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Anticoagulants in non-valvular atrial fibrillation
No full text195 p.ill.,LIST OF FIGURES 6 -- LIST OF TABLES 8 -- LIST OF ABBREVIATIONS 10 -- SCIENTIFIC REPORT 12 -- 1 AIMS 12 -- 2 INTRODUCTION 13 -- 3 BACKGROUND 13 -- 3 1 ANTITHROMBOTICS13 -- 3 3 STROKE RISK ASSESSMENT IN ATRIAL FIBRILLATION 14 -- 3 4 STROKE PREVENTION IN ATRIAL FIBRILLATION 19 -- 3 4 1 Vitamin K antagonists 19 -- 3 4 2 Antiplatelets 19 -- 3 4 3 Combination therapy of anticoagulants and antiplatelets 20 -- 3 4 4 Novel Oral AntiCoagulants (NOACs) 20 -- 3 5 BLEEDING RISK INDUCED BY VITAMIN K ANTAGONISTS 21 -- 4 EFFICACY AND SAFETY OF NOACS 23 -- 4 1 SEARCH STRATEGY 23 -- 4 2 SYSTEMATIC REVIEWS 25 -- 4 3 PRIMARY STUDIES 26 -- 4 3 1 Ximelagatran 26 -- 4 3 2 Dabigatran 26 -- 4 3 3 Rivaroxaban 27 -- 4 3 4 Apixaban 28 -- 4 3 5 Edoxaban 28 -- 4 3 6 Summary table 28 -- 4 4 SAFETY OF NOACS 30 -- 4 5 RISK OF BIAS IN PIVOTAL RCTS 31 -- 4 6 INTERNATIONAL PRACTICE GUIDELINES 32 -- 5 REIMBURSEMENT OF ANTICOAGULANTS IN BELGIUM 35 -- 6 ADHERENCE TO ANTICOAGULATION GUIDELINES IN PRACTICE 37 -- 6 1 PHYSICIANS’ ADHERENCE TO GUIDELINES 37 -- 6 1 1 Literature search 37 -- 6 1 2 Systematic reviews 38 -- 6 1 3 AF patient registries 38 -- 6 2 PHYSICIANS’ ADHERENCE TO APPROPRIATE DOSE PRESCRIPTION 42 -- 6 2 1 VKA dosing 42 -- 6 2 2 NOAC dosing 42 -- 6 3 PATIENTS’ ADHERENCE TO ANTICOAGULANT PRESCRIPTION 43 -- 7 CLINICAL USE OF ANTICOAGULANTS IN NON-VALVULAR AF: DISCUSSION 45 -- 7 1 STROKE RISK ASSOCIATED WITH AF, VERSUS BLEEDING RISK ASSOCIATED WITH ANTICOAGULANTS 45 -- 7 1 1 Undertreatment in high risk populations with a CHA2DS2-VASc risk score of ≥2 (♂) or ≥3 (♀) 47 -- 7 1 2 Overtreatment in low risk populations with a CHA2DS2-VASc risk score of 0 (or 1 in ♀ with no additional risk factors)47 -- 7 1 3 Anticoagulation in patients with a CHA2DS2-VASc risk score of 1 (♂) or 2 (♀) 47 -- 7 1 4 Patients’ adherence to anticoagulants 47 -- 7 2 NEW ORAL ANTICOAGULANTS VS VITAMIN K ANTAGONISTS 48 -- 7 2 1 Effect of NOACs versus VKAs on stroke 48 -- 7 2 2 Effect of NOACs versus VKAs on bleeding 48 -- 7 2 3 Drug monitoring and compliance to treatment 49 -- 8 COST-EFFECTIVENESS OF NOACS 50 -- 8 1 INTRODUCTION 50 -- 8 2 METHODS 50 -- 8 2 1 Literature review 50 -- 8 2 2 Selection process 50 -- 8 3 RESULTS 53 -- 8 3 1 Overview of economic evaluations 53 -- 8 3 2 Type of economic evaluation 57 -- 8 3 3 Time frame and discounting 58 -- 8 3 4 Perspective 58 -- 8 3 5 Population 58 -- 8 3 6 Intervention and comparator 59 -- 8 3 7 Cost and outcome inputs 59 -- 8 3 8 Industry sponsorship 59 -- 8 3 9 Costs 60 -- 8 3 10 Incremental Cost-effectiveness Ratios (ICERs) 78 -- 8 3 11 Sensitivity Analyses 84 -- 8 3 12 Subgroup Analyses 84 -- 8 3 13 Studies in Belgium 85 -- 8 3 14 NICE Health Technology Assessments 91 -- 8 4 DISCUSSION AND CONCLUSIONS 91 -- 8 4 1 Use of adapted models 91 -- 8 4 2 Assumptions and sources of data 92 -- 8 4 3 Conflict of interests 92 -- 8 4 4 Relevance to Belgian healthcare system 92 -- 8 4 5 Conclusions 92 -- 9 FLEMISH GENERAL PRACTITIONERS’ DATA 94 -- 9 1 INTRODUCTION 94 -- 9 2 METHODOLOGY 95 -- 9 2 1 Description of the Intego database 95 -- 9 2 2 Clinical research questions 95 -- 9 2 3 Patient selection 95 -- 9 2 4 Definition of clinical variables and medications 97 -- 9 2 5 Statistical analysis 100 -- 9 3 RESULTS 101 -- 9 3 1 Prescription of oral anticoagulants in general practice in the general population and validation of proxies for the CHA2DS2-VASc and CHADS2 scores (part 1) 101 -- 9 3 2 Trends in prescriptions of OACs in general practice in people with atrial fibrillation (part 2) 107 -- 9 4 CONCLUSIONS 125 -- 9 4 1 Prescription of oral anticoagulants in general practice in the general population and validation of proxies for the CHA2DS2-VASc and CHADS2 scores (part 1) 125 -- 9 4 2 Trends in prescriptions of oral anticoagulants in general practice in people with atrial fibrillation (part 2) 125 -- 10 ANALYSIS OF BELGIAN DATA 126 -- 10 1 INTRODUCTION 126 -- 10 2 METHODS 126 -- 10 2 1 General Methodology 126 -- 10 3 DATA LIMITATIONS 128 -- 10 4 RESULTS 128 -- 10 4 1 Evolution over time 128 -- 10 4 2 Profile of the anticoagulant users 132 -- 10 5 DISCUSSION 145 -- 11 FINAL CONCLUSION147 -- 11 1 TO ANTICOAGULATE OR NOT? 147 -- 11 1 1 Risk of stroke risk associated with non-valvular AF 147 -- 11 1 2 Net clinical benefit of anticoagulants 147 -- 11 1 3 Overdiagnosis and oveartreatment 148 -- 11 1 4 Undertreatment 148 -- 11 2 VKA OR NOAC? 149 -- 11 2 1 Advantages of NOACs versus VKAs 149 -- 11 2 2 Disadvantages of NOACs versus VKAs 149 -- 11 2 3 VKA or NOAC: KCE’s conclusion 150 -- 11 3 TRENDS IN ANTICOAGULANT PRESCRIPTION 151 -- APPENDICES 152 -- APPENDIX 1 RCTS COMPARING NOACS WITH VKA IN NON-VALVULAR AF 152 -- APPENDIX 2 LITERATURE SEARCH FOR EFFICACY OF NOAC 153 -- APPENDIX 3 SUMMARY OF FINDINGS TABLES 157 -- APPENDIX 4 META-ANALYSES OF ISCHEMIC STROKE RISK BY CHA2DS2-VASC SCORE 164 -- APPENDIX 5 SYSTEMATIC REVIEWS ON INAPPROPRIATE USE OF ORAL ANTICOAGULANTS 166 -- APPENDIX 6 SEARCH STRATEGIES FOR C-E CHAPTER 172 -- APPENDIX 7 APPENDICES TO FLEMISH GPS’ DATA 174 -- APPENDIX 8 APPENDICES TO BELGIAN IMA DATA 184 -- REFERENCES 18
The role of biomarkers in ruling out cerebral lesions in mild cranial trauma : Synthesis
No full text16 p.ill.
Use of pneumococcal vaccines in the elderly : an economic evaluation
No full text158 p.ill.,1 INTRODUCTION 14 -- 1.1 PNEUMOCOCCAL DISEASE IN THE ELDERLY 14 -- 1.2 PNEUMOCOCCAL VACCINATION OF THE ELDERLY 14 -- 1.2.1 Pneumococcal vaccines 14 -- 1.2.2 Belgian recommendations 15 -- 1.2.3 Economic and ethical implications 17 -- 1.3 INDIRECT EFFECT FROM INFANT VACCINATION 17 -- 1.4 RESEARCH QUESTIONS 17 -- 2 BURDEN OF PNEUMOCOCCAL DISEASE IN THE ELDERLY 19 -- 2.1 INCIDENCE OF PNEUMOCOCCAL DISEASE 19 -- 2.1.1 Hospitalised invasive pneumococcal disease 19 -- 2.1.2 Hospitalised non-invasive pneumococcal disease 20 -- 2.1.3 Outpatient non-invasive pneumococcal disease 21 -- 2.2 MORTALITY DUE TO PNEUMOCOCCAL DISEASE 24 -- 2.2.1 Mortality due to invasive pneumococcal disease 24 -- 2.2.2 Mortality due to hospitalised non-invasive pneumococcal disease 25 -- 2.2.3 Mortality due to outpatient pneumococcal pneumonia 27 -- 2.3 LONG TERM CONSEQUENCES FOLLOWING MENINGITIS AND EMPYEMA 29 -- 2.3.1 Pneumococcal meningitis 29 -- 2.3.2 Pneumococcal empyema 29 -- 2.3.3 Conclusions 31 -- 2.4 SEROTYPE DISTRIBUTION 32 -- 2.4.1 In invasive pneumococcal disease 32 -- 2.4.2 In non-invasive pneumococcal disease 33 -- 2.4.3 Conclusions for parameters 37 -- 2.5 HEALTH UTILITIES 37 -- 2.5.1 Results of the literature review 37 -- 2.5.2 Selection of utility values for the Belgian economic evaluation 40 -- 2.6 COSTS OF PNEUMOCOCCAL DISEASE 41 -- 2.6.1 Cost of hospitalised episodes of pneumococcal disease 41 -- 2.6.2 Cost of outpatient pneumococcal CAP 42 -- 3 INDIRECT EFFECT OF INFANT PCV VACCINATION ON ADULT DISEASE 43 -- 3.1 INDIRECT EFFECT OF PCV13 VACCINATION 43 -- 3.1.1 PCV13 indirect effect on IPD 43 -- 3.1.2 PCV13 indirect effect on pneumococcal pneumonia 45 -- 3.2 INDIRECT EFFECT OF PCV10 VACCINATION 45 -- 3.2.1 PCV10 indirect effect on IPD 45 -- 3.2.2 PCV10 indirect effect on non-invasive pneumococcal pneumonia 46 -- 4 PNEUMOCOCCAL VACCINES IN ADULTS 47 -- 4.1 EFFICACY AND EFFECTIVENESS OF THE 13-VALENT CONJUGATE VACCINE 47 -- 4.1.1 Invasive pneumococcal disease 47 -- 4.1.2 Pneumococcal community acquired pneumonia 47 -- 4.1.3 Effect of age on efficacy 49 -- 4.1.4 Effect of comorbidities on efficacy 49 -- 4.2 EFFICACY AND EFFECTIVENESS OF THE 23-VALENT POLYSACCHARIDE VACCINE 50 -- 4.2.1 Invasive pneumococcal disease 50 -- 4.2.2 Community acquired pneumonia 54 -- 4.3 DURATION OF VACCINE PROTECTION 56 -- 4.3.1 PCV13 duration of protection 56 -- 4.3.2 PPV23 duration of protection 57 -- 4.4 SELECTION OF EFFICACY PARAMETERS 58 -- 4.4.1 PCV13 58 -- 4.4.2 PPV23 59 -- 4.4.3 Comparison between PCV13 and PPV23 protection 60 -- 4.4.4 Main limitations of this review 60 -- 4.5 VACCINE SAFETY 61 -- 4.5.1 Safety of PCV13 61 -- 4.5.2 Safety of PPV23 61 -- 4.5.3 Comparative PPV23-PCV13 safety studies 62 -- 4.6 VACCINATION UPTAKE IN ADULTS 63 -- 4.7 COST OF VACCINE AND VACCINE ADMINISTRATION 63 -- 5 METHODS FOR ECONOMIC EVALUATION 64 -- 5.1 MODEL AND ANALYTICAL DESCRIPTION 64 -- 5.2 OUTCOMES AND COMPARATORS 66 -- 5.3 PERSPECTIVE, TIME HORIZON, DISCOUNTING 66 -- 5.4 UNCERTAINTY ANALYSIS 67 -- 5.4.1 Probabilistic sensitivity analysis 67 -- 5.5 VACCINATION SCENARIOS TO COMPARE 67 -- 6 SUMMARY OF INPUT DATA FOR ECONOMIC EVALUATION 69 -- 6.1 GENERAL OVERVIEW OF INPUT PARAMETERS 69 -- 6.2 VACCINE EFFICACY PARAMETERS 73 -- 6.2.1 PCV13 vaccine efficacy over time 73 -- 6.2.2 PPV23 efficacy against non-invasive disease 74 -- 6.2.3 PPV23 vaccine efficacy over time 74 -- 6.3 INCIDENCES OF PNEUMOCOCCAL DISEASE 75 -- 6.3.1 Outpatient pneumococcal disease 75 -- 6.3.2 Hospitalised pneumococcal disease 75 -- 6.4 MORTALITY OF PNEUMOCOCCAL DISEASE 75 -- 6.5 COSTS OF PNEUMOCOCCAL DISEASE 76 -- 6.6 SEROTYPE COVERAGE AND SCENARIOS SEROTYPE REPLACEMENT SCENARIOS 77 -- 7 RESULTS 78 -- 7.1 CURRENT DISEASE BURDEN 78 -- 7.2 EFFECTIVENESS AND COST-EFFECTIVENESS ANALYSES 80 -- 7.2.1 Assuming fully parameterised efficacy for both PPV23 and PCV13 80 -- 7.2.2 Assuming fully parameterised efficacy for PCV13 and no protection against non-invasive CAP for PPV23 87 -- 7.2.3 Assuming no protection against non-invasive CAP from either PPV23 or PCV13 93 -- 7.3 SENSITIVITY AND SCENARIO ANALYSES 93 -- 7.3.1 Probabilistic sensitivity analysis 93 -- 7.3.2 Scenario and univariate sensitivity analysis 95 -- 7.3.3 Multivariate sensitivity analysis (MVSA) 104 -- 7.4 BUDGET-IMPACT ANALYSES 112 -- 8 DISCUSSION AND CONCLUSION 114 -- 8.1 BASED ON COST-EFFECTIVENESS, IF WE ARE TO USE (ONE OF) THESE VACCINES, HOW SHOULD WE DO THIS? 114 -- 8.2 BASED ON COST-EFFECTIVENESS, SHOULD WE USE PNEUMOCOCCAL VACCINES IN ALL ADULTS ≥50 YEARS AT ALL? 115 -- 8.3 LIMITATIONS 115 -- 8.4 FINDINGS FROM OTHER ECONOMIC EVALUATIONS 116 -- 8.5 CONCLUSIONS 11
Belrai suite of instruments : an exploratory study on applicability for individual care planning and budget allocation in rehabilitation care
No full text99 p.ill.,KEY MESSAGES 5 -- 2 GLOSSARY 6 -- 3 INTRODUCTION 6 -- 3.1 BELGIAN CONTEXT 7 -- 3.2 SCOPE OF THE REPORT.11 -- 3.2.1 Definition of rehabilitation.11 -- 3.2.2 Belgian rehabilitation patients and services 11 -- 3.2.3 Research questions 12 -- 3.3 METHODS 12 -- 4 INTERRAI SUITE OF INSTRUMENTS: APPLICABILITY IN REHABILITATION FOR INDIVIDUAL CARE PLANNING 13 -- 4.1 GENERAL INFORMATION ON INTERRAI SUITE OF INSTRUMENTS 13 -- 4.2 INTERRAI SUITE OF INSTRUMENTS IN REHABILITATION CARE 15 -- 4.2.1 Comparison interRAI suite of instruments versus ICF and FIM 15 -- 4.2.2 interRAI suite of instruments applicable in rehabilitation care patient populations? 17 -- 5 INTERRAI SUITE OF INSTRUMENTS: APPLICABILITY FOR BUDGET ALLOCATION 24 -- 5.1 DEFINITION AND ELEMENTS OF A CASE MIX REIMBURSEMENT SYSTEM 25 -- 5.1.1 General definition. 25 -- 5.1.2 Suitability of interRAI suite of instruments as case-mix reimbursement system 25 -- 5.2 DEVELOPMENT OF THE INTERRAI CASE MIX SYSTEM.26 -- 5.2.1 General process 26 -- 5.2.2 Registration of the resource use 27 -- 5.2.3 Validity analysis. 27 -- 5.3 IMPLEMENTATION OF THE INTERRAI CASE MIX REIMBURSEMENT SYSTEM 29 -- 5.4 APPLICATION OF THE INTERRAI CASE MIX REIMBURSEMENT SYSTEM IN BELGIUM.29 -- 5.4.1 Available evidence 30 -- 5.4.2 Preliminary budget allocation and eligibility for services 30 -- 5.4.3 Development of a BelRAI case mix reimbursement system 30 -- 6 OVERALL DISCUSSION AND CONCLUSION 31 -- 6.1 OVERALL DISCUSSION 31 -- 6.2 CONCLUSIONS 3
Organisation and payment of emergency care services in Belgium : current situation and options for reform - Supplement
No full text48 p.ill.,1 ANNEX TO CHAPTER 2 3 -- 2 ANNEX TO CHAPTER 3 7 -- 2.1 INAPPROPRIATE USE OF EMERGENCY DEPARTMENT: DEFINITION AND PREVALENCE7 -- 2.2 ECONOMIES OF SCALE 7 -- 2.3 IMPACT OF EMERGENCY DEPARTMENT CLOSURES8 -- 3 ANNEX TO CHAPTER 4 11 -- 3.1 SYSTEMATIC REVIEWS ON EMERGENCY CARE WORKFORCE ISSUES11 -- 4 ANNEX TO CHAPTER 6 12 -- 4.1 SYSTEMATIC REVIEWS ON TELEPHONE TRIAGE.12 -- 5 ANNEX TO CHAPTER 10 .13 -- 5.1 LIST OF EXPERTS13 -- 5.2 EXPERT SURVEY ON EMERGENCY CARE SERVICES IN SELECTED COUNTRIES.14 -- 5.2.1 Introduction .14 -- 5.2.2 Context 14 -- 5.2.3 Questionnaire.17 -- 6 ANNEX TO CHAPTER 10 .20 -- 6.1 SEARCH STRATEGY 20 -- 6.2 FULL AMSTAR EVALUATION.22 -- 6.3 EXTRACTION TABLES 2
Model for the organization and reimbursement of psychological and orthopedagogical care in Belgium
No full text107 p.ill.,1 INTRODUCTION 10 -- 2 OBJECTIVES AND METHODS 11 -- 3 THE LEGISLATIVE BELGIAN CONTEXT 13 -- 3.1 LAW OF 4 APRIL 2014 GOVERNING MENTAL HEALTH PROFESSIONS AND AMENDING ROYAL DECREE NO. 78 OF 10 NOVEMBER 1967 ON THE PRACTICE OF HEALTH PROFESSIONS 13 -- Legal framework on mental health.13 -- Reason for the Law of 4 April 2014 13 -- The development of the law 15 -- Analysis of the key provisions of the Law of 4 April 2014 15 -- Mental Health Council19 -- 3.2 RECENT EVOLUTIONS (JANUARY 2016).19 -- 4 CURRENT SITUATION OF MENTAL HEALTHCARE IN BELGIUM.20 -- 4.1 SOME CONCERNS ABOUT MENTAL HEALTH CARE IN BELGIUM21 -- 4.2 THE POSITION OF CLINICAL PSYCHOLOGISTS, CLINICAL ORTHOPEDAGOGISTS AND PSYCHOTHERAPISTS IN THE BELGIAN MENTAL HEALTH CARE SYSTEM21 -- ‘Centra voor geestelijke gezondheid’ (CGG) – ‘Services de santé mentale’ (SSM) 21 -- Various new initiatives 23 -- The 6th State Reform 26 -- 4.3 MENTAL HEALTHCARE PRACTITIONERS: REGULATION, EDUCATION AND WORK SETTING.26 -- Physicians 26 -- Clinical psychologists.27 -- Psychotherapists28 -- Clinical orthopedagogists 29 -- 4.4 CURRENT FINANCING OF AMBULATORY PSYCHOLOGICAL AND PSYCHOTHERAPY INTERVENTIONS 30 -- Financing of psychological and psychotherapeutic interventions delivered by physicians in ambulatory setting 30 -- 4.4.2 Financing for psychological and psychotherapeutic interventions delivered by psychologists or psychotherapists in ambulatory settings31 -- 4.4.3 Financing for psychological and psychotherapeutic interventions delivered in centres for mental health care (CGG – SSM) 32 -- 4.5 COST OF PSYCHOLOGISTS AND PSYCHOTHERAPISTS IN BELGIUM32 -- Current tariffs for a psychotherapist consultation 32 -- Cost of a psychologist in hospital setting 33 -- Cost of a psychologist in centres for mental healthcare 33 -- 5 INTERNATIONAL COMPARISON 34 -- 5.1 INTRODUCTION 34 -- Objective 34 -- Methods .34 -- Structure of the chapter .34 -- 5.2 THE MENTAL HEALTH CARE PRACTITIONERS 35 -- Regulated professions and functions in the mental health care system 35 -- Work settings .37 -- Education of the mental health practitioners 40 -- Roles of the mental healthcare practitioners .44 -- 5.3 PATIENT’S ACCESS TO REIMBURSED CLINICAL PSYCHOLOGY, PSYCHOTHERAPY AND CLINICAL ORTHOPEDAGOGY INTERVENTIONS44 -- Conditions for reimbursement44 Direct access versus referral systems 47 -- Reimbursed indications for psychological and psychotherapy interventions in ambulatory settings 50 -- Reimbursed psychotherapeutic treatments 52 -- Intensity of the reimbursed treatments 55 -- 5.4 PAYMENT FOR MENTAL HEALTH CARE SERVICES 57 -- Payment of mental health services in GP setting 60 -- Payment of mental health care workers in other ambulatory settings 60 -- Payment of mental health workers in secondary and tertiary settings 62 -- 5.5 QUALITY MANAGEMENT 62 -- 6 BELGIAN STAKEHOLDERS’ VIEWS ON THE ORGANIZATION AND THE REIMBURSEMENT 63 -- 6.1 INTRODUCTION 63 -- 6.2 METHODOLOGY.63 -- General design 63 -- Participants 63 -- Data collection 64 -- Analysis 65 -- 6.3 FINDINGS 65 -- Preliminary considerations.65 -- How to organize clinical psychology, clinical orthopedagogics and psychotherapy?66 -- How to finance clinical psychology, clinical orthopedagogics and psychotherapy in the context of the national health insurance? 69 -- How to support quality 72 -- Additional issues: 72 -- 6.4 CONCLUSION .72 -- 7 INTERMEDIARY RESULTS: TENTATIVE MODEL BASED ON, FOREIGN EXAMPLES AND STAKEHOLDER INTERVIEWS AND “EERSTE LIJNS PSYCHOLOGISCHE FUNCTIE PROJECTEN” 74 -- 7.1 A SYSTEM WITH TWO COMPONENTS.74 -- First line care accessible to all 74 -- A second line of more specialized care for the people who need it, regulated through a gatekeeping 77 -- 7.2 REIMBURSEMENT OF THE PSYCHOLOGY/ORTHOPEDAGOGY CARE 79 -- 8 TEST OF THE TENTATIVE MODEL TO ORGANIZE ACCES TO PSYCHOLOGICAL (AND ORTHOPEDAGOGIC) CARE IN BELGIUM AMONG STAKEHOLDERS 80 -- 8.1 METHODOLOGY.80 -- Design80 -- Participants 80 -- Data collection tools 80 -- 8.2 RESULTS OF THE SURVEY 80 -- Participants 80 -- Proposals according to their acceptability level.81 -- 8.3 ADAPTIONS TO THE MODEL 84 -- 8.4 RESULTS OF THE MEETING .85 -- 8.5 CONCLUSION OF THE STAKEHOLDERS CONSULTATION 86 -- 9 FINANCING OF THE PROPOSED MODEL87 -- 9.1 POSSIBLE MODELS FOR FINANCING MENTAL HEALTH CARE87 -- 9.2 A FINANCIAL MODEL FOR PSYCHOLOGICAL CARE IN BELGIUM88 -- Financing model for first-line psychological care 88 -- Financing of specialised psychological care 89 -- The place of the psychiatrist in the system90 -- 9.3 NEED FOR DATA TO CARRY OUT CALCULATION OF COSTS FOR THE FIRST LINE OF PSYCHOLOGICAL HEALTH CARE IN BELGIUM 91 -- Prevalence of mental health problems 91 -- Search for help 92 -- Acceptance of psychological care .92 -- Choice to remain with non-reimbursed psychologist .92 -- 10 DISCUSSION AND CONCLUSIONS 93 -- 10.1 LIMITATIONS 93 -- 10.2 FINAL MODEL .94 -- First line of psychological care 94 -- A second line of more specialized ambulatory psychological care for the people who need it95 10 -- 3 SYSTEM OF FINANCING THE MODEL 98 -- For the first line 98 -- For the specialized care.98 -- “Soft echeloning” to the psychiatrist 99 Economic model 9
Quality Indicators for the management of lung cancer : Synthesis
No full text30 p.ill.,FOREWORD 1 -- KEY MESSAGES 2 -- SYNTHESIS 4 -- 1 BACKGROUND AND OBJECTIVES 7 -- 1.1 LUNG CANCER, A FREQUENT AND LETHAL DISEASE 7 -- 1.2 IMPROVE QUALITY OF CARE THROUGH FEEDBACK 8 -- 1.2.1 Three objectives 8 -- 1.2.2 Target audience: clinicians specialized in lung cancer and multidisciplinary teams 8 -- 2 DATA AND METHODS 9 -- 2.1 THE DATA: A LINKAGE BETWEEN THE BELGIAN CANCER REGISTRY DATA AND ADMINISTRATIVE DATABASES 9 -- 2.2 THE PATIENTS: DIAGNOSED IN 2010-2011 WITH EXCLUSION OF PATIENTS WITH OTHER INVASIVE TUMOURS 9 -- 2.3 ASSIGNING EACH PATIENT TO A SINGLE CENTRE? NOT STRAIGHTFORWARD… 10 -- 2.4 HOW TO IDENTIFY COMORBIDITY BASED ON DATA OF PHARMACEUTICAL BILLING DATA? 10 -- 2.5 THE ASSOCIATION BETWEEN VOLUME AND OUTCOMES 11 -- 3 WHAT DO THE INDICATORS TELL ABOUT THE QUALITY OF CARE?.12 -- 3.1 A STUDY INCLUDING ALMOST 13 000 PATIENTS 12 -- 3.2 TWENTY-THREE QUALITY INDICATORS MEASURED: FROM DIAGNOSIS TO END-OF-LIFE CARE 12 -- 3.2.1 Survival one year after diagnosis 16 -- 3.2.2 Quality of data reporting to Belgian Cancer Registry (BCR) 16 -- 3.2.3 Diagnosis and staging 16 -- 3.2.4 Treatment 17 -- 3.3 THREE COMORBIDITIES IDENTIFIED USING PATIENT PHARMACEUTICAL BILLING DATA 21 -- 3.4 WHAT’S THE IMPACT OF HOSPITAL VOLUME ON THE OUTCOME? .21 -- 3.4.1 Surgical volume 21 -- 3.4.2 Radiotherapy volume .23 -- 3.4.3 Diagnostic volume 23 -- 4 STRENGTHS AND LIMITATIONS 24 -- 5 CONCLUSIONS AND FUTURE PROSPECTS 25 -- RECOMMENDATIONS 27 -- REFERENCES 2
Clustering pathology groups on hospital stay similarity : Short Report
No full text38 p.ill.,FOREWORD 1 -- SHORT REPORT 2 -- TABLE OF CONTENTS 2 -- LIST OF FIGURES 4 -- LIST OF TABLES .4 -- 1. INTRODUCTION 5 -- 1.1. BACKGROUND 5 -- 1.2. SCOPE AND OBJECTIVES .7 -- 1.3. METHODS .7 -- 2. BACKGROUND ON HOSPITAL PAYMENT IN BELGIUM 7 -- 2.1. THE BUDGET OF FINANCIAL MEANS .7 -- 2.2. PHYSICIAN FEES .8 -- 2.3. MIXED PAYMENTS FOR PHARMACEUTICAL SPECIALTIES .10 -- 2.4. PAYMENTS FOR DAY-CARE STAYS .10 -- 3. DEFINING THREE CLUSTERS 11 -- 3.1. WHAT DATA IS USED? 11 -- 3.1.1. Minimal Hospital Data (MZG – RHM) 11 -- 3.1.2. Hospital Billing Data (AZV – SHA and ADH – HJA) 12 -- 3.1.3. Technical Cell data (TCT) 12 -- 3.1.4. Analysis data set 13 -- 3.2. CLUSTER ANALYSIS METHOD 15 -- 3.2.1. What is a cluster analysis? 15 -- 3.2.2. Choice of cluster method .15 -- 3.2.3. Which variables to include? 15 -- 3.2.4. Cluster validation 16 -- 3.2.5. Cross-border cases .17 -- 3.3. CLUSTER ANALYSIS RESULTS 17 -- 3.3.1. Variable selection with HINoV 17 -- 3.3.2. Description of the three clusters 18 -- 3.3.3. Validation of the three clusters 22 -- 3.4. CAN THE CLUSTERS BE USED AS OUTLINES FOR THREE DIFFERENT PAYMENT SYSTEMS? 23 -- 4. ASSESSING APR-DRGS FOR A LUMP SUM PAYMENT PER STAY .25 -- 4.1. SCOPE .25 -- 4.2. VISUALISING VARIABILITY OF APR-DRG-SOIS IN THE LOW VARIABILITY CLUSTER 26 -- 4.2.1. Finding patterns of low within and between hospital variability 26 -- 4.2.2. Visualising variability on the original scale of the variable 26 -- 4.3. AN EXAMPLE: APR-DRG 301 – HIP JOINT REPLACEMENT 29 -- 5. DISCUSSION AND CONCLUSION 32 -- 5.1. THREE CLUSTERS 32 -- 5.1.1. Conclusion 32 -- 5.1.2. Data improvements for future analysis .32 -- 5.2. APR-DRG-SOIS ELIGIBLE FOR A LUMP SUM PER STAY 32 -- 5.2.1. Conclusion 32 -- 5.2.2. Next steps toward a lump sum per stay 32 -- 5.2.3. Implementation issues 34 -- 5.3. GENERAL CONCLUSION .35 -- RECOMMENDATIONS 36 -- REFERENCES .3
Towards an expansion of the reimbursement conditions for Hepatitis C therapies? : – Summary
No full text25 p.ill.,FOREWORD 1 -- KEY MESSAGES 2 -- SUMMARY 4 -- 1. BACKGROUND 5 -- 1.1. HEPATITIS C 5 -- 1.2. NUMBER OF HCV-INFECTED PEOPLE IN BELGIUM 6 -- 1.3. THERAPIES 6 -- 1.4. OBJECTIVES OF THIS REPORT 6 -- 2. ELIGIBILITY CRITERIA FOR THE TREATMENT 7 -- 2.1. THE CURRENT SITUATION 7 -- 2.2. DETERMINING THE STAGE OF FIBROSIS THROUGH NON-INVASIVE TESTS? 8 -- 2.3. SETTING THE ELIGIBILITY CRITERIA 8 -- 3. COST-EFFECTIVENESS ANALYSIS OF THE VARIOUS POTENTIAL STRATEGIES 9 -- 3.1. FIVE STRATEGIES 9 -- 3.2. METHOD 10 -- 3.3. RESULT OF THE COST-EFFECTIVENESS AND COST-UTILITY ANALYSES 12 -- 3.4. TREATMENT OF THE UNCERTAINTY 14 -- 4. BUDGET IMPACT 16 -- 5. TOWARDS AN ERADICATION? 22 -- 5.1. INTRAVENOUS DRUG USERS. 22 -- 5.2. MSM (MEN WHO HAVE SEX WITH MEN) 22 -- 5.3. IMMIGRATION 22 -- 6. CONCLUSION AND DISCUSSION: TOWARDS A DIFFERENT REIMBURSEMENT MODEL? 23 -- RECOMMENDATIONS 2