Introduction Researchers, policy-makers and healthcare professionals often stress the importance of an early dementia diagnosis. Empirical evidence, however, is scarce leading to a lack of consensus on the necessity of diagnosing dementia early. We emphasise the need for a ‘timely’ diagnosis, that is, one that occurs at the right moment for a person with memory complaints and his/her significant other. As the optimal timing differs between individuals, the implementation of shared decision making (SDM), preferably by the general practitioner (GP), as the start of a diagnostic trajectory, could help to determine this timely moment. SDM, however, is rarely practised with respect to dementia diagnoses. Therefore, in the context of the Shared Decision-Making regarding Dementia Diagnosis project, a patient decision aid (PtDA) for ‘timely’ dementia diagnosis in general practice will be developed. This protocol will describe the planned before and after evaluation of its implementation. Methods and analysis In a mixed-methods pilot study, we will investigate decision-making processes and experiences regarding a diagnostic trajectory before and after the introduction of a PtDA for people with memory complaints, their significant others and their GPs. The ‘before group’ will receive diagnostics as usual from their GPs. The ‘after group’ will use the PtDA. We expect the PtDA to increase the level of SDM and to contribute to a timely and personalised diagnostic trajectory. Data will be collected using semistructured interviews, questionnaires and information retrieved from people with memory complaints’ medical records. Ethics and dissemination This study protocol was approved by the Medical Review Ethics Committee of the Maastricht University Medical Centre. The findings will be published in peer-reviewed international journals and presented at conferences. This study was funded by the public funded Dutch Research Institute for Care and Medical Sciences (ZonMw). Trial registration number NCT04531956 .
Abstract Purpose To evaluate the cost‐effectiveness of ultrathin Descemet stripping automated endothelial keratoplasty ( UT ‐ DSAEK ) versus standard DSAEK . Methods A cost‐effectiveness analysis using data from a multicentre randomized clinical trial was performed. The time horizon was 12 months postoperatively. Sixty‐four eyes of 64 patients with Fuchs’ endothelial dystrophy were included and randomized to UT ‐ DSAEK ( n = 33) or DSAEK ( n = 31). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality‐adjusted life years ( QALY s) were determined using the Health Utilities Index Mark 3 questionnaire. The main outcome was the incremental cost‐effectiveness ratio ( ICER ; incremental societal costs per QALY ). Results Societal costs were €9431 ( US $11 586) for UT ‐ DSAEK and €9110 ( US $11 192) for DSAEK . Quality‐adjusted life years ( QALY s) were 0.74 in both groups. The ICER indicated inferiority of UT ‐ DSAEK . The cost‐effectiveness probability ranged from 37% to 42%, assuming the maximum acceptable ICER ranged from €2500–€80 000 ( US $3071– US $98 280) per QALY . Additional analyses were performed omitting one UT ‐ DSAEK patient who required a regraft [ ICER €9057 ( US $11 127) per QALY , cost‐effectiveness probability: 44–62%] and correcting QALY s for an imbalance in baseline utilities [ ICER €23 827 ( US $29 271) per QALY , cost‐effectiveness probability: 36–59%]. Furthermore, the ICER was €2101 ( US $2581) per patient with clinical improvement in best spectacle‐corrected visual acuity (≥0.2 log MAR ) and €3274 ( US $4022) per patient with clinical improvement in National Eye Institute Visual Functioning Questionnaire‐25 composite score (≥10 points). Conclusion The base case analysis favoured DSAEK , since costs of UT ‐ DSAEK were higher while QALY s were comparable. However, additional analyses revealed no preference for UT ‐ DSAEK or DSAEK . Further cost‐effectiveness studies are required to reduce uncertainty.
<i>Aims:</i> The EndoCost study aims to calculate the costs of endometriosis from a societal perspective. <i>Methods:</i> This multicentre, prevalence-based cost-of-illness analysis aggregates data on endometriosis costs and quality of life from a prospective hospital questionnaire and from both retrospective and prospective patient questionnaires. The EndoCost study comprises 12 representative tertiary care centres involved in the care of women with endometriosis in 10 countries. The sample includes patients with a laparoscopic and/or histological diagnosis of endometriosis and with at least 1 patient contact related to endometriosis during 2008. The EndoCost study measures direct healthcare costs (e.g. costs of medication, physician visits), direct non-healthcare costs (e.g. transportation costs), and indirect costs of productivity loss. Cost questions are developed specifically for the purpose of the EndoCost study. Quality of life is measured using the EuroQol-5D and relevant parts of the Global Study of Women’s Health instruments. Both aggregate analyses and country-specific analyses are planned for total costs per patient. Costs are broken down into cost drivers and into the various payers that incur costs. <i>Conclusions:</i> The cost estimates provided by the EndoCost cost-of-illness analysis may be used to justify the prioritisation of future research in endometriosis.
Abstract Introduction Evidence-based cessation assistance is known to increase cessation rates. Activating personal preferences as part of the decision for smoking cessation assistance tools could further improve tools’ effectiveness. Decision aids (DAs) help individuals to choose amongst the various options by taking these preferences into account and, therefore, could have a positive effect on cessation rates. To develop attractive and effective DAs, potential end users’ needs, and experts’ viewpoints should be considered during development processes. Therefore, the aim of this study was: (1) To explore smokers’ needs and viewpoints regarding a smoking cessation assistance DA, and (2) to obtain consensus among smoking cessation counsellors and scientific experts about the content and format of such a DA. Materials and methods Data was gathered via two approaches applied across three studies: (1) 20 semi-structured interviews with potential end users, (2) two three-round Delphi studies with 61 smoking cessation counsellors and 44 scientific experts. Data from the interviews and the first round of the Delphi studies were analysed qualitatively using the Framework method, while data from the second and third round of the Delphi studies were analysed quantitatively using medians and interquartile ranges. Results Potential end users reported to acquire information in different ways: Via own experiences, their social environment, and the media. Important characteristics to decide between tools also varied, however effectiveness and costs were commonly reported as the most important characteristics. The experts reached consensus on 38 (smoking cessation counsellors) and 40 (scientific experts) statements regarding important cessation assistance tools’ characteristics and their viewpoints on a smoking cessation assistance DA, e.g., that a tool should be appropriate for users’ level of addiction. Discussion and conclusion Some clear trends emerged among the potential end users (especially regarding important characteristics). Experts also reached consensus among a number of statements. However, there was some variation in the needs and wishes among the (different) stakeholders. The combination of these studies highlights that a ‘one size fits all’ approach is not desirable. In the development of DAs, this heterogeneity should be taken into account, e.g., by enabling users to customize a DA based on their personal preferences while safeguarding essential elements. Highlights Potential end users’ needs for a smoking cessation DA vary greatly However, tools’ effectiveness and costs were commonly named as important Customizable elements within a DA could be used to deal with this heterogeneity Conceptualizations (e.g., of effectiveness) may vary between stakeholders Information should be provided to end users in an easily understandable manner
Between 2005 and 2007 a short stay programme for breast cancer surgery was successfully implemented in early adopter hospitals. The current study evaluates the sustainability of this success five years following implementation. A retrospective audit of 160 consecutive patients undergoing breast cancer surgery was performed five years following implementation of short stay. The total proportion of patients treated in short stay was 82% (hospital 1 83%, hospital 2 78%, hospital 3 87%, hospital 4 80%) after five years follow-up, which was comparable to the proportion in short stay directly after implementation (p = 0.938). Overall compliance to the key recommendations to facilitate short stay after breast cancer surgery increased from 65% directly after implementation to 78% five years after implementation. This study shows that short stay after breast cancer surgery was successfully sustained in early adopter hospitals five years following implementation.
Women who suffered from pregnancy complications are at increased risk for anxiety and depression. The aim of this study was to evaluate whether having suffered from preeclampsia (PE) or HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome is associated with anxiety and depression, and whether PE/HELLP is an independent risk factor for developing anxiety and depression. Systematic search on PubMed and PsycInfo with no time limit. Studies presenting original data, including women with a history of PE/HELLP and at least one comparison group of women without PE/HELLP, reporting the results for each group separately or in a multivariate regression analysis with PE/HELLP as an independent variable. Study characteristics and outcomes were extracted using a prespecified form. If necessary, additional calculations were performed. The search yielded 267 articles, with only six being suitable for inclusion in this review. Studies on depression (six studies) showed generally positive associations between PE/HELLP and the prevalence of depression or severity of depressive symptoms. However, the results of three studies were not statistically significant. Studies addressing anxiety (two studies) did not show significant associations between PE/HELLP and anxiety scores. Associations between post-traumatic stress and PE/HELLP, investigated in four studies, were often nonsignificant. Due to heterogeneity of study methods, a meta-analysis of the results was not possible. In most studies, confounder control was poor. Evidence is mixed but generally points to positive associations between various forms of psychopathology and previous PE/HELLP. Causality of the associations can, however, not be judged adequately.
Current frequent follow-up after treatment for breast cancer does not meet its intended aims, but does depend on expensive and scarce specialized knowledge for routine history taking and physical examinations. The study described in this paper compared patient satisfaction with a reduced follow-up strategy, i.e. nurse-led telephone follow-up, to satisfaction with traditional hospital follow-up. Patient satisfaction was assessed among patients (n = 299) who were participants of a randomized controlled trial investigating the cost-effectiveness of several follow-up strategies in the first year after treatment for breast cancer. Data on patient satisfaction were collected at baseline, three, six and 12 months after treatment, using the Dutch version of Ware's Patient Satisfaction Questionnaire III (PSQ III). In addition to general satisfaction, the PSQ III reports on satisfaction scores for technical competence, interpersonal aspects, and access of care. Regression analysis was used to predict satisfaction scores from whether or not nurse-led telephone follow-up was received. Nurse-led telephone follow-up had no statistically significant influence on general patient satisfaction (p = 0.379), satisfaction with technical competence (p = 0.249), and satisfaction with interpersonal aspects (p = 0.662). Regarding access of care, patient satisfaction scores were significantly higher for patients receiving telephone follow-up (p = 0.015). However, a mean difference at 12 months of 3.1 points was judged to be not clinically relevant. No meaningful differences were found in satisfaction scores between nurse-led telephone and hospital follow-up in the first year after breast cancer treatment. With high satisfaction scores and the potential to substantially reduce clinic visits, nurse-led telephone follow-up may be an acceptable alternative to traditional hospital follow-up. ISRCTN 74071417.
