Biomedical subjects

F F Rutten

Publications and source records attributed to F F Rutten.

97 records · Page 6Linked to original sources

PubMedDate not supplied

Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel.

This paper comments on the recently published guidelines of the Washington Panel on incorporation of indirect non-medical costs, or productivity costs, in economic evaluations of health care. Traditionally the human capital or more recently the friction cost method is used to measure these costs. The Panel, however, recommends incorporating productivity costs as health effects in the denominator of the C/E ratio. This paper argues that incorporation of productivity costs in cost-effectiveness analysis expressed as health effects is not correct. Only direct health related effects on quality of life that cannot be meaningfully monetarized should be considered as health effects. Furthermore, measuring productivity costs in terms of quality of life may lead to misrepresentation of these costs from a societal viewpoint. This misrepresentation occurs because of the existence of social security systems and private insurance compensating for income reductions from disease. Furthermore, the patient's viewpoint is useful for quality of life measurement, but not for measuring productivity costs from a societal perspective. Finally, alternative recommendations are formulated for incorporating societal productivity costs in economic evaluations of health care.

Absenteeism↗

PubMedDate not supplied

Lifetime costs of lung transplantation: estimation of incremental costs.

Despite an expanding number of centres which provide lung transplantation, information about the incremental costs of lung transplantation is scarce. From 1991 until 1995, in The Netherlands a technology assessment was performed which provided information about the incremental costs of lung transplantation. Costs in the situation with and without a transplantation programme were compared from a lifetime perspective. Because randomization was ethically inadmissible, only costs in the situation with the programme were observed. Both conventional treatment costs and costs of the transplantation programme were registered. Costs in the situation without the programme were based on the conventional treatment costs in the situation with the programme. Due to the study period of four years, long term follow-up costs were estimated. The total incremental costs per transplanted patient were estimated at Dfl 466,767 (5% discounted costs). The main part of these costs was caused by the high costs during the lifetime follow-up of the patients.

Cost of Illness↗

PubMedDate not supplied

Productivity costs in cost-effectiveness analysis: numerator or denominator: a further discussion.

In this response we concentrate on what Weinstein et al. call the 'major disagreement' between the Erasmus group and the US Panel, which concerns the measurement of productivity losses during illness. We consider the consequences for the individual, for the employer and for the rest of society and argue that when following the Panel's propositions for measuring these consequences, major theoretical and practical difficulties are encountered.

Cost of Illness↗

PubMedDate not supplied

Costs, effects and C/E-ratios alongside a clinical trial.

A general approach is discussed to assess the uncertainty surrounding the cost effectiveness ratio (C/E-ratio) estimated on the basis of data from a randomised clinical trial. The approach includes the calculation of a 95% probability ellipse and introduces the concept of a so called C/E-acceptability curve. This last curve defines for each predefined C/E-ratio the probability that the C/E-ratio found in the study is acceptable. The approach is illustrated by estimates of costs per life saved and costs per patient discharged alive on the basis of data from a phase II trial addressing the value of anakinra in treating sepsis syndrome.

Cost-Benefit Analysis↗

PubMedDate not supplied

The impact of indirect costs on outcomes of health care programs.

The impact of including indirect costs of disease (as a result of absence from work, disability and mortality) on outcomes of economic evaluations of specific health care programs is analyzed. For eight health care programs, changes in indirect costs are estimated using the friction cost method, that seeks to estimate the economic losses due to disease or the economic gains of health care programs. The impact of indirect costs on outcomes varies considerably across programs. Indirect costs tend to play an important role if health care programs produce health effects in the short run, if (short term) absence from work is affected considerably and if a significant proportion of the target population is employed at the moment they benefit from the program. The possible induction of treatment related absence from work and disability may also be relevant.

Adult↗

PubMedDate not supplied

Evaluation of automated information systems in health care: an approach to classifying evaluative studies.

In this paper we discuss an approach to classifying evaluative studies of automated information systems in health care. Selected literature (76 studies) is classified according to the type of automated information system (based on relationship to the care process), the study design used, the data collection methods used, the effect(s) measured and the type of evaluation (e.g. cost-benefit analysis). First results show that certain types of automated information systems have not been evaluated much, going by the number of studies selected. Furthermore, it is observed that certain study designs (time-series design), data collection methods (modelling and simulation) and effect measures (job satisfaction) are hardly to be found in the literature. Only 10 of 76 selected studies used a type of evaluation for which both consequences and costs are considered. Detailed investigation of the literature may provide information for the development of a general framework for the evaluation of different types of automated information systems.

Classification↗

PubMedDate not supplied

The cost of dental implants as compared to that of conventional strategies.

The effectiveness of dental implants is widely studied, especially in terms of their clinical outcomes. However, from the policymaker's point of view, variables other than safety and efficacy, such as the costs and effectiveness of dental implants as compared to other treatment alternatives, are vital in decision making. This paper compares the costs of different treatment strategies in a randomized clinical trial in patients with resorbed mandibles and persistent problems with their conventional dentures: treatment with a mandibular overdenture on permucosal dental implants, an overdenture on a transmandibular implant, new dentures after preprosthetic surgery, and new dentures only. Data were gathered on an individual patient level to gain insight into specific cost episodes. Direct costs were subdivided into labor, material, technique, and overhead. Data concerning these components were gathered during the consecutive treatment phases in the first year. Results show that the resources used to treat a patient with an overdenture supported by a transmandibular implant are seven times those of a complete new set of dentures. Comparison of the cost ratio of an implant-retained overdenture supported by permucosal implants and conventional new prostheses proves less unfavorable: 1:3. New dentures after preprosthetic surgery are almost as expensive as treatment with permucosal implants.

Analysis of Variance↗