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G J Bonsel

Publications and source records attributed to G J Bonsel.

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

[Patients in the Groningen lung transplantation program, 1990-1993; preliminary results of the medical technology assessment].

OBJECTIVE: Medical technology assessment of lung transplant programme in Groningen, the Netherlands. DESIGN: Descriptive evaluation study. SETTING: University Hospital Groningen. METHOD: Description of the patient route through the treatment process of the transplantation programme. RESULTS: From mid-1990 to 1-1-1994, 257 patients (M/F ratio approximately 1, median age 43 years) were evaluated. The most frequent diagnoses were: COPD/emphysema, cystic fibrosis, pulmonary hypertension and lung fibrosis. In 1991 relatively more patients came from the northern provinces, but in 1993 there was no difference from the rest of the Netherlands. Until 1-1-1994, 116 patients were excluded from the programme: 58 patients were denied transplantation in the early phase of the programme, 47 died, 6 withdrew and 5 were lost in follow-up. Until 1-1-94, 77 patients were placed on a waiting list and 35 of these underwent unilateral (n = 12) or bilateral transplantation (n = 23). One patient had a retransplantation. The 1-year survival rate was 84%. The mean time between admission and transplantation was 15 months. CONCLUSION: The results of the lung transplantation programme in Groningen are promising.

Adolescent↗
PubMed1995

Comparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group.

OBJECTIVE: Comparative assessment of performance of pediatric intensive care. DESIGN: Open, prospective multicenter study. SETTING: All pediatric intensive care units (n = 10; six tertiary and four nontertiary) in the Netherlands. PATIENTS: 1063 consecutive unselected admissions, < or = 18 yrs old, during a 4-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Effectiveness was defined as the ratio of observed to expected (Pediatric Risk of Mortality-score-derived) mortality. Efficiency was determined by two objective criteria: mortality risk of > 1%, or administration of at least one intensive care unit (ICU)-dependent therapy. In the total population, observed and expected mortality rates were similar. Between hospitals, crude mortality showed wide variations (mean 7.1%, range 1% to 10%). However, in each center, observed and expected mortality rates were similar (mean ratio of observed/expected mortality 0.99, range 0.8 to 1.5). In tertiary care centers, severity of illness-corrected mortality rates in high-risk patients were less than in a United States reference population. Paradoxically, in low-risk tertiary care patients, the observed mortality rate was higher than expected. The relatively high mortality rate in this group is probably the result of the large number of low-risk tertiary care patients suffering from severe, incurable chronic disease. The average number of efficient ICU days was 72%, although large fluctuations between units were found (range 22% to 95%), suggesting that in several centers efficiency rates might be improved by a better selection of high-risk patients requiring ICU-dependent therapies. CONCLUSIONS: Differences in mortality rates among pediatric ICUs were largely explained by differences in severity of illness. High efficiency rates combined with adequate effectiveness were found in several centers, indicating that admission and discharge decisions might be improved in less efficient centers.

Child, Preschool↗
PubMed1995

The impact of migraine on health status.

PROBLEMS: What is the effect of migraine on health status, defined as the patient's physical, psychological, and social functioning? And, suppose that the health status of migraine sufferers appears to be impaired, to what extent is this a consequence of migraine-associated comorbidity rather than of migraine itself? METHODS: A group of 846 migraineurs, selected from the general population following IHS criteria, and a control group were surveyed with the Medical Outcomes Study 36-item Short-Form Health Survey, Nottingham Health Profile, EuroQol instrument, and the COOP/WONCA charts. Questions on demographic characteristics and comorbidity were included. RESULTS: The health status of migraineurs appeared to be significantly impaired in comparison to the control group. Because statistical significance is distinct from relevance, effect size estimators were employed. Although the direction of the differences indicated consistently a worse health status of the migraineurs, regardless of the instrument used, the sizes of the differences were small to medium. Self-reported comorbidity, especially depression, was more prevalent in the migraine group. However, this offered only a partial explanation for the impaired health status of the migraine group. CONCLUSIONS: Migraine has an independent moderately deteriorating effect on the daily functioning of individuals.

Adult↗
PubMed1995

Long-term survival and state of health after paediatric intensive care.

Survival and state of health were assessed one year after discharge in 468 children admitted to an intensive care unit (ICU). ICU mortality was 7.5%, cumulative hospital mortality 8.3%, and one year mortality 10.5%. An established six domain health status classification was used, comprising sensation, mobility, emotion, cognition, self care, and pain to determine the presence, type, and severity of chronic health impairment. This classification has not been validated for infants, who were therefore excluded. After one year, of the 254 patients eligible for analysis, 80 (31.5%) had no overall health impairment (no affected domains) preceding admission; of these, 11 had died in ICU and 69 were long-term survivors, among whom 45 recovered to perfect health. There was overall health impairment (> or = 1 affected domain) preceding admission in 174 of 254 patients (68.5%). However, after one year, overall state of health was improved or equal to the preadmission state in 164 of 226 survivors (72.6%). In domain-specific health, the proportion improving or remaining unchanged varied from 77.9% (emotional functions) to 89.4% (mobility and pain). Consequently, despite the large number with health impairment before admission, cumulative one year survival was favourable and health status in three quarters of the population was preserved.

Child↗
PubMed1994

Test-retest reliability of health state valuations collected with the EuroQol questionnaire.

This study is a contribution by the Dutch participants to the research programme of the EuroQol Group. This collaborative group of researchers engaged in outcome measurement is working towards the development of a standardized, non-disease-specific instrument for describing and particularly valuing health-related quality of life. The present article analyses the test-retest reliability of the valuations collected with the EuroQol questionnaire in a population survey (n = 208). The choice of the appropriate method for test-retest analysis is discussed and the results of several approaches with the EuroQol data are shown. Generalizability Theory is proposed as the most suitable method. This method is the most comprehensive, giving distinct information about the relative contributions of different sources of variance. The EuroQol valuations appear to have good test-retest reliability.

Adult↗
PubMed1994

Assessing the benefits of transplant services.

This chapter presents some methods for the assessment of transplant benefits, using the example of liver transplantation. An independent assessment of the benefits of medical technology is especially important for evaluation of the balance between the costs and benefits involved. To enable comparison with other health-care facilities, benefits are defined in terms of a combination of life-years gained and quality of life. The number of life-years gained can be calculated by comparing the survival expected with and without transplantation. Survival with transplantation is estimated on the basis of observed survival, acknowledging that the probability of survival may have changed over time, owing to changes in therapy and selection criteria. To estimate survival without transplantation, several techniques are available. Prognostic models, correcting for stage of disease, are often used. Pitfalls in the use of these models are discussed. The number of life-years gained can be corrected for quality of life by weighing survival with and without transplantation with an index representing quality of life. A method for the calculation of such an index is given. Finally, some cost estimates are presented and the results are discussed.

Cost-Benefit Analysis↗
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

Effectiveness and efficiency of a Dutch pediatric intensive care unit: validity and application of the Pediatric Risk of Mortality score.

OBJECTIVE: To assess the performance of pediatric intensive care by an international standard. DESIGN: Prospective, cohort study. SETTING: Nine-bed multidisciplinary pediatric intensive care unit (ICU) within a 174-bed, tertiary care children's hospital. PATIENTS: Consecutive, unselected patients (n = 612) during a 16-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Collected data included age, major diagnostic category, primary clinical specialty, severity of illness (daily Pediatric Risk of Mortality [PRISM] score), administration of ICU-dependent therapy (daily), and vital status at discharge. The PRISM score allowed the calculation of overall and daily mortality risk. After testing the applicability of the predictive model, effectiveness was determined by comparing severity of illness-based predicted mortality rate with vital status at discharge. Efficiency was defined by two criteria: a) the administration of at least one ICU-dependent therapy; or b) a mortality risk of > 1%. Five-hundred ninety-three patients were included (19 survivors were excluded because of incomplete data). Mean age was 55.0 months (median 24). Mean length of stay was 4.4 days (median 2). Overall ICU mortality rate was 8.4%. The overall performance of the PRISM score-based predictive model was found to be good (goodness-of-fit test chi 2[5] = 5.49; p = .35; area under receiver operating characteristic curve 0.92). Subgroup analysis showed that the best model performance was in nonoperative patients. Decreased performance was found in operative patients. In cardiovascular patients, the mortality rate was higher. In other surgical patients, the mortality rate was lower than expected. Of 593 patients, 489 (82.5%) admissions were efficient, as were 2,393 (76.5%) of 3,130 patient days in the ICU. The ranking of daily efficiency according to clinical specialty was as follows: postoperative cardiovascular surgical patients (86.3%); nonsurgical patients (76.6%); and other postoperative patients (49.6%). CONCLUSIONS: In our setting, effectiveness and efficiency of pediatric intensive care appeared to be validly determined using explicit criteria (mortality risk, administration of ICU-dependent therapy). Overall effectiveness met the standard set forth in an American study; validity in stratified analysis of diagnostic subgroups remains to be further established. Efficiency showed marked, specialty-related differences. The low efficiency in other (noncardiovascular) surgical patients was probably caused by the recovery function of the ICU. A more general application of these criteria might be considered in modifying admission and discharge policy, as well as in quality control.

Child↗
PubMed1994

Patient characteristics and resource utilisation in paediatric intensive care.

To determine the relation between basic clinical characteristics and resource utilisation in paediatric intensive care, an open prospective study was performed. Resource utilisation was expressed using the therapeutic intervention score system (TISS) and length of stay (LOS), from which total resource utilisation per admission (TISSTOT) and average daily resource utilisation (TISSMEAN = TISSTOT/LOS) were obtained. Overall 593 admissions, totalling 3130 days, were included. Mortality was 8.4% and non-survivors accounted for 14.1% of overall resource utilisation. In non-survivors, TISSTOT and TISSMEAN were higher, whereas LOS was not different from survivors'. Severity of illness, surgical status, significant chronic comorbidity, emergency admission, and transfer status constituted the major predictive determinants of TISSTOT (r2 = 0.19) and TISSMEAN (r2 = 0.45) in multiple regression analysis. High resource utilisation in high risk patients was probably warranted, as effectiveness of prolonged intensive treatment was demonstrated. It is concluded that TISSTOT and TISSMEAN are appropriate, non-monetary measures of resource utilisation, a considerable proportion of which are determined by a concise set of basic clinical characteristics.

Analysis of Variance↗
PubMed1994

Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure.

OBJECTIVES: Many developed countries have seen declining mortality rates for heart disease, together with an alleged decline in incidence and a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart disease morbidity. METHODS: The simulation model combines data from different sources. It generates acute coronary event and mortality rates from published data on incidences, recurrences, and lethalities of different heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival. RESULTS: Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increase among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people. CONCLUSIONS: Increasing health care needs in the face of declining mortality rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase.

Female↗
PubMed1993

[Cost-effectiveness analysis of long-term liver transplantation; the liver transplantation program of Groningen 1979-1991].

A medical technology assessment of the liver transplantation programme of Groningen University Hospital, which was commissioned by the Dutch National Health Insurance Board, is discussed. The results of all 152 liver transplantations performed between 1979 and November 1990 were analysed. The main objective of the study was to evaluate the long-term effects of liver transplantation. Five years after transplantation 59% of the adult patients were still alive. The survival probability depended greatly on the primary liver disease. Mortality and morbidity occurred mainly within the first year after transplantation. Thereafter the prospects for the patients were excellent, with regard to both the probability of survival and the quality of life. The costs of liver transplantation could be calculated only for patients with primary biliary cirrhosis and other forms of biliary cirrhosis, not caused by hepatitis B infection or alcohol abuse. For these patients the costs of a liver transplantation were estimated at HFl. 263,000--(with a 10% margin), 10 years of follow-up included and corrected for the costs that would have been made for the treatment of the liver disease. For this population of patients a liver transplantation costs between Hfl. 64,000--and Hfl. 79,000--per life year gained, 10 years of follow-up included. Costs of cyclosporin still take up a major part of the costs. The need for liver transplantation in the Netherlands was estimated at between 35 and 126 transplantations per year, depending on indications, contraindications, referral policy and the percentage of retransplantations.

Adolescent↗
PubMed1993

Generalizability of valuations on health states collected with the EuroQolc-questionnaire.

PROBLEM: Non-response and non-usable response were found in population surveys on valuation of health states. If non-response is selective regarding valuations, then generalization of the resulting values to the whole survey population is not permitted. This could limit the use of empirical utility values in resource allocation in health care. METHODS: Response behaviour of a sample of 1400 from the Dutch general population to the mailed EuroQolc-questionnaire was analyzed by four methods. I. Phoning resolute non-respondents; II. comparison of zip code characteristics of respondents and non-respondents (because individual data on background characteristics were not available for the non-respondents); III. analysis of response over time (wave-analysis); IV: comparison of background variables of successful (less than two valuations missing) and unsuccessful respondents, combined with analysis of the effect of these background variables on valuations. RESULTS: No indications for selective non-response were found, although the phenomenon appeared hard to investigate. The successful response came from a slightly younger and better educated subsample. However, a general influence of age and educational level on valuations could not be shown. This finding is consistent with the literature. CONCLUSION: Although the existence of selective non-response cannot be excluded, its relevance can be considered to be small. This finding is encouraging for the use of empirical utility values in allocative decisions.

Adult↗
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

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↗
PubMed1992

[Quality of life of persons with HIV infection in an academic hospital].

OBJECTIVE: Comparison of the quality of life of asymptomatic (n = 24) and symptomatic (n = 20) HIV-infected patients and description of the changes in quality of life during the symptomatic stage. DESIGN: Prospective study. SETTING: University Hospital Utrecht. METHOD: Every four months questionnaires on quality of life were completed by 44 of 55 consecutive HIV-infected patients. RESULTS: Physically, asymptomatic HIV-infected patients were better off than symptomatic HIV-infected patients; psychologically, however, both groups of patients showed similar responses. During the symptomatic stage the patients' physical functioning diminished further, but feelings of anxiety or depression showed no marked change; self-evaluations of health conditions became slightly more negative with time.

Academic Medical Centers↗
PubMed1992

High cost technology in health care: a benefit or a burden?

The influence of high cost technology goes beyond its consequences for the selected patient groups that benefit from its application. Past and future technological developments have a variety of social, economic and ethical implications which have to be taken into account when balancing its costs and benefits to society. Departing from an economic perspective we describe a number of mechanisms underlying the emergence of high cost technology which help us to understand some of the characteristics of high cost technology, such as its focus on quality enhancement rather than on economy. To assess the actual performance of high cost technology in terms of efficiency and equity is difficult as there may be debate about the perspective guiding such assessment and as there still is scarce information on high cost technology in terms of these economic indicators. The increasing technological opportunities have triggered a wider debate on the desired evolution of our health care systems. In some countries there is a tendency to diminish government involvement in health care and emphasize private (for profit) enterprise as a reaction to not being able to finance all new high cost technology. The risks of such strategies are discussed briefly. We conclude that the main actors in health care should adjust their behaviour in order to accomplish the introduction of more cost-effective technologies and to achieve a more socially efficient distribution of their benefits.

Biomedical Research↗
PubMed1992

Assessment of the quality of life before and following liver transplantation. First results.

Analysis of quality-of-life effects is part of the current technology assessment of the Dutch orthotopic liver transplant-program. Data are collected by means of computer-assisted interviewing, including one interview before transplantation and annual follow-up interviews. Data on psychiatric morbidity are obtained from medical records. This article shows preliminary results of a cross-sectional analysis of data collected from 1987 to 1989. Eighty-eight measurements were obtained from 46 adult patients (response rate 82%). Pretransplant scores suggest major restrictions on all domains of life, especially a low amount of energy. After transplantation all indicators show improvement, although the level of the general population is not always attained. Improvement of subjective quality of life is more marked, possibly due to euphoria at surviving the hazardous procedure. Psychiatric events occurred only infrequently. We conclude that orthotopic liver transplantation contributes positively to the quality of life of surviving patients. In addition, computer-assisted interviewing proved to be a feasible survey technique, even when very ill patients were involved.

Adult↗