. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?. BMJ (Clinical research ed.), 347 (7916), 1-7.

BackgroundPatient self-report allows collecting comprehensive data for the purpose of performing economic evaluations. The aim of the current study was to assess the feasibility, reliability and a part of the construct validity of a commonly applied questionnaire on healthcare utilization and productivity losses in patients with a psychiatric disorder (TiC-P).MethodsData were derived alongside two clinical trials performed in the Netherlands in patients with mental health problems. The response rate, average time of filling out the questionnaire and proportions of missing values were used as indicators of feasibility of the questionnaire. Test-retest analyses were performed including Cohen’s kappa and intra class correlation coefficients to assess reliability of the data. The construct validity was assessed by comparing patient reported data on contacts with psychotherapists and reported data on long-term absence from work with data derived from registries.ResultsThe response rate was 72%. The mean time needed for filling out the first TiC-P was 9.4 minutes. The time needed for filling out the questionnaire was 2.3 minutes less for follow up measurements. Proportions of missing values were limited (< 2.4%) except for medication for which in 10% of the cases costs could not be calculated. Cohen’s kappa was satisfactory to almost perfect for most items related to healthcare consumption and satisfactory for items on absence from work and presenteeism. Comparable results were shown by the ICCs on variables measuring volumes of medical consumption and productivity losses indicating good reliability of the questionnaire.Absolute agreement between patient-reported data and data derived from medical registrations of the psychotherapists was satisfactory. Accepting a margin of +/− seven days, the agreement on reported and registered data on long-term absence from work was satisfactory. The validity of self-reported data using the TiC-P is promising.ConclusionsThe results indicate that the TiC-P is a feasible and reliable instrument for collecting data on medical consumption and productivity losses in patients with mild to moderate mental health problems. Additionally, the construct validity of questions related to contacts with psychotherapist and long-term absence from work was satisfactory.

The aim of the study was to determine whether the total cost estimate of a hospital service remains reliable when the cost components of bottom-up microcosting were replaced by the cost components of top-down microcosting or gross costing. Total cost estimates were determined in representative general hospitals in the Netherlands for appendectomy, normal delivery, stroke and acute myocardial infarction for 2005. It was concluded that restricting the use of bottom-up microcosting to those cost components that have a great impact on the total costs (i.e., labour and inpatient stay) would likely result in reliable cost estimates.

ObjectivesDutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version.MethodsAn online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute.ResultsThe majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1) costs within the health care sector; 2) patient and family costs; and 3) costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added.ConclusionsThe usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines.

The Action Plan is quite similar to many health economic guidelines in healthcare. However, the recommendations on particular aspects may differ between national guidelines in some respects. Although the Manual may serve as an example to countries intending to develop a manual of this kind, it should always be kept in mind that preferred methods predominantly depend on a country's specific context.

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Direct costs of ICU days vary widely between the seven departments. Our standardized costing methodology could serve as a valuable instrument to compare actual cost differences, such as those resulting from differences in patient case-mix.

j Abstract Background The impact of attention deficit hyperactive disorder (ADHD) in the Netherlands on health care utilisation, costs and quality of life of these children, as well as of their parents is unknown. Objective The aim of this study was to assess the direct medical costs of patients suffering from ADHD and their quality of life as well as the direct medical costs of their mothers. Study design We selected a group of 70 children who were being treated by a paediatrician for ADHD based on the DSM-IV diagnostic criteria for ADHD. For comparison's sake, we also included a non-matched group of 35 children with behaviour problems and 60 children with no behaviour problem from a large school population-based study on the detection of ADHD. We collected information on the health care utilisation of the children applying the Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness' (TiC-P). Their health related quality of life was collected by using the Dutch 50-item parent version of the Child Health Questionnaire (CHQ PF-50). Measurements were at baseline and at 6 months. Subsequently, we collected data on the health utilisation of the mothers and their production losses due to absence from work and reduced efficiency. Results The mean direct medical costs per ADHD patient per year were e2040 or e1173 when leaving out one patient with a long-term hospital admission, compared to e288 for the group of children with behaviour problems and e177 for the group of children with no behaviour problems. The direct medical costs for children who had psychiatric co-morbidities were significantly higher compared to children with ADHD alone. The mean medical costs per year for the mothers of the ADHD patients were significantly higher than for the mothers of the children with behaviour problems and the mothers of children with no behaviour problems respectively e728, e202 and e154. The physical summary score showed no significant differences between the groups. However, the score on the Psychosocial Summary Score dimension was significantly lower for ADHD patients compared to the scores of the children in the two other samples. The mean annual indirect costs due to absence from work and reduced efficiency at work were e2243 for the mothers of the ADHD patients compared to e408 for the mothers