Proefschrift

Chapter 8 106 The clinical effectiveness of the PWB protocol and the RWB protocol was determined according to the results of the LEFS.16 The outcome of the CUA were the quality adjusted life years (QALYs). The QALYs were calculated based on EQ-5D score and life years. Health status was measured using the five dimensional health state description of the EQ-5D.17 Besides, the quality of life was measured with the Short Form-12 (SF-12) questionnaire. The SF-12 consists of 12 items that assess 8 dimensions of health: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. The SF-12 measures various aspects of physical and mental health from which a physical composite score (PCS) and a mental composite score (MCS) can be calculated, ranging from 0 to 100.18 All measures were registered by a self-completion questionnaire at baseline and at 6, 12 and 26 weeks follow-up. By using the Dutch Tariff for the EQ-5D,17 health states were converted into quality adjusted life years (QALYs). QALYs were calculated using the total-area-underthe-curve approach.17 Costs The costs were determined from the societal and hospital perspective and were divided into four parts: (a) health care costs, (b) patient & family costs, (c) costs associated with productivity losses, and (d) PWB costs. The iMTA (Institute for Medical Technology Assessment) Medical Consumption Questionnaire (iMCQ) measured all healthcare consumption by the participants during the end of 26 weeks of follow-up and included medication costs, visits with General Practitioners (GP), medical specialists, occupational physicians, therapists (physical therapists, dieticians, occupational therapists, speech therapists, homeopaths and psychologists), social workers, emergency rooms visits, ambulance transportation, hospital admittance, homecare (domestic help, help with ADL and nursing), admittance in rehabilitation centers and admittance in assisted living centers.19 Patient and family costs were derived from the iMCQ and consisted of travel costs. The iMTA (Institute for Medical Technology Assessment) Productivity Cost Questionnaire (iPCQ) measured work absence and the number of hours the participant was replaced for unpaid work (for patients in paid employment), production losses to society due to absenteeism (illness-related absence from work), presenteeism (loss of productivity while at work), and compensation for diminished productivity. Diminished productivity due to absence from work may be compensated when lost work can be made up by the sick employees themselves or taken over by other employees within the company during normal working hours.20 Following Dutch guidelines on economic healthcare evaluations, a bottom-up approach was used for this study.21,22 For the valuation of costs, the reference prices from the Dutch costing guideline were used.23 These reference prices were multiplied by the average healthcare consumption as measured with the iMCQ and iPCQ. In

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