), 2) Minimal counseling by a general practitioner (H-MIS), 3) Minimal counseling by a general practitioner combined with Nicotine Replacement Therapy (H-MIS+NRT), 4) Intensive Counseling combined with Nicotine Replacement Therapy (IC+NRT) and 5) Intensive Counseling combined with Bupropion (IC+Bupr), in terms of costs per quitter, costs per life-year gained and costs per qualityadjusted life-year (QALY) gained. Methods: Scenarios on increased implementation of smoking cessation interventions were compared to current practice. Base-case scenarios assumed that one of the five interventions was implemented for a period of either 1 year, 10 years or 75 years and reached 25% of the smokers. A computer simulation model, the RIVM Chronic Disease Model, was used to project future gains in life-years and Quality Adjusted Life Years (QALYs), and savings of health care costs from a decrease in the incidence of smoking-related diseases. Regardless of the duration for which the intervention was implemented, our time horizon was 75 years, i.e. costs and effects were studied over a period of 75 years. Intervention costs were computed

RePEc: Research Papers in Economics, 2011

Targeted versus universal prevention. A resource allocation model to prioritize cardiovascular pr... more Targeted versus universal prevention. A resource allocation model to prioritize cardiovascular prevention. Cost Effectiveness and Resource Allocation, 9, 14. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Door de groei en vergrijzing van de Nederlandse bevolking zal het aantal chronisch zieken de kome... more Door de groei en vergrijzing van de Nederlandse bevolking zal het aantal chronisch zieken de komende twintig jaar sterk toenemen. Vooral het aantal diabeten en mensen met botontkalking (osteoporose) zal stijgen. Naar schatting is het aantal diabeten over twintig jaar met 300.000 toegenomen. Als de huidige toename van het aantal mensen met overgewicht doorzet, zal het aantal diabeten in die periode met 100.000 patiënten extra toenemen. Ook wordt een sterke toename verwacht van het aantal mensen met osteoporose met ongeveer 350.000 personen. De stijging van aan roken gerelateerde ziekten (COPD en longkanker) zal naar verwachting bij vrouwen groter zijn dan op grond van de demografische toename wordt verwacht, en kleiner bij mannen. Dat komt doordat vrouwen de afgelopen decennia meer zijn gaan roken en mannen juist minder. Dit zijn enkele prognoses voor het aantal chronisch zieken tussen 2005 en 2025. Deze prognoses geven meer inzicht in de mate waarin het aantal zieken zal stijgen. Die kennis is van belang om te kunnen anticiperen op de toekomstige vraag naar zorg, en de daarmee gepaard gaande kosten. De prognoses zijn op drie manieren berekend, afhankelijk van de beschikbare informatie. Ten eerste is alleen uitgegaan van de veranderende omvang van de bevolking en de vergrijzing. Vervolgens zijn berekeningen met het Chronische Ziekten Model (CZM), een wiskundig simulatiemodel, uitgevoerd. In deze berekeningen zijn, behalve gegevens over groei en vergrijzing, trends in het aantal patiënten met de onderzochte ziekten verdisconteerd. Ten slotte is, ook met het CZM, berekend wat de invloed is van toekomstige ontwikkelingen van overgewicht en roken. De in dit rapport besproken ziekten zijn: hart-en vaatziekten (hartinfarct, beroerte, hartfalen), diabetes, kanker (long-, borst-, en dikke darmkanker), astma, COPD en osteoporose. Trefwoorden: ziektelast; toekomstprojecties; vergrijzing; chronische ziekten RIVM rapport 260401004 pag. 3 van 98

Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application ... more Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application of the RIVM Chronic Disease Model. Introduction Smoking is the most important single risk factor for mortality in the Netherlands and has been related to 12% of the burden of disease in Western Europe. Hence the Dutch Ministry of Health has asked to assess the cost-effectiveness of interventions to enhance smoking cessation in adults. Objective To evaluate eight interventions for smoking cessation, namely increased tobacco taxes, mass media campaigns, minimal counseling, GP support, telephone counseling, minimal counseling plus nicotine replacement therapy, intensive counseling plus nicotine replacement therapy and intensive counseling plus bupropion. Methods Costs per smoker were estimated based on bottom-up cost analysis. Combined with effectiveness data from meta-analyses and Dutch trials this gave us costs per quitter. To estimate costs per quality adjusted life year (QALY) gained, scenarios for each intervention were compared to current practice in the Netherlands. A dynamic population model, the RIVM Chronic Disease Model, was used to project future health gains and effects on health care costs. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix, and accounts for risks of relapse and incidence of smoking related diseases that depend on time since cessation. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size and discount rates. Results: A tax increase was the most efficient intervention with zero intervention costs from the health care perspective. Additional tax revenues resulting from a 20% tax increase were about 5 billion euro. Costs per smoker for a mass media campaign were relatively low (3,-), and costs per QALY were below 10.000. The effectiveness of these two population measures was uncertain. Costs per smoker for individual cessation support varied from 5 to almost 400. Although all individual interventions had proven effectiveness, the cheapest intervention had an effect that did not differ significantly from current practice cessation rates. Compared to current practice, cost-effectiveness ratios varied between about 8,800 for structured GP stop-advice (H-MIS) to 21,500 for telephone counseling for implementation periods of 5 years. Discussion and conclusions: All smoking cessation interventions were cost-effective compared to current practice. Comparison of interventions is difficult, especially for population and individual interventions, because they are often applied in combination. Taking that into account, taxes seem to provide most value for money, especially since additional tax revenues outweigh the health care costs in life years gained.

www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Intro... more www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Introduction ─ 21 1.2 Reading guide ─ 23 2 Blueprint: approach and intermediate results ─ 25 2.1 Introduction to methods for blueprint ─ 25 2.2 Terminology and definition ─ 26 2.3 Methods for blueprint ─ 27 2.4 Results from panel surveys ─ 32 3 Blueprint, discussion of topics and introduction of business cases ─ 41 3.1 Discussion of topics and their relation to business cases ─ 41 3.2 Blueprint for organizational and methodological issues in relation to ownership choices ─ 62 3.3 Overall summary Blueprint work ─ 69 4 Casus Diabetes Mellitus ─ 77 4.1 Introduction ─ 77 4.2 MICADO-R general outline ─ 78 4.3 Lessons learnt concerning organizational issues. ─ 80 4.4 Lessons learnt concerning methodological issues. ─ 82 4.5 Further lessons learnt from the case study in diabetes mellitus. ─ 88 4.6 Applicability and potential use ─ 88 5 Overall Discussion and conclusions ─ 91 5.1 The prospect of applying multi-use disease models, main study findings ─ 91 Supplement 1. Expert panel ─ 103 Supplement 2. Expert panel rounds 1 and 2 ─ 105 The project consisted of three tasks: 1. To build and provide access to an up-to-date disease model, by way of a model interface. 2. To investigate the methodological and organizational issues involved in using disease models for health care policy support. 3. To report on the findings. The current report is the result of task 3.

Opportunities for preventing diabetes and its cardiovascular complications: a modelling approach ... more Opportunities for preventing diabetes and its cardiovascular complications: a modelling approach If interventions aimed to reduce overweight and promote physical activity would be implemented on a national scale in the Netherlands, between 1% and 2% of new cases of diabetes would be prevented over a 20-year period. More intensive treatment of persons with diabetes would prevent 5% to 10% of new cases of macrovascular complications. In order to prevent the burden of disease due to diabetes, prevention is crucial. In this study the long-term efficacy of various interventions in preventing diabetes and its complications was investigated. In addition the costs and cost-effectiveness of these interventions were evaluated. This was done with the help of a computer model that was designed to track the evolution of the Dutch population over time, with regard to risk factors, chronic diseases and mortality. Reducing the prevalence of overweight is the most powerful tool in preventing diabetes. As the interventions currently available allow the realisation of not more than a small part of the potential health gains, it is mandatory to continue to invest in identifying and developing effective measures to loose weight in a sustainable manner. Smoking cessation does not contribute to preventing diabetes. But, of course, it does prevent other diseases. In treating indivuals with diabetes, interventions aimed at lowering cholesterol and blood pressure result in greater health gains than intensifying blood sugar control. Succesful prevention of diabetes and its complications leads to higher overall costs of care due to the fact that people live longer and as a consequence incur healthcare costs in life years gained. However, in all interventions evaluated, health gains justify the extra costs.

Diabetic medicine : a journal of the British Diabetic Association, Jan 25, 2015

To test a simulation model, the MICADO model, for estimating the long-term effects of interventio... more To test a simulation model, the MICADO model, for estimating the long-term effects of interventions in people with and without diabetes. The MICADO model includes micro- and macrovascular diseases in relation to their risk factors. The strengths of this model are its population scope and the possibility to assess parameter uncertainty using probabilistic sensitivity analyses. Outcomes include incidence and prevalence of complications, quality of life, costs and cost-effectiveness. We externally validated MICADO's estimates of micro- and macrovascular complications in a Dutch cohort with diabetes (n = 498 400) by comparing these estimates with national and international empirical data. For the annual number of people undergoing amputations, MICADO's estimate was 592 (95% interquantile range 291-842), which compared well with the registered number of people with diabetes-related amputations in the Netherlands (728). The incidence of end-stage renal disease estimated using the ...

www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Intro... more www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Introduction ─ 21 1.2 Reading guide ─ 23 2 Blueprint: approach and intermediate results ─ 25 2.1 Introduction to methods for blueprint ─ 25 2.2 Terminology and definition ─ 26 2.3 Methods for blueprint ─ 27 2.4 Results from panel surveys ─ 32 3 Blueprint, discussion of topics and introduction of business cases ─ 41 3.1 Discussion of topics and their relation to business cases ─ 41 3.2 Blueprint for organizational and methodological issues in relation to ownership choices ─ 62 3.3 Overall summary Blueprint work ─ 69 4 Casus Diabetes Mellitus ─ 77 4.1 Introduction ─ 77 4.2 MICADO-R general outline ─ 78 4.3 Lessons learnt concerning organizational issues. ─ 80 4.4 Lessons learnt concerning methodological issues. ─ 82 4.5 Further lessons learnt from the case study in diabetes mellitus. ─ 88 4.6 Applicability and potential use ─ 88 5 Overall Discussion and conclusions ─ 91 5.1 The prospect of applying multi-use disease models, main study findings ─ 91 Supplement 1. Expert panel ─ 103 Supplement 2. Expert panel rounds 1 and 2 ─ 105 The project consisted of three tasks: 1. To build and provide access to an up-to-date disease model, by way of a model interface. 2. To investigate the methodological and organizational issues involved in using disease models for health care policy support. 3. To report on the findings. The current report is the result of task 3.

The European respiratory journal, Jun 30, 2013

Pavlovic D, Wendt M. Diaphragm pacing during prolonged mechanical ventilation of the lungs could ... more Pavlovic D, Wendt M. Diaphragm pacing during prolonged mechanical ventilation of the lungs could prevent from respiratory muscle fatigue. Med Hypotheses 2003; 60: 398-403. 6 Assouad J, Masmoudi H, Steltzlen C, et al. Minimally invasive trans-mediastinal endoscopic approach to insert phrenic stimulation electrodes in the human diaphragm: a preliminary description in cadavers. Eur J Cardiothorac Surg 2011; 40: e142-e145. 7 Finkelstein DI, Andrianakis P, Luff AR, et al. Developmental changes in hindlimb muscles and diaphragm of sheep.

Objectives: 1) To improve an existing COPD model by incorporating the distinction between mild, m... more Objectives: 1) To improve an existing COPD model by incorporating the distinction between mild, moderate, severe and very severe COPD and by quantifying the progression of COPD over these stages 2) To use the improved model to estimate the potential impact of smoking cessation programs offered to COPD patients and project their effect on the future burden of COPD. Methods: An existing population model for COPD, which is a module of the RIVM Chronic Disease model, was extended with disease progression over time. Prevalent cases in the starting year were distributed over 4 severity stages mild (28%), moderate (54%), severe (15%) and very severe (3%) (GOLD-classification). The severity distribution was based on data from GP registrations. The COPD incidence was 41% in mild, 55% in moderate and 4% in severe. Disease progression was modelled as annual decline in lung function in FEV 1 % predicted. The Lung Health Study was used to estimate gender, age, smoking and baseline FEV 1 % predicted dependent values of lung function decline and one-time increase in lung function associated with smoking cessation. A meta-analysis was done to obtain severity stage specific mortality rates.

Value in Health, Nov 1, 2006

in AMD patients versus € 1,287 in controls. Of the €12,156 per AMD patient, 9% were AMD drug cost... more in AMD patients versus € 1,287 in controls. Of the €12,156 per AMD patient, 9% were AMD drug costs, 14% were direct vision-related medical costs, 9 % were direct other medical costs, and 68% were non-medical costs. CONCLUSION: In Germany, bilateral AMD patients reported substantially worse quality of life, poorer vision-related functioning, and higher economic burden compared to controls without AMD. AMD poses significant emotional and financial burdens to the society.

Value in Health, May 1, 2005

Objectives: To estimate the cost-effectiveness of five faceto-face smoking cessation intervention... more Objectives: To estimate the cost-effectiveness of five faceto-face smoking cessation interventions (i.e., minimal counseling by a general practitioner (GP) with, or without nicotine replacement therapy (NRT), intensive counseling with NRT, or bupropion, and telephone counseling) in terms of costs per quitter, costs per life-year gained, and costs per quality-adjusted life-year (QALY) gained. Methods: Scenarios on increased implementation of smoking cessation interventions were compared with current practice in The Netherlands. One of the five interventions was implemented for a period of 1, 10, or 75 years reaching 25% of the smokers each year. A dynamic population model, the RIVM chronic disease model, was used to project future gains in life-years and QALYs, and savings of health-care costs from a decrease in the incidence of 11 smoking-related diseases over a time horizon of 75 years. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size, and discount rates. Results: Compared with current practice, minimal GP counseling was a dominant intervention, generating both gains in life-years and QALYs and savings that were higher than intervention costs. For the other interventions, incremental costs per QALY gained ranged from about 1100€ for telephone counseling to 4900€ for intensive counseling with nicotine patches or gum for implementation periods of 75 years. Conclusions: All five smoking cessation interventions were cost-effective compared with current practice, and minimal GP counseling was even cost-saving.

European Respiratory Journal, Sep 1, 2013

Introduction:Smoking is the most important single risk factor for mortality in the Netherlands an... more Introduction:Smoking is the most important single risk factor for mortality in the Netherlands and has been related to 12% of the burden of disease in Western Europe. Hence the Dutch Ministry of Health has asked to assess the cost-effectiveness of interventions to enhance smoking cessation in adults. Objective:To evaluate eight interventions for smoking cessation, namely increased tobacco taxes, mass media campaigns, minimal counseling, GP support, telephone counseling, minimal counseling plus nicotine replacement therapy, intensive counseling plus nicotine replacement therapy and intensive counseling plus bupropion. Methods: Costs per smoker were estimated based on bottom-up cost analysis. Combined with effectiveness data from meta-analyses and Dutch trials this gave us costs per quitter. To estimate costs per quality adjusted life year (QALY) gained, scenarios for each intervention were compared to current practice in the Netherlands. A dynamic population model, the RIVM Chronic Disease Model, was used to project future health gains and effects on health care costs. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix, and accounts for risks of relapse and incidence of smoking related diseases that depend on time since cessation. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size and discount rates. Results: A tax increase was the most efficient intervention with zero intervention costs from the health care perspective. Additional tax revenues resulting from a 20% tax increase were about 5 billion euro. Costs per smoker for a mass media campaign were relatively low (3 euro) and costs per QALY were below 10.000 euro.The effectiveness of these two population measures was uncertain. Costs per smoker for individual cessation support varied from 5 to almost 400 euro. Although all individual interventions had proven effectiveness, the cheapest intervention had an effect that did not differ significantly from current practice cessation rates. Compared to current practice, cost-effectiveness ratios varied between about 8,800 euro for structured GP stop-advice (H-MIS) to 21,500 euro for telephone counseling for implementation periods of 5 years. Discussion and conclusions: All smoking cessation interventions were cost-effective compared to current practice. Comparison of interventions is difficult, especially for population and individual interventions, because they are often applied in combination. Taking that into account, taxes seem to provide most value for money, especially since additional tax revenues outweigh the health care costs in life years gained.

Objectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventio... more Objectives: To estimate the cost-effectiveness of five face-to-face smoking cessation interventions: 1) Telephone Counseling (TC), 2) Minimal counseling by a general practitioner (H-MIS), 3) Minimal counseling by a general practitioner combined with Nicotine Replacement Therapy (H-MIS+NRT), 4) Intensive Counseling combined with Nicotine Replacement Therapy (IC+NRT) and 5) Intensive Counseling combined with Bupropion (IC+Bupr), in terms of costs per quitter, costs per life-year gained and costs per qualityadjusted life-year (QALY) gained. Methods: Scenarios on increased implementation of smoking cessation interventions were compared to current practice. Base-case scenarios assumed that one of the five interventions was implemented for a period of either 1 year, 10 years or 75 years and reached 25% of the smokers. A computer simulation model, the RIVM Chronic Disease Model, was used to project future gains in life-years and Quality Adjusted Life Years (QALYs), and savings of health care costs from a decrease in the incidence of smoking-related diseases. Regardless of the duration for which the intervention was implemented, our time horizon was 75 years, i.e. costs and effects were studied over a period of 75 years. Intervention costs were computed

RePEc: Research Papers in Economics, 2011

Targeted versus universal prevention. A resource allocation model to prioritize cardiovascular pr... more Targeted versus universal prevention. A resource allocation model to prioritize cardiovascular prevention. Cost Effectiveness and Resource Allocation, 9, 14. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Door de groei en vergrijzing van de Nederlandse bevolking zal het aantal chronisch zieken de kome... more Door de groei en vergrijzing van de Nederlandse bevolking zal het aantal chronisch zieken de komende twintig jaar sterk toenemen. Vooral het aantal diabeten en mensen met botontkalking (osteoporose) zal stijgen. Naar schatting is het aantal diabeten over twintig jaar met 300.000 toegenomen. Als de huidige toename van het aantal mensen met overgewicht doorzet, zal het aantal diabeten in die periode met 100.000 patiënten extra toenemen. Ook wordt een sterke toename verwacht van het aantal mensen met osteoporose met ongeveer 350.000 personen. De stijging van aan roken gerelateerde ziekten (COPD en longkanker) zal naar verwachting bij vrouwen groter zijn dan op grond van de demografische toename wordt verwacht, en kleiner bij mannen. Dat komt doordat vrouwen de afgelopen decennia meer zijn gaan roken en mannen juist minder. Dit zijn enkele prognoses voor het aantal chronisch zieken tussen 2005 en 2025. Deze prognoses geven meer inzicht in de mate waarin het aantal zieken zal stijgen. Die kennis is van belang om te kunnen anticiperen op de toekomstige vraag naar zorg, en de daarmee gepaard gaande kosten. De prognoses zijn op drie manieren berekend, afhankelijk van de beschikbare informatie. Ten eerste is alleen uitgegaan van de veranderende omvang van de bevolking en de vergrijzing. Vervolgens zijn berekeningen met het Chronische Ziekten Model (CZM), een wiskundig simulatiemodel, uitgevoerd. In deze berekeningen zijn, behalve gegevens over groei en vergrijzing, trends in het aantal patiënten met de onderzochte ziekten verdisconteerd. Ten slotte is, ook met het CZM, berekend wat de invloed is van toekomstige ontwikkelingen van overgewicht en roken. De in dit rapport besproken ziekten zijn: hart-en vaatziekten (hartinfarct, beroerte, hartfalen), diabetes, kanker (long-, borst-, en dikke darmkanker), astma, COPD en osteoporose. Trefwoorden: ziektelast; toekomstprojecties; vergrijzing; chronische ziekten RIVM rapport 260401004 pag. 3 van 98

Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application ... more Cost-effectiveness of interventions to reduce tobacco smoking in the Netherlands. An application of the RIVM Chronic Disease Model. Introduction Smoking is the most important single risk factor for mortality in the Netherlands and has been related to 12% of the burden of disease in Western Europe. Hence the Dutch Ministry of Health has asked to assess the cost-effectiveness of interventions to enhance smoking cessation in adults. Objective To evaluate eight interventions for smoking cessation, namely increased tobacco taxes, mass media campaigns, minimal counseling, GP support, telephone counseling, minimal counseling plus nicotine replacement therapy, intensive counseling plus nicotine replacement therapy and intensive counseling plus bupropion. Methods Costs per smoker were estimated based on bottom-up cost analysis. Combined with effectiveness data from meta-analyses and Dutch trials this gave us costs per quitter. To estimate costs per quality adjusted life year (QALY) gained, scenarios for each intervention were compared to current practice in the Netherlands. A dynamic population model, the RIVM Chronic Disease Model, was used to project future health gains and effects on health care costs. This model allows the repetitive application of increased cessation rates to a population with a changing demographic and risk factor mix, and accounts for risks of relapse and incidence of smoking related diseases that depend on time since cessation. Sensitivity analyses were performed for variations in costs, effects, time horizon, program size and discount rates. Results: A tax increase was the most efficient intervention with zero intervention costs from the health care perspective. Additional tax revenues resulting from a 20% tax increase were about 5 billion euro. Costs per smoker for a mass media campaign were relatively low (3,-), and costs per QALY were below 10.000. The effectiveness of these two population measures was uncertain. Costs per smoker for individual cessation support varied from 5 to almost 400. Although all individual interventions had proven effectiveness, the cheapest intervention had an effect that did not differ significantly from current practice cessation rates. Compared to current practice, cost-effectiveness ratios varied between about 8,800 for structured GP stop-advice (H-MIS) to 21,500 for telephone counseling for implementation periods of 5 years. Discussion and conclusions: All smoking cessation interventions were cost-effective compared to current practice. Comparison of interventions is difficult, especially for population and individual interventions, because they are often applied in combination. Taking that into account, taxes seem to provide most value for money, especially since additional tax revenues outweigh the health care costs in life years gained.

www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Intro... more www.rivm.nl/en Contents Management Samenvatting ─ 11 1 Introduction and Background ─ 21 1.1 Introduction ─ 21 1.2 Reading guide ─ 23 2 Blueprint: approach and intermediate results ─ 25 2.1 Introduction to methods for blueprint ─ 25 2.2 Terminology and definition ─ 26 2.3 Methods for blueprint ─ 27 2.4 Results from panel surveys ─ 32 3 Blueprint, discussion of topics and introduction of business cases ─ 41 3.1 Discussion of topics and their relation to business cases ─ 41 3.2 Blueprint for organizational and methodological issues in relation to ownership choices ─ 62 3.3 Overall summary Blueprint work ─ 69 4 Casus Diabetes Mellitus ─ 77 4.1 Introduction ─ 77 4.2 MICADO-R general outline ─ 78 4.3 Lessons learnt concerning organizational issues. ─ 80 4.4 Lessons learnt concerning methodological issues. ─ 82 4.5 Further lessons learnt from the case study in diabetes mellitus. ─ 88 4.6 Applicability and potential use ─ 88 5 Overall Discussion and conclusions ─ 91 5.1 The prospect of applying multi-use disease models, main study findings ─ 91 Supplement 1. Expert panel ─ 103 Supplement 2. Expert panel rounds 1 and 2 ─ 105 The project consisted of three tasks: 1. To build and provide access to an up-to-date disease model, by way of a model interface. 2. To investigate the methodological and organizational issues involved in using disease models for health care policy support. 3. To report on the findings. The current report is the result of task 3.

Opportunities for preventing diabetes and its cardiovascular complications: a modelling approach ... more Opportunities for preventing diabetes and its cardiovascular complications: a modelling approach If interventions aimed to reduce overweight and promote physical activity would be implemented on a national scale in the Netherlands, between 1% and 2% of new cases of diabetes would be prevented over a 20-year period. More intensive treatment of persons with diabetes would prevent 5% to 10% of new cases of macrovascular complications. In order to prevent the burden of disease due to diabetes, prevention is crucial. In this study the long-term efficacy of various interventions in preventing diabetes and its complications was investigated. In addition the costs and cost-effectiveness of these interventions were evaluated. This was done with the help of a computer model that was designed to track the evolution of the Dutch population over time, with regard to risk factors, chronic diseases and mortality. Reducing the prevalence of overweight is the most powerful tool in preventing diabetes. As the interventions currently available allow the realisation of not more than a small part of the potential health gains, it is mandatory to continue to invest in identifying and developing effective measures to loose weight in a sustainable manner. Smoking cessation does not contribute to preventing diabetes. But, of course, it does prevent other diseases. In treating indivuals with diabetes, interventions aimed at lowering cholesterol and blood pressure result in greater health gains than intensifying blood sugar control. Succesful prevention of diabetes and its complications leads to higher overall costs of care due to the fact that people live longer and as a consequence incur healthcare costs in life years gained. However, in all interventions evaluated, health gains justify the extra costs.

Diabetic medicine : a journal of the British Diabetic Association, Jan 25, 2015

To test a simulation model, the MICADO model, for estimating the long-term effects of interventio... more To test a simulation model, the MICADO model, for estimating the long-term effects of interventions in people with and without diabetes. The MICADO model includes micro- and macrovascular diseases in relation to their risk factors. The strengths of this model are its population scope and the possibility to assess parameter uncertainty using probabilistic sensitivity analyses. Outcomes include incidence and prevalence of complications, quality of life, costs and cost-effectiveness. We externally validated MICADO's estimates of micro- and macrovascular complications in a Dutch cohort with diabetes (n = 498 400) by comparing these estimates with national and international empirical data. For the annual number of people undergoing amputations, MICADO's estimate was 592 (95% interquantile range 291-842), which compared well with the registered number of people with diabetes-related amputations in the Netherlands (728). The incidence of end-stage renal disease estimated using the ...