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Biomedical subjects

C D Dirksen

Publications and source records attributed to C D Dirksen.

13 recordsLinked to original sources
PubMed2006

Economic evaluations of single- versus double-embryo transfer in IVF.

Multiple pregnancies lead to complications and induce high costs. The most successful way to decrease multiple pregnancies in IVF is to transfer only one embryo, which might reduce the efficacy of treatment. The objective of this review is to determine which embryo-transfer policy is most cost-effective: elective single-embryo transfer (eSET) or double-embryo transfer (DET). Several databases were searched for (cost* or econ*) and (single embryo* or double embryo* or one embryo* or two embryo* or elect* embryo or multip* embryo*). On the basis of five exclusion criteria, titles and abstracts were screened by two individual reviewers. The remaining papers were read for further selection, and data were extracted from the selected studies. A total of 496 titles were identified through the searches and resulted in the selection of one observational study and three randomized studies. Study characteristics, total costs and probability of live births were extracted. Besides this, cost-effectiveness and incremental cost-effectiveness were derived. It can be concluded that DET is the most expensive strategy. DET is also most effective if performed in one fresh cycle. eSET is only preferred from a cost-effectiveness point of view when performed in good prognosis patients and when frozen/thawed cycles are included. If frozen/thawed cycles are excluded, the choice between eSET and DET depends on how much society is willing to pay for one extra successful pregnancy.

Embryo Transfer↗
PubMed2003

The reliability of diagnosis using store-and-forward teledermatology.

We compared diagnoses made by a teledermatologist from digital photographs and patient histories sent from general practitioners using a store-and-forward technique and those made by another dermatologist in a face-to-face consultation with the same patients. A total of 117 patients (mean age 47 years) were referred by 18 general practitioners for diagnosis of a skin condition. Between one and seven digital images were transmitted per case. In 31% of the cases, three images were transmitted. There was full concordance between store-and-forward and face-to-face diagnoses in 57 of 106 cases (54%); in 10 cases (9%) there was overlap between the differential diagnoses provided by the teledermatologist and the face-to-face consultant. Diagnostic categories with relatively high concordances were eczema and follicular eruptions. General practitioners need to be trained in the making of digital images and in giving a good patient history.

Diagnosis, Differential↗
PubMed2001

[Ambulatory laparoscopic cholecystectomy is as effective as hospitalization and from a social perspective less expensive: a randomized study].

OBJECTIVE: To compare the effects and costs of an ambulatory treatment versus an overnight stay for laparoscopic cholecystectomy. DESIGN: Prospective, randomised. METHOD: In the St Antonius hospital, Nieuwegein, the Netherlands, 86 patients with symptomatic cholelithiasis without comorbidity underwent either ambulatory (AM: 42 patients: 8 men and 36 women; mean age: 48.9 years (SD: 11.9)) or overnight stay (OS: 44 patients: 10 men and 32 women; mean age: 44.9 years (SD: 11.8)) laparoscopic cholecystectomy in the period 1 November 1997-30 September 1999. The following were registered: operative time, complications, hospital stay and readmissions, as well as reported pain, nausea, activity resumption, quality of life and patient satisfaction. The cost analysis was performed from a societal and hospital perspective. RESULTS: In the OS group one laparoscopic procedure was converted to open cholecystectomy, two relaparotomies were performed due to intra-abdominal haemorrhage and 1 patient had a catheter inserted due to urine retention. Two patients were readmitted, one for postoperative pancreatitis and the other for a retained bile duct stone. In the AM group one laparoscopic procedure was converted to open cholecystectomy, in 1 patient a wound abscess was treated with drainage in the outpatient clinic, in 1 patient there was peroperative stone loss without further complications and in 1 patient a catheter was placed to drain peroperative bile and blood loss. In the AM group 11 (26%) patients were kept overnight due to nausea and/or pain (n = 7) or one of the aforementioned complications (n = 4). Two patients were readmitted within 24 hours of being discharged due to abdominal pain. The average hospital stay was 3.1 (OS) versus 1.7 (AM) days. The quality of life, pain, nausea and activity resumption were comparable for both groups. Due to the difference in hospital stay, costs for the ambulatory procedure were lower. CONCLUSION: Laparoscopic cholecystectomy was successfully performed as an ambulatory surgery procedure in 69% of the patients. The quality of life, patient satisfaction and resumption of activities in both groups were comparable. The ambulatory treatment was less expensive.

Adult↗
PubMed2001

Timing of adoption of laparoscopic cholecystectomy in Denmark and in The Netherlands: a comparative study.

Laparoscopic cholecystectomy (LC) has diffused rapidly in most industrialised countries. The aim of this study has been to analyse the impact of different hospital characteristics on the hospital adoption of LC in Denmark and The Netherlands. Data on the timing of the adoption of LC and hospital characteristics (hospital size, teaching status and location) were retrieved in both countries. Proportional hazard regression was used to analyse different multivariate models. A total of 59 Danish and 109 Dutch hospitals adopting LC were identified. The multivariate analyses showed that increased hospital size was associated with relatively early adoption of LC in Denmark. Neither this nor other hospital characteristics influenced the timing of adoption in The Netherlands. As in other countries studied, hospital size is identified as an important factor in hospital adoption, whereas teaching status and location play a more limited role. The study shows that a multivariate method, such as the proportional hazard regression, can be used to elucidate differences among countries of the impact of different factors on the adoption of medium-ticket technologies like LC. Such multinational comparisons provide valuable information for health policy and planning.

Cholecystectomy, Laparoscopic↗
PubMed2000

[Laparoscopic inguinal hernia operation].

After the introduction of laparoscopic operations for repair of inguinal hernias, circa 1990, randomized comparative studies showed that this method causes less postoperative pain and requires a shorter recovery period than conventional operations. The duration of follow-up is still too short for comparison of proportions of recurrences. The costs of laparoscopic interventions are higher for the hospital (among other things because of the use of disposable instruments) and lower for society (because of shorter absenteeism). Implementation of the intervention by allotment of a higher fee to hospitals has not been done, because meanwhile a third method--conventional surgery with implantation of a prosthetic mesh in ambulatory surgery--has become possible. A meta-analysis based on European registration of all treated patients will once more have to demonstrate what method of treatment is to be preferred.

European Union↗
PubMed1999

Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial.

BACKGROUND: Giant prosthetic reinforcement of the visceral sac (GPRVS), an open preperitoneal mesh repair, is a very effective groin hernia repair. Laparoscopic transabdominal preperitoneal repair (TAPP), based on the same principle, is expected to combine low recurrence rates with minimal postoperation morbidity. METHODS: Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were randomized between GPRVS (37 patients) and TAPP (42 patients). Operating time, complications, pain, analgesia use, disability period, and recurrences were recorded. RESULTS: Mean operating time was 56 min with GPRVS versus 79 min with TAPP (p < 0. 001). Most complications were minor, except for a pulmonary embolus and an ileus, both after GPRVS. Patients experienced less pain after a laparoscopic repair. Average disability period was 23 days with GPRVS versus 13 days with TAPP (p = 0.03) for work, and 29 versus 21 days, respectively (p = 0.07) for physical activities. Recurrence rates at a mean follow-up of 34 months were 1 in 52 (1.9%) for GPRVS versus 7 in 56 (12.5%) for TAPP (p = 0.04). Hospital costs in U.S. dollars were comparable, with GPRVS at $1,150 and TAPP at $1,179. CONCLUSIONS: Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS. However, laparoscopic repair is a difficult operation, and the potential technical failure rate is higher. With regard to recurrence rates, the open preperitoneal prosthetic mesh repair remains the best repair.

Adult↗
PubMed1998

Cost-effectiveness of open versus laparoscopic repair for primary inguinal hernia.

A cost-effectiveness (CE) analysis was performed of Bassini versus laparoscopic repair for primary inguinal hernia. Incremental costs per 1-year recurrence-free patient were calculated for the societal and hospital perspective. From the hospital perspective, the incremental CE ratio of laparoscopic repair is 5.348 guilders. From the societal perspective, laparoscopic repair is both less costly and more effective than Bassini repair. Results were sensitive to assumptions about recurrence rates, laparoscopic operating time, and return to work. Laparoscopic repair should replace Bassini repair in order to benefit society. From the hospital perspective, the decision to accept laparoscopic repair depends on the willingness to pay.

Adult↗
PubMed1998

Bassini repair compared with laparoscopic repair for primary inguinal hernia: a randomised controlled trial.

OBJECTIVE: To compare the effectiveness of open and laparoscopic primary inguinal hernia repair. DESIGN: Randomised controlled trial. SETTING: University hospital, The Netherlands. SUBJECTS: 87 patients had 103 open repairs and 88 patients had 114 laparoscopic repairs between November 1993 and July 1995. INTERVENTIONS: Laparoscopic repair by the transabdominal preperitoneal (TAPP) technique and open repair by the Bassini technique. MAIN OUTCOME MEASURES: Recurrence, morbidity, pain, and duration of convalescence. RESULTS: Operating time was longer for laparoscopy (mean (SD): 82 (28) compared with 45 (15) minutes p < 0.001). Patients in the Bassini group had higher postoperative pain scores (mean (SD)VAS: 2.9 (1.6) compared with 2.0 (1.6) p=0.002), used more analgesics (median total intake: 2 (0-54) compared with 0 tablets (0-42) p=0.008), and needed a longer convalescence time (mean (SD) time to return to work: 22 (12.6) compared with 14 (10.1) days p < 0.001; mean (SD) time to return to physical activities: 27 (12.6) compared with 17 (12.2) days p < 0.001). Mean follow up was 24 months. Recurrence rates were 21% (22/ 103) after Bassini and 6% (7/114) after laparoscopic repair (p=0.001). CONCLUSION: Laparoscopic hernia repair is a safe operation, which has obvious advantages over the Bassini repair in terms of pain, use of analgesic drugs, resumption of activities, and recurrence. A disadvantage of the laparoscopic repair is the longer operating time.

Analgesics↗
PubMed1996

Diffusion of six surgical endoscopic procedures in the Netherlands. Stimulating and restraining factors.

The diffusion of six surgical endoscopic procedures in the Netherlands was investigated. Questionnaires were sent to 138 laparoscopic surgeons. They were asked which of the following laparoscopic procedures they had adopted in their hospital: cholecystectomy, appendicectomy, Nissen fundoplication, inguinal hernia repair, large bowel resection and thoracoscopic procedures. Furthermore, they were asked to indicate the influence of 13 pre-defined factors: "budget', "competition', "conference', "extra benefit', "media', "nature of the technology', "patient demand', "planning/logistics', "reimbursement', "service industry', "support industry', "surgical technique' and "training/course' on the adoption of those procedures. The adoption rates for the procedures were: 100%, 69%, 19%, 43%, 19% and 52%, respectively. In general, factors were assessed more positively by adopters than by non-adopters. Significant differences were mainly found for "extra benefit', "nature of the technology', "surgical technique' and "conference'. The surgeon's perception of the additional benefits of an endoscopic technique and, to a lesser degree, of its technical aspects were the most important factors in deciding whether or not to adopt a procedure. In an ideal diffusion model, a description is given of when and how the 13 factors can influence the diffusion of an endoscopic procedure in the desired direction. In this model, the extra benefit of a new procedure must be proven before other factors are allowed to influence the diffusion.

Budgets↗
PubMed1996

Medical technology assessment and the role of economic evaluation in health care.

The growth in health care expenditure over the last few decades has necessitated the introduction of priority setting and decision making based on the results of critical evaluation. Medical technology assessment (MTA) is a valuable tool to assist policy makers in controlling existing and new medical technologies. Medical technology assessment and the role of economic evaluation as part of MTA are described, and various techniques of economic evaluation are discussed.

Cost-Benefit Analysis↗
PubMedDate not supplied

Medical technology assessment: economic evaluation of new technologies.

Growing expenditures in health care made it necessary to find control mechanisms to evaluate expenditure. Medical technology assessment is becoming a valuable tool to assist policymakers in controlling new medical technologies. This review deals with the increasing importance of economic evaluation as part of medical technology assessment and describes various techniques by which an economic evaluation can be performed.

Cost Control↗
PubMedDate not supplied

Five years of laparoscopic cholecystectomy in The Netherlands.

Since its introduction in spring 1990, laparoscopic cholecystectomy has become the treatment of choice for uncomplicated gallstone disease in The Netherlands. Several nation-wide surveys conducted by the authors show a rapid diffusion of this operation. 70-75% of all cholecystectomies are performed laparoscopically in almost all Dutch hospitals. The incidence of common bile duct lesions was relatively high at the beginning (1% in 1991) but declined to 0.68% at the end of 1992. It is assumed that the incidence of these lesions will decrease further to a percentage comparable to that after conventional cholecystectomies of 0.5%. The wound related complications of 1.65% is rather low. Despite the reduction in operative morbidity and early resumption of full activity resumption laparoscopic cholecystectomy has met financial restraints, because of the budget system in The Netherlands. There are no incentives for surgeons, hospital management and health insurance companies to stimulate laparoscopic cholecystectomy. The social-economic benefit of the operation is difficult to quantify in the current health care system in The Netherlands.

Activities of Daily Living↗