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Purpose: To assess trends in Disability-Free Life Expectancy, in life expectancy with disabilities according to levels of severity and in Disability-Adjusted Life Expectancy in the Netherlands between 1989 and 2000. Method: The disability-free life expectancy, a composite population health status measure, was calculated with data on long-term disability. Weights reflecting the impact of disability on personal functioning were assigned to different levels of severity of disability, in order to calculate a Disability-Adjusted Life Expectancy and to define cut-off points, in order to distinguish between levels of severity. Results: At an aggregated level, for both males and females at the ages of 16 and of 65 years, an increase in years with disabilities and a decline in disability-free life expectancy were observed. These trends were mainly caused by a rise in the number of years with mild disabilities, with the number of years with moderate and severe disabilities decreasing. The combined changes have resulted in an increase in the Disability-Adjusted Life Expectancy. Conclusion: Trends in disability-free life expectancy and in years with disabilities provide support for a scenario of dynamic equilibrium. The number of years with moderate and severe disabilities has reduced, resulting in an increase in the number of years with minor disabilities. Further research should focus on the underlying causes of the increase of years with minor disabilities. © 2004 Taylor & Francis Ltd.

Background. Guidelines for screening and subsequent treatment of hypertension vary widely between countries. Part of this variation can be attributed to systematic differences between populations, but little is known about the way in which guidelines should be targeted to the population of interest. Optimal guidelines should have high yield and low complexity. The goal is to fit procedures for screening and subsequent treatment of hypertension optimally to a specific population. Methods. Simulation study on individual cardiovascular risk profiles, with drug treatment altering the 10-year cardiovascular risk. The analysis compares the consequences of various screening and treatment alternatives. The reference scenario consists of the Dutch hypertension guidelines for primary care. A representative sample of the Dutch population aged 20 years and older is taken as the target. Main outcome measures include incidence, quality-adjusted life years won, number needed to screen, and costs (prevention, morbidity, and mortality). The discount rate is 4%. Results. Strict adherence to the current hypertension guidelines saves costs (i.e., the total prevention costs are less than the costs of prevented morbidity and mortality). The following changes increase its cost-effectiveness: use of lower blood pressure levels for screening and treatment, reduction of the number of screens from 5 to 3, and active call-up of high-risk patients. The adherence to guidelines has a large influence on actual cost-effectiveness achieved in practice. Conclusions. Appropriate targeting of hypertension guidelines to a population and critical appraisal of the entire screening procedure can enhance cost-effectiveness.

BACKGROUND: Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. METHODS: We used primary data to compare cost-effectiveness of four screening strategies for NBSCF, i.e. immunoreactive trypsinogen-testing followed by pancreatitis-associated protein-testing (IRT-PAP), IRT-DNA, IRT-DNA-sequencing, and IRT-PAP-DNA-sequencing, each compared to no-screening. A previously developed decision analysis model for NBSCF was fed with model parameters mainly based on a study evaluating two novel screening strategies among 145,499 newborns in The Netherlands. RESULTS: The four screening strategies had cost-effectiveness ratios varying from €23,600 to €29,200 per life-year gained. IRT-PAP had the most favourable cost-effectiveness ratio. Additional life-years can be gained by IRT-DNA but against higher costs. When treatment costs reduce with 5% due to early diagnosis, screening will lead to financial savings. CONCLUSION: NBSCF is as an economically justifiable public health initiative. Of the four strategies tested IRT-PAP is the most economic and this finding should be included in any decision making model, when considering implementation of newborn screening for CF