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1. Prospective BMI changes in preschool children are not effected by changes in EBRBs but by parental characteristics and body weight perceptions: The ToyBox-study

Author

Manios Y., Lambert K.A., Karaglani E., Mavrogianni C., Moreno L.A., Iotova V., Swiader-Lesniak A., Koletzko B., Cardon G., Androutsos O., Moschonis G., de Bourdeaudhuij I., Paw M.C.A., Summerbell C., Lobstein T., Annemans L., Buijs G., Reilly J., Swinburn B., Ward D., Grammatikaki E., Katsarou C., Apostolidou E., Livaniou A., Lymperopoulou K., Efstathopoulou E., Lambrinou C.-P., Giannopoulou A., Siatitsa E., Argiri E., Maragkopoulou K., Douligeris A., Duvinage K., Ibrügger S., Strauß A., Herbert B., Birnbaum J., Payr A., Geyer C., de Craemer M., de Decker E., de Henauw S., Maes L., Vereecken C., van Assche J., Pil L., te Velde S., Moreno L., Mouratidou T., Fernandez J., Mesana M., de Miguel-Etayo P., González-Gil E.M., Gracia-Marco L., Oves B., Yngve A., Kugelberg S., Lynch C., Mosdøl A., Nilsen B.B., Moore H., Douthwaite W., Nixon C., Kreichauf S., Wildgruber A., Socha P., Kulaga Z., Zych K., Gózdz M., Gurzkowska B., Szott K., Lateva M., Usheva N., Galcheva S., Marinova V., Radkova Z., Feschieva N., Aikenhead A., Dorgelo A., Nethe A., Jansen J., Gmeiner O., Retterath J., Wildeis J., Günthersberger A., Gibson L., Voegele C., and ToyBox Study Group

Abstract

Objective: To examine the effect of the intervention implemented in the ToyBox study on changes observed in age and sex specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. Design: A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomized design. A standardized protocol was used to measure children’s body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socioeconomic status and school were used. Setting: Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). Participants: A sample of 6, 268 pre-schoolers aged 3.5-5.5 (51.9% boys). Results: There was no intervention effect on the change in children’s BMI percentile. However, parents’ underestimation of their children’s actual weight status, parental overweight and mothers’ pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children’s BMI percentile in multivariate modelling. Conclusion: Before or as part of the implementation of any childhood obesity intervention initiative, it is important to assist parents/caregivers to correctly perceive their own and their children’s weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family. © 2021 Lippincott Williams and Wilkins. All rights reserved.

Published
2022

2. Prospective BMI changes in preschool children are associated with parental characteristics and body weight perceptions: the ToyBox-study

Author

Manios, Y, Lambert, Katrina, Karaglani, E, Mavrogianni, C, Moreno, LA, Iotova, V, Świąder-Leśniak, A, Koletzko, B, Cardon, G, Androutsos, O, Moschonis, George, de Bourdeaudhuij, I, Paw, MCA, Summerbell, C, Lobstein, T, Annemans, L, Buijs, G, Reilly, J, Swinburn, B, Ward, D, Grammatikaki, E, Katsarou, C, Apostolidou, E, Livaniou, A, Lymperopoulou, K, Efstathopoulou, E, Lambrinou, CP, Giannopoulou, A, Siatitsa, E, Argiri, E, Maragkopoulou, K, Douligeris, A, Duvinage, K, Ibrügger, S, Strauß, A, Herbert, B, Birnbaum, J, Payr, A, Geyer, C, de Craemer, M, de Decker, E, de Henauw, S, Maes, L, Vereecken, C, van Assche, J, Pil, L, Velde, S te, Mouratidou, T, Fernandez, J, Mesana, M, de Miguel-Etayo, P, González-Gil, EM, Gracia-Marco, L, Oves, B, Yngve, A, Kugelberg, S, Lynch, C, Mosdøl, A, Nilsen, BB, Moore, H, Douthwaite, W, Nixon, C, Kreichauf, S, Wildgruber, A, Socha, P, Kulaga, Z, Zych, K, Góźdź, M, Gurzkowska, B, Szott, K, Lateva, M, Usheva, N, Galcheva, S, Marinova, V, Radkova, Z, Feschieva, N, Aikenhead, A, Dorgelo, A, Nethe, A, Jansen, J, Gmeiner, O, Retterath, J, Wildeis, J, Günthersberger, A, Gibson, L, and Voegele, C

Subjects
111712 Health Promotion, 111707 Family Care, FOS: Health sciences, 111704 Community Child Health
Abstract

Objective: To examine the effect of the intervention implemented in the ToyBox study on changes observed in age and sex specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. Design: A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomized design. A standardized protocol was used to measure children’s body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socioeconomic status and school were used. Setting: Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). Participants: A sample of 6,268 pre-schoolers aged 3.5-5.5 (51.9% boys). Results: There was no intervention effect on the change in children’s BMI percentile. However, parents’ underestimation of their children’s actual weight status, parental overweight and mothers’ pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children’s BMI percentile in multivariate modelling. Conclusion: Before or as part of the implementation of any childhood obesity intervention initiative, it is important to assist parents/caregivers to correctly perceive their own and their children’s weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.

Published
2022
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5. Methodology of the health economic evaluation of the Feel4Diabetes-study

Author

Willems, R. Pil, L. Lambrinou, C.-P. Kivelä, J. Wikström, K. Gonzalez-Gil, E.M. De Miguel-Etayo, P. Nánási, A. Semánová, C. Van Stappen, V. Cardon, G. Tsochev, K. Iotova, V. Chakarova, N. Makrilakis, K. Dafoulas, G. Timpel, P. Schwarz, P. Manios, Y. Annemans, L.

Abstract

Background: The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus. Methods: The aim of this paper is to describe the detailed methodology of the intervention's cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention's value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only. Conclusions: The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources. © 2020 The Author(s).

Published
2020

6. Effectiveness of a family-, school- And community-based intervention on physical activity and its correlates in Belgian families with an increased risk for type 2 diabetes mellitus- And Feel4Diabetes-study

Author

Huys, N. Van Stappen, V. Shadid, S. De Craemer, M. Androutsos, O. Wikström, K. Makrilakis, K. Moreno, L.A. Iotova, V. Tankova, T. Nánási, A. Manios, Y. Cardon, G. Manios, Y. Kontogianni, M. Androutsos, O. Moschonis, G. Tsoutsoulopoulou, K. Mavrogianni, C. Katsarou, C. Karaglani, E. Efstathopoulou, E. Kechribari, I. Maragkopoulou, K. Argyri, E. Douligeris, A. Nikolaou, M. Vampouli, E.-A. Kouroupaki, K. Koutsi, R. Tzormpatzaki, E. Manou, E. Mpinou, P. Karachaliou, A. Filippou, C. Filippou, A. Lindström, J. Laatikainen, T. Wikström, K. Nelimarkka, K. Kivelä, J. Valve, P. Cardon, G. Latomme, J. Van Stappen, V. Huys, N. Annemans, L. Pil, L. Schwarz, P. Panchyrz, I. Holland, M. Timpel, P. Makrilakis, K. Liatis, S. Dafoulas, G. Lambrinou, C.-P. Giannopoulou, A. Tsirigoti, L. Fappa, E. Anastasiou, C. Zachari, K. Rabemananjara, L. Kakoulis, D. Mandalia, M. De Sabata, M.S. Pall, N. Civeira, F. Bueno, G. De Miguel-Etayo, P. Gonzalez-Gil, E.M. Mesana, M.I. Vicente-Rodriguez, G. Rodriguez, G. Baila-Rueda, L. Cenarro, A. Jarauta, E. Mateo-Gallego, R. Iotova, V. Tankova, T. Usheva, N. Tsochev, K. Chakarova, N. Galcheva, S. Dimova, R. Bocheva, Y. Radkova, Z. Marinova, V. Rurik, I. Ungvari, T. Jancsó, Z. Nánási, A. Kolozsvári, L. Martinez, R. Tong, M. Joutsenniemi, K. Wendel-Mitoraj, K.

Abstract

Background: The study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium. Methods: The Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4 years; 72.0% women) and 444 children (mean age 8.0 years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year. Results: In parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p = 0.05; ηp2 = 0.008) and steps (p = 0.03; ηp2 = 0.006%) on weekdays, with physical activity decreasing (more) in the intervention group. Conclusions: The F4D-intervention lacks effectiveness on high-risk families' physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group). Trial registration: The Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015. © 2020 The Author(s).

Published
2020

8. Differences in energy balance-related behaviours in European preschool children: The ToyBox-study

Author

De Craemer, M., Lateva, M., Iotova, V., De Decker, E., Verloigne, M., De Bourdeaudhuij, I., Androutsos, O., Socha, P., Kulaga, Z., Moreno, L., Koletzko, B., Manios, Y., Cardon, G., Paw, M.C.A., Summerbell, C., Lobstein, T., Annemans, L., Buijs, G., Reilly, J., Swinburn, B., Ward, D., Grammatikaki, E., Katsarou, C., Apostolidou, E., Efstathopoulou, E., Duvinage, K., Ibrügger, S., Strauß, A., Herbert, B., Birnbaum, J., Payr, A., Geyer, C., De Henauw, S., Maes, L., Vereecken, C., Van Assche, J., Pil, L., Te Velde, S., Mouratidou, T., Fernandez, J., Mesana, M., De Miguel-Etayo, P., González, E., Gracia-Marco, L., Oves, B., Yngve, A., Kugelberg, S., Lynch, C., Mosdøl, A., Moore, H., Douthwaite, W., Nixon, C., Kreichauf, S., Wildgruber, A., Zych, K., Gózdz, M., Gurzkowska, B., Szott, K., Usheva, N., Galcheva, S., Marinova, V., Radkova, Z., Feschieva, N., Aikenhead, A., Dorgelo, A., Nethe, A., Jansen, J., Gmeiner, O., Retterath, J., Wildeis, J., Günthersberger, A., Gibson, L., and Voegele, C.

Abstract

Background: The aim of the current study was to compare levels of energy balance-related behaviours (physical activity, sedentary behaviour, and dietary behaviours (more specifically water consumption, sugar-sweetened beverage consumption and unhealthy snacking)) in four- to six-year-old preschoolers from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) within the ToyBox cross-sectional study. Methods: A sample of 4,045 preschoolers (4.77 ± 0.43 years; 52.2% boys) had valid physical activity data (steps per day), parents of 8,117 preschoolers (4.78 ± 0.46 years; 53.0% boys) completed a parental questionnaire with questions on sedentary behaviours (television viewing, computer use, and quiet play), and parents of 7,244 preschoolers (4.77 ± 0.44 years; 52.0% boys) completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking. Results: The highest levels of physical activity were found in Spain (12,669 steps/day on weekdays), while the lowest levels were found in Bulgaria and Greece (9,777 and 9,656 steps/day on weekdays, respectively). German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays), while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays). A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays), and the lowest levels in Spain (60.4 min/day on weekdays). Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of snacks was the highest in Belgian preschoolers (73.1 g/day) and the lowest in Greek preschoolers (53.3 g/day). Conclusions: Across six European countries, differences in preschoolers'' energy balance-related behaviours were found. Future interventions should target European preschoolers '' energy balance- related behaviours simultaneously, but should apply country-specific adaptations.

Published
2015

9. Establishing a method to estimate the cost-effectiveness of a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study

Author

Pil, L, Putman, K, Cardon, G, De Bourdeaudhuij, I, Manios, Y, Androutsos, O, Lateva, M, Iotova, V, Zych, K, Góźdź, M, González-Gil, E M, De Miguel-Etayo, P, Geyer, C, Birnbaum, J, Annemans, L, ToyBox-study group, Public Health Sciences, Interuniversity Centre For Health Economics Research, Organisation, policy and social inequalities in health care, Movement and Sports Training, Spine Research Group, and Biomechanics and Human Biometry

Subjects
Male, Evidence-based medicine, Health Knowledge, Attitudes, Practice, Pediatric Obesity, Child, preschool, Markov chains, Cost-Benefit Analysis, parents, life style, Motor Activity, Europe, social environment, Models, Economic, Surveys and Questionnaires, Humans, Multicenter Studies as Topic, Female, reproducibility of results, Program Development, diet, health care economics and organizations, Program Evaluation, Randomized Controlled Trials as Topic, School Health Services
Abstract

Overweight and obesity in children are recognized as a major health problem. The ToyBox-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the ToyBox-intervention. In order to estimate the long-term impact of the ToyBox-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the ToyBox-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the ToyBox-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers.

Published
2014

11. Testing an analogue game to promote peer support and person‐centredness in education for people with diabetes: A realist evaluation

Author

Vibeke Stenov, Pil Lindgreen, Ingrid Willaing, Henning Grubb Basballe, and Lene Eide Joensen

Subjects
dialogue tools, game, gamification, nursing, patient education, peer support, Nursing, RT1-120
Abstract

Abstract Aim To explore the outcomes of testing an analogue game to incorporate person‐centredness and peer dialogues in group‐based diabetes education targeting people with diabetes. Design Realist evaluation using quantitative and qualitative methods to explore context, mechanisms and outcomes of the intervention. Methods In March–July 2019, the game was tested among 76 people with type 2 diabetes and 17 professionals in 19 settings across nine Danish municipalities. Data consisted of game tests, interviews and questionnaires. Data were analysed using systematic text condensation and descriptive statistics. Results Outcomes of using the game were as follows: (a) a playful atmosphere; (b) active engagement; c) reflections on diabetes‐specific experiences; (d) focused dialogues; (e) professionals gaining insight into the needs of participants; and (f) professionals experiencing peer dialogue as important to incorporate into education. Questionnaire responses showed that 92% people with diabetes and 94% professionals found that the game incorporated person‐centredness and peer dialogues into education.

Published
2021
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12. Cost-effectiveness of a helpline for suicide prevention

Author

Pil, L., Pauwels, K., Muijzers, Ekke, Portzky, G., Annemans, Lieven, Biomechanics and Human Biometry, and Interuniversity Centre For Health Economics Research

Subjects
Cost-effectiveness of a helpline for suicide preve
Abstract

We evaluated the cost-effectiveness and budget impact of a suicide helpline in Belgium, consisting of a telephone- and a chat service. An age- and gender-dependent Markov model with a ten-year time horizon and a one-year cycle length was developed, assuming a societal perspective, to predict cumulative costs and quality-adjusted life-years (QALYs) in the helpline users. The model included six transition states: the initial state (at risk), first attempt, re-attempt, follow-up, suicide and death from other causes. Data on the effect of the helpline and costs associated with model states were obtained from the literature. One-way and probabilistic sensitivity analyses were performed to capture uncertainty. In addition, the budget impact of the helpline was analysed. Over ten years, the telephone- as well as the chat service could avoid about 36 of suicides and attempts in this high-risk population. In males, 0.063 QALYs (95 confidence interval, CI 0.0300.097) and 0.035 QALYs (95CI 0.0260.096) were gained by users of the telephone- and chat service respectively. The corresponding values for females were 0.019 QALYs (95CI 0.0150.052) and a QALY-neutral result of 0.005 (95CI 0.0710.062). There were net societal savings of respectively 2382 (95CI 19532859) and 2282 (95CI 18552758) in male users; 2171 (95CI 17352664) and 2458 (95CI 19453025) in female users. At the population level, an investment of 218,899 saved 1,452,022 for the public health service (national health insurance), mainly due to the telephone service. The analysis predicted that both means of telemedicine for suicide prevention in Flanders are cost-saving, and have a modest effect on QALYs.

Published
2013

14. Self-operated endovaginal telemonitoring versus traditional monitoring of ovarian stimulation in assisted reproduction: an RCT

Author

Gerris, J., primary, Delvigne, A., additional, Dhont, N., additional, Vandekerckhove, F., additional, Madoc, B., additional, Buyle, M., additional, Neyskens, J., additional, Deschepper, E., additional, De Bacquer, D., additional, Pil, L., additional, Annemans, L., additional, Verpoest, W., additional, and De Sutter, P., additional

Published
2014
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16. Reproductive endocrinology

Author

Nazzaro, A., primary, Salerno, A., additional, Di Iorio, L., additional, Landino, G., additional, Marino, S., additional, Pastore, E., additional, Fabregues, F., additional, Iraola, A., additional, Casals, G., additional, Creus, M., additional, Peralta, S., additional, Penarrubia, J., additional, Manau, D., additional, Civico, S., additional, Balasch, J., additional, Lindgren, I., additional, Giwercman, Y. L., additional, Celik, E., additional, Turkcuoglu, I., additional, Ata, B., additional, Karaer, A., additional, Kirici, P., additional, Berker, B., additional, Park, J., additional, Kim, J., additional, Rhee, J., additional, Krishnan, M., additional, Rustamov, O., additional, Russel, R., additional, Fitzgerald, C., additional, Roberts, S., additional, Hapuarachi, S., additional, Tan, B. K., additional, Mathur, R. S., additional, van de Vijver, A., additional, Blockeel, C., additional, Camus, M., additional, Polyzos, N., additional, Van Landuyt, L., additional, Tournaye, H., additional, Turhan, N. O., additional, Hizli, D., additional, Kamalak, Z., additional, Kosus, A., additional, Kosus, N., additional, Kafali, H., additional, Lukaszuk, A., additional, Kunicki, M., additional, Liss, J., additional, Bednarowska, A., additional, Jakiel, G., additional, Lukaszuk, K., additional, Lukaszuk, M., additional, Olszak-Sokolowska, B., additional, Wasniewski, T., additional, Neuberg, M., additional, Cavalcanti, V., additional, Peluso, C., additional, Lechado, B. L., additional, Cordts, E. B., additional, Christofolini, D. M., additional, Barbosa, C. P., additional, Bianco, B., additional, Venetis, C. A., additional, Kolibianakis, E. M., additional, Bosdou, J., additional, Tarlatzis, B. C., additional, Onal, M., additional, Gungor, D. N., additional, Acet, M., additional, Kahraman, S., additional, Kuijper, E., additional, Twisk, J., additional, Caanen, M., additional, Korsen, T., additional, Hompes, P., additional, Kushnir, M., additional, Rockwood, A., additional, Meikle, W., additional, Lambalk, C. B., additional, Yan, X., additional, Dai, X., additional, Wang, J., additional, Zhao, N., additional, Cui, Y., additional, Liu, J., additional, Yarde, F., additional, Maas, A. H. E. M., additional, Franx, A., additional, Eijkemans, M. J. C., additional, Drost, J. T., additional, van Rijn, B. B., additional, van Eyck, J., additional, van der Schouw, Y. T., additional, Broekmans, F. J. M., additional, Martyn, F., additional, Anglim, B., additional, Wingfield, M., additional, Fang, T., additional, Yan, G. J., additional, Sun, H. X., additional, Hu, Y. L., additional, Chrudimska, J., additional, Krenkova, P., additional, Macek, M., additional, Teixeira da Silva, J., additional, Cunha, M., additional, Silva, J., additional, Viana, P., additional, Goncalves, A., additional, Barros, N., additional, Oliveira, C., additional, Sousa, M., additional, Barros, A., additional, Nelson, S. M., additional, Lloyd, S. M., additional, McConnachie, A., additional, Khader, A., additional, Fleming, R., additional, Lawlor, D. A., additional, Thuesen, L., additional, Andersen, A. N., additional, Loft, A., additional, Smitz, J., additional, Abdel-Rahman, M., additional, Ismail, S., additional, Silk, J., additional, Abdellah, M., additional, Abdellah, A. H., additional, Ruiz, F., additional, Cruz, M., additional, Piro, M., additional, Collado, D., additional, Garcia-Velasco, J. A., additional, Requena, A., additional, Kollmann, Z., additional, Bersinger, N. A., additional, McKinnon, B., additional, Schneider, S., additional, Mueller, M. D., additional, von Wolff, M., additional, Vaucher, A., additional, Weiss, B., additional, Stute, P., additional, Marti, U., additional, Chai, J., additional, Yeung, W. Y. T., additional, Lee, C. Y. V., additional, Li, W. H. R., additional, Ho, P. C., additional, Ng, H. Y. E., additional, Kim, S. M., additional, Kim, S. H., additional, Jee, B. C., additional, Ku, S., additional, Suh, C. S., additional, Choi, Y. M., additional, Kim, J. G., additional, Moon, S. Y., additional, Lee, J. H., additional, Kim, S. G., additional, Kim, Y. Y., additional, Kim, H. J., additional, Lee, K. H., additional, Park, I. H., additional, Sun, H. G., additional, Hwang, Y. I., additional, Sung, N. Y., additional, Choi, M. H., additional, Cha, S. H., additional, Park, C. W., additional, Kim, J. Y., additional, Yang, K. M., additional, Song, I. O., additional, Koong, M. K., additional, Kang, I. S., additional, Kim, H. O., additional, Haines, C., additional, Wong, W. Y., additional, Kong, W. S., additional, Cheung, L. P., additional, Choy, T. K., additional, Leung, P. C., additional, Fadini, R., additional, Coticchio, G., additional, Renzini, M. M., additional, Guglielmo, M. C., additional, Brambillasca, F., additional, Hourvitz, A., additional, Albertini, D. F., additional, Novara, P., additional, Merola, M., additional, Dal Canto, M., additional, Iza, J. A. A., additional, DePablo, J. L., additional, Anarte, C., additional, Domingo, A., additional, Abanto, E., additional, Barrenetxea, G., additional, Kato, R., additional, Kawachiya, S., additional, Bodri, D., additional, Kondo, M., additional, Matsumoto, T., additional, Maldonado, L. G. L., additional, Setti, A. S., additional, Braga, D. P. A. F., additional, Iaconelli, A., additional, Borges, E., additional, Iaconelli, C., additional, Figueira, R. C. S., additional, Kitaya, K., additional, Taguchi, S., additional, Funabiki, M., additional, Tada, Y., additional, Hayashi, T., additional, Nakamura, Y., additional, Snajderova, M., additional, Zemkova, D., additional, Lanska, V., additional, Teslik, L., additional, Calonge, R. N. -, additional, Ortega, L., additional, Garcia, A., additional, Cortes, S., additional, Guijarro, A., additional, Peregrin, P. C., additional, Bellavia, M., additional, Pesant, M. H., additional, Wirthner, D., additional, Portman, L., additional, de Ziegler, D., additional, Wunder, D., additional, Chen, X., additional, Chen, S. H. L., additional, Liu, Y. D., additional, Tao, T., additional, Xu, L. J., additional, Tian, X. L., additional, Ye, D. S. H., additional, He, Y. X., additional, Carby, A., additional, Barsoum, E., additional, El-Shawarby, S., additional, Trew, G., additional, Lavery, S., additional, Mishieva, N., additional, Barkalina, N., additional, Korneeva, I., additional, Ivanets, T., additional, Abubakirov, A., additional, Chavoshinejad, R., additional, Hartshorne, G. m., additional, Marei, W., additional, Fouladi-nashta, A. a., additional, Kyrkou, G., additional, Trakakis, E., additional, Chrelias, C. H., additional, Alexiou, E., additional, Lykeridou, K., additional, Mastorakos, G., additional, Bersinger, N., additional, Ferrero, H., additional, Gomez, R., additional, Garcia-Pascual, C. M., additional, Simon, C., additional, Pellicer, A., additional, Turienzo, A., additional, Lledo, B., additional, Guerrero, J., additional, Ortiz, J. A., additional, Morales, R., additional, Ten, J., additional, Llacer, J., additional, Bernabeu, R., additional, De Leo, V., additional, Focarelli, R., additional, Capaldo, A., additional, Stendardi, A., additional, Gambera, L., additional, Marca, A. L., additional, Piomboni, P., additional, Kim, J. J., additional, Kang, J. H., additional, Hwang, K. R., additional, Chae, S. J., additional, Yoon, S. H., additional, Ku, S. Y., additional, Iliodromiti, S., additional, Kelsey, T. W., additional, Anderson, R. A., additional, Lee, H. J., additional, Weghofer, A., additional, Kushnir, V. A., additional, Shohat-Tal, A., additional, Lazzaroni, E., additional, Barad, D. H., additional, Gleicher, N. N., additional, Shavit, T., additional, Shalom-Paz, E., additional, Fainaru, O., additional, Michaeli, M., additional, Kartchovsky, E., additional, Ellenbogen, A., additional, Gerris, J., additional, Vandekerckhove, F., additional, Delvigne, A., additional, Dhont, N., additional, Madoc, B., additional, Neyskens, J., additional, Buyle, M., additional, Vansteenkiste, E., additional, De Schepper, E., additional, Pil, L., additional, Van Keirsbilck, N., additional, Verpoest, W., additional, Debacquer, D., additional, Annemans, L., additional, De Sutter, P., additional, Von Wolff, M., additional, Bersinger, N. a., additional, Verit, F. F., additional, Keskin, S., additional, Sargin, A. K., additional, Karahuseyinoglu, S., additional, Yucel, O., additional, Yalcinkaya, S., additional, Comninos, A. N., additional, Jayasena, C. N., additional, Nijher, G. M. K., additional, Abbara, A., additional, De Silva, A., additional, Veldhuis, J. D., additional, Ratnasabapathy, R., additional, Izzi-Engbeaya, C., additional, Lim, A., additional, Patel, D. A., additional, Ghatei, M. A., additional, Bloom, S. R., additional, Dhillo, W. S., additional, Colodron, M., additional, Guillen, J. J., additional, Garcia, D., additional, Coll, O., additional, Vassena, R., additional, Vernaeve, V., additional, Pazoki, H., additional, Bolouri, G., additional, Farokhi, F., additional, Azarbayjani, M. A., additional, Alebic, M. S., additional, Stojanovic, N., additional, Abali, R., additional, Yuksel, A., additional, Aktas, C., additional, Celik, C., additional, Guzel, S., additional, Erfan, G., additional, Sahin, O., additional, Zhongying, H., additional, Shangwei, L., additional, Qianhong, M., additional, Wei, F., additional, Lei, L., additional, Zhun, X., additional, Yan, W., additional, De Baerdemaeker, A., additional, Tilleman, K., additional, Vansteelandt, S., additional, Oliveira, J. B. A., additional, Baruffi, R. L. R., additional, Petersen, C. G., additional, Mauri, A. L., additional, Nascimento, A. M., additional, Vagnini, L., additional, Ricci, J., additional, Cavagna, M., additional, Massaro, F. C., additional, Pontes, A., additional, Franco, J. G., additional, El-khayat, W., additional, Elsadek, M., additional, Foroozanfard, F., additional, Saberi, H., additional, Moravvegi, A., additional, Kazemi, M., additional, Gidoni, Y. S., additional, Raziel, A., additional, Friedler, S., additional, Strassburger, D., additional, Hadari, D., additional, Kasterstein, E., additional, Ben-Ami, I., additional, Komarovsky, D., additional, Maslansky, B., additional, Bern, O., additional, Ron-El, R., additional, Izquierdo, M. P., additional, Araico, F., additional, Somova, O., additional, Feskov, O., additional, Feskova, I., additional, Bezpechnaya, I., additional, Zhylkova, I., additional, Tishchenko, O., additional, Oguic, S. K., additional, Baldani, D. P., additional, Skrgatic, L., additional, Simunic, V., additional, Vrcic, H., additional, Rogic, D., additional, Juras, J., additional, Goldstein, M. S., additional, Garcia De Miguel, L., additional, Campo, M. C., additional, Gurria, A., additional, Alonso, J., additional, Serrano, A., additional, Marban, E., additional, Shalev, L., additional, Yung, Y., additional, Yerushalmi, G., additional, Giovanni, C., additional, Has, J., additional, Maman, E., additional, Monterde, M., additional, Marzal, A., additional, Vega, O., additional, Rubio, J. m., additional, Diaz-Garcia, C., additional, Eapen, A., additional, Datta, A., additional, Kurinchi-selvan, A., additional, Birch, H., additional, Lockwood, G. M., additional, Ornek, M. C., additional, Ates, U., additional, Usta, T., additional, Goksedef, C. P., additional, Bruszczynska, A., additional, Glowacka, J., additional, Jaguszewska, K., additional, Oehninger, S., additional, Nelson, S., additional, Verweij, P., additional, Stegmann, B., additional, Ando, H., additional, Takayanagi, T., additional, Minamoto, H., additional, Suzuki, N., additional, Rubinshtein, N., additional, Saltek, S., additional, Demir, B., additional, Dilbaz, B., additional, Demirtas, C., additional, Kutteh, W., additional, Shapiro, B., additional, Witjes, H., additional, Gordon, K., additional, Lauritsen, M. P., additional, Pinborg, A., additional, Freiesleben, N. L., additional, Mikkelsen, A. L., additional, Bjerge, M. R., additional, Chakraborty, P., additional, Goswami, S. K., additional, Chakravarty, B. N., additional, Mittal, M., additional, Bajoria, R., additional, Narvekar, N., additional, Chatterjee, R., additional, Bentzen, J. G., additional, Johannsen, T. H., additional, Scheike, T., additional, Friis-Hansen, L., additional, Sunkara, S., additional, Coomarasamy, A., additional, Faris, R., additional, Braude, P., additional, Khalaf, Y., additional, Makedos, A., additional, Masouridou, S., additional, Chatzimeletiou, K., additional, Zepiridis, L., additional, Mitsoli, A., additional, Lainas, G., additional, Sfontouris, I., additional, Tzamtzoglou, A., additional, Kyrou, D., additional, Lainas, T., additional, Fermin, A., additional, Crisol, L., additional, Exposito, A., additional, Prieto, B., additional, Mendoza, R., additional, Matorras, R., additional, Louwers, Y., additional, Lao, O., additional, Kayser, M., additional, Palumbo, A., additional, Sanabria, V., additional, Rouleau, J. P., additional, Puopolo, M., additional, Hernandez, M. J., additional, Rubio, J. M., additional, Ozturk, S., additional, Sozen, B., additional, Yaba-Ucar, A., additional, Mutlu, D., additional, Demir, N., additional, Olsson, H., additional, Sandstrom, R., additional, Grundemar, L., additional, Papaleo, E., additional, Corti, L., additional, Rabellotti, E., additional, Vanni, V. S., additional, Potenza, M., additional, Molgora, M., additional, Vigano, P., additional, Candiani, M., additional, Fernandez-Sanchez, M., additional, Bosch, E., additional, Visnova, H., additional, Barri, P., additional, Fauser, B. J. C. M., additional, Arce, J. C., additional, Peluso, P., additional, Trevisan, C. M., additional, Fonseca, F. A., additional, Bakas, P., additional, Vlahos, N., additional, Hassiakos, D., additional, Tzanakaki, D., additional, Gregoriou, O., additional, Liapis, A., additional, Creatsas, G., additional, Adda-Herzog, E., additional, Steffann, J., additional, Sebag-Peyrelevade, S., additional, Poulain, M., additional, Benachi, A., additional, Fanchin, R., additional, Zhang, D., additional, Aybar, F., additional, Temel, S., additional, Hamdine, O., additional, Macklon, N. S., additional, Laven, J. S., additional, Cohlen, B. J., additional, Verhoeff, A., additional, van Dop, P. A., additional, Bernardus, R. E., additional, Oosterhuis, G. J. E., additional, Holleboom, C. A. G., additional, van den Dool-Maasland, G. C., additional, Verburg, H. J., additional, van der Heijden, P. F. M., additional, Blankhart, A., additional, Fauser, B. C. J. M., additional, Broekmans, F. J., additional, Bhattacharya, J., additional, Mitra, A., additional, Dutta, G. B., additional, Kundu, A., additional, Bhattacharya, M., additional, Kundu, S., additional, Pigny, P., additional, Dassonneville, A., additional, Catteau-Jonard, S., additional, Decanter, C., additional, Dewailly, D., additional, Pouly, J., additional, Olivennes, F., additional, Massin, N., additional, Celle, M., additional, Caizergues, N., additional, Gaudoin, M., additional, Messow, M., additional, Vanhove, L., additional, Peigne, M., additional, Thomas, P., additional, and Robin, G., additional

Published
2013
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18. Patient use of a self‐monitoring app during eating disorder treatment: Naturalistic longitudinal cohort study

Author

Pil Lindgreen, Kirsten Lomborg, and Loa Clausen

Subjects
eating disorders, smartphone, anorexia, bulimia, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Abstract Objective To explore patients’ use of the self‐monitoring app Recovery Record during 26 weeks of naturalistic eating disorder treatment. Methods Selected patient characteristics at baseline were explored as predictors of app use using linear regression. Patients were grouped according to diagnosis (anorexia versus bulimia), and mixed‐effects analyses were used to explore differences in app use between diagnoses across four time periods (weeks 1–4; weeks 5–8; weeks 9–12; weeks 13–26). Results Eighty‐four patients were included of which 41 had anorexia and 43 had bulimia. The total number of logs varied greatly (mean (SD): 592 (628.50)), and patient app activity almost ceased at week 13. Increasing age and no previous eating disorder treatment predicted increased app activity (p = .007; p = .039, respectively). Patients with anorexia logged over four times more often than patients with bulimia in the last time period (median (CI): 4.27 (1.28;14.31); p = .018). Time predicted declining app use (all p ≤ .007). Conclusion Future research on long‐term app engagement should investigate associations between patients’ app use and changes in their eating disorder symptom severity over time.

Published
2021
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19. Belgium, Kingdom of

Author

Decavele, Johan, primary, Tyghem, Frieda van, additional, Cleven, Jean van, additional, Smeyers, M., additional, Vlieghe, Hans, additional, Vanbergen, J., additional, Klinckaert, J. W., additional, Jacobs, Lynn F., additional, Lawrence, Cynthia, additional, Lettens, Hugo, additional, Pil, L., additional, Vandenberghe, Stéphane, additional, Lombaerde-Fabri, Ria, additional, Dumortier, Claire, additional, Jottrand, Mireille, additional, Verhoeven, Isabelle, additional, Schroder, Timothy, additional, Ren, Leo de, additional, Daenens, Lieven, additional, Hornsby, Peter, additional, Hemeldonck, G. van, additional, Duverger, Erik, additional, Wardle, Patricia, additional, Umans, Marc, additional, Todts, Herwig, additional, Morel-Deckers, Yolande, additional, Verpoest, Luc, additional, and Willis, Alfred, additional

Published
2003
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20. Establishing a method to estimate the cost-effectiveness of a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The Toy Box-study.

Author

Pil, L., Putman, K., Cardon, G., De Bourdeaudhuij, I., Manios, Y., Androutsos, O., Lateva, M., Iotova, V., Zych, K., Góźdź, M., González‐Gil, E. M., De Miguel‐Etayo, P., Geyer, C., Birnbaum, J., and Annemans, L.

Subjects
*CONTINGENT fees, *WEIGHT-based pricing, *EXTERNALITIES, *OBESITY complications, *WEIGHT loss, *OVERWEIGHT persons, *PREVENTION
Abstract

Overweight and obesity in children are recognized as a major health problem. The Toy Box-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the Toy Box-intervention. In order to estimate the long-term impact of the Toy Box-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the Toy Box-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the Toy Box-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers. [ABSTRACT FROM AUTHOR]

Published
2014
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23. Impact of altering the invitation package on screening participation among never-screeners in the Flemish population-based cancer screening programs.

Author

Kellen E, Meers Z, Pil L, and Goossens MC

Subjects
Female, Humans, Early Detection of Cancer, Mammography, Cervix Uteri, Mass Screening methods, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms prevention & control, Breast Neoplasms diagnosis, Breast Neoplasms prevention & control
Abstract

Background: The total coverage of both the Flemish breast cancer and cervical screening program remain suboptimal, with approximately 63% for both. Of all the women invited to the breast cancer screening program, 14.1% never underwent any type of breast cancer screening (any type of mammogram, ultrasound, or clinical breast examination). For the cervical cancer screening, this proportion of 'never-screeners' is 12.1%. We conducted two randomized controlled trials to assess whether various communication and presentation styles in the invitation package, were effective at motivating women who had never participated to attend., Methods: The study population was limited to never-screeners (women who had never participated in the screening program). The RCT embedded in the breast cancer screening consisted of seven intervention arms and one control arm (all of them included a fixed appointment by letter). The RCT embedded in the cervical cancer screening consisted of three intervention arms and two control arms. In both RCTs, several content and style adaptations were made to the invitation letter, information leaflet, and envelope., Results: None of the intervention arms in either the breast cancer screening or the cervical cancer screening had a statistically significant impact on the participation rate compared to 'usual care' (the regular invitation package used in the screening program)., Conclusion: Sending adapted invitation packages to never-screeners, from the Flemish breast and cervical cancer screening program, does not seem to be effective in increasing the proportion of women screened. Innovative methods are needed to motivate never-screeners to be screened., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2024
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24. Methodology of the health economic evaluation of the Feel4Diabetes-study.

Author

Willems R, Pil L, Lambrinou CP, Kivelä J, Wikström K, Gonzalez-Gil EM, De Miguel-Etayo P, Nánási A, Semánová C, Van Stappen V, Cardon G, Tsochev K, Iotova V, Chakarova N, Makrilakis K, Dafoulas G, Timpel P, Schwarz P, Manios Y, and Annemans L

Subjects
Adult, Child, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 etiology, Diet, Europe epidemiology, Exercise, Family, Female, Health Promotion economics, Health Promotion methods, Health Promotion organization & administration, Health Promotion standards, Healthy Lifestyle, Humans, Life Style, Male, Preventive Health Services organization & administration, Risk Factors, Surveys and Questionnaires, Cost-Benefit Analysis methods, Diabetes Mellitus, Type 2 prevention & control, Preventive Health Services economics, Preventive Health Services methods
Abstract

Background: The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus., Methods: The aim of this paper is to describe the detailed methodology of the intervention's cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention's value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only., Conclusions: The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources.

Published
2020
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25. Cost-effectiveness and Budget Effect Analysis of a Population-Based Skin Cancer Screening.

Author

Pil L, Hoorens I, Vossaert K, Kruse V, Tromme I, Speybroeck N, Annemans L, and Brochez L

Abstract

Importance: Several epidemiological studies show an alarming global increase in incidence of melanoma and nonmelanoma skin cancer., Objectives: To examine the cost-effectiveness of 2 population-based skin cancer screening methods and to assess their budget effect and the influence on skin cancer epidemiological findings., Design, Setting, and Participants: A Markov model with a latent period of 20 years and a time horizon of 50 years was used to analyze the cost-effectiveness (societal perspective) and budget effect (public health care payer perspective) of 2 population-based skin cancer screening programs in Belgium compared with the absence of a screening program. A health economic analysis was based on a clinical trial performed in 2014 in Belgium. In the economic model, the total Belgian population 18 years or older was assumed to have been invited for the screening program., Main Outcomes and Measures: The influence of the screening program on skin cancer epidemiological findings and the cost per quality-adjusted life-year (QALY) gained, as well as the budget effect, expressed as the net costs for the health care payer over 50 years., Results: All participants (1668 total-body skin examination [TBSE] and 248 lesion-directed screening [LDS]) were screened by a team of 6 dermatologists from March 14 to 18, 2014, for TSBE and April 22 and 25 to 27, 2014, for LDS. Both screening strategies produced a gain in QALYs, resulting in incremental cost-effectiveness ratios of €33 072 (US $35 475) per QALY in men and €18 687 (US $20 044) per QALY in women for TBSE and €34 836 (US $37 365) per QALY in men and €19 470 (US $20 884) per QALY in women for LDS. With a 1-time screening, a 4.0% decrease in the incidence rates of stage III and IV melanoma was predicted at the population level relative to the comparator. The budget effect analysis demonstrated that during 20 years, a 1-time screening would incur a net cost for the health care payer of almost €36 million (US $38.6 million) for TBSE or just over €6 million (US $6.4 million) for LDS (€4.1 [US $4.40] or €0.7 [US $0.80], respectively, per adult)., Conclusions and Relevance: These results can be interpreted as cost-effective at a willingness-to-pay threshold in Belgium of €35 000 (US $37 541) per QALY gained. Based on these findings, a 1-time TBSE in the general adult population 18 years or older is the most cost-effective strategy and is predicted to result in a reduction of skin cancer mortality over 20 years and 50 years. The cost-effectiveness for skin cancer screening is higher in women than in men.

Published
2017
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26. Burden of skin cancer in Belgium and cost-effectiveness of primary prevention by reducing ultraviolet exposure.

Author

Pil L, Hoorens I, Vossaert K, Kruse V, Tromme I, Speybroeck N, Brochez L, and Annemans L

Subjects
Belgium epidemiology, Cost Savings, Cost of Illness, Humans, Melanoma economics, Melanoma mortality, Melanoma prevention & control, Primary Prevention methods, Quality-Adjusted Life Years, Retrospective Studies, Skin Neoplasms epidemiology, Skin Neoplasms mortality, Sunburn prevention & control, Cost-Benefit Analysis economics, Primary Prevention economics, Skin Neoplasms economics, Skin Neoplasms prevention & control, Ultraviolet Rays adverse effects
Abstract

Skin cancer (melanoma- and non-melanoma skin cancer) is one of the most rapidly increasing cancers worldwide. This study analysed the current and future economic burden of skin cancer in Belgium and the cost-effectiveness of primary prevention of skin cancer. A retrospective bottom-up cost-of-illness study was performed, together with a Markov model in order to analyse the cost-effectiveness and the budget impact analysis of primary prevention of skin cancer in Belgium. Total prevalence of skin cancer in Belgium was estimated to triple in the next 20years. The total economic burden of skin cancer in 2014 in Belgium was estimated at €106 million, with a cumulative cost of €3 billion in 2034. The majority of this total cost was due to melanoma (65%). Over a period of 50years, both a sensitisation campaign and a total ban on sunbed use would lead to a gain in quality-adjusted life-years and cost-savings. For every euro invested in the campaign, €3.6 would be saved on the long-term for the healthcare payer. Policy makers and clinicians should promote UV protection strategies, as they were estimated to be dominant strategies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Published
2016
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27. Total-Body Examination vs Lesion-Directed Skin Cancer Screening.

Author

Hoorens I, Vossaert K, Pil L, Boone B, De Schepper S, Ongenae K, Annemans L, Chevolet I, and Brochez L

Subjects
Adult, Aged, Belgium, Carcinoma, Basal Cell diagnosis, Carcinoma, Basal Cell epidemiology, Carcinoma, Basal Cell pathology, Carcinoma, Squamous Cell diagnosis, Carcinoma, Squamous Cell epidemiology, Carcinoma, Squamous Cell pathology, Cost-Benefit Analysis, Cross-Sectional Studies, Early Detection of Cancer economics, Female, Humans, Male, Mass Screening economics, Melanoma diagnosis, Melanoma epidemiology, Melanoma pathology, Middle Aged, Physical Examination economics, Predictive Value of Tests, Skin Neoplasms epidemiology, Skin Neoplasms pathology, Early Detection of Cancer methods, Mass Screening methods, Physical Examination methods, Skin Neoplasms diagnosis
Abstract

Importance: Skin cancer is the most frequent cancer type. It remains unknown if and how screening programs can be organized in a cost-effective manner., Objective: To compare the 2 screening strategies of systematic total-body examination (TBE) and lesion-directed screening (LDS), with a focus on the participation rate, detection rate, anxiety, and cost., Design, Setting, and Participants: Population-based cross-sectional screenings by a team of 6 dermatologists were organized in 2 sociodemographically similar regions. The TBE was organized in a community of 9325 inhabitants 18 years and older (Wichelen, East Flanders, Belgium) during a 5-day screening (March 14-18, 2014). The LDS was organized in a sociodemographically comparable community (Nevele, East Flanders, Belgium) of 9484 adult inhabitants during a 4-day screening (April 22 and 25-27, 2014). The first population received a personal invitation for a standard TBE. In the second population, individuals were invited for an LDS if they had a lesion meeting 1 or more of the following criteria: ABCD rule (A, asymmetry; B, borders; C, colors; and D, differential structures), ugly duckling sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions., Main Outcomes and Measures: In total, 1982 individuals were screened, and 47 skin cancers (2.4%) were histologically confirmed, including 9 melanomas (0.5%), 37 basal cell carcinomas (1.9%), and 1 squamous cell carcinoma or Bowen disease (0.1%)., Results: The positive predictive value for all suspicious lesions was 56.6% (47 of 83). The participation rate was 17.9% (1668 of 9325) in the TBE group vs 3.3% (314 of 9484) in the LDS group (P < .01). The skin cancer detection rate per 100 participants did not differ significantly between the 2 groups, with rates of 2.3% (39 of 1668) in the TBE group vs 3.2% (8 of 248) in the LDS group (P = .40). The operational effectiveness per 100 invitees was 0.4% (39 of 9325) in the TBE group vs 0.1% (8 of 9484) in the LDS group (P < .01). In addition, LDS was 5.6 times less time consuming than TBE. Participants in the LDS group had significantly higher baseline anxiety levels compared with participants in the TBE group (3.7 vs 3.3 points on a visual analog scale, P < .01). In screenees without a suspicious lesion, anxiety levels significantly dropped after screening., Conclusions and Relevance: Total-body examination yielded a higher absolute number of skin cancers. Lesion-directed screening had a similar detection rate of 3.2% (8 of 248) but was 5.6 times less time consuming. When performed by dermatologists, LDS is an acceptable alternative screening method in health care systems with limited budgets or long waiting lists.

Published
2016
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28. Cost-effectiveness of a helpline for suicide prevention.

Author

Pil L, Pauwels K, Muijzers E, Portzky G, and Annemans L

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Belgium, Child, Cost-Benefit Analysis, Female, Health Care Costs, Humans, Male, Middle Aged, Preventive Health Services economics, Quality of Life, Suicide economics, Young Adult, Hotlines economics, Preventive Health Services methods, Suicide Prevention
Abstract

We evaluated the cost-effectiveness and budget impact of a suicide helpline in Belgium, consisting of a telephone- and a chat service. An age- and gender-dependent Markov model with a ten-year time horizon and a one-year cycle length was developed, assuming a societal perspective, to predict cumulative costs and quality-adjusted life-years (QALYs) in the helpline users. The model included six transition states: the initial state (at risk), first attempt, re-attempt, follow-up, suicide and death from other causes. Data on the effect of the helpline and costs associated with model states were obtained from the literature. One-way and probabilistic sensitivity analyses were performed to capture uncertainty. In addition, the budget impact of the helpline was analysed. Over ten years, the telephone- as well as the chat service could avoid about 36% of suicides and attempts in this high-risk population. In males, 0.063 QALYs (95% confidence interval, CI 0.030-0.097) and 0.035 QALYs (95%CI -0.026-0.096) were gained by users of the telephone- and chat service respectively. The corresponding values for females were 0.019 QALYs (95%CI -0.015-0.052) and a QALY-neutral result of -0.005 (95%CI -0.071-0.062). There were net societal savings of respectively €2382 (95%CI 1953-2859) and €2282 (95%CI 1855-2758) in male users; €2171 (95%CI 1735-2664) and €2458 (95%CI 1945-3025) in female users. At the population level, an investment of €218,899 saved €1,452,022 for the public health service (national health insurance), mainly due to the telephone service. The analysis predicted that both means of telemedicine for suicide prevention in Flanders are cost-saving, and have a modest effect on QALYs.

Published
2013
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