Search

In the European countries, age standardized incidence rates (European standard) for ovarian cancer vary between 7.2 and 19.3/100,000 while mortality rates are ranging between 2.8 and 12.2/100,000.1 In Belgium, ovarian cancer is not as frequent as breast cancer since breast cancer presents with very high incidence rates (similar for other European countries). However, age standardized breast cancer mortality rates in 2008 were less than one fourth of the age standardized incidence rates whereas for ovarian cancer, mortality rates were two thirds of the incidence rates (see figure 1). And, unlike for breast cancer, mortality rates for ovarian cancer were not decreasing over the past years.2 Indeed, ovarian cancer is one of the leading causes of death from gynaecological malignancies.3 This is explained by the fact that in general, ovarian cancer is detected at too advanced stages. Early diagnosis of ovarian cancer is thus the key for improving outcomes for the disease. Medical imaging techniques have revolutionised medicine during the last decades. Ultrasound (US) in particular gives access to vital data in a non-invasive way and is effective for imaging soft tissues of the body. Compared to other medical imaging modalities, US has the following positive attributes: • US is a real-time, easy operation medical imaging technique • US has a non-invasive and radiation free nature • US is relatively low-priced, Hence US has become widely used as a diagnostic technique in general clinical practice. In gynaecology, US is one of the most important and primary diagnostic tools. Its use continues to increase and it is now an essential part of the diagnostic procedure in examining the female pelvis. Indeed, the use of US morphology to characterize adnexal masses and thus diagnose ovarian cancer is well established.4 As a part of patient management, gynaecologists use US morphology to differentiate between malignant and non-malignant ovarian masses that come to their attention. I, (MED 3) -- UCL, 2011

This article analyses the influence of the World Bank on reforms of the health sector in Bolivia during the period 1986–2006, and assesses their impact on the health care delivery system to date. The article examines the transformation of health services undertaken by the current socialist government since 2006. A literature review and interviews with decision-makers critically examine the outcome of reforms on criteria linked to health system integration. The study illustrates that Bolivia applied quite comprehensively the WB recommendations. Among others these included indirect privatization through public health services’ restriction of access to a basic package of care and decentralization with devolution. In consequence, the segmentation and fragmentation of the health system was exacerbated, accessibility and quality of care suffered and health status barely improved. The article attempts to locate the relationship between policy, health care delivery and health systems functioning.

Le Centre de bioéthique pour l’Afrique francophone (CIBAF) a initié en 2007 une recherche-action sur la base d’un renforcement des capabilités pour lutter contre les infections sexuellement transmissibles IST/VIH/SIDA pour les enfants de la rue (EDR) de la ville de Kinshasa (RDC). Nous avons adopté ce modèle alternatif de prévention des IST/VIH/SIDA permettant de lutter contre les IST chez les enfants de la rue par la co-responsabilisation des acteurs de la prévention. Elle repose sur un modèle universel pragmatique articulant éthique narrative et approche par les capabilités. Cette approche « bottom up » sera présentée et discutée, ainsi que ses applications., [Reinforcing the Capacity of Street Children: A Sustainable Way of Combatting AIDS in the Democratic Republic of Congo] The francophone bioethics center (CIBAF) in Kinshasa initiated in 2007 a research-action on the basis of reinforcement of capabilities in the struggle against HIV for street children in Kinshasa. We have adopted an alternative model of prevention allowing to better fight sexually transmissible disease in street children by a co-responsabilisation of actors of prevention. It relies on a pragmatic universalism articulating narratives and capabilities. This bottom up approach will be presented and discussed in its applications.

La plupart des études qui mettent en évidence un lien positif entre la perception d’une responsabilité sociale de l’entreprise et des attitudes positives de la part des travailleurs réduisent souvent le champ de la responsabilité sociale à celui du climat éthique au sein de l’entreprise. L’objectif de cette contribution est double. Premièrement, nous proposons de tester le lien entre toutes les dimensions de la RSE et l’implication organisationnelle affective ainsi qu’avec la satisfaction au travail. Deuxièmement nous formulons l’hypothèse que les attentes des travailleurs en matière de responsabilité sociale de leur entreprise jouent un rôle modérateur dans cette relation entre la perception des pratiques de RSE et les attitudes des travailleurs. Les analyses basées sur les réponses de 267 employés montrent que les travailleurs sont surtout attentifs aux dimensions éthique et légale de la responsabilité sociale et ce que ce soit à l’égard des acteurs internes ou externes de l’entreprise. La perception de ces pratiques est liée positivement à l’implication organisationnelle et à la satisfaction au travail. L’effet modérateur des attentes n’a pas pu être démontré., info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

OBJECTIVES: The number of countries adopting per case hospital payment systems has been continuously increasing in recent years. Nonetheless, debates persist regarding their consequences for equity of access to services. This concern relates to the failure of diagnostic classifications properly to take into account patients' care requirements, raising the threat of case selection ('cream skimming'). We examine the heterogeneity of costs within diagnostic categories related to socioeconomic (SE) factors using length of stay (LOS) as a proxy measure of care needs and costs. We evaluate its consequences in terms of fairness in resource allocation between hospitals. METHODS: We employ data on all discharges in 2002-03 from a sample of 60 Belgian hospitals (617,275 observations), measuring the association between LOS and SE factors using generalized linear models. We design a resource allocation formula based on the Belgian financing scheme, where non-medical activity is paid based on a normative number of in-patient days, and measure financial penalties and rewards according to whether payment is adjusted for the SE characteristics of patients or not. RESULTS: Both patients' SE status and hospitals' area SE profile have a significant impact on LOS, which persists after controlling for detailed diagnostic and hospital characteristics. Hospitals treating low income patients are financially penalized as a result. CONCLUSION: SE factors are a predictor of in-patient LOS and should be taken into account in per case resource allocation among hospitals.

Rationale, aims and objectives In the current context, the assessment of the quality of care in daily clinical practice becomes essential. The aim of this study was to use medical basic datasets associated with information on pharmacological treatments to assess the quality of care of a prophylaxis treatment after major orthopaedic surgery and to compare hospitals' clinical practices. Methods The study was performed in 20 Belgian hospitals. Patients who underwent total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery (HFS) were selected retrospectively from the hospitals' 2002 and 2003 administrative databases (n = 14 991). Quality indicators assessed were incidence of venous thromboembolism, major bleeding and death. Prophylaxis analysed were enoxaparin, nadroparin and fondaparinux. Results Venous thromboembolism and major bleeding events were rare (1.9% and 1.1% respectively). Patients who underwent HFS were at greater risk of having pulmonary embolism [OR = 2.01; confidence interval (CI) = 1.38-2.92; P = 0.0002], major bleeding (OR = 4.00; CI = 2.93-5.46; P < 0.0001) or death from any cause (OR = 8.86; CI = 6.85-11.45; P < 0.0001) than patients who underwent THR or TKR. Multivariate analyses showed that the hospital variable had a significant impact on the probability to have adverse events and that patients who received enoxaparin were at greater risk of death than patients who received nadroparin (OR(enoxaparin vs fraxiparin) = 1.59; 95% CI = 1.04-2.44; P = 0.033). Conclusion Results indicate that differences in thromboembolism prophylaxis practices among hospitals have a significant impact on adverse events. This reinforces the need to develop data-processing tools that enable better monitoring of quality of care.

info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/published

info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/nonPublished

Important differences are seen in the nurse(+aid)-to-bed ratio between the different EU countries. These differences have been documented by a questionnaire send to all EU and EFTA countries. It looks very difficult to find a reason for these important differences, sometimes seen within one country. Further research is urgently needed to find out what is the minimum staffing level, adapted to the workload, for the quality of the care, the job satisfaction of the nurses and the satisfaction of the patients and their families. © 2010 Elsevier Masson SAS and European Union Geriatric Medicine Society., SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

Low-income countries still face a number of major health challenges. Public health services respond to them with great difficulty. This low performance is traditionally attributed to a lack of resources. Our hypothesis is that the observed low performance stems also from the institutional organisation of the public health systems. Our belief is that the institutional dimension has not been correctly appreciated so far in theories and policies of health service organisation in low-income countries. Our general strategy is to tap recent developments in organisational economic theory to gain more insights in the related scientific questions and the connected health policy issues. Our investigation is organised in two parts. Part 1 aims mainly at validating the utilisation of economics (and its institutional branches in particular) to analyse the organisation of public health systems. This validation is done in successive steps. In our chapter 1, we introduce public health systems in rural areas in low-income countries. This largely descriptive and historical chapter is helpful to provide the situation of reference discussed throughout the thesis. With the next chapters, we shift to economic theory. Our chapter 2 provides a review of recent developments in the economics of institutions; it sketches the overall theoretical background and allows us to situate our own research program in this panorama. The next four chapters are dedicated to concepts that are helpful for the economic study of public health systems, concepts that we draw from this literature. Our chapters 3 and 4 introduce respectively the concepts of institutions and organisations. In our chapters 5 and 6, we highlight how institutions structure property rights and how property rights set incentives to economic agents. This tedious application of organisational economics to our case of study allows us to highlight a few pending conceptual questions in institutional economic theories. In our chapter 7, we p, Les pays à faible revenu font face à un certain nombre de défis sanitaires auxquels les services publics de santé répondent avec difficulté. Cette faible performance est traditionnellement attribuée à un manque de ressources. Notre hypothèse est qu'elle découle aussi de la façon même dont ces systèmes publics de santé sont établis sur le plan institutionnel. Notre conviction est que la dimension institutionnelle n’a pas été appréciée à sa juste valeur jusqu’à présent dans les théories et politiques organisant les services de santé dans les pays à faible revenu. Notre stratégie a consisté à exploiter les développements récents dans la théorie économique des organisations pour mieux comprendre les questions scientifiques et les enjeux politiques sous-jacents. Notre recherche est organisée en deux parties. La première partie vise principalement à valider l’utilisation des sciences économiques (et ses branches institutionnelles en particulier) pour analyser l’organisation des systèmes publics de santé. Cette validation est faite en étapes successives. Dans notre premier chapitre, nous introduisons les systèmes publics de santé tels qu’ils sont observables dans les zones rurales des pays pauvres. Ce chapitre descriptif et historique vise à fournir la situation de référence discutée tout au long de la thèse. Avec les chapitres suivants, nous nous tournons vers la théorie économique. Dans notre chapitre 2, nous passons en revue les développements récents en économie organisationnelle. Nous esquissons le cadre théorique général et pouvons ainsi situer notre propre programme de recherche. Les quatre chapitres suivants sont consacrés aux concepts nécessaires pour l’étude économique des systèmes publics de santé. Dans les chapitres 3 et 4, nous présentons respectivement les concepts d’institution et d’organisation. Dans nos chapitres 5 et 6, nous présentons comment les institutions structurent les droits de propriété et comment ces derniers établissent des incitations pour les, (ECON 3) -- UCL, 2009

Background: Previous research has provided evidence that socioeconomic status has an impact on invasive treatments use after acute myocardial infarction. In this paper, we compare the socioeconomic inequality in the use of high-technology diagnosis and treatment after acute myocardial infarction between the US, Quebec and Belgium paying special attention to financial incentives and regulations as explanatory factors. Methods: We examined hospital-discharge abstracts for all patients older than 65 who were admitted to hospitals during the 1993-1998 period in the US, Quebec and Belgium with a primary diagnosis of acute myocardial infarction. Patients' income data were imputed from the median incomes of their residential area. For each country, we compared the risk-adjusted probability of undergoing each procedure between socioeconomic categories measured by the patient's area median income. Results: Our findings indicate that income-related inequality exists in the use of high-technology treatment and diagnosis techniques that is not justified by differences in patients' health characteristics. Those inequalities are largely explained, in the US and Quebec, by inequalities in distances to hospitals with on-site cardiac facilities. However, in both Belgium and the US, inequalities persist among patients admitted to hospitals with on-site cardiac facilities, rejecting the hospital location effect as the single explanation for inequalities. Meanwhile, inequality levels diverge across countries ( higher in the US and in Belgium, extremely low in Quebec). Conclusion: The findings support the hypothesis that income-related inequality in treatment for AMI exists and is likely to be affected by a country's system of health care.

L’objectif de la présente étude consiste, d’une part, à décrire le système français d’indemnisation des victimes de dommages médicaux et, d’autre part, à calculer l’impact budgétaire de la transposition d’un tel système en Belgique. Les spécificités du système qui sera introduit en Belgique n’étant pas connues au moment de l’étude, le coût a été calculé sur la base des modalités du système en vigueur en France. Les statistiques françaises de fréquences des différents types de dommages (infections nosocomiales, dommages exceptionnels,…), ont été extrapolées à la situation belge. Au niveau des coûts, nous avons utilisé les données fournies par Assuralia, après avoir vérifié si elles étaient cohérentes par rapport aux coûts du système français. Sur la base de ces données, nous avons pu calculer le coût moyen des dommages à indemniser par le Fonds. Au total, les coûts moyens doivent être multipliés par le nombre de cas de dommages remboursables dans le nouveau système. Pour parvenir au coût global d’un système comparable à celui en vigueur en France, il convient d’ajouter à ce total le coût des dommages exceptionnels, celui des dommages consécutifs aux infections nosocomiales ainsi que les frais administratifs.

Cette recherche s'organise autour de deux champs conceptuels. La première thématique s'articule, au niveau théorique et empirique, autour du rôle de l'entreprise dans le défi de la conciliation vie travail - vie famille des travailleurs.La seconde thématique garde comme axe de réflexion le rôle de l’entreprise en matière de conciliation en faveur de ses travailleurs mais plus uniquement au niveau de l’interface vie au travail – vie privée. Il s’agit ici d’un niveau plus global, celui de la conciliation vie au travail – vie de citoyen. Cette seconde thématique sera également traitée théoriquement et empiriquement en se structurant autour du concept de la Responsabilité Sociale des Entreprises., Doctorat en Sciences Psychologiques et de l'éducation, info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/published

info:eu-repo/semantics/nonPublished

This study proposes to apply the paradigm of Churchill in the case of the adaptation in french and validation of the Maignan and Ferrell scale (1999) based on the model developed by Carroll (1979). This model proposes to distinguish four principles of social responsibility: economic, legal, ethical and philanthropic responsibility. Four factors were highlighted in a first exploratory study conducted among 320 workers. This structure was confirmed during a second confirmatory investigation among 287others workers. If the four identified factors do not match exactly to the theoretical chosen model, they bring value to support the differences in social responsibility between the internal actors and external actors., SCOPUS: ar.j, info:eu-repo/semantics/published

info:eu-repo/semantics/published

PURPOSE: The 4-year results of this trial demonstrated that a higher dose of epirubicin with cyclophosphamide (HEC) is superior to a lower dose of epirubicin, 60 mg/m(2) (EC), for event-free survival (EFS; 27% reduction), but is not superior to classical oral cyclophosphamide, methotrexate, and fluorouracil (CMF) in the adjuvant treatment of node-positive breast cancer. Herein we report the 15-year data on efficacy and long-term toxicity of this three-arm Belgian multicenter trial. PATIENTS AND METHODS: Between March 1988 and December 1996, 777 eligible patients were randomly assigned to six cycles of CMF, eight cycles of EC, or eight cycles HEC. RESULTS: The 15-year EFS was 45% for patients who received CMF, 39% for patients who received EC, and 50% for patients who received HEC. The hazard ratios (HR) were 0.77 for HEC versus EC (95% CI, 0.60 to 0.98; P = .03), 0.90 for HEC versus CMF (P = .39), and 0.86 for EC versus CMF (P = .21). No difference in overall survival (OS) was seen. Cardiac toxicity was more frequent with HEC than with CMF (11 patients v 1 patient; P = .006), but no more than with EC (P = .21). CONCLUSION: Treatment with HEC demonstrated superior EFS when compared with lower-dose epirubicin. However, we do not recommend the use of HEC regimen in daily clinical practice, mainly because of the higher risk of cardiotoxicity related to the cumulative doses of epirubicin and the lack of superiority of anthracyclines over CMF in our study., Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

PURPOSE: The 4-year results of this trial demonstrated that a higher dose of epirubicin with cyclophosphamide (HEC) is superior to a lower dose of epirubicin, 60 mg/m(2) (EC), for event-free survival (EFS; 27% reduction), but is not superior to classical oral cyclophosphamide, methotrexate, and fluorouracil (CMF) in the adjuvant treatment of node-positive breast cancer. Herein we report the 15-year data on efficacy and long-term toxicity of this three-arm Belgian multicenter trial. PATIENTS AND METHODS: Between March 1988 and December 1996, 777 eligible patients were randomly assigned to six cycles of CMF, eight cycles of EC, or eight cycles HEC. RESULTS: The 15-year EFS was 45% for patients who received CMF, 39% for patients who received EC, and 50% for patients who received HEC. The hazard ratios (HR) were 0.77 for HEC versus EC (95% CI, 0.60 to 0.98; P = .03), 0.90 for HEC versus CMF (P = .39), and 0.86 for EC versus CMF (P = .21). No difference in overall survival (OS) was seen. Cardiac toxicity was more frequent with HEC than with CMF (11 patients v 1 patient; P = .006), but no more than with EC (P = .21). CONCLUSION: Treatment with HEC demonstrated superior EFS when compared with lower-dose epirubicin. However, we do not recommend the use of HEC regimen in daily clinical practice, mainly because of the higher risk of cardiotoxicity related to the cumulative doses of epirubicin and the lack of superiority of anthracyclines over CMF in our study., Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

viii, 134 p., ill.

ix, 134 p., ill.

xi, 51 p., ill.

xi, 51 p., ill.

The imperfect risk adjustment of prospective payment for hospitals may have dramatic consequences on equity. If the hospital is able to distinguish subgroups of patients with different expected costs within a group for which the risk-adjusted payment per admission is the same, it is likely to select the most profitable cases and deny care to the others. Meanwhile, hospitals refusing to practice patients' selection may experience solvency problems. In the long term, either those hospitals fail and access to care is at risk, or they decrease the quality of treatments and access to quality is at risk. In Belgium, since 1995, a prospective payment per case has replaced the traditional per diem payments for non-medical expenditures. A fixed number of days are paid to each admission, based on the patient's characteristics, namely diagnosis, age and geriatric profile. In this paper, we examine the imperfect risk adjustment related to the non-inclusion of socio-economic factors in the hospital financing formula. Using data from 61 Belgian hospitals from 1995, we observe that socio-economic status, which is currently not accounted for as risk adjuster, has a significant impact on length of stay (LOS). We estimate that patients in the upper-income categories, patients with a self-employed status and patients with an employee status are beneficial for hospitals' financial results, due to their shorter stays. On the contrary, the non-active, the low-income patients and patients benefiting from an insurance preferential regime represent, on average, a financial loss for hospitals. Finally, we find that financial results under the current financing scheme are biased due to the non-inclusion of SES risk-adjustors. Hospitals with the most beneficial social case-mix are shown to experience a shift from a positive to a negative financial outcome when SES risk adjustors are included, while the reverse is observed for hospitals with the worst social case-mix.

Rationale, aims and objectives 'Real world data' are needed to assess the quality of pharmacological treatments in clinical practice. The aim of this study was to determine whether administrative databases can be used to assess the quality of prophylaxis with low-molecular-weight heparin after major orthopaedic surgery. Methods The study was performed in a Belgian university hospital. Patients undergoing total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) were selected retrospectively from the hospital's 2002 and 2003 administrative databases. Readmissions during the same year as the procedure were also analysed. Three quality indicators were assessed: incidence of venous thromboembolism (VTE), major bleeding and death; adherence to guidelines; and the costs of care. Results Although 70% of data were collected from administrative databases, patients' records also had to be examined. During the period studied, VTE and major bleeding events were rare. Patients undergoing HFS were at greater risk of having a pulmonary embolism [Exact odds ratio (OR) = 3.78; 95% confidence interval (CI) = 1.13-16.22; P = 0.03] or of death from any cause (Exact OR = 2.15; 95% CI = 1.52-infinity; P < 0.01) than patients undergoing THR or TKR. The hospital's prophylaxis protocol was not always followed. Half the patients received higher prophylaxis doses than recommended and 11% received lower doses but no impact on adverse events was demonstrated. Conclusion Results show that administrative databases contain enough information to measure the frequency of adverse events but complementary data on patient weight and on non-reimbursed drugs must be extracted from the patients' records to evaluate adherence to guidelines. Our findings stress the need for better integration of information systems.

Objectives: The increasing use of full economic evaluations has led to the development of various instruments to assess their quality. The purpose of this study was to compare the frequently used British Medical Journal (BMJ) check-list and two new instruments: the Consensus Health Economic Criteria (CHEC) list and the Quality of Health Economic Studies (QHES) instrument. The analysis was based on a practical exercise on economic evaluations of the surgical treatment of obesity.Methods: The quality of nine selected studies was assessed independently by two health economists. To compare instruments, the Spearman rank correlation coefficient was calculated for each assessor. Moreover, the test-retest reliability for each instrument was assessed with the intraclass correlation coefficient (ICC) (3,1). Finally, the inter-rater agreement for each instrument was estimated at two levels: comparison of the total score of each article by the ICC(2,1) and comparison of results per item by kappa values.Results: The Spearman's rank correlation coefficient between instruments was usually high (rho > 0.70). Furthermore, test-retest reliability was good for every instruments, that is, 0.98 (95 percent CI, 0.86-0.99) for the BMJ check-list, 0.97 (95 percent CI, 0.73-0.98) for the CHEC list, and 0.95 (95 percent CI, 0.75-0.99) for the QHES instrument. However, inter-rater agreement was poor (kappa < 0.40 for most items and ICC(2,1)

In the current context of the growing of health care expenses, the allocation of scarce resources in the most efficient way becomes essential. Consequently, the routinely use of full economic evaluations in decision processes should be promoted. However, information provided by economic evaluations is not used in an optimal way by health care decision makers, mostly because of their lack of transferability to other countries and the difficulty of judging about their quality. The aim of the thesis was thus to investigate a number of methods in the field of economic evaluations which could be used to improve the information transmitted to Belgian health care decision makers. Three tools were investigated in this research: the use of Belgian administrative databases, the use of Markov models, and the use of quality assessment instruments. The first part of the thesis analyzed the use of Belgian administrative databases to assess the quality of prophylactic treatment in prevention of venous thromboembolism after major orthopedic surgery. In the second part, the use of Markov models to assess the treatment of patients with chronic hepatitis C was analyzed and finally, in the third part, three quality assessment instruments were compared and used in a systematic review of economic evaluations on the surgical treatment of obesity. Such investigations allowed us to formulate methodological recommendations but also suggestions to improve the quality of care. While recommendations concerning the use of Belgian administrative databases and the use of Markov models were mostly specific to the Belgian context, recommendations on the use of quality assessment instruments had an international impact. Health care decision makers could use the information provided by this research in decision processes concerning the reimbursement of health care programs but also in the process of determining new clinical practice and health economic guidelines. This research would thus be interesti, (SBIM 3) -- UCL, 2008

Des contrats privés d’assurance maladie sont conclus par bon nombre de personnes ou par leurs employeurs pour couvrir des frais résultant de soins de santé et qui ne sont pas remboursés par l’assurance maladie obligatoire. On estime que plus de cinq millions de personnes sont couvertes par de tels contrats en Belgique. Il est fréquent que ces contrats ne soient pas renouvelés par les assureurs ou que leurs conditions contractuelles soient modifiées et en particulier leurs tarifs. La loi du 20 juillet 2007 modifiant la loi du 25 juin 1992 sur le contrat d’assurance terrestre en ce qui concerne les contrats d’assurance maladie vise à protéger les assurés en limitant notamment les possibilités de modification des conditions tarifaires des contrats d’assurance maladie aux cas de réelles augmentations du coût des prestations garanties. Le KCE a été chargé par le législateur de mettre au point une méthodologie de construction d’un index médical qui traduirait, sur la base de paramètres objectifs, l’augmentation réelle des coûts auxquels doivent faire face les assureurs et qui pourrait donc être utilisé pour limiter l’adaptation annuelle des primes demandées.

info:eu-repo/semantics/nonPublished

info:eu-repo/semantics/published

info:eu-repo/semantics/published

info:eu-repo/semantics/published

Lorsque le Belge, devenu plus âgé, constate que son audition baisse et achète un appareil auditif, il s’oriente souvent vers les modèles les plus chers. Au-delà du montant versé par l’assurance maladie, il doit payer de sa poche un montant variant entre 500 et 1000 € par appareil auditif. Ce montant est doublé lorsqu’il achète un appareil auditif pour les deux oreilles. Pourtant, de tels appareils auditifs, plus coûteux et plus sophistiqués, n’offrent pour beaucoup de patients aucun avantage particulier. Dans une étude effectuée en collaboration avec l’UCL, le Centre fédéral d’expertise des soins de santé (KCE) suggère quelques pistes pour améliorer la situation.

318-325, OBJECTIVES: The increasing use of full economic evaluations has led to the development of various instruments to assess their quality. The purpose of this study was to compare the frequently used British Medical Journal (BMJ) check-list and two new instruments: the Consensus Health Economic Criteria (CHEC) list and the Quality of Health Economic Studies (QHES) instrument. The analysis was based on a practical exercise on economic evaluations of the surgical treatment of obesity. METHODS: The quality of nine selected studies was assessed independently by two health economists. To compare instruments, the Spearman rank correlation coefficient was calculated for each assessor. Moreover, the test-retest reliability for each instrument was assessed with the intraclass correlation coefficient (ICC) (3,1). Finally, the inter-rater agreement for each instrument was estimated at two levels: comparison of the total score of each article by the ICC(2,1) and comparison of results per item by kappa values. RESULTS: The Spearman's rank correlation coefficient between instruments was usually high (rho > 0.70). Furthermore, test-retest reliability was good for every instruments, that is, 0.98 (95 percent CI, 0.86-0.99) for the BMJ check-list, 0.97 (95 percent CI, 0.73-0.98) for the CHEC list, and 0.95 (95 percent CI, 0.75-0.99) for the QHES instrument. However, inter-rater agreement was poor (kappa < 0.40 for most items and ICC(2,1) < or = 0.5). CONCLUSIONS: The study shows that the results of the quality assessment of economic evaluations are not so much influenced by the instrument used but more by the assessor. Therefore, quality assessments should be performed by at least two independent experts and final scoring based on consensus.

vi, 172 p., ill.

viii, 172 p., ill.