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Articles by Janneke Kaper
Total Records ( 2 ) for Janneke Kaper
  Constant P. Van Schayck , Janneke Kaper , Edwin J. Wagena , Emiel F. M. Wouters and Johannes L. Severens
  ObjectivesIn healthy smokers, antidepressants can double the odds of cessation. Because of its four times lower costs and comparable efficacy in healthy smokers, nortriptyline appears to be favourable compared to bupropion. We assessed which of both drugs was most effective and cost-effective in stopping smoking after 1 year compared with placebo among smokers at risk or with existing chronic obstructive pulmonary disease (COPD). MethodsA total of 255 participants, aged 30-70 years, received smoking cessation counselling and were assigned bupropion, nortriptyline or placebo randomly for 12 weeks. Prolonged abstinence from smoking was defined as a participant's report of no cigarettes from week 4 to week 52, validated by urinary cotinine. Costs were calculated using a societal perspective and uncertainty was assessed using the bootstrap method. ResultsThe prolonged abstinence rate was 20.9% with bupropion, 20.0% with nortriptyline and 13.5% with placebo. The differences between bupropion and placebo [relative risk (RR)=1.6; 95% confidence interval (CI) 0.8-3.0] and between nortriptyline and placebo (RR=1.5; 95% CI 0.8-2.9) were not significant. Severity of airway obstruction did not influence abstinence significantly. Societal costs were €1368 (2.5th-97.5th percentile 193-5260) with bupropion, €1906 (2.5th-97.5th 120-17761) with nortriptyline and €1212 (2.5th-97.5th 96-6602) with placebo. Were society willing to pay more than €2000 for a quitter, bupropion was most likely to be cost-effective. ConclusionsBupropion and nortriptyline seem to be equally effective, but bupropion appears to be more cost-effective when compared to placebo and nortriptyline. This impression holds using only health care costs. As the cost-effectiveness analyses concern some uncertainties, the results should be interpreted with care and future studies are needed to replicate the findings.
  Pepijn Vemer , Maureen P. M. H. Rutten-van Molken , Janneke Kaper , Rudolf T. Hoogenveen , C. P. van Schayck and Talitha L. Feenstra
  Background   Smoking cessation can be encouraged by reimbursing the costs of smoking cessation support (SCS). The short-term efficiency of reimbursement has been evaluated previously. However, a thorough estimate of the long-term cost–utility is lacking.  Objectives   To evaluate long-term effects of reimbursement of SCS.  Methods   Results from a randomized controlled trial were extrapolated to long-term outcomes in terms of health care costs and (quality adjusted) life years (QALY) gained, using the Chronic Disease Model. Our first scenario was no reimbursement. In a second scenario, the short-term cessation rates from the trial were extrapolated directly. Sensitivity analyses were based on the trial’s confidence intervals. In the third scenario the additional use of SCS as found in the trial was combined with cessation rates from international meta-analyses.  Results   Intervention costs per QALY gained compared to the reference scenario were approximately €1200 extrapolating the trial effects directly, and €4200 when combining the trial’s use of SCS with the cessation rates from the literature. Taking all health care effects into account, even costs in life years gained, resulted in an estimated incremental cost–utility of €4500 and €7400, respectively. In both scenarios costs per QALY remained below €16 000 in sensitivity analyses using a life-time horizon.  Conclusions   Extrapolating the higher use of SCS due to reimbursement led to more successful quitters and a gain in life years and QALYs. Accounting for overheads, administration costs and the costs of SCS, these health gains could be obtained at relatively low cost, even when including costs in life years gained. Hence, reimbursement of SCS seems to be cost-effective from a health care perspective.
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