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Compliance and efficiency before and after implementation of a clinical practice guideline for laryngeal carcinomas

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology and Head & Neck Aims and scope Submit manuscript

Abstract

We evaluated whether the implementation of a nationwide clinical practice guideline for diagnosis, treatment and follow-up of laryngeal carcinomas led to changes in hospital costs, balanced against clinical changes observed following the guideline’s implementation. Charts of 822 patients with larynx carcinoma (459 treated before the introduction of the guideline and 363 thereafter) in five hospitals were retrospectively investigated. In all phases, no differences in total hospital costs were observed after the guideline’s implementation. Total mean costs were € 3,207 (95%CI 3,091–3,395) for diagnosis, € 3,169 (2,153–4,182), € 5,026 (3,996–6,057), € 6,458 (5,579–7,337), € 8,037 (7,469–8,606), € 12,765 (10,763–14,769), € 19,227 (16,848–21,605) for treatment of dysplasia, carcinoma in situ, T1, T2, T3 and T4 carcinoma, respectively, and € 1,856 (1,491–2,220) for 1 year disease-free follow-up. In an earlier study, we observed several positive changes after the guideline’s implementation. Balanced against the equal costs before and after the guideline’s implementation, we conclude that the efficiency of the care process improved.

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Authors and Affiliations

  1. Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Michel van Agthoven & Carin A. Uyl-de Groot

  2. Department of Head and Neck Surgery, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands

    Hélène A. G. Heule-Dieleman, Paul P. Knegt & Maarten F. de Boer

  3. Department of Radiotherapy, University Medical Centre St. Radboud, Nijmegen, The Netherlands

    Johannes H. A. M. Kaanders

  4. Department of Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands

    Robert J. Baatenburg de Jong

  5. Department of Head and Neck Surgery, University Hospital, Maastricht, The Netherlands

    Bernd Kremer & Johannes J. Manni

  6. Department of Head and Neck Surgery, VU University Medical Centre, Amsterdam, The Netherlands

    C. René Leemans

  7. Department of Head and Neck Surgery, University Medical Centre St. Radboud, Nijmegen, The Netherlands

    Henri A. M. Marres

  8. Department of Radiotherapy, VU University Medical Centre, Amsterdam, The Netherlands

    Johannes A. Langendijk

  9. Department of Radiotherapy, Erasmus MC Daniel Den Hoed, University Medical Centre, Rotterdam, The Netherlands

    Peter C. Levendag

  10. Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands

    Reina E. Tjho-Heslinga

  11. Maastro Clinic, Maastricht, The Netherlands

    Joseph M. A. de Jong

Authors
  1. Michel van Agthoven
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  2. Hélène A. G. Heule-Dieleman
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  3. Paul P. Knegt
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  4. Johannes H. A. M. Kaanders
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  6. Bernd Kremer
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  7. C. René Leemans
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  8. Henri A. M. Marres
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  9. Johannes J. Manni
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  10. Johannes A. Langendijk
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  11. Peter C. Levendag
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  12. Reina E. Tjho-Heslinga
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  13. Joseph M. A. de Jong
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  14. Maarten F. de Boer
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  15. Carin A. Uyl-de Groot
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Correspondence to Michel van Agthoven.

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van Agthoven, M., Heule-Dieleman, H.A.G., Knegt, P.P. et al. Compliance and efficiency before and after implementation of a clinical practice guideline for laryngeal carcinomas. Eur Arch Otorhinolaryngol 263, 729–737 (2006). https://doi.org/10.1007/s00405-006-0062-6

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  • DOI: https://doi.org/10.1007/s00405-006-0062-6

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