Inter-organizational networks on the Dutch home health care market

The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age-related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors. In order to promote coordinated care, Dutch health care providers are building inter-organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter-organizational networks contribute to the balance between quality and cost.     

Economic study of neutropenia induced by myelotoxic chemotherapy

This article describes the economic and social impact of nutropenia induced by myelotoxic chemotherapy in patients with cancer during the period 1 January–31 December 1991. Neutropenia is a life-threatening complication of chemotherapy in patients with cancer. The episodes of (ever and infections originating from neutropenia require hospitalization of the patient until the granulocyte levels are restored. The calculation of the economic cost was based on the following parameters: length of stay in hospital, analytical tests performed on the patient, type and cost of drug therapy administered, blood transfusions performed, health assistance received, cost of isolation and absence from work. The overall economic cost of neutropenia in patients with cancer reached 329,775 pesetas ($2,893). Cost of the health-care staff was the largest budget item in relation to the total health resources estimated.     

甲型肝炎疫苗免疫前后发病情况分析

为比较沙县在甲型肝炎（甲肝）疫苗免疫前后甲肝的发病情况,对本站疫情定收集的1990～1997年报告的882例甲肝病例进行了分析。结果表明,疫苗免疫前甲肝发病率在63.36／10万～99.90／10万,免疫后为16.20／10万～21.87／10万,免疫前后平均发病率之比为422：1。按＜15岁、15～44岁和≥45岁分组,发病率下降最明显的是＜15岁,其次是15～44岁和≥45岁,依次下降了91.9％、70.1％和37.1％．工人、农民、学生（大、小、小学生）不同职业人群,以学生下降最明显,农民下降不明显,存在差别的原因可能是甲肝疫苗接种率的高低。甲肝疫苗接种的成本效益为1：953．     

Towards Cost-Value Analysis in Health Care?

By describing societal value judgements in health care in numerical terms one may in theory increase the precision of guidelines for priority setting and allow decision makers to judge more accurately the degree to which different health care programs provide societal value for money. However, valuing health programs in terms of QALYs disregards salient societal concerns for fairness in resource allocation. A different kind of numerical valuation of medical interventions, that incorporates concerns for fairness, is described. The usefulness to decision makers of such numerical information remains to be tested. This revised version was published online in August 2006 with corrections to the Cover Date.     

Transient decrease in sound tolerance levels following hearing deprivation in normal-hearing subjects

ObjectiveTo determine the circadian influence on sound sensitivity produced by temporal hearing deprivation in healthy normal human subjects.DesignParticipants underwent bilateral earplugging before completion of anthropometry, the author's developed questionnaire, the Hamilton Anxiety and Depression Inventory, pure tone audiometry (PTA), stapedial reflex thresholds (SRT), distortion products otoacoustic emissions input/output (DPOAE-I/O), and uncomfortable loudness levels (ULLs). Afterward, the participants were randomly divided into group A, starting at 8:00 a.m. and finishing at 8:00 p.m., and group B, starting at 4:00 p.m. and ending at 4:00 a.m. Serum cortisol levels and audiological test results were obtained at the beginning and end of the session and 24-h free urinary cortisol levels were measured.Study sampleThirty healthy volunteers.ResultsPTA was 2.68 and 3.33 dB HL in groups A and B, respectively, with no statistical difference between them. ULLs were significantly lower in group A compared to group B, with an average of 8.1 dB SPL in group A and 3.3 dB SPL in group B (p < 0.0001). A SRT shift was observed in group A, with no difference in group B, and a night shift in DPOAE-I/O in group B.ConclusionsReduced loudness tolerance is demonstrated during daytime hearing deprivation in contrast to nighttime; this may be due to increased central gain in the awake cortex.     

A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax

Background: Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric PSP. Methods: We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June 30, 1996. Results: Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 ± 1.1 years, boy–girl ratio 4:1, median body mass index 18 (normal, 20–25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14 with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000. In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a single recurrence would be $230,000. Conclusions: A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation, followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax. Received: 15 May 1998/Accepted: 15 January 1999     

儿童接种肾综合征出血热Ⅰ型灭活疫苗的成本效益和效果分析

采用建德市肾综合征出血热Ⅰ型灭活疫苗效果考核现场资料,计算５～９岁和１０～１４岁各年龄组的效益费用比（ＢＣＲ）和效果费用比（ＣＥＲ）。结果各年龄组ＢＣＲ和ＣＥＲ均小于１或大于０;５～９岁年龄组儿童接种疫苗后的ＣＥＲ和预防一个病人的费用是１０～１４岁年龄组的一倍左右。结论：可在高发区１０～１４岁儿童中开展ＨＦＲＳ疫苗预防接种。     

抗幽门螺杆菌感染的4种药物治疗方案的成本-效果分析

目的: 对幽门螺杆菌(Hp)感染的消化性溃疡4种治疗方案进行分析比较.方法: 用药物经济学成本效果分析进行评价.结果: 无论是成本效果比分析(C/E),还是增量成本效果比分析(△C/△E),均得出P1(奥美拉唑 阿莫西林 甲硝唑 果胶铋)组为最佳方案.结论: 药物经济学在优化治疗方案,指导合理用药,提高经济效益方面具有重要作用.