• Cost-effectiveness of newborn screening for severe combined immunodeficiency.

      Van der Ploeg, Catharina P B; Blom, Maartje; Bredius, Robbert G M; van der Burg, Mirjam; Schielen, Peter C J I; Verkerk, Paul H; van den Akker-van Marle, M Elske (2019-02-25)
      Severe combined immunodeficiency (SCID) is a condition that often results in severe infections and death at young age. Early detection shortly after birth, followed by treatment before infections occur, largely increases the chances of survival. As the incidence of SCID is low, assessing cost-effectiveness of adding screening for SCID to the newborn screening program is relevant for decision making. Lifetime costs and effects of newborn screening for SCID were compared to a situation without screening in the Netherlands in a decision analysis model. Model parameters were based on literature and expert opinions. Sensitivity analyses were performed. Due to earlier detection, the number of deaths due to SCID per 100,000 children was assessed to decrease from 0.57 to 0.23 and a number of 11.7 quality adjusted life-years (QALYs) gained was expected. Total yearly healthcare costs, including costs of screening, diagnostics, and treatment, were €390,800 higher in a situation with screening compared to a situation without screening, resulting in a cost-utility ratio of €33,400 per QALY gained.Conclusion: Newborn screening for SCID might be cost-effective. However, there is still a lot of uncertainty around the cost-effectiveness estimate. Pilot screening projects are warranted to obtain more accurate estimates for the European situation. What is Known: • Severe combined immunodeficiency (SCID) is a condition that often results in severe infections and death at a young age. • As the incidence of SCID is low, assessing cost-effectiveness of adding screening for SCID to the newborn screening program is needed. What is New: • Newborn screening for SCID is expected to reduce mortality from 0.57 to 0.23 per 100,000 children at additional healthcare costs of €390,800. The cost-utility ratio is €33,400 per QALY gained. • Due to large uncertainty around cost-effectiveness estimates, pilot screening projects are warranted for Europe.
    • Cost-effectiveness of screening for chronic hepatitis B and C among migrant populations in a low endemic country.

      Suijkerbuijk, Anita W M; van Hoek, Albert Jan; Koopsen, Jelle; de Man, Robert A; Mangen, Marie-Josee J; de Melker, Hester E; Polder, Johan J; de Wit, G Ardine; Veldhuijzen, Irene K (2018-01-01)
      Chronic infection with hepatitis B or C virus (HBV/HCV) can progress to cirrhosis, liver cancer, and even death. In a low endemic country as the Netherlands, migrants are a key risk group and could benefit from early diagnosis and antiviral treatment. We assessed the cost-effectiveness of screening foreign-born migrants for chronic HBV and/or HCV using a societal perspective. The cost-effectiveness was evaluated using a Markov model. Estimates on prevalence, screening programme costs, participation and treatment uptake, transition probabilities, healthcare costs, productivity losses and utilities were derived from the literature. The cost per Quality Adjusted Life Year (QALY) gained was estimated and sensitivity analyses were performed. For most migrant groups with an expected high number of chronically infected cases in the Netherlands combined screening is cost-effective, with incremental cost-effectiveness ratios (ICERs) ranging from €4,962/QALY gained for migrants originating from the Former Soviet Union and Vietnam to €9,375/QALY gained for Polish migrants. HBV and HCV screening proved to be cost-effective for migrants from countries with chronic HBV or HCV prevalence of ≥0.41% and ≥0.22%, with ICERs below the Dutch cost-effectiveness reference value of €20,000/QALY gained. Sensitivity analysis showed that treatment costs influenced the ICER for both infections. For most migrant populations in a low-endemic country offering combined HBV and HCV screening is cost-effective. Implementation of targeted HBV and HCV screening programmes to increase early diagnosis and treatment is important to reduce the burden of chronic hepatitis B and C among migrants.
    • Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands.

      de Boer, Pieter T; de Lange, Marit M A; Wielders, Cornelia C H; Dijkstra, Frederika; van Roeden, Sonja E; Bleeker-Rovers, Chantal P; Oosterheert, Jan Jelrik; Schneeberger, Peter M; van der Hoek, Wim (2020-01-01)
    • Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis.

      van Hout, Denise; Plantinga, Nienke L; Bruijning-Verhagen, Patricia C; Oostdijk, Evelien A N; de Smet, Anne Marie G A; de Wit, G Ardine; Bonten, Marc J M; van Werkhoven, Cornelis H (2019-09-06)
    • Cost-effectiveness of the SLIMMER diabetes prevention intervention in Dutch primary health care: economic evaluation from a randomised controlled trial.

      Duijzer, Geerke; Bukman, Andrea J; Meints-Groenveld, Aafke; Haveman-Nies, Annemien; Jansen, Sophia C; Heinrich, Judith; Hiddink, Gerrit J; Feskens, Edith J M; de Wit, G Ardine (2019-11-11)
    • Cost-effectiveness of two screening strategies for and as part of the PrEP programme in the Netherlands: a modelling study.

      van Wifferen, Francine; Hoornenborg, Elske; Schim van der Loeff, Maarten F; Heijne, Janneke; van Hoek, Albert Jan (2021-01-11)
      Pre-exposure prophylaxis (PrEP) users are routinely tested four times a year (3 monthly) for asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections on three anatomical locations. Given the high costs of this testing to the PrEP programme, we assessed the impact of 3 monthly screening(current practice), compared with 6 monthly on the disease burden. We quantified the difference in impact of these two testing frequencies on the prevalence of CT and NG among all men who have sex with men (MSM) who are at risk of an STI, and explored the cost-effectiveness of 3-monthly screening compared with a baseline scenario of 6-monthly screening.
    • Cost-effectiveness of vaccination of immunocompetent older adults against herpes zoster in the Netherlands: a comparison between the adjuvanted subunit and live-attenuated vaccines.

      de Boer, Pieter T; van Lier, Alies; de Melker, Hester; van Wijck, Albert J M; Wilschut, Jan C; van Hoek, Albert Jan; Postma, Maarten J (2018-12-06)
      The newly registered adjuvanted herpes zoster subunit vaccine (HZ/su) has a higher efficacy than the available live-attenuated vaccine (ZVL). National decision-makers soon need to decide whether to introduce HZ/su or to prefer HZ/su above ZVL. Using a Markov model with a decision tree, we conducted a cost-effectiveness analysis of vaccination with HZ/su (two doses within 2 months) or zoster vaccine live (ZVL) (single dose, or single dose with a booster after 10 years) for cohorts of 50-, 60-, 70- or 80-year-olds in the Netherlands. The model was parameterized using vaccine efficacy data from randomized clinical trials and up-to-date incidence, costs and health-related quality of life data from national datasets. We used a time horizon of 15 years, and the analysis was conducted from the societal perspective. At a coverage of 50%, vaccination with two doses of HZ/su was estimated to prevent 4335 to 10,896 HZ cases, depending on the cohort age. In comparison, this reduction was estimated at 400-4877 for ZVL and 427-6466 for ZVL with a booster. The maximum vaccine cost per series of HZ/su to remain cost-effective to a willingness-to-pay threshold of €20,000 per quality-adjusted life year (QALY) gained ranged from €109.09 for 70-year-olds to €63.68 for 50-year-olds. The cost-effectiveness of ZVL changed considerably by age, with corresponding maximum vaccine cost per dose ranging from €51.37 for 60-year-olds to €0.73 for 80-year-olds. Adding a ZVL booster after 10 years would require a substantial reduction of the maximum cost per dose to remain cost-effective as compared to ZVL single dose. Sensitivity analyses on the vaccine cost demonstrated that there were scenarios in which vaccination with either HZ/su (two doses), ZVL single dose or ZVL + booster could be the most cost-effective strategy. A strategy with two doses of HZ/su was superior in reducing the burden of HZ as compared to a single dose or single dose + booster of ZVL. Both vaccines could potentially be cost-effective to a conventional Dutch willingness-to-pay threshold for preventive interventions. However, whether HZ/su or ZVL would be the most cost-effective alternative depends largely on the vaccine cost.
    • The cost-effectiveness profile of sex-neutral HPV immunisation in European tender-based settings: a model-based assessment.

      Qendri, Venetia; Bogaards, Johannes A; Baussano, Iacopo; Lazzarato, Fulvio; Vänskä, Simopekka; Berkhof, Johannes (2020-01-01)
    • The cost-utility of stepped-care algorithms according to depression guideline recommendations - Results of a state-transition model analysis.

      Meeuwissen, Jolanda A C; Feenstra, Talitha L; Smit, Filip; Blankers, Matthijs; Spijker, Jan; Bockting, Claudi L H; van Balkom, Anton J L M; Buskens, Erik (2019-01-01)
      Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands.
    • Costs of a clinical pathway with point-of-care testing during influenza epidemic in a Dutch hospital.

      Marbus, Sierk D; Lutgens, Suzanne P M; van Gageldonk-Lafeber, Arianne B; Hazenberg, Eric H L C M; Hermans, Mirjam H A; Suijkerbuijk, Anita W M (2020-10-12)
    • Counterattacking the tick bite: towards a rational design of anti-tick vaccines targeting pathogen transmission.

      Rego, Ryan O M; Trentelman, Jos J A; Anguita, Juan; Nijhof, Ard M; Sprong, Hein; Klempa, Boris; Hajdusek, Ondrej; Tomás-Cortázar, Julen; Azagi, Tal; Strnad, Martin; et al. (2019-05-14)
    • Coupling mixture reference models with DGT-perceived metal flux for deciphering the nonadditive effects of rare earth mixtures to wheat in soils.

      Gong, Bing; He, Erkai; Peijnenburg, Willie J G M; Iwasaki, Yuichi; Van Gestel, Cornelis A M; Cao, Xinde; Zhao, Ling; Xu, Xiaoyun; Qiu, Hao (2020-06-02)
      The risk assessment of mixtures of rare earth elements (REEs) is hampered by a lack of fundamental understanding of their interactions in different soil types. Here, we assessed mixture interactions and toxicity to Triticum aestivum of Y and Ce in four different soils in relation to their bioavailability. Mixture toxicity was modelled by concentration addition (CA) and independent action (IA), in combination with different expressions of exposure: three equilibrium-based doses (total soil concentrations [M]tot, free ion activity in soil solution {M3+}, and the fraction (f) of metal ions bound to the biotic ligands (BLs)) and one kinetically controlled dose ([M]flux) metrics. Upon single exposure, REE toxicity was increasingly better described when using exposure expressions based on deepened understanding of their bioavailability: [M]flux > f > {M3+} > [M]tot. The mixture analyses based on [M]tot and {M3+} displayed deviations from additivity depending on the soil type. With the parameters derived from single exposures, the BLM approach gave better predictions of mixture toxicity (R2 ~ 0.70) than when using CA and IA based on either [M]tot or {M3+} (R2 < 0.64). About 30% of the variance in toxicity remained unexplained, challenging the view that the free metal ion is the main bioavailable form under the BLM framework based on thermodynamic equilibrium. Toxicity was best described when accounting for changes in the size of the labile metal pool by using a kinetically controlled dose metric (R2 ~ 0.80). This suggests that dynamic bioavailability analysis could provide a robust basis for modeling and reconciling the interplays and toxicity of metal mixtures in different soils.
    • COVID-19 in health-care workers in three hospitals in the south of the Netherlands: a cross-sectional study.

      Sikkema, Reina S; Pas, Suzan D; Nieuwenhuijse, David F; O'Toole, Áine; Verweij, Jaco; van der Linden, Anne; Chestakova, Irina; Schapendonk, Claudia; Pronk, Mark; Lexmond, Pascal; et al. (2020-07-02)
    • The COVID-19 pandemic and global environmental change: Emerging research needs.

      Barouki, Robert; Kogevinas, Manolis; Audouze, Karine; Belesova, Kristine; Bergman, Ake; Birnbaum, Linda; Boekhold, Sandra; Denys, Sebastien; Desseille, Celine; Drakvik, Elina; et al. (2020-11-19)
    • Coxiella burnetii (Q fever) prevalence in associated populations of humans and small ruminants in The Gambia.

      Bok, Jeroen; Hogerwerf, Lenny; Germeraad, Eveline A; Roest, Hendrik I J; Faye-Joof, Tisbeh; Jeng, Momodou; Nwakanma, Davis; Secka, Arss; Stegeman, Arjan; Goossens, Bart; et al. (2017)
      To simultaneously estimate the prevalence of antibodies against Coxiella burnetii (Q fever) among adults and small ruminants, and C. burnetii shedding prevalence among small ruminants in households in the Kiang West district of The Gambia, and to assess associated risk factors.
    • Crisisopvang vol luizen.

      Groot M de; Broek I van den (2016-11)
    • Critical evaluation of the newborn screening for congenital hypothyroidism in the Netherlands.

      Stroek, Kevin; Heijboer, Annemieke C; Bouva, Marelle J; Van der Ploeg, Catharina P B; Heijnen, Marie-Louise A; Weijman, Gert; Bosch, Annet M; de Jonge, Robert; Schielen, Peter C J I; van Trotsenburg, A S; et al. (2020-06-01)
    • Critical knowledge gaps and research needs related to the environmental dimensions of antibiotic resistance.

      Larsson, D G Joakim; Andremont, Antoine; Bengtsson-Palme, Johan; Brandt, Kristian Koefoed; de Roda Husman, Ana Maria; Fagerstedt, Patriq; Fick, Jerker; Flach, Carl-Fredrik; Gaze, William H; Kuroda, Makoto; et al. (2018-05-07)
      There is growing understanding that the environment plays an important role both in the transmission of antibiotic resistant pathogens and in their evolution. Accordingly, researchers and stakeholders world-wide seek to further explore the mechanisms and drivers involved, quantify risks and identify suitable interventions. There is a clear value in establishing research needs and coordinating efforts within and across nations in order to best tackle this global challenge. At an international workshop in late September 2017, scientists from 14 countries with expertise on the environmental dimensions of antibiotic resistance gathered to define critical knowledge gaps. Four key areas were identified where research is urgently needed: 1) the relative contributions of different sources of antibiotics and antibiotic resistant bacteria into the environment; 2) the role of the environment, and particularly anthropogenic inputs, in the evolution of resistance; 3) the overall human and animal health impacts caused by exposure to environmental resistant bacteria; and 4) the efficacy and feasibility of different technological, social, economic and behavioral interventions to mitigate environmental antibiotic resistance.1.
    • Critical Orientation in the Jungle of Currently Available Methods and Types of Data for Source Attribution of Foodborne Diseases.

      Mughini-Gras, Lapo; Kooh, Pauline; Fravalo, Philippe; Augustin, Jean-Christophe; Guillier, Laurent; David, Julie; Thébault, Anne; Carlin, Frederic; Leclercq, Alexandre; Jourdan-Da-Silva, Nathalie; et al. (2019-01-01)