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Cost of Illness in the Netherlands: description, comparison and projection

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Over the past decades health economics has emerged as a new scientific discipline. From the very beginning the field has continued to expand and take on increasing significance. An important focus is on the economic evaluation of health care facilities withln the area of Medical Technology Assessment (MTA) or Health Technology Assessment (HTA). Other topics studied by health economists regard among others the demand for care, the role of health insurance, the industrial organisation of the health care sector and the international comparison of health care systems. Cost-of-illness (COI) studies have also attracted the attention of health economists. Since the pioneering work of Dorothy Rice in the United States in the Sixties [Rice 1966], cost-of-illness data have been published for several countries. There is, however, some controversy about the results. Physicians and policymakers frequently ask what the often very large financial estimates for costs of specific diseases mean and how reliable, valid and useful they are. This thesis focuses on COI studies. We will start with a few definitions [Rice 1994].
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... This bottom-up strategy estimates total costs by multiplying the average costs of a certain diagnosis with the average health care use by that diagnosis. Data on health care use and prices are usually collected at the patient level (Polder, 2001). An often mentioned ...
... For example elderly are often suffering from more diseases at the same time. In this case the allocation of costs to only one disease or diagnosis might become a little arbitrary (Polder, 2001). Furthermore determinants of diseases will not be exposed (for example diabetes causing cardiovascular problems), because costs are only allocated to the main or final diagnosis. ...
Article
All Western countries spent every year a lot of money on health care. Cost of illness (COI) studies describe how health care costs are related to epidemiological and demographic variables. This report compares COI-studies for some European and OECD countries as the Netherlands, Germany, France, Canada and Australia. It is demonstrated that COI-studies can help to explain international differences in health expenditure. It is also shown that acute care costs for major disease groups are more or less the same in the different countries. Comparisons of long term care expenditure were hampered by country specific definitions and provisions. This report argues that cost of illness studies can be useful: 1) to identify cross-national differences in health expenditure; 2) to monitor the cost development between countries; 3) to investigate the effect of health care reforms from the perspective of disease, age and gender. The availability of appropriate data is a critical condition here. International standardization of data, classifications and methods is important, as well as for expenditure data as with regard to utilization data and the allocation of costs to disease, age and gender. A common approach will result in better cost of illness figures that serve the national and international debate on health and health expenditure with a deeper understanding of the interrelationships between demand and supply of health care. Steeds meer landen binnen en buiten Europa publiceren studies op het gebied van kosten van ziekten, de zogenaamde KVZ-studies. Daarmee ontstaat ook behoefte aan een internationale vergelijking van deze studies. Dit rapport geeft een globale vergelijking van de kostenramingen van tien landen en daarnaast een meer gedetailleerde vergelijking voor Australie, Canada, Duitsland, Frankrijk en Nederland. Het rapport laat zien dat de grote patronen in kosten van ziekten voor de meeste landen gelijk zijn. Tegelijkertijd blijken er aanzienlijke verschillen te bestaan die vooral samenhangen met wat er wel en niet onder gezondheidszorg wordt verstaan. Deze verschillen doen zich vooral voor op het terrein van de langdurige zorg. Het rapport laat zien dat bij een zorgvuldige selectie van sectoren en diagnosegroepen KVZ-studies een goed instrument zijn om: 1) internationale verschillen in zorgkosten nader te identificeren ten behoeve van meer gedetailleerde vergelijkingen; 2) de kostenontwikkeling van landen ten opzichte van elkaar te monitoren; 3) het effect van stelselwijzigingen op de sectorale en totale zorgkosten te bekijken vanuit ziekte en leeftijd en dat te vergelijken met landen waar die wijzigingen niet zijn doorgevoerd. Een algemene voorwaarde hiervoor is de beschikbaarheid van een adequate gegevensinfrastructuur. Dit geldt zowel voor de hoogte van de zorgkosten - per actor en in de aansluiting op het System of Health Accounts - als de gegevens over het zorggebruik die nodig zijn om de kosten toe te wijzen aan ziekten en demografische kenmerken. Uniforme, internationale definities en een standaard methodologie voor de kostentoewijzing kunnen hierbij de vergelijkbaarheid van KVZ-studies aanzienlijk bevorderen.
... Most studies focused on cost of acute care or comparison of two or more rehabilitation programs [8][9][10][11], but only a limited number of studies evaluated costs of post-stroke care [12]. Using different types of rehabilitation services or poststroke care programs offered in the same setting but with different care approaches, the benefits for the patient can be maximized while costs are minimized [13][14][15]. ...
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Objectives: Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. Methods: A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. Results: We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. Conclusion: The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.
... (15) In this study, the prevalence-based approach was used to calculate economic burden of tuberculosis. Calculating disease costs based on prevalence has the advantage of considering total annual costs of health care, and it is especially useful for chronic diseases such as diabetes, cancer, etc. which require long-term treatment (16). In order to analyze data, since there was no suitable and accurate database, bottom-up method was used (15). ...
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Present study calculates and analyzes Cost of illness of tuberculosis in Tehran. This study was a descriptive analytical study conducted among 121 patients in two stages in 2011. In the first stage, questionnaires were collected by reviewing patient records and phone interviews with patients. The second stage deals with the calculation of costs. For cost calculation, we used incidence based and bottom-up approach, and for calculating indirect costs, human capital approach was used. The vision used for this study was community-based in which all costs are included. The average costs per patient were calculated to be as follows: 28,467,737 Rials(2588 dollars) for direct medical costs, 1,011,360 Rials (92 dollars) for indirect medical costs and 5,533,020 (503 dollars) Rials for indirect costs. On the whole, average costs per patient was 35,056,170 Rials most of which were related to hospital costs (62/11%). Also, the average time away from work was 47 days. Cost calculated for all patients with tuberculosis in Tehran in 1390, including indirect costs caused by premature deaths of patients, was 101,900,501,328 Rials (9,263,681 U.S.$). To sum up, in Tehran in 2011 on average every day about 279,179,456 Rials (25,380 dollars) was spent on TB patients. Moreover, heavy costs caused by TB, which are usually imposed to the households in two or three months, have significant effect of decreasing households' quality of life which calls health policy makers' attention.
... COI studies are performed in various ways with various methods8910. In this article general COI studies were compared from five countries. ...
Article
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About 36 billion euro was spent on health care in the Netherlands in 1999. Due to ageing, epidemiological trends and technological change this amount is expected to increase in the next decades. An adequate health care policy requires detailed information on how this amount is spent. This report describes health care consumption of the Dutch population in 1999 by health care sectors, disease categories, age and gender. Trends in the recent past are highlighted and projections of future health expenditures are presented. This report also contains an estimation of health care costs in the last year of life. The role of these costs in projections of future health expenditure is discussed. Health care costs are also attributed to risk factors and aspects of unhealthy behaviour. In addition a comparison is made with cost of illness studies from other western countries. The report ends with a checklist for the interpretation and comparison of cost of illness figures. In Nederland werd in 1999 ongeveer 36 miljard euro aan gezondheidszorg uitgegeven. Dat bedrag zal de komende jaren stijgen onder invloed van toenemende medische mogelijkheden en de vergrijzing van de bevolking. Om vast te stellen of al dat geld zo goed mogelijk wordt besteed, moet eerst bekend zijn waar dat geld precies aan wordt besteed. Dit rapport beschrijft hoe het zorggebruik in 1999 was verdeeld over ziekten, mannen en vrouwen, verschillende leeftijdsgroepen en zorgsectoren. Ook wordt beschreven hoe de kosten van de gezondheidszorg zich in de afgelopen jaren hebben ontwikkeld, en hoe zij zich in de toekomst naar verwachting zullen ontwikkelen. Daarbij wordt rekening gehouden met het geheel afwijkende patroon van zorgkosten in het laatste levensjaar. In dit rapport wordt tevens een eerste aanzet gegeven om de kosten ook te verdelen naar risicofactoren achter de ziekten. Verder wordt een vergelijking gemaakt met kosten van ziektenstudies uit andere landen. Het rapport besluit met een algemene checklist van 10 punten voor de interpretatie van kostenstudies in de gezondheidszorg.
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