Diana De Graeve

University of Antwerp | UA · Economics

Background Out-of-hours primary care (OOH-PC) has emerged as a promising solution to improve efficiency, accessibility, and quality of care and to reduce the strain on emergency departments. As this modality gains traction in diverse healthcare settings, it is increasingly important to fully assess its societal value-for-money and conduct thorough...

Background We compared the cost-consequence of a home-based multidrug-resistant tuberculosis (MDR-TB) model of care, based on task-shifting of directly observed therapy (DOT) and MDR-TB injection administration to lay health workers, to a routine clinic-based strategy within an established national TB programme in Eswatini. Methods Data on costs a...

Background : During the TRIAGE trial, emergency nurses diverted 13.3% of patients with low-risk complaints from a Belgian emergency department (ED) to the adjacent general practitioner cooperative (GPC). We examined the effects of this diversion on the total cost, insurance costs and patient costs, as charged on the invoice. Changes in the cost com...

Background This study assessed knowledge, attitudes and practices (KAP) of lay community treatment supporters (CTSs) delegated with directly observed treatment (DOT) supervision and administration of intramuscular multidrug-resistant tuberculosis (MDR-TB) injections in the Shiselweni region in Eswatini. Methodology A cross-sectional survey among a...

Objectives In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to compl...

Aims This process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). Design & Methods Semi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a...

Background During the cluster randomised TRIAGE-trial, a nurse advised 13% of low-risk patients presenting at an emergency department in Belgium to visit the adjacent general practitioner cooperative. Patients had the right to refuse this advice. This exploratory study examines the characteristics of refusers by uncovering the determinants of non-c...

Objectives To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). Methods Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extensi...

Objectives: To determine the effectiveness and safety of a tool diverting low urgency patients eligible for primary care from an emergency department (ED) to the adjacent general practitioner cooperative (GPC). Methods: Unblinded, randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The inter...

Background Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium...

Background Eswatini is facing a critical shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. This study assessed multiple stakeholders’ perceptions of task-shifting directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections to...

Background: The human resources for health crisis in rural Eswatini led to a novel community-based multidrug-resistant tuberculosis (MDR-TB) treatment strategy based on task-shifting, that is delegation of directly observed treatment (DOT) and administration of MDR-TB injections, traditionally restricted to professional nurses, to lay community tre...

Background Breast cancer accounts for 10 to 20 percent of the total cancer cost. The direct cost of cancer care are the health care expenses directly related to prevention and cancer treatment. The indirect cost, 2-3 times the direct cost include presenteeism, disability to work, absenteism and workers compensation. The aim of this study is to achi...

Background: The Colombian health authorities introduced the pneumococcal conjugated vaccine and the seasonal influenza vaccine into the national immunization schedule for children in 2009 and 2007, respectively. Despite this, the health authorities continue to be concerned about the high economic and disease burden among children from low-income h...

Objective To estimate the burden of disease and related direct medical cost of Acute Respiratory Infections (ARI) for the health-care system in a low-income district of Bogota, generated by children under age five and senior population over age sixty. Methods A cross-sectional, retrospective, patient level study was conducted in San Cristobal distr...

Fairness in the finance of health care relates to the distribution of health-care payments across the population and is an important issue for most health-care systems. The focus is on whether payments for health care are in accordance with ability to pay and on whether households are protected against catastrophic expenses.This article describes a...

Considering the sizeable cost of transcatheter aortic valve implantation (TAVI) and conflicting cost-effectiveness studies, it is useful to gain more insight into the cost structure of the TAVI hospitalization. This study provides such a cost analysis and starts to evaluate options to soften the hospitalization cost burden in order to make TAVI eco...

Objective Considering the sizeable cost of transcatheter aortic valve implantation (TAVI) and confl icting cost-eff ectiveness studies, it is useful to gain more insight into the cost structure of the TAVI hospitalization. This study provides such a cost analysis and starts to evaluate options to soften the hospitalization cost burden in order to m...

Countries try to achieve affordable health care for everyone. The way in which they do this differs. Belgium chose for a system with universal coverage in which patients and providers have a lot of freedom and with financing mainly through contributions and taxation. To make patients responsible, they have to pay part of the costs out of their own...

Increasing cost pressure and changing patients' needs in the healthcare sector have led to new delivery models for primary care. Researchers and practitioners need to establish innovative methods to obtain insights into patients' preferences and effectiveness of healthcare services. This study reveals the crucial decision criteria of patients in ch...

In this article we investigate the possibility to account for selection bias in observational data by using econometric techniques. One-year costs of 15,237 patients who received a drug-eluting stent (DES) or a bare metal stent (BMS) in Belgium in 2004 were compared. The treatment choice between DES and BMS could be influenced by patient characteri...

In many countries, a reassessment of after-hours primary care has become necessary. In particular, centralised general practitioner deputizing services (GPDS) have emerged. In this study, consumers' preferences for after-hours medical care were obtained and the use of the new GPDS was predicted. On the basis of the Theory of Reasoned Action, a surv...

Objectives: To summarize scientific evidence for individual psychosocial treatment of developmental disorders of speech and language (DD-L), and developmental disorders of scholastic skills (DDSch). To describe care organization for these disorders in 7 Western countries. Methodology: EBM literature review including systematic reviews, meta-analyse...

The effects of supplemental health insurance on health-care consumption crucially depend on specific institutional features of the health-care system. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. Within th...

Although there is a comprehensive public health insurance system in Belgium, out-of-pocket expenditures can be very high, mainly for inpatients. While a large part of the official price is reimbursed, patients are confronted with increased extra billing (supplements). Therefore, the government imposed various restrictions on the amount of supplemen...

This Schizophrenia Outcome Survey compared medical costs, psychopathology and adverse events in outpatients for 2 years following hospitalisation for an acute schizophrenic episode. Adults stabilised with haloperidol, olanzapine or risperidone entered this observational study <or=1 month after discharge and were assessed at baseline, 3, 6, 12, 18 a...

Objective: To estimate the cost effectiveness of olanzapine and risperidone for the treatment of schizophrenia in Belgium. Methods: Data were retrieved from a prospective, observational, nonrandomized, follow-up survey. Clinical investigators assigned 265 patients with schizophrenia to either olanzapine (n = 136) or risperidone (n = 129). Patients...

Fairness in the finance of health care relates to the distribution of health-care payments across the population and is an important issue for most health-care systems. The focus is on whether payments for health care are in accordance with ability to pay and on whether households are protected against catastrophic expenses. This article describes...

Schizophrenia is a serious mental disease with an early onset mostly between the ages 15-25. It is characterised by distortions of thinking and perception with inappropriate or blunted personal and social behaviour as a result. Schizophrenia is usually a chronic disease with acute relapses. It is therefore expensive in terms of direct treatment cos...

Recent evidence shows that drug-eluting stent devices (DES) substantially reduce the risk of in-stent restenosis compared with classic bare metal stent devices (BMS). In Belgium, however, the use of BMS is still standard procedure due to the higher prices of the newer DES. Although the use of DES is more expensive in the short term it might be bene...

Background: Belgium has dominantly fee for service remuneration with fixed official tariffs for medical and paramedical interventions, implants and nursing and hotel costs in hospital. On top of these tariffs there is a large degree of freedom to charge additional fees, so-called supplements. Protective legislation limits this freedom in common roo...

Objectives: While policymakers already debated a lot on co-payments, there is an increasing concern about the huge increase of supplements as well. In this study we investigate the distribution of the burden of supplements. We want to describe the characteristics of the payer of supplements. Methodology: We use an administrative dataset of the diff...

The purpose of this study was to provide quantitative information on the economic, social and emotional burden borne by families of children with attention-deficit hyperactivity disorder (ADHD) and on the public healthcare costs of a child with ADHD in Flanders, Belgium, and to compare costs of ADHD children with those of siblings without the disor...

Coronary heart disease is a major cause of death and morbidity in developed countries. It is caused by narrowing of the coronary arteries and is treated by coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI) which include balloon angioplasty and stenting. A common consequence of PCI is restenosis, a re-narrowing of t...

Une recherche de la littérature en exécution de la mission confiée par le Service des Soins de Santé de l’Institut National d’Assurance Maladie-Invalidité.STOP

This study investigated the presence of order bias in contingent valuation studies. We compared the willingness to pay (WTP) for an improved drug for attention-deficit/hyperactivity disorder with that for the standard drug and examined whether the order in which the drugs are presented influences the results obtained. A pretested questionnaire was...

Patients with schizophrenia suffer numerous relapses and rehospitalizations that are associated with high direct and indirect medical expense. Suboptimal therapeutic efficacy and, in particular, problems with compliance are major factors leading to relapse. Atypical antipsychotic agents offer improved efficacy and a lower rate of extrapyramidal adv...

Our multidisciplinary project on TB control in the Free State, South Africa, is targeting two dimensions for intervention: firstly, patients, to facilitate compliance and improve quality of care; secondly, the health care system, to identify weaknesses that require remedying and best practices to promote better TB control. This communication illust...

This article briefly outlines the principles of economic evaluation in dentistry. It discusses the different types of analyses, such as cost-effectiveness analysis, cost-benefit analysis and cost-utility analysis. Furthermore, it makes clear when these analyses are most appropriate for use. Having a basic understanding of the most common analyses c...

In this review, the economic aspects of pneumococcal pneumonia are analysed, including the costs, cost effectiveness and cost benefit of treatment and prevention. We identified eight cost-of-illness studies, 15 analyses comparing the costs of different treatment options and 15 economic evaluations of prevention that met our search criteria. The stu...

This article summarises, extends and updates previous empirical work on the distributional implications of alternative health care financing arrangements in a selection of European countries and the US. On the one hand, total health care payments are almost proportional to ability to pay in most countries. This is predominantly driven by a high rel...

The objective was to investigate the financial situation of people living with HIV in Europe. Two surveys using an anonymous questionnaire were organized in Europe among people living with HIV, the first in 1996-97 and the second in 1998-99. One thousand one hundred and sixty-one people from the 1996-97 survey and 899 from the 1998-99 survey were i...

A typology to classify provider payment systems from an incentive point of view is developed. We analyse the way, how these systems can influence provider behaviour and, a fortiori, contribute to attain the general objectives of health care, i.e. quality of care, efficiency and accessibility. The first dimension of the typology indicates whether th...

The cost of HIV/AIDS care was measured in Belgium in 1996. This paper is concerned with direct costs (formal and informal care). This is a prospective study, stratified by CDC-disease stage. A societal point of view was chosen. Eighty-two sequential patients agreed to join the study during outpatient visits. Data on service use and costs were obtai...

Economics is the science of analysing how relatively scarce resources are allocated across virtually unlimited wants. Health economics, as subdicipline, focuses on this allocation process with respect to health care. Applied to mental health services (in general and for children and adolescents) this means getting insight in (1) wants (2) demand (3...

OBJECTIVES: New drugs with extended release formulations are being developed to treat patients with ADHD. While currently available drugs need to be administered two or three times daily, the new medication offers the prospect of a once-daily administration with a more consistent working profile throughout the day. The purpose of the present study...

The German health care system is based on the principles of solidarity and subsidiarity. People whose income does not exceed a certain limit are obliged to take insurance with a sickness fund. The other people however can choose a sickness fund or a private insurer. Physicians are reimbursed fee-for-service. Before 1997, the exact value of the fee...

The Dutch health care system is characterised by a mixture of government intervention and market mechanisms. Patients are insured by sickness funds or private insurers, depending on their income level. Both types of insurers negotiate contracts with care providers. Physicians treating a private patient are paid fee-for-service; physicians treating...

The British National Health Service (NHS) is characterised by a broad access and a relatively low level of expenditures. After the purchaser/provider split in 1991, health care purchasing. Since, the Health Authorities have to negotiate contracts with care providers and to reimburse them within budget limits. Another related reform was the introduc...

The French health care system is characterised by principles of equality and freedom. The French State provides equal treatment to all that are in need. The freedom relates to the freedom granted to patients and the medical profession. Patients are free to choose their physician; physicians are free to set up practice anywhere in France with a paym...

The health care system in Switzerland is highly decentralised: the regulation and the financing of health care are the responsibilities of the cantons and municipalities. Since 1996, health insurance has been made compulsory. The package of benefits has been defined. The premiums are community-rated and risk-adjusted within a canton. The insured pa...

This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are mor...

Several studies have shown that pneumococcal vaccination of older persons would be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection for this condition is uncertain. Given much better evidence of vaccination effectiveness against invasive disease, studies showing that vaccination is cost-effective in preventin...

Pneumococcal vaccination of older persons is thought to be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection is uncertain. Because there is better evidence of vaccination effectiveness against invasive pneumococcal disease, we determined the cost-effectiveness of pneumococcal vaccination of persons aged ≥65 ye...

Objective: To analyse the direct medical costs and effectiveness of vaccinating adults aged between 18 and 64 years and elderly persons ≥65 years of age with the 23-valent pneumococcal polysaccharide vaccine. Design and setting: This was a decision-analytic modelling study from the societal perspective in Belgium. The analysis compared ‘evaccinatio...

Background: Several studies have shown that pneumococcal vaccination of older persons would be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection for this condition is uncertain. Given much better evidence of vaccination effectiveness against invasive disease, studies showing that vaccination is cost-effective...

Physicians in Belgium are paid on a fee-for-service basis with official fees negotiated between representatives of the medical profession and the sickness funds. The article analyses the evolution and the determinants of five of these fees: the consultation fee and the home visit fee of a GP, and the consultation fees of a general specialist, an in...

The study calculates inpatient costs generated at the University Hospital in Antwerp (Belgium) and outpatient costs generated at the Institute of Tropical Medicine or at the University Hospital of 213 seropositive patients without AIDS and of 48 AIDS patients, for the year 1991. Outpatient drug use other than Zidovudine was excluded. An HIV + patie...

The literature on economic evaluation of pharmaceuticals is growing rapidly. Although there have been substantial methodologic advances, there remain serious problems and pitfalls. This presentation focuses on three aspects, i.e., use (and abuse) of evaluation studies, methodologic problems, and the quality of published studies.

On average, couples have more children when the costs of raising a child are low and expected benefits from children are high. We could postulate an analogous weighing of costs and benefits in the use of IVF. However, market imperfections, especially information asymmetry, can stand in the way of well-considered use. Hence, IVF is often regulated b...

The effects of immunisation programmes that have existed for several decades in developed countries are demonstrated by the decrease and even eradication of smallpox, poliomyelitis, measles, mumps and hepatitis B. Cost, health policy and spontaneous evolution in the incidence of communicable diseases have a decisive influence on the use of a vaccin...

The Belgian Ministry of Public Health distributes an Independent Drug Formulary (IDF) on a 2-yearly basis. This formulary (called the Gecommentarieerd Geneesmiddelenrepertorium) is edited by a group of prominent experts in pharmacology, brought together by the Belgian Centre for Pharmacotherapeutic Information. It contains scientific information ab...

The article focuses on the consumption of drugs from an economic point of view. The behavior of the patient as well as of the physician is empirically analyzed. As regards the patient, we found that drug consumption is determined by economic factors. Variables such as income, price, age, and education level, which emerge from economic models, can e...