Doelmatigheidsonderzoek: gebruik case-mix informatie
Het case-mix informatiesysteem van het AMC bevat kostprijzen van medische verrichtingen en diagnoses. Deze data zijn gebruikt voor verschillende doelmatigheidsonderzoeken. Onderstaand zijn twee verschillende voorbeelden van doelmatigheidsonderzoeken van het AMC weergegeven die hebben geleid hebben tot publicaties in wetenschappelijke tijdschriften.
De ICTUS trial (in English)
The ICTUS trial compared an early invasive versus a selectively invasive strategy in high risk patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. Alongside the ICTUS trial a cost-effectiveness analysis from a provider perspective was performed. A total of 1200 patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T were randomized. An early invasive strategy was not superior to a selectively strategy. Total costs per patient were 1379 euros (95% CI 416-2356) more expensive in the early invasive group (13,364 euros) than in the selectively invasive group (11,985 euros). Costs of revascularization were the main determinant of the cost difference between the two groups. The incremental cost-effectiveness ratio of the extra costs per prevented cardiac event was minus 89,477 euros. The overall results of the ICTUS study showed that an early invasive strategy was not superior to a selectively invasive strategy for patients with non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. This economic analysis of the ICTUS study showed that an early invasive strategy was slightly more expensive during the first year without gain in prevented cardiac events. In fact, we demonstrated a very moderate probability of the early invasive strategy being cost-efficient, even at a high level of willingness-to-pay.
Dijksman, L. et al (2008). Cost-effectiveness of early versus selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation. International Journal of Cardiology, 131 (2), 204-211.
The REACT trial (in English)
Objective: To determine the cost-effectiveness of trauma room CT compared with CT performed at the radiology department. Methods: In this randomised controlled trial, adult patients requiring evaluation in a level 1 trauma centre were included. In the intervention hospital the CT system was located within the trauma room and in the control hospital within the radiology department. Direct and indirect medical costs of the institutionalised stay and diagnostic and therapeutic procedures were calculated. Results: A total of 1,124 patients were randomised with comparable demographic characteristics. Mean number of non-institutionalised days alive was 322.5 in the intervention group (95 % CI 314-331) and 320.7 in the control group (95 % CI 312.1-329.2). Mean costs of diagnostic and therapeutic procedures per hospital inpatient day were 554 for the intervention group and 468 for the control group. Total mean costs in the intervention group were 16,002 (95 % CI 13,075-18,929) and 16,635 (95 % CI 13,528-19,743) for the control group (P = 0.77). Conclusion: The present study showed that in trauma patients the setting with a CT system located in the trauma room did not provide any advantages or disadvantages from a health economics perspective over a CT system located in the radiology department.
Saltzherr, T. (2013), Cost-effectiveness of trauma CT in the trauma room versus the radiology department: the REACT trial. Eur Radiology, 23, 148 – 155.