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Biomedical subjects

M J Postma

Publications and source records attributed to M J Postma.

54 records · Page 3Linked to original sources
PubMed1999

[Opportunistic screening for genital infections with Chlamydia trachomatis among the sexually active population in Amsterdam. III. Cost-effectiveness analysis of screening women and the role of reinfection and partner treatment].

The role of reinfection and the importance of partner treatment were added to a pharmacoeconomic model for the analysis of a GP-based opportunistic screening programme for Chlamydia trachomatis (CT) in sexually active women in Amsterdam. A favourable cost-effectiveness was found for partner treatment. Partner treatment was cost saving and overall net costs per major outcome averted by the screening programme were reduced by 40% or more due to partner treatment. From a pharmacoeconomic point of view partner treatment should be routinely provided in the framework of a CT screening programme for Amsterdam women.

Adolescent↗
PubMed1999

Universal HIV screening of pregnant women in England: cost effectiveness analysis.

OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital between 1986 and 1996. These were combined with estimates of the health benefits and costs of antenatal screening so that the cost effectiveness of universal, voluntary antenatal screening for HIV infection in England could be estimated. MAIN OUTCOME MEASURES: Lifetime, direct costs of medical care of childhood HIV infection; life years gained as a result of the screening programme; net cost per life year gained for different pretest counselling costs; and different prevalence rates of pregnant women who were unaware that they were HIV positive. RESULTS: Estimated direct lifetime medical and social care costs of childhood HIV infection were pound178 300 using a 5% discount rate for time preference (1995-6 prices). In high prevalence areas screening pregnant women for HIV is estimated to be a cost effective intervention with a net cost of less than pound4000 for each life year gained. For areas with comparatively low prevalence rates, cost effectiveness could be less than pound20 000 per life year gained, depending on the number of pregnant women who are unaware that they are infected and local screening costs. CONCLUSIONS: Our results confirm recent recommendations that universal, voluntary antenatal HIV screening should be implemented in the London area. Serious consideration of the policy should be given for other areas in England depending on local prevalence and screening costs.

AIDS Serodiagnosis↗
PubMed1999

[Opportunistic screening for genital infections with Chlamydia trachomatis in sexually active population of Amsterdam. II. Cost-effectiveness analysis of screening women].

OBJECTIVE: To estimate the cost effectiveness of Chlamydia trachomatis (CT) screening of young women visiting general practitioners. DESIGN: Economic model analysis. METHODS: Data on the health care needs for CT complications were derived from various sources; costing was done using estimated cost prices, charges and the friction cost method; epidemiological data were derived from a pilot study among 22 general practices in Amsterdam, the Netherlands. The analyses were carried out assuming screening with ligase chain reaction test of a urine sample and treatment of identified cases of infection with single-dose azitromycin. The model intervention consisted of screening all heterosexually active women aged 15-19, 15-24, 15-29, or 15-34 years (strategies 1, 2, 3 and 4, respectively). Cost effectiveness was presented in net direct and indirect costs per woman cured and per major outcome averted (pelvic inflammatory disease (PID), chronic pelvic pain, ectopic pregnancy, infertility and pneumonia of newborns). RESULTS: The first two strategies were cost saving. For the third strategy net costs per woman cured and per major outcome averted were almost 110.- Dutch guilders (DFL) and over DFL 300, respectively. The last strategy costs over DFL 320 per woman cured and over DFL 910 per major outcome averted. The cost effectiveness was sensitive to the assumed probability of progression of CT infection to PID. CONCLUSION: Universal implementation of the screening programme investigated in Amsterdam for women aged 15-24 years would result in approximately equal savings and costs. Screening of all 15-29-year-old women would require a net investment of DFL 350,000.

Adolescent↗
PubMed1999

Current and future medical costs of asthma and chronic obstructive pulmonary disease in The Netherlands.

The aim of this study was to estimate the healthcare costs of asthma and chronic obstructive pulmonary disease (COPD), in the Netherlands, in 1993. Also studied was the future development of these costs, as a result of ageing and possible changes in smoking behavior. A prevalence-based cost-of-illness approach was used to estimate direct medical costs. Age- and gender-specific data were obtained from representative national registries and large, representative surveys. To model future costs, cost estimates were linked to an epidemiological model based on a dynamic multi-state lifetable. It describes 1 yr changes, from one state to another, that result from ageing, birth, migration, incidence, recovery from asthma and death due to asthma, COPD or other causes, and starting or quitting smoking. Three different scenarios were modelled: 1) a reference scenario which primarily predicts the impact of ageing. 2) an 'attainable' smoking reduction scenario and 3) an 'extreme' smoking reduction scenario. Direct medical costs were estimated to be $US 346 million in 1993. With increasing age, the relative importance of asthma in total asthma and COPD costs decreased from 91% to less than 4%. Annual costs per patient were estimated to be $US 499 for asthma and $US 876 for COPD. The breakdown of costs differed considerably between asthma and COPD. The reference scenario predicted the costs to increase by 60% to reach $US 555 million by 2010, COPD prevention as modelled in the second and the third scenario reduced the projected cost increase from 60%, to 57% and 48%, respectively. Together, the direct costs of asthma and COPD represent 1.3% of the Dutch health care budget. The breakdown of the costs shows different patterns for asthma and COPD. The costs of these diseases are expected to increase by 60% in the near future. In the short run the impact of smoking reduction on reducing this increase is relatively small, but it will be greater in the long run.

Adolescent↗
PubMed1999

Economic evaluation of influenza vaccination. Assessment for The Netherlands.

OBJECTIVE: The objective of this study was to determine the costs associated with influenza and the cost effectiveness (net costs per life-year gained) of influenza vaccination in The Netherlands. DESIGN AND SETTING: The economic evaluation comprised a cost-of-illness assessment and a cost-effectiveness analysis, both of which were conducted from the healthcare perspective in The Netherlands. The modelling framework for the economic evaluation linked epidemiological aspects of influenza (e.g. incidence, mortality, years of life lost) to vaccination coverage and healthcare resource use. Healthcare resource use was specified for hospitalisations, general practitioner visits and drugs. INTERVENTION: The intervention assessed in the cost-effectiveness analysis was influenza vaccination. MAIN OUTCOME MEASURES AND RESULTS: The costs of influenza were estimated to be 31 million euros (EUR) for the influenza season 1995/96 in The Netherlands (EUR1 approximately $US1.1). For the extended programme in 1997/98, i.e. all elderly people, the cost-effectiveness ratio was estimated at EUR1820 per life-year gained. Sub-group analysis demonstrated that the programme had a more favourable cost effectiveness among the chronically ill elderly population (cost saving) than among the rest of the elderly population (EUR6900 per life-year gained). CONCLUSION: Influenza vaccination has a cost-effectiveness ratio that is better than or comparable to that of other implemented Dutch programmes in the prevention of infectious diseases.

Cost-Benefit Analysis↗
PubMed1998

Disease-staging for modelling current and future health-care impact of disease: illustrations for diabetes mellitus and AIDS.

This paper addresses the economic relevance of appropriately staging progression of disease for cost assessment and projection. Illustrations are drawn from two Dutch cost-of-illness studies for Diabetes Mellitus (DM) and AIDS. Our disease-staging specifies a separate late stage to capture terminal high-intensity care for end-stage complications. Data are used from a registration of national hospital resource utilization for DM and from a detailed database on AIDS hospital care and costs. In particular, differences in average length of hospital stay for several potential DM end-stage complications are compared with non-DM patients. Neglecting the separation of a specific late stage is estimated to possibly miscalculate 15-20% of the hospital bed needs for DM and AIDS in the Netherlands. In particular, confidence intervals of future projections for AIDS hospital beds--using respectively staged and non-staged models--do not overlap. AIDS hospital costs are overprojected by almost 11% in the non-staged model. Our estimation of DM hospital bed needs raises the percentage in total Dutch hospital beds from 1.7% (neglecting a specific late stage) to 2.0%. For DM and AIDS an appropriate disease-staging averts structural biases in estimations of bed needs and costs, and therefore benefits the planning of hospital care facilities. Obviously, gathering comparable information and developing similar methodology on other diseases, such as respiratory disease, cardiovascular disease and cancer, is needed and could benefit planning in these fields.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Estimating influenza-related hospitalization in The Netherlands.

The purpose of this study was to examine the impact of influenza on hospitalization in The Netherlands. Two methods were applied to estimate this effect: (a) regression analysis and (b) comparison of hospitalization in epidemic years with non-epidemic years. Hospital discharge rates in 1984-93 have been considered. The study shows that, during the period studied, on average, almost 2700 people were hospitalized for influenza per annum, and that influenza was diagnosed as the main cause for hospitalization in only a fraction of these hospitalizations (326: 12%). From an economic perspective, these results imply that the cost-effectiveness of vaccination against influenza may be severely underestimated when looking only at changes achieved in the number of hospitalizations attributed to influenza.

Adolescent↗
PubMed1997

[Cost-effectiveness of influenza vaccination The Netherlands].

OBJECTIVE: To determine the cost-effectiveness of influenza vaccination of all people aged 65 or over in the Netherlands. DESIGN: Model calculations. SETTING: National Institute of Public Health and Environment, Bilthoven, the Netherlands. METHOD: The cost-effectiveness of vaccination strategies was calculated using a mathematical model, with which the epidemiological effects in terms of morbidity and mortality as well as the direct costs of care of an influenza epidemic can be determined. The cost-effectiveness of non-intervention, of the current vaccination scenario for risk groups, and of an alternative scenario involving vaccination of all persons aged 65 or over and of all younger persons in risk groups, was calculated. RESULTS: Influenza-related care (the number of GP contacts and hospital days) and related costs decreased more with the alternative than with the current risk group scenario. Although the costs of care decreased when more people were vaccinated, the cost of vaccination increased more so that total net costs rose (55 million guilders versus 24 million). In the alternative scenario yearly 1115 life years more were won than with the current practice. CONCLUSION: Vaccinating all risk groups and all persons aged 65 or more has a favourable cost-effect ratio in comparison with other preventive intervention programmes.

Adult↗
PubMed1997

Hospital care for persons with AIDS in the European Union.

This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on the utilization of hospital care for AIDS have been selected to provide the data for our analysis. The selection criteria involve recentness, quality, comparability, accessibility and representativeness. Baseline hospital resource utilization is estimated for hospital inpatient days and outpatient contracts, using a standardized approach controlling for two severity stages of AIDS (chronic stage and late stage). The epidemiological part of the study is based on standard models for backcalculating HIV incidence and projecting AIDS incidence, prevalence and mortality. In the next step, baseline resource utilization is linked to epidemiological information in a mixed prevalence and mortality-based approach. Several scenarios render different future epidemiological developments and hospital resource needs. For the year 1999, hospital bed needs of 10,000-12,700 in the EU are indicated, representing an increase of 20-60% compared to the estimated current (1995) level. The projected range for 1999 corresponds to a maximum of 0.65% of all hospital beds available in the EU. The growth in the number of outpatient hospital contacts is projected to possibly exceed that of inpatient days up to 1.82 million in 1999. Our methodology illustrates that estimation of current and future hospital care for AIDS has to be controlled for severity stages, to prevent biases. Further application of the multinational approach is demonstrated through a 'what-if' analysis of the potential impact of combination triple therapy for HIV/AIDS. Estimation of the economic impact of other diseases could as well benefit from the severity-stages approach.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Lifetime hospitalization profiles for symptomatic, HIV-infected persons.

We explored the relationship between the incidence of hospitalization and disease progression in a group of 140 symptomatic, HIV infected patients by linking hospitalizations to the time of diagnosis, the time of death, or both. The relationship could best be described by positively skewed U-patterns or (weak) J-patterns with a high use of resources immediately following diagnosis and preceding death. The lifetime hospitalization profiles differed according to the type of insurance, age, the initial diagnosis in the CDC-IV stage and the length of survival. The results not only confirm general hypotheses posed by other research groups, but also demonstrate the existence of variations among subgroups of patients. The results can be used to improve economic assessments of the impact of AIDS in The Netherlands and the European Union. The method used has the advantage of being based on a bottom-up approach to resource utilization, involving the use pf prospective data for the patients' full lifespans, and can easily be applied to other areas of health services research.

Adult↗
PubMed1995

AIDS scenarios for The Netherlands; the economic impact on hospitals.

OBJECTIVE: To assess the economic impact of HIV/AIDS on the health care system in The Netherlands. DATA AND METHODS: Two types of data are used: (i) routine surveillance data on AIDS incidence and (ii) information on hospital resource utilisation and corresponding monetary costs. Progression of disease is modelled using a multi-stage model, with stages corresponding to clinical classifications and to different phases of health care need. Economic impact is analysed for all stages in three scenarios: the reference and two alternative scenarios. RESULTS: In the year 2000 hospital bed need would reach 220 beds if yearly new HIV infections in the 1990s remain at the level estimated for the end of the 1980s, and if the intensity of hospital care remains constant. A minimum need of 125 beds is projected if no new HIV infections occur in the 1990s. Hospital costs in 1993 are estimated to amount to 33.8 million ECUs. Scenarios indicate a range of 26.7-50.7 million ECUs for the year 2000 (price level: 1993). The proportion of the costs of hospital inpatient care and cure in total hospital costs increases, whereas the proportion for outpatient services decreases. CONCLUSIONS: Projected hospital bed need of 125-220 for HIV/AIDS in the year 2000 is limited compared to the projections for coronary heart disease and stroke, but approaches that for lung cancer, pneumonia and diabetes. We estimate hospital costs to have been 85% of total health care costs for HIV/AIDS in 1993. In 1993, the estimated proportions in hospital costs are 41% for inpatient care, 20% for inpatient cure and 39% for outpatient facilities. Our scenarios indicate a decreasing share of outpatient costs--possibly to 30% of total hospital costs for HIV/AIDS in 2000--illustrating the growing relative importance of the AIDS stage for the hospital costs. We project hospital costs for HIV/AIDS in 2000 to reach up to 0.53% of projected hospital costs for all diseases. A present value of 38 million ECUs (23%) of hospital costs projected in the reference scenario might be avoidable, during the period 1994-2000. However, with unchanged treatment patterns a present value of 127 million ECUs for hospital costs during the same period is projected to represent unavoidable costs (discount rate: 5%). In The Netherlands, data needs in the field of economic impact assessment of HIV/AIDS especially refer to registrations of non-hospital outpatient resource utilisation and costs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Economic impact of the AIDS epidemic in the European Community: towards multinational scenarios on hospital care and costs.

OBJECTIVE: To underpin multinational public-health HIV/AIDS strategy planning in the European Community (EC) by integrating national studies on HIV/AIDS in scenario analysis. METHOD: Three types of data are used: routine surveillance data, information on disease progression and observational studies on the economic impact. The HIV/AIDS epidemic is simulated using two models (MIDAS and PC-Based AIDS Scenarios). Selected simulations, consistent with surveillance data, are connected to economic impact (hospital-bed needs and annual hospital costs for AIDS patients). Parameter values expressing per person-year economic impacts are derived from a structured review of publications on economic aspects of AIDS. RESULTS: Evaluation of published studies on hospital resource use and costs in EC countries shows that there are significant differences between both countries and studies, even after conversion to similar measures (for example, using purchasing power parities). These differences are partly due to factors such as the composition of the patient population. Differences in methodology may also have influenced the results. Economic impact is analysed for combinations of three factors; survival time after AIDS diagnosis, hospital inpatient days needed per person-year and corresponding hospital costs per person-year. All scenarios indicate 1995 hospital-bed needs above the 1990 level of 5400 beds. Hospital cost projections for 1995 vary (up to US$1050 million). CONCLUSIONS: (1) For economic impact assessment, there are important gaps in epidemiological and economic data, and in the methods for linking these. (2) Standardization of studies on the resource use and costs of HIV/AIDS is necessary to provide a sound basis for multinational scenarios. (3) Preliminary multinational scenarios show that by 1995 hospital-bed needs for AIDS might reach 0.45% of all hospital beds available in the EC, and that hospital cost projections for AIDS in that year will range from 0.15% to 0.30% of EC health-care expenditure.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Benefit of the serological screening program for syphilis in pregnant women in Amsterdam in the period 1985-1989].

The results of the serological syphilis screening programme for pregnant women in the region of Amsterdam in the period 1985-1989 are described. In addition, a cost-benefit analysis was done to determine useful effects of the programme. Every GP and obstetrician routinely takes blood samples from pregnant women to determine the blood group, rhesus factor and syphilis serology. In the period 1985-1989, a total of 37,520 serum samples were screened for syphilis in the Amsterdam region by the Central Laboratory of the Blood Transfusion Service (until mid-1986) and by the Regional Public Health Laboratory of the Municipal Health Service (from mid-1986). In 55 women (0.15%) both the Treponema pallidum haemagglutination assay (TPHA) and the venereal disease research laboratory (VDRL) tests were positive. Further evaluation of these 55 women ultimately brought to light 10 women with positive syphilis serology who had not been treated and consequently might infect their child with Treponema pallidum. Considering the various transmission percentages of the bacterium from mother to foetus, which depend on the stage of the maternal infection, the screening programme has prevented two cases of congenital syphilis. This brings the cost-benefit ratio of the syphilis screening programme for the region of Amsterdam to 1:6.2. In view of these findings there is no reason to reconsider the current screening practice in Amsterdam.

Adult↗
PubMedDate not supplied

Cost-effectiveness of partner pharmacotherapy in screening women for asymptomatic infection with Chlamydia Trachomatis.

OBJECTIVE: To assess the cost-effectiveness of pharmacotherapy for male partners in screening women for asymptomatic infection with Chlamydia trachomatis (CT). METHODS AND DATA: A pharmacoeconomic decision analysis model was constructed for the health outcomes of a CT screening program, such as averted cases of pelvic inflammatory disease and infertility (major outcomes). Reinfection in the absence of partner pharmacotherapy was included in the model. Cost-effectiveness from a societal perspective was estimated for prevalence data from a selective opportunistic screening program in Amsterdam. For diagnosis of asymptomatic CT infection a Ligase Chain Reaction (LCR) test on urine was used; for pharmacotherapy of women and partners azithromycin was used. By linking health outcomes with health care costs and productivity losses, averted costs were estimated. Cost-effectiveness was expressed as net costs per major outcome averted. RESULTS: Partner pharmacotherapy reduces net costs per major outcome averted of the screening program by approximately 50%. Sensitivity analysis indicates significant improvements in cost-effectiveness of the screening program, even when relevant assumptions are varied. Within the broader framework of the screening program, partner pharmacotherapy is a cost-saving activity. CONCLUSIONS: Inclusion of partner pharmacotherpy provides significant improvements in overall cost-effectiveness of the CT screening program among women aged 15 to 29. Partner pharmacotherapy lowers net costs per major outcome averted to the realm where implementation of the screening program should be considered. Considering the cost-saving potential, male partner pharmacotherapy should be pursued within the broader framework of a CT screening program for women. Reinfection should be included in any future pharmacoeconomic model of CT screening. Further work on this type of model should also be directed to linking cost-effectiveness to epidemiological models for the long-term spread of infectious diseases in populations.

Adolescent↗
PubMedDate not supplied

Projecting utilization of hospital in-patient days in The Netherlands: a time-series analysis.

The object was to model and project utilization of hospital in-patient days for selected diseases in The Netherlands. We used sex- and age-specific standardized monthly utilization of hospital in-patient days during 1980-90 for lung cancer, diabetes, coronary heart disease, stroke, and pneumonia. These data were supplied by the Health Care Information Centre (Stichting Informatiecentrum voor de Gezondheidszorg). We applied Box-Jenkins time-series analysis seasonal autoregressive integrated moving-average (SARIMA) models. Estimated models are tested by considering the Portmanteau test and the Akaike information criterion. SARIMA models give an adequate representation of hospital-in-patient-days utilization for the major sex and age classes of most selected diseases. Poor modelling results are obtained for diabetes in all sex and age groups and in elderly women with coronary heart disease or with stroke. Seasonality is an important factor in most of the models that we have estimated, particularly for utilization of pneumonia and stroke patients. The major trends in standardized in-patient days are downward, and projected 1995 levels of standardized utilization are below the 1990 levels for all the selected diseases. Population-based projections for 1995 are lower than the 1990 projections only for lung cancer and diabetes. The adequacy of the SARIMA models appears to be sensitive with respect to the parameter in the Portmanteau test. We discuss two possible explanatory developments for in-patient-days utilization: (i) developments in the provision of hospital care, and (ii) epidemiological developments. The selected diseases showed a decreasing mean duration of stay in 1980-90. Only for coronary heart disease did a rise in discharges in the same period outweigh this trend. We assessed contrasts between published epidemiological developments and the trends in in-patient-days utilization. Possible explanations concern shifts from in-patient to out-patient care and changes in treatment. Finally, complementary to our SARIMA models, the investigation of future in-patient days utilization by means of scenario analytic approaches remains important.

Adolescent↗