Page 89 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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The marginal benefits of healthcare spending in the Netherlands
repetitions, assuming normal deviation around the mean, we found a 95% confidence interval around the threshold value between €59,178 and €88,076. The standard error around the threshold was €7,372.
 F(6,13611) = 170.35 Prob>F=0.000 R =0.0817
Variable Coefficient         Standard error t-value p-value   95% confidence interval Ln(spending) -0.0461 0.0779       -0.59 0.554       [-0.1988;0.1066]
 Table 4.4: main regression results
  N=13,618
2
      2
Ln(spending) 0.0033 0.0060 0.55 0.583 [-0.0085; 0.0151]
       Ln(spending)*Ln(patients) -0.0372 0.0127       -2.93       0.003       [-0.0620;-0.0123] Ln(patients) 1.3012 0.0837 15.55 0.000 [1.1372; 1.4653] Ln(patients) 0.0222 0.0075       2.95       0.003       [0.0074; 0.0370] Time trend 2 -0.0185 0.0017 -10.89 0.000 [-0.0219; -0.0152]
                  Constant
35.330 3.456             10.22             0.000             [28.556;42.105]
         Data transformations increase uncertainty, which is not incorporated into the thresholds. Therefore, we used Monte Carlo simulations (table 4.5). Including transformation uncertainty increased our confidence intervals to between €54,000 and €94,000. Most uncertainty is attributable to LYoL-costs.
       In line with standard Dutch guidelines on HTA research, we used a discount rate of 1.5% to discount future health gains (Zorginstituut Nederland, 2015). As most gains of deaths averted are in the future, a higher discount rate increases the threshold. For example, our point estimate for a discount rate of 3% was €80,800, while a discount rate of 5% resulted in a threshold of €90,200. A 0% discount rate, which has also been advocated in the literature (Parsonage and Neuburger, 1992), lowered the threshold to €66,500. Each percent increase in the discount rate shifted the threshold upwards by €4,700.
 Table 4.5: Outcomes Monte Carlo distributions
Healthy life expectancy
Burden of disease
All variables
Standard Confidence interval error   (Euro per QALY)
Distribution
Range
Source
              Variable
Central Bureau of
Normally             SD from source Statistics (CBS)         € 877         € 69,400 - € 75,800
       Quality of life gains
Netherlands
Normally SD from CBS health   € 732   € 69,700 - € 75,100 regressions questionnaires
   Continuous           Between BoD- Volksgezondheid en         € 517             € 66,800 - € 70,500 value and 1       Zorg (2011)
  Cost in last year of life
Normally           SD is assumed to Van Baal et al.   € 2,767 € 59,900 - € 80,800 be 10% of mean       (2011)               € 2,789         € 56,600 - € 79,000
     €10,161                           €54,000 - €94,000
 Total uncertainty including uncertainty of the main specification
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