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ObjectivesTo determine the effectiveness and safety of a tool diverting low urgency patients eligible for primary care from an emergency department (ED) to the adjacent general practitioner cooperative (GPC).MethodsUnblinded, randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was nurse-led triage using a new tool assigning patients to either ED or GPC. During intervention weekends, patients were encouraged to follow this assignment while it was not communicated to the patients during control weekends (they remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC during intervention and control weekends. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care eligible patients (with the opinion of the treating physician as the gold standard).ResultsIn the intervention group, 838/6374 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC (secondary outcome), in the control group 431/1744 (24.7%, 95% CI 22.7 to 26.8). In the intervention group, 599/6374 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the chosen MTS presentational flowchart, patient’s age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) patients were referred back to the ED of which three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised.ConclusionsED nurses using a new tool safely diverted 9.5% of the included patients to primary care.ClinicalTrials.gov IdentifierNCT03793972FundingResearch Foundation – Flanders (FWO)

Background Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium, the Czech Republic and Germany. Methods Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe is used. A two-part model with a logit model in the first part and a generalised linear model in the second part is applied. Results The diseases increasing the burden in the observed countries are heart attacks, high blood pressure, cancer, emotional disorders, rheumatoid arthritis and osteoarthritis. Reflecting country differences Parkinson’s disease and its drug burden is relevant in Belgium, the drugs burden related to heart attack and outpatient care burden to chronic kidney disease in the Czech Republic and the outpatient care burden of cancer and chronic lung disease in Germany. In addition, we confirm the regressive character of out-of-pocket payments. Conclusions We conclude that the burden is not equitably distributed among older adults with chronic diseases. Identification of chronic diseases with a high burden can serve as a supplementary protective feature.

Background Breast cancer accounts for 10 to 20 percent of the total cancer cost. The direct cost of cancer care are the health care expenses directly related to prevention and cancer treatment. The indirect cost, 2-3 times the direct cost include presenteeism, disability to work, absenteism and workers compensation. The aim of this study is to achieve a better understanding of the direct cost and the importance of the variables. Methods This retrospective descriptive study used the administrative data of AZ KLINA linked to the Cancer Registry of Belgium. The study comprised women diagnosed with breast cancer between July 2015 and December 2015. The direct health care costs were calculated for the diagnostic and treatment phase up to 365 days after diagnosis. The costs were grouped according to the different kinds of medical interventions. Regression analyses were performed for 3 dependent variables i.e. the patient contribution, the health insurance cost and the total cost. The type of room, age, chemotherapy, radiation therapy, antibody therapy, disease stage, number of hospital visits and right for increased reimbursement were independent variables. Results The study population included 107 patients. The total mean cost of the diagnostic phase was 817 €, divided into the personal contribution of 80 € and the health insurance cost of 737 €. The mean patient cost of the treatment phase was 1.712 €, for the health insurance 17.282 €. The regression analyses revealed the number of hospital visits was significantly associated with total cost, patient cost and health insurance cost. The patient cost was highly predictive by the choice of the room. The total cost of the diagnostic phase for 107 patients was 87.377 €. Imaging 32.742 € and pathology 32.895 € were most important, followed by pharmacy 9.641 € and consultation 6.598 €. In the treatment phase radiotherapy 436.247 €, antibody treatment with trastuzumab 326.961 € were most important, followed by chemotherapy 189.729 €, hospitalisation cost 153.026 €, pathology cost 144.239 €, and surgery cost 134.251 €. Conclusions In our study an estimation was given of all direct medical costs of breast cancer of the diagnostic and treatment phase. The results can inform hospital executives and policy makers to determine further strategic decisions for financing breast cancer care. Legal entity responsible for the study University of Antwerp. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

ObjectivesThis Schizophrenia Outcome Survey compared medical costs, psychopathology and adverse events in outpatients for 2 years following hospitalisation for an acute schizophrenic episode.MethodsAdults stabilised with haloperidol, olanzapine or risperidone entered this observational study ≤1 month after discharge and were assessed at baseline, 3, 6, 12, 18 and 24 months using Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Global Assessment of Functioning and adverse events reporting.ResultsAmong 323 patients (haloperidol 32, olanzapine 149, risperidone 142), baseline characteristics were similar in the olanzapine and risperidone groups, except for more first episodes in the risperidone group (p = 0.01). Haloperidol patients were more often single and institutionalised, less educated, had more residual schizophrenia, were longer hospitalised in the previous year, took more corrective and psychotropic drugs and had more extrapyramidal symptoms (EPS) and gynaecomastia (all significantly). Sixty-eight percent of patients completed a 2-year follow-up. In all groups, CGI and GAF improved during the first 3 months (both p < 0.0001) while BPRS deteriorated in the first year (all within group changes p < 0.05, between group changes NS) before it stabilised. There were no significant differences in hospitalisations and no change in social profile. At the last visit, 66% of haloperidol (p < 0.01), 35% of olanzapine (NS) and 39% (NS) of risperidone patients had ≥1 EPS; 69% (p < 0.013), 40 and 44%, respectively, had ≥1 sexual problem (NS). Mean weight gain was 0.4 (NS), 2.6 (p < 0.05) and 2.6 kg (p < 0.05), respectively.ConclusionsIn this naturalistic study, treatment allocation might have introduced a bias in the interpretation of efficiency results, but olanzapine and risperidone caused less EPS than haloperidol during 2 years of outpatient follow-up.

Objective: To estimate the cost effectiveness of olanzapine and risperidone for the treatment of schizophrenia in Belgium. Methods: Data were retrieved from a prospective, observational, non-randomized, follow-up survey. Clinical investigators assigned 265 patients with schizophrenia to either olanzapine (n - 136) or risperidone (n - 129). Patients were followed up for 2 years. Total healthcare costs were determined from the public payer perspective and calculated by multiplying resource use with official tariffs; effectiveness of the drugs was measured with the EQ-5D. This study uses a net-benefit regression approach to accommodate for baseline differences between treatment groups and uncertainty. Results: Total 2-year costs were very similar for patients receiving risperidone and olanzapine (€20 915.33 and €20 569.69, respectively; p - 0.925) &lsqb;year 2002 values&rsqb;. The health condition of the patients receiving risperidone was better than that of patients receiving olanzapine but not significantly so (1.46 and 1.41, respectively; p - 0.191). Simple ordinary least squares (OLS) regressions indicated that, for λ - €40 000, we could not reject the null hypothesis that the drugs provide similar net monetary benefits to the patient (risperidone vs olanzapine €2046.95; p - 0.656). When we controlled for several patient characteristics, risperidone moved further away from olanzapine but the difference did not reach statistical significance (risperidone vs olanzapine €3198.07; p - 0.595). Numerous sensitivity analyses confirmed the robustness of the results. Conclusion: Results of this study suggest that it is important to control for baseline patient characteristics when performing a cost-effectiveness analysis. No significant difference in net monetary benefit was found between risperidone and olanzapine.

Objective To estimate the burden of disease and related direct medical cost of Acute Respiratory Infections (ARI) for the health-care system in a low-income district of Bogota, generated by children under age five and senior population over age sixty. Methods A cross-sectional, retrospective, patient level study was conducted in San Cristobal district from 2008 to 2012 among the subsidized population. All inpatients and outpatients with ARI from three hospitals were reported. The total and average direct medical costs were estimated and are reported in International Dollars (Int$). Results It is estimated that, for children, ambulatory incidence rate for ARI varied between 54.4 % and 66.3 % and hospitalization rate between 9.2 % and 12.3 %. The mortality rate in the district oscillated between 18.1 and 27.7 deaths per 100000. The main medical costs where attributed to hospitalizations, and the total medical hospitalization cost per year estimated ranged between Int$ 1,334,352 and Int$ 2,139,597. In the case of senior population, the ambulatory incidence rate fluctuated between 7.6 % and 10.0 %, and the hospitalization rates between 0.6 % and 2.1 %; the mortality rate ranged between 8.9 and 47.8 deaths per 100.000. Hospitalization cost per year was estimated to be between Int$ 88,957 and Int$ 373,382. Conclusion Direct medical costs due to ARI have an important disease and direct medical cost burden in this low-income district.

In this review, the economic aspects of pneumococcal pneumonia are analysed, including the costs, cost effectiveness and cost benefit of treatment and prevention. We identified eight cost-of-illness studies, 15 analyses comparing the costs of different treatment options and 15 economic evaluations of prevention that met our search criteria. The studies were conducted largely in Europe and the US. Most pertained to community-acquired pneumonia (CAP) in general, without specific analysis of pneumococcus-related illness. Many of the studies were considered to be of poor quality for the following reasons: comparison without randomisation or control variables, disregard of health outcomes, small sample size, restriction of costs to drug costs and vague or disputable sources of cost information. In the US, hospitalisation costs resulting from CAP can be estimated to be between US 7,000 dollars and US 8,000 dollars per admission or US 4 million dollars per 100,000 population. Hospitalisation costs are significant (representing about 90% of total costs), but are much lower in Europe than in the US (one-third to one-ninth of the US estimates in the UK and Spain, respectively). In general, economic studies of treatment for pneumococcal pneumonia are in line with clinical evidence. A drug with proven clinical effectiveness would also appear to be supported from an economic stand point. Furthermore, economic data support an early switch from an intravenous to an oral antibacterial, the use of quinolones for inpatients with CAP, and also the use of guidelines built on clinical evidence. Of all the possible preventive strategies for pneumococcal pneumonia, only vaccination has been subjected to economic evaluation. Pneumococcal polysaccharide vaccine seems relatively cost effective (and potentially cost saving) for those between 65 and 75 years of age, for military recruits and for HIV positive patients with a sufficiently high CD4 cell count. Evaluations of the pneumococcal conjugate vaccine (PCV) indicate the price of the vaccine to be the main determinant of cost effectiveness. As the current price is high (in the order of US 50 dollars per dose), the economic attractiveness of the universal PCV vaccination strategies hinges on the potential for price reductions and the willingness of decision makers to adopt a societal perspective.

Pneumococcal vaccination of older persons is thought to be cost-effective in preventing pneumococcal pneumonia, but evidence of clinical protection is uncertain. Because there is better evidence of vaccination effectiveness against invasive pneumococcal disease, we determined the cost-effectiveness of pneumococcal vaccination of persons agedor =65 years in preventing hospital admission for both invasive pneumococcal disease and pneumococcal pneumonia in 5 western European countries. In the base case analyses, the cost-effectiveness ratios for preventing invasive disease varied from approximately 11,000 to approximately 33,000 European currency units (ecu) per quality-adjusted life year (QALY). Assuming a common incidence (50 cases per 100,000) and mortality rate (20%-40%) for invasive disease, the cost-effectiveness ratios were12,000 ecu per QALY in all 5 countries. For preventing pneumococcal pneumonia, vaccinating all elderly persons would be highly cost-effective to cost saving. Public health authorities should consider policies for encouraging pneumococcal vaccination for all persons agedor =65 years.

The effects of immunisation programmes that have existed for several decades in developed countries are demonstrated by the decrease and even eradication of smallpox, poliomyelitis, measles, mumps and hepatitis B. Cost, health policy and spontaneous evolution in the incidence of communicable diseases have a decisive influence on the use of a vaccine. Investment in vaccination policy has to be encouraged to maintain this progress made in the control of infectious diseases and to meet new challenges. Studies re-evaluating ongoing immunisation programmes are scarce. Nevertheless, it can be concluded that for vaccination against hepatitis B in professionally exposed at-risk populations, arguments for positive returns are consistent. The same holds for vaccination against S. pneumoniae and for influenza virus in the elderly. The results of the economic evaluation of revaccination against measles, when insufficient coverage exists, are inconclusive. Universal vaccination of children against Haemophilus influenzae type b (Hib) and of children of hepatitis B-positive mothers against hepatitis may require costs to be paid in order to gain extra health benefits.

Introduction In many countries, a reassessment of after-hours primary care has become necessary. In particular, centralised general practitioner deputizing services (GPDS) have emerged. In this study, consumers' preferences for after-hours medical care were obtained and the use of the new GPDS was predicted.Method On the basis of the Theory of Reasoned Action, a survey was developed that was used at the Free Newborn and Child health care services in Antwerp. Consumers were asked about their knowledge, experience and perceptions concerning the performance of different medical services.Results 350 questionnaires were used for analysis. 98.6% of the respondents knew about the existence of the emergency department, whereas the GPDS was known by 81.7% of the respondents. The main reasons for preferring emergency department over the other services were an easy access, good explanation by the doctor and a late due time of the payment. Respondents preferred the GPDS mainly because of an expected shorter waiting time. Experience had a strong positive influence on choosing a particular after-hours medical service.Conclusion In our study, the consumers' preferences concerning after-hours medical care were assessed. The following items are crucial for choosing after-hours care: experience with the services, easy access to the service, explanation by the doctor about the illness and the treatment and waiting time.

Objectives: Although there is a comprehensive public health insurance system in Belgium, out-of-pocket expenditures can be very high, mainly for inpatients. While a large part of the official price is reimbursed, patients are confronted with increased extra billing (supplements). Therefore, the government imposed various restrictions on the amount of supplements to be charged, related to the type of room and the patient's insurance status. We investigate how prices are set and whether the restrictions have been effective. Methods: We use an administrative dataset of the Belgian sickness funds for the year 2003 with billing data per hospitalisation and hospital characteristics. Boxplots describe the distribution of several categories of supplements. OLS is used to explore the relationship between hospital characteristics and extra billing. Results: There is a large and intransparent variation in extra billing practices among different hospitals. Given the room type, supplements per day are smaller for patients qualifying for protection, confirming that the regulation is applied quite well. However, because of their longer length of stay this does not result in lower supplements per stay for these patients. Conclusions: Currently the price setting behavior of providers lacks transparency. Protective regulation could be refined by taking into account the longer length of stay of vulnerable groups. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Objective - Recent evidence shows that drug-eluting stent devices (DES) substantially reduce the risk of in-stent restenosis compared with classic bare metal stent devices (BMS). In Belgium, however, the use of BMS is still standard procedure due to the higher prices of the newer DES. Although the use of DES is more expensive in the short term it might be beneficial in the long term due to the avoidance of revascularization costs. The primary objective of this study is to compare the net cost of DES and BMS from the perspective of Belgian health care. Methods and results - Cost differences between DES and BMS are determined by the difference in stent price and the difference in the rate of re-intervention.The cost of revascularization of patients with in-stent restenosis was estimated based on data gathered at the Antwerp University hospital (UZA). Data on effectiveness were obtained from a literature meta-analysis. Because of some important study limitations, a sensitivity analysis was included in this study. In general, the use of DES was cost saving as compared with BMS, with savings amounting to ? 165 for Cypher stent devices and ? 128 for Taxus stent devices in the base case scenario. For patients with a high risk of restenosis net savings persist in almost all sensitivity analyses. Conclusion - The use of DES in patients with a high in-stent restenosis risk is cost saving. Price evolutions in the stent device market predict that the use of DES, if not yet cost saving, will become cost saving in the near future for all types of patients. Recent evidence, however, casts some doubt on the long-term effectiveness of DES.

Background: The purpose of this study was to provide quantitative information on the economic, social and emotional burden borne by families of children with attention-deficit hyperactivity disorder (ADHD) and on the public healthcare costs of a child with ADHD in Flanders, Belgium, and to compare costs of ADHD children with those of siblings without the disorder. Methods: A pilot-tested questionnaire was sent to all members of the Flemish ADHD society in February 2003. Parents were asked to record utilisation of healthcare, social care and other non-medical resources for their ADHD child and his/her sibling. In addition, data were collected on ADHD severity (IOWA-Conners Rating Scale) and on the sociodemographic and economic characteristics of the parents. Parents’ out-of-pocket and public annual costs were calculated using tariffs. These costs were corrected for several confounding variables using general linear model (GLM) estimates. Results: ADHD affects school results and parents’ productivity and places a psychological and emotional burden on the family. Childhood ADHD also results in a significantly higher use of healthcare: ADHD children have a significantly higher probability of visiting a general practitioner (60.3% vs 37.4%) and a specialist (50.9% vs 12.9%); they also visit the emergency department significantly more often (26% vs 12.1%), and they are hospitalised significantly more often (14% vs 8.4%). Consequently, Flemish children with ADHD incur significantly higher medical costs than their siblings without the disorder. Even after correction for several covariates, these cost differences are still striking. In fact, compared with their sibling, the annual cost for an ADHD child is more than six times higher for the parent (€588.3 vs €91.5), and public costs are twice as high (€779 vs €371.3) [year of costing 2002]. Conclusions: Childhood ADHD results in significantly higher use of healthcare and adversely affects academic achievements and parents’ productivity.

Patients with schizophrenia suffer numerous relapses and rehospitalizations that are associated with high direct and indirect medical expense. Suboptimal therapeutic efficacy and, in particular, problems with compliance are major factors leading to relapse. Atypical antipsychotic agents offer improved efficacy and a lower rate of extrapyramidal adverse effects compared with conventional antipsychotic drugs. Long-acting intramuscular risperidone combines these benefits with improvements in compliance associated with depot injections. To assist decision making regarding the place of long-acting risperidone in therapy, a cost-effectiveness analysis of strategies involving first-line treatment with long-acting risperidone, oral olanzapine or depot haloperidol was performed from the perspective of the Belgian healthcare system. A decision tree model was created to compare the cost effectiveness of three first-line treatment strategies in a sample of young schizophrenic patients who had been treated for 1 year and whose disease had not been diagnosed for longer than 5 years. The model used a time horizon of 2 years, with health state transition probabilities, resource use and cost estimates derived from clinical trials, expert opinion and published prices. The four health states in the model were derived from an analysis of the literature. The principal efficacy measure was the proportion of patients successfully treated, defined as those who responded to initial treatment and who had none to two episodes of clinical deterioration without needing a change of treatment over the 2-year period. Comprehensive sensitivity analysis was carried out to test the robustness of the model. A greater proportion of patients were successfully treated with long-acting risperidone (82.7%) for 2 years, compared with those treated with olanzapine (74.8%) or haloperidol (57.3%). Total mean costs per patient over 2 years were 16,406 Euro with long-acting risperidone, 17,074 Euro with olanzapine and 21,779 Euro with haloperidol (year of costing 2003). The mean cost-effectiveness ratios were 19,839 Euro, 22,826 Euro and 38,008 Euro per successfully treated patient for long-acting risperidone, olanzapine and haloperidol, respectively. Results of the sensitivity analysis confirmed that the results were robust to a wide variation of different input variables (effectiveness, dosing distribution, patient status according to healthcare system). Long-acting risperidone was the dominant strategy, being both more effective and less costly than either oral olanzapine or depot haloperidol. Long-acting risperidone appears to represent a favourable first-line strategy for patients with schizophrenia requiring long-term maintenance treatment.

Objectives: To summarize scientific evidence for individual psychosocial treatment of developmental disorders of speech and language (DD-L), and developmental disorders of scholastic skills (DDSch). To describe care organization for these disorders in 7 Western countries. Methodology: EBM literature review including systematic reviews, meta-analyses, randomized controlled trials and quasi-experimental studies. Questionnaires sent to renowned experts in France, Germany, the Netherlands, Finland, UK, and Switzerland; description of the Belgian situation. Results: In the short term, speech and language interventions for expressive phonological or vocabulary difficulties are effective; long term effects are not well-studied. In a few studies, no difference was found between treatment by trained parents or clinicians, or between individual and group therapy. For treatment of receptive language difficulties, only few studies are available suggesting little effects. Effective reading programs for reading disabilities should include training of the alphabetic principle and phonological awareness, and integration of these elements with comprehension and fluency skills. For mathematical disorders, too few publications are available to conclude. Very few studies evaluated treatment intensity and duration, or the differences between monoand multidisciplinary treatment. Publications on treatment of co-morbid developmental or behavioral disorders were also lacking. In most countries, multidisciplinary treatment (2 disciplines or more) is almost standard for DD-L and DD-Sch. Governmental responsibility for organization and funding belongs mostly to health and educational departments together. Conclusion: It seems standard in Western societies to provide multidisciplinary treatment for DD-L and DD-Sch, but effectiveness of this strategy has been little evaluated.

Objective: To analyse the direct medical costs and effectiveness of vaccinating adults aged between 18 and 64 years and elderly persons ≥65 years of age with the 23-valent pneumococcal polysaccharide vaccine. Design and setting: This was a decision-analytic modelling study from the societal perspective in Belgium. The analysis compared ‘evaccination’ with ‘no vaccination and treatment’. Methods: Calculations were based on the assumption that vaccination is as effective against all pneumococcal infections as it is against invasive pneumococcal disease. Data on the incidence of pneumococcal pneumonia and meningitis, frequency of hospitalisation, mortality rates and vaccine effectiveness were derived from the international literature. Costs were derived from analysis of historical data for cases of pneumococcal infection in Belgium. Results: Vaccinating 1000 adults between the ages of 18 and 64 years gains approximately 2 life-years in comparison with the no vaccination option. However, to realise these additional health benefits requires additional costs of 11 800 European Currency Units (ECU; 1995 values) per life-year saved. Vaccinating 1000 elderly people (≥65 years) leads to >9 life-years gained as well as a small monetary benefit of ECU1250. An extensive sensitivity analysis did not greatly affect the results for the elderly population: vaccination in this age group always remained favourable, and thus it is clearly indicated from an economic point of view. A crucial assumption for both age groups is that the effectiveness of the vaccine holds for all pneumococcal pneumonia. It is clear that the results will become less favourable if this assumption is dropped. Conclusions: Preventing pneumococcal infections by vaccination clearly benefits people’s health. Reimbursement can be recommended for the elderly group; however, more accurate epidemiological data are still needed to make decisions concerning routine pneumococcal vaccination in adults

The study calculates inpatient costs generated at the University Hospital in Antwerp (Belgium) and outpatient costs generated at the Institute of Tropical Medicine or at the University Hospital of 213 seropositive patients without AIDS and of 48 AIDS patients, for the year 1991. Outpatient drug use other than Zidovudine was excluded. An HIV + patient has an average annual total billing cost of 2062 ECU, 43% of which is spent in hospital, 29% on Zidovudine and 28% for follow-up at the Institute of Tropical Medicine. The average cost of care for an AIDS patient is 5.5 times higher and amounts to 11 277 ECU—hospitalisation costs (8349 ECU) and costs of Zidovudine (2031 ECU) are much higher. Costs vary with the severity of illness. In comparison to 1987, costs decreased due to lower drug prices and reduced hospitalisations. Life time costs of a seropositive patient are estimated at about 35 000 ECU, based on cost calculations per CD4-class for a follow-up period from 1991 to 1993.

The Belgian Ministry of Public Health distributes an Independent Drug Formulary (IDF) on a 2-yearly basis. This formulary (called the Gecommentarieerd Geneesmiddelenrepertorium) is edited by a group of prominent experts in pharmacology, brought together by the Belgian Centre for Pharmacotherapeutic Information. It contains scientific information about all drugs marketed in Belgium; it also mentions the brand name, composition, package form, prices per package and reimbursement category. [The NHI reimburses drugs according to their reimbursement category. Drugs of category (a) are totally reimbursed. For pensioners, widows, orphans and invalids, the NHI reimburses 85%, 50% and 40% for drugs of categories (b), (c) and (cs) respectively; for other insured persons, the reimbursement percentages are respectively 75%, 50% and 40%. Drugs of category (d) are not reimbursed.] Daily drug costs and comparisons between those costs for similar therapies are not provided, however. There is also a brief comparison between the relative medical effectiveness of the drugs in similar therapeutic categories; price comparisons are absent, however. This formulary is sent, free of charge, to all Belgian physicians and pharmacists. Students in the last 2 years of their graduate studies also receive a copy.

Objective:SOS compared during 2 years medical costs in Belgian out-patients with schizophrenia.Methods:Patients older than 18 and stabilized with haloperidol(H), olanzapine(O) or risperidone(R) monotherapy entered this observational study at discharge from the hospital.Results:Of 323 patients included, 68% (219/323) completed the study (H59% (19/32), O66% (99/149), R71% (101/142)). In the R group were more first episode patients (H6%, O17%, R27%). H patients were more chronic with more previous hospitalizations.Treatment continuation (no drop out, without medication change or addition) was 31%(H), 50%(O) and 43%(R). The mean dosages were H 8.9 (±9.6), O 14 (±6) and R 4.2 (±1.9) mg/day. Two years medical costs were H 30484 (± 36332), O 20897 (± 27863), R 20916 (± 31776) (NS)The CGI improved during the first 3 months and then remained stable. The percentage of patients with at least 1 EPS at the last visit was: H66%, O35% and R39% (p=0.005) and at least 1 sexual/reproductive problem was H69%, O40%, R44% (p=0.013). Weight gain was H 0.53 ± 5.0, O 3.3 ± 8.3 and R 3.2 ± 8.4 kg.Conclusion:Even in this group of stabilized patients, treatment continuation was poor: in only 1 out of 3 haloperidol patients, treatment was not changed during the 2 years follow up. The fewest treatment change was in the olanzapine group (1 out of 2). Treatment cost was not significantly higher in the haloperidol group and similar in olanzapine and risperidone group as hospitalization was the main cost driver.

Patients with severe aortic stenosis, but who are not good candidates for surgical aortic valve replacement can be treated with trans-catheter aortic valve implantation (TAVI). This latest technology however comes at a considerable cost. The objective of the current study is to calculate and analyse