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TY - JOUR AU - Berende, A. AU - Nieuwenhuis, L. AU - Hofstede, H.J.M. ter AU - Vos, F.J. AU - Vogelaar, M.L. AU - Tromp, M.A. AU - Middendorp, H. van AU - Donders, A.R.T. AU - Evers, A.W.M. AU - Kullberg, B.J. AU - Adang, E.M.M. PY - 2018 UR - http://hdl.handle.net/2066/190807 AB - BACKGROUND: The treatment of persistent symptoms attributed to Lyme disease remains controversial. Recently, the PLEASE study did not demonstrate any additional clinical benefit of longer-term versus shorter-term antibiotic treatment. However, the economic impact of the antibiotic strategies has not been investigated. METHODS: This prospective economic evaluation, adhering a societal perspective, was performed alongside the PLEASE study, a multicenter, placebo-controlled, double-blind 1:1:1 randomized clinical trial in which all patients received open-label intravenous ceftriaxone for two weeks before the 12-week randomized blinded oral antibiotic regimen (doxycycline, clarithromycin plus hydroxychloroquine, or placebo). Between 2010 and 2013, patients (n = 271) with borreliosis-attributed persistent symptoms were enrolled and followed for one year. Main outcomes were costs, quality-adjusted life years, and incremental net monetary benefit of longer-term versus shorter-term antibiotic therapy. RESULTS: Mean quality-adjusted life years (95% CI) were not significantly different (p = 0.96): 0.82 (0.77-0.88) for ceftriaxone/doxycycline (n = 82), 0.81 (0.76-0.88) for ceftriaxone/clarithromycin-hydroxychloroquine (n = 93), and 0.81 (0.76-0.86) for ceftriaxone/placebo (n = 96). Total societal costs per patient (95% CI) were not significantly different either (p = 0.35): euro11,995 (euro8,823-euro15,670) for ceftriaxone/doxycycline, euro12,202 (euro9,572-euro15,253) for ceftriaxone/clarithromycin-hydroxychloroquine, and euro15,249 (euro11,294-euro19,781) for ceftriaxone/placebo. Incremental net monetary benefit (95% CI) for ceftriaxone/doxycycline compared to ceftriaxone/placebo varied from euro3,317 (-euro2,199-euro8,998) to euro4,285 (-euro6,085-euro14,524) over the willingness-to-pay range, and that of ceftriaxone/clarithromycin-hydroxychloroquine compared to ceftriaxone/placebo from euro3,098 (-euro888-euro7,172) to euro3,710 (-euro4,254-euro11,651). For every willingness-to-pay threshold, the incremental net monetary benefits did not significantly differ from zero. CONCLUSION: The longer-term treatments were similar with regard to costs, effectiveness and cost-effectiveness compared to shorter-term treatment in patients with borreliosis-attributed persistent symptoms after one year of follow-up. Given the results of this study, and taking into account the external costs associated with antibiotic resistance, the shorter-term treatment is the antibiotic regimen of first choice. TI - Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease SN - 1932-6203 IS - iss. 4 JF - PLoS One VL - vol. 13 DO - https://doi.org/10.1371/journal.pone.0195260 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/190807/190807.pdf?sequence=1 ER - TY - JOUR AU - Smit, M. de AU - Smit, C. AU - Geerlings, S. AU - Gras, L. AU - Brinkman, K. AU - Hallett, T.B. AU - Wolf, F. de AU - Koopmans †, P.P. AU - Keuter, M. AU - Ven, A.J.A.M. van der AU - Hofstede, H.J.M. ter AU - Dofferhoff, A.S.M. AU - Warris, A. AU - Crevel, R. van AU - et al. PY - 2013 UR - http://hdl.handle.net/2066/125527 AB - OBJECTIVES: Document progress in HIV-treatment in The Netherlands since 1996 by reviewing changing patterns of cART use and relating those to trends in patients' short-term clinical outcomes between 1996 and 2010. DESIGN AND METHODS: 1996-2010 data from 10,278 patients in the Dutch ATHENA national observational cohort were analysed. The annual number of patients starting a type of regimen was quantified. Trends in the following outcomes were described: i) recovery of 150 CD4 cells/mm(3) within 12 months of starting cART; ii) achieving viral load (VL) suppression =1,000 copies/ml within 12 months of starting cART; iii) switching from first-line to second-line regimen within three years of starting treatment; and iv) all-cause mortality rate per 100 person-years within three years of starting treatment. RESULTS: Between 1996 and 2010, first-line regimens changed from lamivudine/zidovudine-based or lamivudine/stavudine-ba