PubMed Health⌕ Search

Biomedical subjects

F F Rutten

Publications and source records attributed to F F Rutten.

At least 73 records · Page 4Linked to original sources
PubMed1995

Cost-effectiveness of ABMT in comparison with CHOP chemotherapy in patients with intermediate- and high-grade malignant non-Hodgkin's lymphoma (NHL).

A prospective randomized clinical trial with simultaneous data collection for an economic appraisal was carried out to assess the effectiveness, quality of life and cost implications of ABMT vs standard chemotherapy in slowly responding patients with intermediate- and high-grade malignant non-Hodgkin's lymphoma (NHL). The patients had a partial response after three cycles of chemotherapy and had no evidence of BM involvement of NHL. The overall and disease-free survival at 3 years were 61% and 60%, respectively, in the ABMT group and 85% and 77% in the CHOP group (P = NS). Moreover, there were more (severe) complications and symptoms in the ABMT than in the CHOP group. The average costs of CHOP chemotherapy were significantly lower than the average costs in the ABMT group (CHOP: US$ 3118 vs ABMT: US$ 34,447). Considering long-term consequences the ABMT group was more expensive (US$ 34,580) and patients experienced 0.14 life years and 0.22 quality adjusted life years less than the CHOP group (discount rate 5%). As a result, changing therapy from CHOP to ABMT, as primary treatment in slow responders to CHOP, can not be recommended as the required additional investment does not produce health gains in terms of survival or quality of life.

Adolescent↗
PubMed1994

[Oral treatment of onychomycosis of the toe nails; comparison of cost-effectiveness of griseofulvin, itraconazole, ketoconazole and terbinafine].

OBJECTIVE: Determination of the most cost-effective oral drug treatment of onychomycosis of the toenails in the Dutch situation, by comparing griseofulvin, itraconazole, ketoconazole and terbinafine. DESIGN: Calculation of cost prices using a published meta-analysis. SETTING: The Netherlands. METHOD: Published efficacy and adverse reactions of treatment with griseofulvin, itraconazole, ketoconazole or terbinafine were related to 1993 Dutch cost prices of treatment. RESULTS: Itraconazole and terbinafine offered similar chances of success, but itroconazole treatment had to be repeated more often. On average, the costs of the treatment with itraconazole were 1.5 times as high as those of treatment with terbinafine. Griseofulvin treatment was cheapest but required the longest treatment course. CONCLUSION: A treatment with terbinafine is the most cost-effective, provided that onychomycosis has actually been established mycologically and all possible measures have been taken to prevent recurrence. It remains to be seen whether this drug treatment should be offered to all people affected by this essentially cosmetic problem.

Administration, Oral↗
PubMed1994

[Costs of intensive care in The Netherlands].

OBJECTIVE: To estimate the comprehensive costs of intensive care units in general and university hospitals. DESIGN: Cost analysis. SETTING: Nine Dutch hospitals. METHOD: The costs of the ICUs were estimated on the basis of data from the internal accounting systems of the nine hospitals. Allocation keys were used to allocate the costs of other departments to those of the respective ICUs. RESULTS: The average costs of an ICU in a general hospital were Dfl. 527,000 per bed and Dfl. 2260 per patient day. Corresponding figures for a university hospital were Dfl. 771,000 and Dfl. 2530, respectively. Combined ICUs (i.e. intensive and medium care) cost Dfl. 430,000 and Dfl. 1130, respectively. The total costs of intensive care in the Netherlands for 1990 were estimated at Dfl. 1209 million, about 2.5% of total health care costs.

Cost of Illness↗
PubMed1994

[Costs of autologous bone marrow transplantation in non-Hodgkin lymphoma and acute leukemia].

OBJECTIVE: To estimate the costs of an autologous bone marrow transplantation (auto BMT) for patients with non-Hodgkin lymphoma and patients with acute lymphoid leukaemia. DESIGN: Cost analysis. SETTING: Five Dutch hospitals. METHOD: By means of detailed cost registration forms, interviews with haematologists, research nurses, research analysts and hospital information systems, the costs of auto BMT were estimated. RESULTS: The costs of an auto BMT were estimated at f 63,400 per patient with non-Hodgkin lymphoma and at f 86,400 for patients with acute leukaemia. The latter patients stayed longer in hospital and needed more intensive isolation care, more blood transfusions and more antibiotics. CONCLUSION: These data are important when the Medical Insurance Board decides on provision for this treatment.

Bone Marrow Transplantation↗
PubMed1994

Peripheral blood progenitor cell transplantation mobilised by r-metHuG-CSF (filgrastim); a less costly alternative to autologous bone marrow transplantation.

In a retrospective study, we calculated the treatment costs of 63 patients who received either autologous bone marrow transplantation (ABMT) with recombinant human granulocyte colony-stimulating factor (r-metHuG-CSF) (filgrastim) (n = 13) or without r-metHuG-CSF (n = 22) or alternatively, peripheral blood progenitor cell (PBPC) transplantation mobilised by r-metHuG-CSF (n = 28). The recovery of granulocytes, platelets and reticulocytes after PBPC was markedly accelerated as compared with ABMT with or without r-metHuG-CSF. The accelerated haematopoietic recovery was associated with a reduction in platelets and red blood cell transfusion requirements, with a reduction in episodes of fever and with earlier discharge from the hospital. This resulted in the average cost per treatment of the PBPC group being almost 30% lower than the treatment costs in the ABMT groups.

Adolescent↗
PubMed1994

The costs of peripheral blood progenitor cell reinfusion mobilised by granulocyte colony-stimulating factor following high dose melphalan as compared with conventional therapy in multiple myeloma.

In a retrospective study, we calculated the treatment costs of 26 patients, who received either high dose melphalan combined with granulocyte colony-stimulating factor (G-CSF; filgrastim)(n = 7) or without G-CSF (n = 11) or alternatively, peripheral blood progenitor cell reinfusion (PBPC) mobilised by G-CSF following high dose melphalan. In comparison with the control group, a shortening of the pancytopenic period and platelet recovery was noticed in the PBPC group. This resulted in a reduction in hospital costs, diagnostics, laboratory services, total parenteral nutrition and transfusions. The average costs per treatment in the PBPC group amounted to about US$ 17,908 as compared to US$ 32,223 in the control group, implying a cost reduction of 44% when changing to PBPC reinfusion.

Blood Transfusion, Autologous↗
PubMed1994

Measurement and valuation of quality of life in economic appraisal of cancer treatment.

In the economic evaluation (EE) of technologies in cancer treatment at least three endpoints are relevant: costs, survival and quality of life (QoL). This article is focused on QoL. EE requires the use of generic and valuation QoL instruments at a disease non-specific level, but the inclusion of cancer-specific instruments may be advisable, particularly for reasons of explanation if changes in dimensions are small or conflicting. Given the pros and cons of the available questionnaires, we advocate the use of the Nottingham Health Profile, the EuroQol and the Rotterdam Symptom Checklist. In our experience the QoL issue in EE linked with cancer trials is associated with practical problems like questionnaire composition, follow-up time, interviewing schedule, patients' compliance and doctors' acceptance. These problems are discussed and some practical guidelines for the design of QoL measurement in cancer trials are given.

Cost of Illness↗
PubMed1994

[Effect of physical activity in the elderly: a review of current literature and the possibility of economic evaluation].

The Netherlands government emphasizes the importance of preventive care for the elderly. From an economic and preventive point of view the potential of exercise programmes to reduce the use of health care services by the elderly deserves attention. We present an overview of the literature on the effects of physical activity on health and psychological well-being of the elderly and their use of health services. Our review covers the period 1988-1993 and also includes review articles. We found almost sixty relevant articles which about all satisfied our methodological criteria. In men, physical activity probably has a positive influence on the frequency of ischaemic heart disease. Exercise delays the onset of osteoporosis in women. The results for other diseases are ambiguous, despite the large amount of literature. Similarly, it is not clear yet whether physical activity can enhance well-being. Research on the effects of physical activity on the use of health services has hardly been done. We conclude that well-designed studies are needed to determine the cost-effectiveness of exercise programmes in the elderly.

Aged↗
PubMed1994

Cost-effectiveness of HA-1A treatment for patients with sepsis.

The cost-effectiveness of prescribing HA-1A for sepsis patients was analyzed by comparing effectiveness and direct medical costs. Effectiveness was estimated on the basis of published data from a randomized clinical trial. Costs were determined by combining data from the same trial with expectations about hospital days. Average costs per life year gained were estimated at 25,000 Dutch guilders (1 Dutch guilder is approximately 53 US cents). Sensitivity analyses were applied and showed that the effectiveness and cost-effectiveness of treating patients with HA-1A depend a great deal on the expected duration of survival after successful treatment. If the objective is to maximize the cost-effectiveness of treatment, this means that the prognosis of the patient should be considered when deciding about the appropriateness of treatment with HA-1A. As one would expect, another way to increase cost-effectiveness would be to increase the proportion of gram-negative sepsis patients amongst those receiving treatment.

Antibodies, Monoclonal↗
PubMed1993

[Costs and effectiveness of diagnosis and treatment of patients with dyspepsia, determined with the aid of a computer model].

A theoretical investigation was carried out to determine whether the use of an antibody test for Helicobacter pylori (HP) and the use of bismuth oxide with optional antibiotics, would be cost effective in the diagnosis and treatment of patients with dyspepsia. With literature data on therapeutic effectiveness a computer simulation was carried out. A quick antibody test reduced the number of gastroscopic investigations necessary. Gastroscopic investigation still had to be carried out for patients suffering from non-HP-related dyspepsia. This strategy not only reduced costs, but enabled the general practitioner to start treating the patient immediately. The treatment of a HP-related gastritis with histamine receptor blockers (cimetidine, ranitidine) proved less effective than treatment with bismuth oxide, and more expensive. The treatment with bismuth oxide combined with antibiotics, the so called triple treatment, proved to be the most effective, however disproportionately more expensive. Although the interpretation of the serological test is not without problems, treating dyspepsia with bismuth oxide, especially when the HP serological test result is positive, is the cheaper option and achieves the required effectiveness.

Bismuth↗
PubMed1993

[Cost-effectiveness analysis of human monoclonal antibody HA-1A in patients with sepsis syndrome].

The efficiency of prescribing HA-1A for sepsis patients is analysed by comparing direct medical costs and effects. Effects are estimated on the basis of published data from a randomised clinical trial. Costs are analysed by combining data from the same trial with expectations about hospital days. Average costs per life year gained are estimated at DF1. 25,000. Sensitivity analysis is applied and the efficiency of treating patients with HA1A is shown to depend highly on the expected duration of survival after successful treatment. This leads to the advice to take epidemiologic knowledge into special account before setting the indication for using HA-1A.

Antibodies, Monoclonal↗
PubMed1993

Economic evaluation alongside cancer trials: methodological and practical aspects.

A recent extension of clinical evaluation is "economic evaluation", which seeks to characterise each relevant alternative health care strategy in terms of a summary measure incorporating the costs and benefits of such strategies. In an economic evaluation, separate measurements of resource volumina and resource prices on the cost side, and separate measurements of survival and quality of life effects and valuation of these outcome effects on the benefit side are required. From these effect parameters, which should be calculated for all competing strategies considered in the analysis, the relative cost-effectiveness of one strategy as against the other can be derived. The degree of generalisability of the study results determines the validity of economic evaluation in decision-making. This depends on the generalisability of the clinical findings, and in this respect the so-called "piggyback" economic evaluation, which is added to a clinical trial, has its limitations. In the field of cancer, specific attention should be given to costs and effects occurring after non-mortality endpoints, to patient and family costs and to variations in treatments between settings of care. It is argued that conventional clinical trials and economic evaluations will integrate further in the future.

Clinical Trials as Topic↗
PubMed1993

The cost-effectiveness of preservation with UW and EC solution for use in cadaveric kidney transplantation in the case of single kidney donors.

University of Wisconsin (UW) solution is now commonly used as a single-flush solution during multiorgan procurement for effective preservation of all intraabdominal organs including the kidney. Many kidneys from single kidney donors are still preserved in Eurocollins solution and the question is whether preservation in UW solution is more cost-effective. A European randomized multicenter trial was organized by the Department of Surgery of Leiden University in close cooperation with Eurotransplant to study the efficacy of UW solution as compared with EC solution. On the basis of this trial we found that at three months after transplant 92.4% of the patients in the UW group had a functioning graft in comparison with 88.4% in the EC group (similar figures after one year were 88.2% and 82.5%, P approximately 0.04), while health care expenditure during these first three months was on average US$ 700 lower for the UW group than for the EC group, taking into account the price difference in the preservation fluids. The long-term benefits of using UW solution as compared with EC solution were conservatively estimated at US$ 7000 per patient reflecting the additional expenses for dialysis in the EC group. We concluded that the extra costs of using UW solution instead of EC solution (US$ 230 per kidney) can be easily earned back within three months and that the long-term savings of such a strategy are considerable. Moreover, the health status of patients in the UW group is expected to be better on the average than in the EC group. Simply reacting to the price tag of the UW solution may be penny-wise but pound-foolish.

Adenosine↗
PubMed1993

Effects of ACE inhibitors on heart failure in The Netherlands: a pharmacoeconomic model.

A modelling approach is used to analyse the cost effectiveness of prescribing angiotensin converting enzyme (ACE) inhibitors, compared with standard practice, as first-line therapeutic agents in the treatment of heart failure in The Netherlands. Data concerning costs, incidence, prevalence and survival are used to construct an age-dependent semi-Markov-chain model. Two scenarios are compared. The first reflects the continuation of common practice. The second, containing assumptions made on the basis of results from randomised clinical trials, reflects the situation in which ACE inhibitors are given as first-line pharmacotherapy. Conditional on the estimates and assumptions made, it is shown that prescribing ACE inhibitors as first-line pharmacotherapy will improve survival by about 4% over the first 10 years, and will save about 17% in costs over the first 10 years. Sensitivity analysis shows the robustness of the conclusions to all major parameters.

Adult↗
PubMed1993

Cost effectiveness of inhaled corticosteroid plus bronchodilator therapy versus bronchodilator monotherapy in children with asthma.

In an incremental cost-effectiveness analysis, combined inhaled beta 2-receptor agonist plus inhaled corticosteroid therapy (BA + CS) was compared with inhaled beta 2-agonist plus placebo (BA + PL) in 116 asthmatic children aged 7 to 16 years. Clinical data have been reported previously. To account for the selective withdrawal rate due to pulmonary problems that occurred in the group receiving BA + PL, costs were calculated using 2 approaches: (1) the cumulative cost approach and (2) the patient-year approach. Besides improvements in forced expiratory volume in 1 second (FEV 1) and airway responsiveness expressed as the provocative dose of histamine required to give a 20% fall in FEV 1 (PD 20), the frequency of asthma symptoms and school absenteeism were significantly reduced in the BA + CS group. Annual drug acquisition costs for the group receiving BA + CS were NLG480 higher than for the BA + PL group ($US1 = NLG2.12, 1989 prices). Based on conservative calculations using the cumulative cost approach, annual savings due to reduced healthcare utilisation, excluding the cost of study drugs, by the group receiving BA + CS compared with BA + PL were estimated to be about NLG273 per patient. The incremental cost effectiveness of BA + CS was estimated to be about NLG175 per 10% increase in FEV 1, or somewhat less than NLG10 per symptom-free day gained. The patient-year approach estimated savings due to corticosteroids of about 43% of the costs of BA + PL (95% confidence intervals, 21 to 58%). Savings were larger when the indirect costs that a family incurred during school absenteeism were considered. Addition of an inhaled corticosteroid to an inhaled beta 2-receptor agonist is a cost-effective treatment option that could even result in net healthcare savings.

Adolescent↗
PubMed1993

Indirect costs in economic studies: confronting the confusion.

Indirect costs of disease often constitute a substantial part of estimated costs or savings in economic evaluations of healthcare programmes. The human capital approach is almost unanimously used for estimating indirect costs, defined as production loss due to disease, although a growing number of authors question its validity. This article discusses the relevance of indirect cost estimates for health policy and reviews the current empirical and methodological literature on this issue. It describes several important issues and controversies regarding indirect costs, such as the consequences of short term absence from work for productivity, reduced productivity without absence from work, the influence of unemployment on production loss, the relation between health effects and indirect costs, and the possible medium term macroeconomic consequences of absence from work and disability. It concludes that indirect costs are relevant for health policy, provided that the estimates of indirect costs reflect the real changes in production due to disease, including the production of unpaid labour. Future research should focus on attaining these estimates. Indirect costs in economic evaluations should preferably be presented separately from direct costs, health effects and other study outcomes.

Absenteeism↗