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This retrospective incidence-based cost-of-illness analysis aims to quantify the costs associated with female breast cancer in Flanders for the year prior to diagnosis and for each of the 5 years following diagnosis. A bottom-up analysis from the societal perspective included direct health care costs and indirect costs of productivity loss due to morbidity and premature mortality. A case-control study design compared total costs of breast cancer patients with costs of an equivalent standardised population with a view to calculating the additional costs that can be attributed to breast cancer. Total average costs of breast cancer amounted to 107,456 per patient over 6 years. Total costs consisted of productivity loss costs (89% of costs) and health care costs (11% of costs). Health care costs did not vary with age at diagnosis. Health care costs of breast cancer patients converged with those of the general population at 5 years following diagnosis. Patients with advanced breast cancer stadia had higher health care costs. Cost estimates provided by this analysis can be used to determine priorities for, and inform, future research on breast cancer. In particular, attention needs to be focussed on decreasing productivity loss from breast cancer.

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The Scheldt is a tidal river that originates in France and flows through Belgium and the Netherlands. The tides create significant flood risks in both the Flemish region in Belgium and the Netherlands. Due to sea level rise and economic development, flood risks will increase during this century. This is the main reason for the Flemish government to update its flood risk management plan. For this purpose, the Flemish government requested a cost-benefit analysis of flood protection measures, considering long-term developments. Measures evaluated include a storm surge barrier, dyke heightening and additional floodplains with or without the development of wetlands. Some of these measures affect the flood risk in both countries. As policies concerning the limitation of flood risk differ significantly between the Netherlands and Flanders, distinctive methodologies were used to estimate the impacts of measures on flood risk. A risk-based approach was applied for Flanders by calculating the impacts of flood damage at different levels of recurrence, for the base year (2000) and in case of a sea level rise of 60 cm by 2100. Policy within the Netherlands stipulates a required minimal protection level along the Scheldt against storms with a recurrence period of 1 in 4,000 years. It was estimated how flood protection measures would delay further dyke heightening, which is foreseen as protection levels are presently decreasing due to rising sea levels. Impacts of measures (safety benefits) consist of delays in further dyke heightening. The results illustrate the importance of sea level rise. Flood risks increased fivefolds when a sea level rise of 60 cm was applied. Although more drastic measures such as a storm surge barrier near Antwerp offer more protection for very extreme storms, a combination of dykes and floodplains can offer higher benefits at lower costs.