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Diverse maatschappelijke ontwikkelingen roepen de vraag op of we over de juiste kennis beschikken om de (potentiele) werkende bevolking duurzaam inzetbaar te houden. In samenwerking met vertegenwoordigers uit de praktijk, beleid en wetenschap heeft het RIVM het initiatief genomen een kennisagenda op het brede domein van Arbeid en Gezondheid te ontwikkelen. Hiertoe zijn interviews gehouden en is een werkconferentie gehouden met vertegenwoordigers uit praktijk, beleid en wetenschap. Dit heeft geresulteerd in een kennisagenda met 9 thema’s: wisselwerking arbeid en gezondheid, duurzame inzetbaarheid, preventie, arbeid en zorg, technologische ontwikkelingen, flexibilisering, psychische gezondheid, (her)waardering van werk, en inclusieve arbeidsmarkt. Naast behoefte aan kennisontwikkeling is de indruk dat bestaande preventieve interventies niet bekend zijn bij professionals in de praktijk en daardoor onvoldoende benut worden. Verspreiding van bestaande kennis verdient aandacht. Van belang is dat alle stakeholders kennisontwikkeling initieren om de kennisvraagstukken op te pakken teneinde de gezondheid van werkenden te bevorderen.

Objectives In many Western societies, the state pension age is being raised to stimulate prolonged working. In the Netherlands, the raise of the state pension age is linked to the remaining life expectancy at age 65 with a factor of 2/3rd, and is expected to be 68 years in 2040. It is not yet well understood whether health of the 60+ permits this increase. In this study, health of Dutch adults aged 60 to 68 is forecasted up to 2040. Methods Data are from the Dutch Health Interview Survey (HIS) 1990-2017 (N≈280.000) and the Dutch Public Health Monitor (PHM) 2016 (N≈460.000). Health is operationalized using binomial scores of 1) self-rated health and 2) limitations in hearing, seeing or mobility. Categories are: good health (healthy on both items), moderate health (healthy on one item) and poor health (unhealthy on both items). First, based on the HIS, health status in 5-year age categories was modelled up to 2040 using logistic regression analysis in R. Second, the growth factor from 2016 to 2040 was applied to the health level from the PHM 2016. Results In 2016, 63% of men aged 60-65 had good health, 25% had moderate health and 12% had poor health. Among women, this distribution was 64%, 22% and 14%, respectively. In 2040, the health distribution among men aged 60-68 is estimated to be 63-71% in good health, 17-28% in moderate health and 9-12% in poor health. Among women this is estimated to be 64-69%, 17-24% and 12-14%, respectively. Conclusions Health of Dutch cohorts nearing the state pension age in the future is estimated to remain the same or improve up to 2040. This development in health is not an obstacle to raising the state pension age. However, due to the increasing state pension age and the baby boom generation reaching age 60+ in the coming years, the absolute number of people aged 60+ in poor and moderate health that participates in labor will increase. Policy aiming at sustainable employability will therefore become increasingly important. Key messages Health of Dutch cohorts nearing the state pension age is estimated to remain the same or improve in the future. The development in health is not an obstacle to raising the state pension age. Although health is estimated to remain the same or improve, the absolute number of people aged 60+ in poor and moderate health that participate in labor will increase due to an aging population.

Item does not contain fulltext The recent epidemic of Ebola virus disease (EVD) resulted in countries worldwide to prepare for the possibility of having an EVD patient. In this study, we estimate the costs of Ebola preparedness and response borne by the Dutch health system. An activity-based costing method was used, in which the cost of staff time spent in preparedness and response activities was calculated based on a time-recording system and interviews with key professionals at the healthcare organizations involved. In addition, the organizations provided cost information on patient days of hospitalization, laboratory tests, personal protective equipment (PPE), as well as the additional cleaning and disinfection required. The estimated total costs averaged euro12.6 million, ranging from euro6.7 to euro22.5 million. The main cost drivers were PPE expenditures and preparedness activities of personnel, especially those associated with ambulance services and hospitals. There were 13 possible cases clinically evaluated and one confirmed case admitted to hospital. The estimated total cost of EVD preparedness and response in the Netherlands was substantial. Future costs might be reduced and efficiency increased by designating one ambulance service for transportation and fewer hospitals for the assessment of possible patients with a highly infectious disease of high consequences.

Introduction In November 2018, the Ministry of Health, Welfare and Sports presented the National Prevention Agreement (NPA). Within this NPA, interventions targeting smoking, being overweight and problematic alcohol use were proposed to induce lifestyle changes. In addition to measures aimed at these three themes, there is also a range of interventions that are promising, either because they could be cost saving or cost-effective, or because they have a positive impact on burden of disease. We explored which preventive interventions are promising in the Dutch context and systematically quantified costs, savings and health effects. Methods In a literature search via the website kosteneffectviteitvanpreventie.nl we selected interventions that: a) have not yet been introduced in the Netherlands; and b) were promising with respect to effectiveness and cost-effectiveness. All interventions, including health protection and environmental measures, were eligible. We estimated the number of people who are eligible and compliant, costs and possible savings related to the interventions and health effects in terms of DALYs avoided. Interventions were ranked with regard to possible savings and DALYs avoided. Results Our exploration shows a number of preventive interventions that are cost saving or cost-effective. These interventions are aimed at anxiety and depression, heart disease, skin cancer, fractures, air quality and road safety. Examples of cost-saving or cost-effective interventions are a food tax on food and drinks with high fat/sugar content, screening an aneurysm of the aorta and fully subsidized sound insulation of homes. Conclusions Our study shows that there are much more preventive opportunities than those presented in the NPA. The substantiation of the interventions is often based on foreign research and findings therefore cannot be simply translated to the Netherlands. However, the interventions identified in this study are promising and deserve further consideration. Key messages Health gain by environmental measures. Many interventions are not systematically implemented.

Background In the Netherlands, toxoplasmosis ranks third in disease burden among foodborne pathogens, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. We performed a Social Cost-Benefit Analysis (SCBA) to evaluate the net value of two potential interventions, freezing meat and improving biosecurity in pig farms, for the Dutch society. Methods We assessed the costs and benefits of the two interventions and compared them with the current practice of education, especially during pregnancy. A ‘minimum scenario’ and a ‘maximum scenario’ was assumed, using input parameters with least benefits to society and input parameters with most benefits to society, respectively. Results The freezing meat intervention was far more effective than the biosecurity intervention. Despite high freezing costs, freezing two meat products: steak tartare and mutton leg yielded net social benefits in both the minimum and maximum scenario, ranging from €10.6 million to €31 million for steak tartare and €0.6 million to €1.5 million for mutton leg. The biosecurity intervention would result in net costs in all scenarios ranging from €1 million to €2.5 millions. Conclusions From a public health perspective (i.e. reducing the burden of toxoplasmosis) freezing steak tartare and leg of mutton is to be considered.

Introduction In 2015, Dutch healthcare expenditure exceeded 85 billion euros. But what about prevention? In this study we estimated national expenditure on prevention. A distinction was made between health protection, health promotion and disease prevention. In the estimation of prevention expenditures, this study is limited to universal, selective and indicated prevention, as healthcare-related prevention can hardly be distinguished from curative care. This study analyzed expenditure on preventive activities in the Netherlands in 2015 and took a societal perspective. Methods We used various sources to investigate spending on prevention in 2015. Insofar as costs were part of healthcare expenditure, estimates were based on the Care Accounts of Statistics Netherlands. For the remainder, we estimated expenditure using annual reports and annual accounts of governments and other organizations. We included preventive activities by consumers, industry, NGOs, insurance companies, and government. Results In 2015, an estimated € 12.4 billion (1.8% of the GDP) was spent on prevention: € 2.4 billion on disease prevention (19%), € 0.6 billion on health promotion (5%) and € 9.4 billion on health protection (76%). This is a decrease of 17% compared to 2007, the last year that a similar estimate was made. Within health promotion, the largest expenditure was for working conditions and safety: € 160 million. € 67 million was spent on mental disorders. The largest expenditure item within disease prevention was dental care: € 675 million. Within health protection, this was the sewer by more than € 3 billion. Conclusions Spending on prevention is relatively low compared to total spending on healthcare. The largest part is targeted at health protection. In the coming years there may be an increase in expenditure, due to more governmental prevention policies such as the National Prevention Agreement. Key messages Spending on prevention is relatively low compared to total spending on healthcare. Relatively little money for health protection.

Item does not contain fulltext BACKGROUND: In The Netherlands, 1168 Q-fever patients were notified in 2007 and 2008. Patients and general practitioners (GPs) regularly reported persisting symptoms after acute Q-fever, especially fatigue and long periods of sick leave, to the public health authorities. International studies on smaller Q-fever outbreaks demonstrate that symptoms may persist years after acute illness. Data for the Dutch outbreaks were unavailable. The aim of this study is to quantify sick leave after acute Q-fever and long-term symptoms. METHODS: Our study targeted 898 acute Q-fever patients, notified in 2007 and 2008 residing in the Province Noord-Brabant. Patients from the 2008 cohort were mailed a questionnaire at 12 months and those of the 2007 cohort at 12-26 months after onset of illness. Patients reported underlying illness, Q-fever-related symptoms and sick leave. RESULTS: The response rate was 64%. Forty percent of the working patients reported long-term (>1 month) sick leave. Pre-existent heart disease odds ratio (OR) 4.50; confidence interval (CI) 1.27-16.09), hospitalization in the acute phase (OR 3.99; 95% CI 2.15-7.43) and smoking (OR 1.69; 95% CI 1.01-2.84) were significant predictors for long-term absence. Of the patients who resumed work, 9% were-at the time of completing the questionnaire-still unable to function at pre-infection levels due to fatigue or concentration problems. Of the respondents, 40% reported persisting physical symptoms at the time of follow-up. Fatigue (20%) was most frequently reported. Daily activities were affected in 30% of cases. CONCLUSIONS: Q-fever poses a serious persisting long-term burden on patients and society.

A shortcoming of many economic evaluations is that they do not include all medical costs in life-years gained (also termed indirect medical costs). One of the reasons for this is the practical difficulties in the estimation of these costs. While some methods have been proposed to estimate indirect medical costs in a standardized manner, these methods fail to take into account that not all costs in life-years gained can be estimated in such a way. Costs in life-years gained caused by diseases related to the intervention are difficult to estimate in a standardized manner and should always be explicitly modelled. However, costs of all other (unrelated) diseases in life-years gained can be estimated in such a way. We propose a conceptual model of how to estimate costs of unrelated diseases in life-years gained in a standardized manner. Furthermore, we describe how we estimated the parameters of this conceptual model using various data sources and studies conducted in the Netherlands. Results of the estimates are embedded in a software package called 'Practical Application to Include future Disease costs' (PAID 1.0). PAID 1.0 is available as a Microsoft® Excel tool (available as Supplemental Digital Content via a link in this article) and enables researchers to 'switch off' those disease categories that were already included in their own analysis and to estimate future healthcare costs of all other diseases for incorporation in their economic evaluations. We assumed that total healthcare expenditure can be explained by age, sex and time to death, while the relationship between costs and these three variables differs per disease. To estimate values for age- and sex-specific per capita health expenditure per disease and healthcare provider stratified by time to death we used Dutch cost-of-illness (COI) data for the year 2005 as a backbone. The COI data consisted of age- and sex-specific per capita health expenditure uniquely attributed to 107 disease categories and eight healthcare provider categories. Since the Dutch COI figures do not distinguish between costs of those who die at a certain age (decedents) and those who survive that age (survivors), we decomposed average per capita expenditure into parts that are attributable to decedents and survivors, respectively, using other data sources.

BackgroundChronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective.MethodsThe cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed.ResultsFor most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from (sic)4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to (sic)9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of >= 0.41% and >= 0.22%, with ICERs below the Dutch cost-effectiveness reference value of (sic)20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections.ConclusionsFor most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants.

Aim The cost-effectiveness of passive immunisation against respiratory syncytial virus (RSV) in the Netherlands was studied by assessing incremental costs to prevent one hospitalisation in high-risk children using a novel individualised monthly approach. Methods Cost-effectiveness analysis was performed by combining estimates of individual hospitalisation costs and monthly hospitalisation risks, with immunisation costs, parental costs and efficacy of passive immunisation for a reference case with the highest hospitalisation risks and costs of hospitalisation during the RSV season (male, gestational age ≤28 weeks, birth weight ≤2500 g, having bronchopulmonary dysplasia (BPD), aged 0 months at the beginning of the season (October)). Various sensitivity analyses and a cost-neutrality analysis were performed. Results Cost-effectiveness of passive immunisation varied widely by child characteristics and seasonal month. For the reference case it was most cost effective in December at €13 190 per hospitalisation averted. Cost-effectiveness was most sensitive to changes in hospitalisation risk. For the reference case, cost neutrality was reached in December, if acquisition costs of passive immunisation decreased from €930 to €375, monthly hospitalisation risk increased from 7.6% to 17%, or hospitalisation costs increased from €10 250 to €23 250 per hospitalisation. Even if passive immunisation prevented all hospitalisations, costs per hospitalisation averted in December would still exceed €2645. Conclusions Although cost-effectiveness of passive immunisation varied strongly by child characteristics and seasonal month, incremental costs per hospitalisation averted were always high. A restrictive immunisation policy only immunising children with BPD in high-risk months is therefore recommended. The costs of passive immunisation would have to be considerably reduced to achieve cost-effectiveness.

Objectives To assess international comparability of general cost of illness (COI) studies and to examine the extent to which COI estimates differ and why. Methods Five general COI studies were examined. COI estimates were classified by health provider using the system of health accounts (SHA). Provider groups fully included in all studies and matching SHA estimates were selected to create a common data set. In order to explain cost differences descriptive analyses were carried out on a number of determinants. Results In general similar COI patterns emerged for these countries, despite their health care system differences. In addition to these similarities, certain significant disease-specific differences were found. Comparisons of nursing and residential care expenditure by disease showed major variation. Epidemiological explanations of differences were hardly found, whereas demographic differences were influential. Significant treatment variation appeared from hospital data. Conclusions A systematic analysis of COI data from different countries may assist in comparing health expenditure internationally. All cost data dimensions shed greater light on the effects of health care system differences within various aspects of health care. Still, the study's objectives can only be reached by a further improvement of the SHA, by international use of the SHA in COI studies and by a standardized methodology.

Achtergrond: De invloed van leefstijl op zorguitgaven speelt een belangrijke rol in het debat rondom preventie. Doel van het onderzoek was te onderzoeken welk deel van de zorguitgaven in 2003 kan worden toegewezen aan roken en overgewicht, wat de invloed is van roken en overgewicht op toekomstige zorguitgaven en wat de invloed is van trends in roken en overgewicht op ontwikkelingen in zorguitgaven, in vergelijking met de invloed van demografische ontwikkelingen. Methode: Met behulp van het RIVM Chronische Ziekten Model (CZM) en data van de Kosten van Ziekten 2003 studie is geschat welk deel van de zorgkosten in 2003 toewijsbaar was aan roken en overgewicht. Vervolgens is geschat hoe de zorguitgaven zich zouden ontwikkelen als roken en overgewicht hypothetisch worden uitgebannen. Ten slotte is de invloed van trends in roken en overgewicht op zorguitgaven afgezet tegen de invloed van demografische ontwikkelingen op zorguitgaven. Resultaten: In 2003 was 3,7% van de zorguitgaven toewijsbaar aan roken en 2,0% aan overgewicht. Echter, uitbanning van roken en overgewicht zou leiden tot stijging van de zorguitgaven op lange termijn vanwege een stijging in de levensverwachting. Demografische ontwikkelingen verhogen de jaarlijkse groei van de zorguitgaven met ongeveer 1%. Trends in roken en overgewicht verhogen deze jaarlijkse groei van de zorguitgaven met maximaal 0,06%. Conclusie: Gezond gedrag is een belangrijke determinant van de volksgezondheid, voor de zorguitgaven is de betekenis echter gering.

Background Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention. Methods and Findings With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and “healthy-living” persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions. Conclusions Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures., Using a simulation model, Pieter van Baal and colleagues conclude that obesity prevention leads to a decrease in costs of obesity-related diseases, but this is offset by cost increases due to diseases unrelated to obesity in life-years gained., Editors' Summary Background. Since the mid 1970s, the proportion of people who are obese (people who have an unhealthy amount of body fat) has increased sharply in many countries. One-third of all US adults, for example, are now classified as obese, and recent forecasts suggest that by 2025 half of US adults will be obese. A person is overweight if their body mass index (BMI, calculated by dividing their weight in kilograms by their height in meters squared) is between 25 and 30, and obese if BMI is greater than 30. Compared to people with a healthy weight (a BMI between 18.5 and 25), overweight and obese individuals have an increased risk of developing many diseases, such as diabetes, coronary heart disease and stroke, and tend to die younger. People become unhealthily fat by consuming food and drink that contains more energy than they need for their daily activities. In these circumstances, the body converts the excess energy into fat for use at a later date. Obesity can be prevented, therefore, by having a healthy diet and exercising regularly. Why Was This Study Done? Because obesity causes so much illness and premature death, many governments have public-health policies that aim to prevent obesity. Clearly, the improvement in health associated with the prevention of obesity is a worthwhile goal in itself but the prevention of obesity might also reduce national spending on medical care. It would do this, the argument goes, by reducing the amount of money spent on treating the diseases for which obesity is a risk factor. However, some experts have suggested that these short-term savings might be offset by spending on treating the diseases that would occur during the extra lifespan experienced by non-obese individuals. In this study, therefore, the researchers have used a computer model to calculate yearly and lifetime medical costs associated with obesity in The Netherlands. What Did the Researchers Do and Find? The researchers used their model to estimate the number of surviving individuals and the occurrence of various diseases for three hypothetical groups of men and women, examining data from the age of 20 until the time when the model predicted that everyone had died. The “obese” group consisted of never-smoking people with a BMI of more than 30; the “healthy-living” group consisted of never-smoking people with a healthy weight; the “smoking” group consisted of lifetime smokers with a healthy weight. Data from the Netherlands on the costs of illness were fed into the model to calculate the yearly and lifetime health-care costs of all three groups. The model predicted that until the age of 56, yearly health costs were highest for obese people and lowest for healthy-living people. At older ages, the highest yearly costs were incurred by the smoking group. However, because of differences in life expectancy (life expectancy at age 20 was 5 years less for the obese group, and 8 years less for the smoking group, compared to the healthy-living group), total lifetime health spending was greatest for the healthy-living people, lowest for the smokers, and intermediate for the obese people. What Do These Findings Mean? As with all mathematical models such as this, the accuracy of these findings depend on how well the model reflects real life and the data fed into it. In this case, the model does not take into account varying degrees of obesity, which are likely to affect lifetime health-care costs, nor indirect costs of obesity such as reduced productivity. Nevertheless, these findings suggest that although effective obesity prevention reduces the costs of obesity-related diseases, this reduction is offset by the increased costs of diseases unrelated to obesity that occur during the extra years of life gained by slimming down. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/doi:10.1371/journal.pmed.0050029. The MedlinePlus encyclopedia has a page on obesity (in English and Spanish) The US Centers for Disease Control and Prevention provides information on all aspects of obesity (in English and Spanish) The UK National Health Service's health Web site (NHS Direct) provides information about obesity The International Obesity Taskforce provides information about preventing obesity The UK Foods Standards Agency, the United States Department of Agriculture, and Shaping America's Health all provide useful advice about healthy eating The Netherlands National Institute for Public Health and the Environment (RIVM) Web site provides more information on the cost of illness and illness prevention in the Netherlands (in English and Dutch)

Stelt u zich eens voor: Een prachtig dorpje in een verder groene vallei. Het is ochtend. Er hangt nog een laatste restje nevel over de groene velden rondom het dorpje, dat nu snel zal verdwijnen dankzij de opkomende zon. Het enige geluid dat u hoort terwijl u het dorpje nadert over het zandpaadje waarlangs allerhande bloemen de nieuwe dag begroeten met hun kleurenpracht, is het geluid van het ruisen van de zachte wind vermengd met het gezang van de vele vogels die deze vallei herbergt. Als u het dorpje binnenloopt, en over de soms steile straatjes omhoog wandelt in de richting van de toren van het eeuwenoude kerkje, dat op het met bomen omgeven pleintje in het midden van het dorpje staat, komt u plotseling de geur van vers gebakken brood tegemoet.

Dit is de tweede in een serie van tien bijdragen waarin verschillende gezondheidseconomische concepten en aspecten worden belicht. Deze bijdrage stelt een aantal aspecten van de zorgverzekering centraal (noot a).

Health expenditure depends heavily on age. Common wisdom is that the age pattern is dominated by costs in the last year of life. Knowledge about these costs is important for the debate on the future development of health expenditure. According to the 'red herring' argument traditional projection methods overestimate the influence of ageing because improvements in life expectancy will postpone rather than raise health expenditure. This paper has four objectives: (1) to estimate health care costs in the last year of life in the Netherlands; (2) to describe age patterns and differences between causes of death for men and women; (3) to compare cost profiles of decedents and survivors; and (4) to use these figures in projections of future health expenditure. We used health insurance data of 2.1 million persons (13% of the Dutch population), linked at the individual level with data on the use of home care and nursing homes and causes of death in 1999. On average, health care costs amounted to 1100 Euro per person. Costs per decedent were 13.5 times higher and approximated 14,906 Euro in the last year of life. Most costs related to hospital care (54%) and nursing home care (19%). Among the major causes of death, costs were highest for cancer (19,000 Euro) and lowest for myocardial infarctions (8068 Euro). Between the other causes of death, however, cost differences were rather limited. On average costs for the younger decedents were higher than for people who died at higher ages. Ten per cent of total health expenditure was associated with the health care use of people in their last year of life. Increasing longevity will result in higher costs because people live longer. The decline of costs in the last year of life with increasing age will have a moderate lowering effect. Our projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods.

Reliable estimates of hospitalization costs for severe respiratory syncytial virus (RSV) infection are necessary to perform economic analyses of preventive strategies of severe RSV disease. We aimed to develop a model that predicts anticipated mean RSV hospitalization costs of groups of young children at risk for hospitalization, but not yet hospitalized, based on readily available child characteristics.We determined real direct medical costs of RSV hospitalization from a societal perspective, using a bottom-up strategy, in 3458 infants and young children hospitalized for severe RSV disease during the RSV seasons 1996-1997 to 1999-2000 in the Southwest of the Netherlands. We used a linear regression model to predict anticipated mean RSV hospitalization costs of groups of children at risk, based on 4 child characteristics [age, gestational age, birth weight and bronchopulmonary dysplasia (BPD)], expressed in EC Euros as of the year 2000.The mean RSV hospitalization costs of all patients were 3110 Euros. RSV hospitalization costs were higher for patients with lower gestational age (5555 Euros; gestational age,/=28 weeks), lower birth weight (3895 Euros; birth weight/=2500 g), BPD (5785 Euros; with BPD) and young age (4730 Euros; first month of life). The linear regression model had an adjusted R of 0.08. This indicates a low explanatory ability for hospitalization costs of individual children. However, the model could accurately estimate the anticipated mean hospitalization costs of groups of children with the same characteristics.RSV hospitalization costs were substantial, especially of specific high risk groups. Anticipated mean hospitalization costs of groups of children at risk for RSV hospitalization, but not yet hospitalized, could well be estimated with 4 child characteristics (age, gestational age, birth weight and BPD). These estimated costs can be used for economic analyses of preventive strategies for severe RSV disease.

Contains fulltext : 142607.pdf (Publisher’s version ) (Closed access) - Background: The study describes variations in use of surgical procedures by community income in the Netherlands. From the literature it is known that surgical rates have a socioeconomic gradient. Both positive and negative associations of socioeconomic factors of patients (for example, income, education) with surgical rates have been reported. The question raised here is: how do (possible) socioeconomic variations in surgery in the Netherlands compare with variations observed elsewhere? - Data and Methods: The data comprised Dutch hospital discharges and population estimates for 1999. Socioeconomic status was indicated by a patient’s income and based on the average family income of the postcode area of residence. Poisson regression was used to compute relative incidence (odds ratios) for 10 common surgical procedures. The model included age, gender, degree of urbanisation, and province of residence. - Results: The association between surgical rates and community level income is rather weak. For half of the surgical rates the authors observed higher utilisation rates in communities with low income levels, but the differences are small. The range of odds ratios in the lowest income quintile group (compared with the group with the highest income) observed is: 0.87 to 1.18. Men from a low income community received more appendicectomies (1.18), cholecystectomies (1.12), knee replacements (1.06), and prostatectomies (1.14) and less tonsillectomies (0.90). Women from a low income community received more appendicectomies (1.12), caesarean sections (1.18), hip and knee replacements (1.05,1.17), and hysterectomies (1.14). Whereas they received less coronary artery bypass grafts (0.92), cholecystectomies (0.87), and tonsillectomies (0.92). - Conclusions: Compared with findings reported in the international literature, this study indicates that variations in use of surgical procedures by community income in the Netherlands are comparatively small. Because of lack of data the authors could not study the influence of variations in need for surgical care by community income, but as the incidence of conditions requiring surgical interventions generally is higher in lower income groups, it is suspected some degree of underutilisation exists in these groups.

Background: The escalating costs of health care raise questions about demographic, epidemiological and technological determinants and future projections. The objectives of this work are to describe the age pattern of health care costs, to analyse the age‐specific cost changes and to project future health care costs in an ageing population. Methods: Comprehensive cost‐of‐illness data for the whole Dutch population in 1988 and 1994 are compared by age and type of care. National data on all hospital admissions, nursing days and clinical interventions for the period 1988–1994 is used to describe trends in hospital care. Population forecasts are used to project the age distribution of future health care costs. Results: The distribution of health care costs per capita depends strongly on age. The growth rate of per capita costs increases by age for acute care but decreases by age for long‐term care. Both combined cause an average annual growth rate of 4.6%, nearly constant with age. Conclusions: Ageing will result in increasing health care demands and costs. Secular trends in acute and long‐term care indicate major shifts in costs from younger to older people and from long‐term to acute care. Received 9 June 2000. Accepted 16 February 2001.

De recessie is een feit. Knarsend en piepend is de economie tot stilstand gekomen. [1] “Zo’n crisis maak je maar een keer mee. En wil je ook maar een keer meemaken,” aldus een dramatische Coen Teulings, directeur van het Centraal Plan Bureau eind vorig jaar bij de presentatie van de decemberraming. Het CPB voorziet zwaar weer en verwacht dat de Nederlandse economie in 2009 fors zal krimpen. [2] Volgens Ruding en Wellink, economen van naam en faam, zijn de voorspellingen van het CPB echter nog te rooskleurig. Zij verwachten een veel sterkere teruggang die grote repercussies zal hebben. [3] Anderzijds zijn er ook opinieleiders die veel minder somber tegen de economische malaise aankijken. Zoals Erica Verdegaal. “Wolvengehuil”, schreef ze boven haar column in het NRC Handelsblad. “Een crisis is geen Titanic, die hele werelddelen naar de ondergang vaart. Het is meer een griepepidemie. Zodra het heerst, voelt half Nederland zich plotseling niet helemaal lekker. Hooguit een kwart blijft, al dan niet noodzakelijk, een poosje thuis. Een beperkte club pechvogels tot slot meestal met te hoge of te dure (hypotheek)schuldenzal helaas aan het crisisvirus bezwijken.” [4]

Wie een willekeurig dagblad openslaat ziet daar een stroom van onderwerpen voorbij trekken die vaak onder het kopje ‘economie’ worden gebracht en meestal gaan over geld: “Goede sier maken met de huizen van anderen.” “Rabobank wint aandeel hypotheekmarkt terug.” “Loonstijging blijft achter bij eis vakbond.” “USG profiteert van economische groei.”1 Zelfs het Journaal heeft een vaste rubriek economisch nieuws waarin meestal vooral de actuele standen van de beurzen worden genoemd.

Tot 11 december 2006 behoorde ik tot de kleine groep gelukkigen die niets van voetbal weten en ik dacht dat nog lang vol te houden. Niet dus. Een uitnodiging van de Nationale DenkTank bracht mij in het ING House te Amsterdam. Dit opmerkelijke gebouw aan de A10 is onmiskenbaar geschoeid op de leest van koning voetbal (zie www.inghouse.com). Het was echter niet het gebouw dat mij inwijdde in de wondere wereld van Johan Cruijff. De DenkTank zelf zette mij aan het denken. Als “Recept voor Morgen” presenteerde zij een menu met tien ingredienten voor “Een frisse blik op betere zorg voor chronisch zieken”.1 Het eerste advies zal de supporters van preventie voor altijd aan de groene mat binden: “Introduceer het Health Transfer Systeem”. Op pagina 31 van het rapport lezen we: “Het Health Transfer Systeem creeert gezonde financiele prikkels. Het stimuleert investeringen van zorgverzekeraars op het gebied van preventie, die complementair zijn aan het overheidsbeleid. Het principe is geinspireerd op het transfersysteem in de voetbalwereld. De voetbaltransfersom is het bedrag dat de nieuwe club betaalt aan de oude club, wanneer een niet-transfervrije voetballer van club wisselt.”

Topdrukte werd er verwacht, een jaar of drie geleden, op de Oudlaan in Utrecht waar het hoofdkantoor van Actiz is gevestigd. Lange files met durfkapitalisten, banken, private equity financiers en alle anderen die wat meer rendement uit hun euro’s willen halen dan de schamele percentages die de banken bieden.

Objectives : To determine the demands on healthcare resources caused by different types of illnesses and variation with age and sex. Design: Information on healthcare use was obtained from all 22 healthcare sectors in the Netherlands. Most important sectors (hospitals, nursing homes, inpatient psychiatric care, institutions for mentally disabled people) have national registries. Total expenditures for each sector were subdivided into 21 age groups, sex, and 34 diagnostic groups. Setting: Netherlands, 1994. Main outcome measures: Proportion of healthcare budget spent on each category of disease and cost of health care per person at various ages. Results: After the first year of life, costs per person for children were lowest. Costs rose slowly throughout adult life and increased exponentially from age 50 onwards till the oldest age group (95). The top five areas of healthcare costs were mental retardation, musculoskeletal disease (predominantly joint disease and dorsopathy), dementia, a heterogeneous group of other mental disorders, and ill defined conditions. Stroke, all cancers combined, and coronary heart disease ranked 7, 8, and 10, respectively. Conclusions: The main determinants of healthcare use in the Netherlands are old age and disabling conditions, particularly mental disability. A large share of the healthcare budget is spent on long term nursing care, and this cost will inevitably increase further in an ageing population. Non-specific cost containment measures may endanger the quality of care for old and mentally disabled people. Key messages Little is known about demands for health care outside acute sectors In the Netherlands health costs are strongly age dependent, increasing exponentially after age 50 The five highest healthcare costs are for mental retardation, musculoskeletal disease, dementia, other mental disorders, and ill defined conditions Coronary heart disease, all cancers, and stroke accounted for only 9% of costs The main healthcare costs are for care not cure and costs are likely to increase rapidly in an ageing society

Objective: Evaluation of the costs, effects and savings of three strategies for female fragile X premutation and full mutation carrier screening in the general population. Methods: We calculated the costs, effects and savings by using a general model for prenatal, preconceptional, and school carrier screening. Assumptions were based on literature data, expert opinions, prices and tariffs. Results: Prenatal screening will detect most carriers and will lead to the highest number of avoided fragile X syndrome patients. The costs per detected carrier are quite similar for all screening programmes (around USD 45,000). All screening strategies have a favourable cost-savings balance (USD 14 million for prenatal screening, USD 9 million for preconceptional screening and USD 2 million for school screening). Conclusions: From an economic point of view, there is no obstacle to fragile X screening. The decision to screen or not can (and should) therefore concentrate on discussion of medical, social, psychological and ethical considerations.

We study long-term care demand in the Netherlands for a sample of elderly Dutch households using detailed administrative data. Long-term care in the Netherlands is provided by a public health care system that is generous in comparison to that in many other countries, but offers few possibilities for differentiation. Moving to a nursing home is generally postponed as long as possible because of the loss of privacy involved, while use of care at home increases. We test three hypotheses: i) wealthier people are better able to postpone a move to a nursing home, ii) those who own the house in which they live stay there longer when health deteriorates, and iii) those living in a house that is especially suitable for elderly are better able to postpone a move to nursing home. Results of our analyses confirm hypothesis i) but reject or do not find substantial evidence to confirm ii) and iii).

Objective This article presents methods for using administrative data to study multimorbidity in hospitalized individuals and indicates how the findings can be used to gain a deeper understanding of hospital multimorbidity. Study Design and Setting A Dutch nationwide hospital register ( n =4,521,856) was used to calculate age- and sex-standardized observed/expected ratios of disease-pairing prevalences with corresponding confidence intervals. Results The strongest association was found for the combination between alcoholic liver and mental disorders due to alcohol abuse (observed/expected=39.2). Septicemia was found to cluster most frequently with other diseases. The consistency of the ratios over time depended on the number of observed cases. Furthermore, the ratios also depend on the length of the time frame considered. Conclusion Using observed/expected ratios calculated from the administrative data set, we were able to (1) better quantify known morbidity pairings while also revealing hitherto unnoticed associations, (2) find out which pairings cluster most strongly, and (3) gain insight into which diseases cluster frequently with other diseases. Caveats with this method are finding spurious associations on the basis of too few observed cases and the dependency of the ratio magnitude on the length of the time frame observed.

In this paper, we investigate the relationship between baseline health and costs of hospital use over a period of eight years. We combine cross-sectional survey data with information from the Dutch national hospital register. Four different indicators of health (self-perceived health, long-term impairments, ADL limitations and comorbidity) are considered. We find that for ages 50 to 70, differences in hospital costs between good health and bad health are substantial and persist during the whole time period. However, for higher ages expected hospital costs for individuals in bad health decline rapidly and become lower than those for people in good health after about six to seven years. The higher mortality rate among people in bad health is the primary cause here. Our results are confirmed for all four health indicators. We conclude that relying on better health to contain healthcare expenditures is too optimistic, and the interaction between health and mortality should be taken into account when projecting healthcare costs. Healthy ageing is important, but more for health gains than for cost savings.

It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998-1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by 4040 euro in women, and by 4100 euro in men. Of these, 660 euro in women, and 890 euro in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately 4000 euro. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications.

To assess international comparability of general cost of illness (COI) studies and to examine the extent to which COI estimates differ and why.Five general COI studies were examined. COI estimates were classified by health provider using the system of health accounts (SHA). Provider groups fully included in all studies and matching SHA estimates were selected to create a common data set. In order to explain cost differences descriptive analyses were carried out on a number of determinants.In general similar COI patterns emerged for these countries, despite their health care system differences. In addition to these similarities, certain significant disease-specific differences were found. Comparisons of nursing and residential care expenditure by disease showed major variation. Epidemiological explanations of differences were hardly found, whereas demographic differences were influential. Significant treatment variation appeared from hospital data.A systematic analysis of COI data from different countries may assist in comparing health expenditure internationally. All cost data dimensions shed greater light on the effects of health care system differences within various aspects of health care. Still, the study's objectives can only be reached by a further improvement of the SHA, by international use of the SHA in COI studies and by a standardized methodology.

towards the end of the first part of Shakespeare's Henry VI, one might ask: 'For what is wedlock forced but a hell, an age of discord and continual strife?' Isn't it for the better if economics and public health break up and forget about each other? We argue it is not. The application of economic principles in the field of public health may be complex, but the attraction between the two is too obvious to ignore and the potential bene- fits of going hand in hand are too great to squander. Wealth is health, and health is wealth. The marriage may be the opposite of forced and the Earl of Suffolk indeed continues: 'Whereas the contrarybringeth bliss, and is a pattern of celestial peace'. We will highlight the potential bliss of cooperation between economics and public health in the following three areas: (i) the optimal mix between pre- vention and care; (ii) the value of health (gains); and (iii) economic incentives to promote public health. These examples willalso showthat theweddingceremony has already started.

De Betuwelijn, de Hogesnelheidslijn-Zuid, de aanleg van de Tweede Maasvlakte, het zijn zomaar een paar voorbeelden van grote infrastructurele projecten waartoe besloten is na een uitgebreide afweging van de kosten en de opbrengsten. Dit vanuit een perspectief van de maatschappij als geheel.

Objective: To assess the screening performance of a specific language-screening instrument at 18 and 24 months of age and to assess its effect on the early detection and prognosis of language delay. Design: Child health care physicians were randomised to the intervention group, in which specific language screening was conducted twice (at age 18 months and 24 months), or to the control group (usual care). The specific screening instrument consisted of a uniform set of questions for the parents and test elements for the child, with scaled scores to assess responses. Setting: Child health care in the Netherlands and referral of screen-positive children. Subjects: 5734 children in the intervention group and 4621 in the control group. Main outcome measures: Test characteristics and disorders at 24 months, and confirmed diagnoses of a language disorder before 36 months in both groups. Gold standard based on reports of parents, specialists and expert panel. Prognosis estimated from two diagnostic language development performance scores at 36 months (in questionnaire). Results: In the intervention group, 3147 of the 5734 children (55%) were screened with the specific screening instrument and 73 of the screened children (2.3%) were screen-positive. Of the screen-positive children, 41 (55%) had confirmed language delay (diagnostic assessment and/or reported treatment). The estimated sensitivity of the test ranged between 24–52% depending on the severity of language disorders. The prevalence of language disorders in three-year olds was estimated to be 2.4–5.3%. In the intervention group, 1.25–2 times more children with language delay had been diagnosed before 36 months. The assessment of language development at 36 months showed no statistically significant differences between the intervention and the control groups. Conclusions: The inclusion of a specific language-screening instrument in child health centre activities resulted in the earlier detection of children with language delay. Short-term health benefits could not be demonstrated. Large-scale introduction cannot be recommended on the basis of this information alone.

It is widely assumed that health care costs can be reduced considerably by providing care in appropriate health care institutions without unnecessary technological overhead. This assumption has been tested in a prospective study. Conventional discharge after hip fracture surgery was compared with an early discharge policy in which patients were discharged to a nursing home with specialised facilities for rehabilitation. We compared costs for both strategies from a societal perspective, using comprehensive and detailed data on type of residence and all kinds of medical consumption during a 4-month follow-up period. As expected, early discharge reduced the hospital stay (with 13 days, p=0.001). More patients were discharged to a nursing home (76% versus 53%). Total medical costs during follow-up were reduced from an average of €15 338 to €14 281, representing relatively small and not significant savings (p=0.3). There are two explanations for this unexpected result. First, costs incurred by hip fracture patients were relatively less while in hospital. Hence, nursing home costs almost equalled hospital costs per admission day. Second, compared with the conventionally discharged group early discharged patients were subjected to more medical procedures during the first post-operative days. We conclude that: (1) early discharge shifted rather than reduced costs; (2) the details of costing have a major influence on the cost-effectiveness of alternative discharge policies. Copyright © 2002 John Wiley & Sons, Ltd.

Healthcare costs are continuously increasing, and impose a strong responsibility on governments for an adequate allocation of resources among healthcare provisions and patients. The aims of the present study were to describe the healthcare costs of intellectual disability (ID) and other mental disorders in the context of the total costs of all other diseases, and to determinate the future need of healthcare resources, especially for ID and mental disorders. The present authors performed a top-down cost-of-illness study comprising all healthcare costs of the Netherlands in 1994. Data on healthcare use were obtained for all 22 healthcare sectors, and used to ascribe costs to disease groups, age and sex. Costs of mental disorders are by far the largest in the Dutch healthcare system. Some 25.8% of total disease-specific costs could be ascribed to mental disorders: psychiatric conditions, 10.6%; ID, 9.0%; and dementia, 6.2%. There are large differences between age and sex groups. The costs of ID and schizophrenia are higher among men, and the costs of dementia and depression are higher among women. The age pattern shows two peaks: the first occurs at 25-35 years of age (ID and psychiatric conditions); and the second at 75-85 years of age (dementia). Time trends between 1988 and 1994 show an average annual growth rate of 5.2% for total healthcare costs: psychiatric conditions, 4.8%; ID, 5.4%; and dementia, 9.4%. Demographic projections suggest a less-than-average cost increase for ID and psychiatric disorders (with annual growth rates of 0.2% and 0.4%, respectively) compared to the costs of dementia and total healthcare (with annual growth rates of 1.6% and 0.9%, respectively). Intellectual disability and mental disorders represent a large part of healthcare use in the Netherlands. The costs will inevitably increase because of the ageing of the population and increasing life expectancy among people with disabilities. Non-specific cost containment measures may endanger the quality of care for vulnerable people at younger and older ages.

Met de volksgezondheid in Nederland gaat het redelijk goed. Maar dat is geen pleidooi om in het volksgezondheidbeleid gas terug te nemen. Integendeel. Nederland kan en moet blijven investeren in de volksgezondheid. Omdat gezondheid een groot goed is, maar ook omdat een vergrijzende economie gezonde burgers broodnodig heeft.

ObjectiveFragile X syndrome is the most common cause of mental retardation from a single gene defect, transmitted in an X-linked semidominant fashion. Cloning of the gene responsible for fragile X syndrome has made it possible to identify carriers who are at risk of giving birth to a child with fragile X syndrome. One of the proposed strategies for identifying carriers is cascade testing, in which relatives of a patient with fragile X syndrome (the index case) are tested. Because the effectiveness of this type of testing is unknown, the objective of this study was to develop a simulation model for studying the consequences of cascade testing for fragile X syndrome. MethodsWith this model, 100 000 five-generation pedigrees were simulated to assess the maximum number of carriers that would be detected for three scenarios: (a) only first degree relatives of the index case are tested; (b) relatives up to the third degree are tested; (c) relatives up to the fifth degree are tested. ResultsIn the start-up phase of the testing programme, 18% of couples who will have a fragile X syndrome child are detected. After this phase the (stabilised) cascade testing programme detects 7% of undetected couples who would have a fragile X syndrome child if only first degree relatives were tested, 12% if first to third degree relatives were tested, and 15% if first to fifth degree relatives were tested. To detect 90% of all premutation and full mutation carriers at least eight consecutive generations need to be tested. ConclusionsThe results of our analysis show that cascade testing is not very effective in detecting carriers.

Spectrum biedt ruimte voor beschouwingen, discussies en opinierende artikelen over onderwerpen op het terrein van de volksgezondheid en de gezondheidszorg. Bijdragen dienen te worden aangeboden conform de aanwijzingen voor de auteurs. Voor overleg over het thema kan contact worden opgenomen met de rubrieksredacteuren van Spectrum: prof. dr. J.A.M. van Oers en dr. N. Hoeymans (e-mail: Nancy.Hoeymans@rivm.nl)

During the last decades, healthcare costs in all Western countries continuously increased. An adequate healthcare policy must be based on realistic expectations about the development of healthcare costs in the years to come. In this paper, some projections of future healthcare costs in the Netherlands are made, using cost-of-illness data for 1994, population forecasts and quantitative insight in the cost development in the past. It is concluded that Dutch healthcare costs will increase in the next decades by an annual rate of 2.4%. This projected cost increase consists of increasing healthcare use due to demographic change (0.9-1.0%), developments in epidemiology and technology (1.1-1.2%) and of price and wage developments in healthcare which exceed general inflation by 0.3%.