Cardiovascular diseases are still common worldwide. Considering that there are risk assessment tools and preventive measures available, it has been suggested that population-based screening might be a promising strategy for identifying potential high-risk persons and consequently start preventive treatment. The ROBINSCA trial investigates whether screening for a high risk of cardiovascular diseases followed by preventive measures in asymptomatic individuals reduces cardiovascular morbidity and mortality. This thesis describes the secondary outcomes of the ROBINSCA screening trial, including contamination of screening arms, the impact of screening on participants, the risk distribution among the asymptomatic population and the potential reduction in overtreatment.
Esophageal adenocarcinoma is the most common type of esophageal cancer in Western countries. Various risk factors are associated with EAC, of which Barrett’s esophagus (BE) is the most important one. Targeted screening of well-defined high-risk populations and surveillance of BE patients using an upper gastrointestinal endoscopy is recommended by several clinical practice guidelines in the world. However, there are discrepancies in guidelines’ recommendations.
In this thesis, we conducted cost-effectiveness analyses on BE screening and surveillance strategies. First, we focused on screening for BE and evaluated the cost-effectiveness of using a minimally invasive method to screen high-risk people for BE, and we assessed the impact of including unrelated health effects and costs on our cost-effectiveness estimates. Then, we evaluated several ways to further improve the cost-effectiveness of BE surveillance by optimizing different aspects of BE management. Subsequently, we evaluated how the lack of adherence to surveillance guidelines for BE patients can impact cost-effectiveness estimates.
In the United States, annual lung cancer screening has been recommended since 2013, for persons aged 55-80 with a smoking history of at least 30 pack-years, that currently smoke or quit less than 15 years ago. Despite this recommendation, the uptake of lung cancer screening in the United States remains low. In Europe and the United Kingdom, many countries have been debating a possible implementation of lung cancer screening. In the meantime, many topics of debate remain. This thesis deals with two of these topics. The first part of this thesis (Chapters 1-3) investigates which treatments lung cancer patients in the United States received before the implementation of lung cancer screening, and how these treatment patterns change as a result of the implementation of lung cancer screening. In the second part of this thesis (Chapters 4-6), the benefits and harms of population-based lung cancer screening in the United States are investigated from different perspectives.
Traumatic brain injury (TBI) is defined as “an alteration in brain function, or other evidence of brain pathology, caused by an external force”. TBI is considered “the most complex disease in the most complex organ” and it is known that no two TBIs are rendered exactly the same, thus recovery after TBI leads to variability and uncertainty. On top of this, TBI is a leading cause of death and disability worldwide and has tremendous economic repercussions.
The overall aim of this thesis was to expand our knowledge on assessing outcome following TBI, and measuring outcome preferences for TBI and stroke among patients and the general population. The first part of this thesis (Chapter 2-8) describes the association between post-concussion symptoms and health-related quality of life in mild TBI and assesses the outcome following mild TBI, the prevalence and risk factors of post-concussion symptoms in patients with mild TBI and the general population and lastly, classifies post-concussion symptoms. In part two of this thesis (Chapter 9-12) we examine the preferences and utility weights for TBI and stroke health states and their application.
The effect of endovascular treatment (EVT) for ischemic stroke due to an intracranial large vessel occlusion varies between individual patients. Treatment benefit is affected by differences in clinical characteristics at baseline and early initiation of EVT is associated with improved chances of good recovery. A possibility to reduce delay is to directly transport patients with suspected large vessel occlusion stroke to an intervention center capable of performing EVT. However, this strategy might be harmful for stroke patients without large vessel occlusion, who only benefit from rapid intravenous thrombolysis in the nearest hospital. The optimal triage strategy requires a tradeoff between the harm of delaying intravenous thrombolysis versus the potential benefit of rapid EVT.
The overall aim of this thesis was to increase the benefit of EVT by optimizing prediction of outcome and treatment effect, reducing treatment delay, and improving prehospital triage strategies.
The objective of the thesis was to study the health economic aspects of leprosy prevention through post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR). The Leprosy Post-Exposure Prophylaxis program (LPEP) was a multi-centre study, included India where single-dose rifampicin was administered to the contacts of the leprosy patients. We found that SDR is feasible to implement along with the national leprosy control programme. SDR is cost-effective with an incremental cost of US$ 443 per DALY averted over 25 years. We recommend to scale-up SDR in India.
Please find a PDF version of the thesis here.
Watch the defence online here.
Decision models can be a useful tool to extrapolate information from randomized controlled trials and investigate colorectal cancer (CRC) screening in specific problem conditions. The aim of this thesis is to first describe the steps that are required to standardize the structure of a microsimulation model (as MISCAN-Colon) and make it as the core of an online user-friendly model application. Briefly, these steps include: i) assessing effectiveness of CRC screening in different screening settings; ii) validating the model structure and its assumptions; and iii) building an online user-friendly platform that allow users to easily upload country-specific data, adjust a model, and simulate future outcomes of CRC screening in their countries. Subsequently, this thesis aims to demonstrate how models can be used to help policymakers in their decisions about CRC screening regarding populations at different risk of CRC.