Economic evaluation of prevention; further evidence

This report is the third in a series of reports that aim to identify cost-effective preventive interventions that have not yet been diffused into the Dutch health care system or into a public health setting. In the first part of this report, five new interventions are presented and at the same time, renew the information on cost-effectiveness and implementation issues for six interventions that were described in less detail in our first report. For all eleven interventions, brief information on the magnitude and character of the health problem is presented, along with information on the intervention, its cost-effectiveness, and issues related to the transferability of foreign study results to the Dutch situation and possible future implementation of the intervention in the Netherlands. There is strong evidence for cost-effectiveness for (1) screening for neonatal group beta streptococcal infections, (2) fluoridation of drinking water, (3) mandatory folic acid fortification of staple foods, (4) vaccination against varicella zoster virus and (5) stop smoking interventions. Evidence on cost-effectiveness is moderate for (6) influenza vaccination of healthy working adults, (7) rotavirus vaccination of newborns, (8) universal hepatitis B vaccination, (9) pertussis vaccination of adolescents, (10) human papilomavirus vaccination of adolescents, and (11) pneumococcal vaccination of elderly persons. However, for all interventions, we conclude that the transferability of the results to the Dutch situation is poor and more research is needed to investigate cost-effectiveness in the Dutch context. With respect to implementation opportunities, it is anticipated that screening for neonatal group beta streptococcal infections, pertussis vaccination of adolescents, influenza vaccination of healthy working adults and pneumococcal vaccination of elderly persons is feasible. In the second part of this report, the cost-effectiveness was modelled for two interventions that were shown to be cost-effective in an international context and had no major barriers for implementation in the Netherlands. The two interventions were the prevention of recurrent depression by maintenance cognitive behavioural therapy (mCBT), and the prevention of chronic diseases by pharmacologic treatment of obesity. The analyses showed that mCBT is more cost-effective than usual care, which is prescription of anti-depressive medication. Compared to usual care, mCBT has a cost-effectiveness ratio of 15,000 per QALY. The cost-effectiveness of providing pharmacologic treatment (Orlistat) in combination with a diet is relatively high. Costs per QALY gained are 62,000 for Orlistat plus diet compared to diet alone. The modelling study underlines the importance of performing Dutch specific cost-effectiveness analyses and confirms the low transferability of foreign studies to the Dutch situation as was shown in the first part of the report.