Biomedical subjects

Marjon van der Pol

Publications and source records attributed to Marjon van der Pol.

6 recordsLinked to original sources

PubMed2006

Does supplementary prenatal nursing and home visitation reduce healthcare costs in the year after childbirth?

AIM: This paper reports the costs of a programme of supplementary prenatal care, including healthcare costs, in the year following childbirth. BACKGROUND: Publicly funded healthcare systems have provided pregnant women with adequate medical care, but access to resources to address their non-medical needs is still an issue. To improve women's access to pregnancy-related resources, a community-based, prenatal programme involving consultations with a specialist nurse, or nurse plus a home visitor was evaluated. METHOD: A sample of 284 women who had participated in a randomized controlled trial of the prenatal care programme participated in this partial economic analysis. Women had been randomized to one of three trial arms: (1) standard care, (2) standard care plus consultations with a specialist prenatal care nurse, or (3) standard care plus nurse consultations and a home visitor. For the economic study, each woman was asked about her and her baby's use of healthcare services in the 12 months after the baby's birth. Health service utilization was multiplied by the unit cost of each service and summed to arrive at the total cost of services used. The study was undertaken in 2004. RESULTS: Supplementary prenatal care neither increased the use of health services nor resulted in savings in health spending. Compared with standard care, women in the two intervention groups made more use of family physicians and less use of paediatricians, but no significant differences in the overall costs of health care were noted. CONCLUSION: While supplementary prenatal care had no impact on costs, some benefits occurred for those at greatest risk of not accessing services. However, it would be premature to draw widespread recommendations for policy from the results of a single study. Further investment in prenatal care should continue to be accompanied by rigorous evaluation of its costs and the value that women place on the service provided.

Adult↗

PubMed2004

Repeated follow-up as a method for reducing non-trading behaviour in discrete choice experiments.

Eliciting individuals' preferences using discrete choice experiments is becoming increasingly popular. An emerging issue is that some people do not trade, that is, their choices are consistent with them having a dominant preference. However, it may be the case that these individuals have not been presented with the 'right' trade-offs. This experiment presents individuals with trade-offs that are systematically varied in response to their previous answer. It is thus assessed whether individuals have truly dominant preferences or whether they will trade given the 'right' choices. The preferences studied are time preferences over future health states. After being presented with an initial discrete choice, 203 university students were asked a series of follow-up questions using a web-based questionnaire. Very little evidence of any dominant preferences was found in this sample of respondents. Only one subject did not trade duration and timing following repeated follow-up questions. This finding suggests that non-trading behaviour could be virtually eliminated by asking the 'right' questions.

Adult↗

PubMed2003

A review of studies assessing the costs and consequences of interventions to reduce mother-to-child HIV transmission in sub-Saharan Africa.

OBJECTIVE: To review the methods and findings of studies that assess the costs and consequences of interventions to reduce mother-to-child HIV transmission in sub-Saharan Africa. DESIGN: Systematic literature review. METHODS: A literature search was conducted to identify studies that assessed the costs and consequences of interventions aimed at reducing mother-to-child HIV transmission in African populations. The methodological quality of included studies was appraised using the British Medical Journal Economic Evaluation Working Party checklist and data were extracted for comparison using a data extraction template. RESULTS: Nine studies, all of which used modelling techniques to predict the cost-effectiveness of anti-retroviral interventions, were identified for inclusion in the review. The quality of reporting was found to be lacking in several key areas. In particular a lack of detail was given regarding quantities of resources required for interventions, and the methods for valuing health outcomes and unit costs. In general, the more recent evaluations report more favourable cost-effectiveness ratios than earlier studies due to lower drug costs and in some cases the use of shorter drug regimens. CONCLUSIONS: Comparisons between studies were hampered by variations in the values attached to model parameters and by differences in the structure and design of models. The most encouraging findings have been reported for the CDC short zidovudine regimen and the HIVNET012 single dose nevirapine regimen. The generalizability of these findings is limited by the use of incremental costing, combined with uncertainty surrounding the level of infrastructure required to implement the interventions. In low-income sub-Saharan countries, the costs of strengthening the infrastructure to levels capable of providing such interventions, needs to be assessed before an optimal policy for the prevention of mother-to-child HIV transmission in sub-Saharan Africa can be established.

Africa South of the Sahara↗

PubMed2003

Predicting attendance for breast screening using routinely collected data.

The aim of this paper is to predict attendance if the age range for routine invitation to breast screening were to be extended. The response to the most recent screening invitation is modelled for women eligible for screening if the age range were extended. The independent variables include (i) the woman's characteristics: her screening history; the deprivation score of the area she lives in and (ii) the characteristics of the screening: whether the screening took place in a mobile van or at a static site; and time of the year. The predictive ability of the regression model is tested by goodness of fit measures and by predicting attendance for a holdout sample of the data and for women who participated in a demonstration project. The modelling of attendance is quite successful in that most hypothesised variables have the expected sign. Moreover, the predictive ability of the model is satisfactory in terms of goodness of fit statistics and in terms of accuracy of predictions for a holdout sample. The model predicts less well for the demonstration project possibly because it is less representative of usual screening practice.

Aged↗

PubMed2003

Valuing food safety improvements using willingness to pay.

Food safety policies are coming under increasing scrutiny. A challenging issue when devising food policies is to assess the 'intangible' benefits such as a reduction in suffering from food-related illness. Here, contingent valuation is used to elicit individuals' willingness to pay (WTP) for the elimination of the risk of poultry-borne illness through irradiation and a hypothetical treatment. Two hundred members of the general public were interviewed and the results show that people are willing to pay extra for food safety. WTP is found to be sensitive to the elicitation format.

Adolescent↗

PubMed2002

Decision making heuristics and the elicitation of preferences: being fast and frugal about the future.

It has been suggested that individuals employ simple decision heuristics when answering stated preference questions. Evidence from discrete choice experiments of individuals failing to trade may indicate that they employ simple decision making heuristics. However, individuals might not trade because their preferences are not captured by the range of trade-offs they are offered. This is explored by offering a series of choices where the trade-offs implied by subsequent choices depend on the subject's responses to previous choices. The results suggest that individuals answer discrete choices without recourse to simplifying heuristics, and that information is generated on their preferences rather than on how they make such choices.

Consumer Behavior↗