Publications by authors named "Carl Devos"

8 Publications

  • Page 1 of 1

Impact of shortened length of stay for delivery on the required bed capacity in maternity services: results from forecast analysis on administrative data.

BMC Health Serv Res 2019 Sep 5;19(1):637. Epub 2019 Sep 5.

Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000, Bruxelles, Belgium.

Background: We examine the implications of reducing the average length of stay (ALOS) for a delivery on the required capacity in terms of service volume and maternity beds in Belgium, using administrative data covering all inpatient stays in Belgian general hospitals over the period 2003-2014.

Methods: A projection model generates forecasts of all inpatient and day-care services with a time horizon of 2025. It adjusts the observed hospital use in 2014 to the combined effect of three evolutions: the change in population size and composition, the time trend evolution of ALOS, and the time trend evolution of the admission rates. In addition, we develop an alternative scenario to evaluate the impact of an accelerated reduction of ALOS.

Results: Between 2014 and 2025, we expect the number of deliveries to increase by 4.41%, and the number of stays in maternity services by 3.38%. At the same time, a reduction in ALOS is projected for all types of deliveries. The required capacity for maternity beds will decrease by 17%. In case of an accelerated reduction of the ALOS to reach international standards, this required capacity for maternity beds will decrease by more than 30%.

Conclusions: Despite an expected increase in the number of deliveries, future hospital capacity in terms of maternity beds can be considerably reduced in Belgium, due to the continuing reduction of ALOS.
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http://dx.doi.org/10.1186/s12913-019-4500-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729074PMC
September 2019

Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review.

BMC Pregnancy Childbirth 2017 09 6;17(1):289. Epub 2017 Sep 6.

KCE Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique 55, 1000, Bruxelles, Belgium.

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http://dx.doi.org/10.1186/s12884-017-1465-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5588709PMC
September 2017

Authors' reply to Ward.

BMJ 2013 Oct 2;347:f5868. Epub 2013 Oct 2.

Belgian Health Care Knowledge Centre, Brussels 1000, Belgium.

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http://dx.doi.org/10.1136/bmj.f5868DOI Listing
October 2013

The cost-utility of catheter ablation of atrial fibrillation: a systematic review and critical appraisal of economic evaluations.

BMC Cardiovasc Disord 2013 Sep 26;13:78. Epub 2013 Sep 26.

Belgian Health Care Knowledge Centre (KCE), Doorbuilding Kruidtuinlaan 55, B-1000, Brussels, Belgium.

Background: A health technology assessment (HTA) of catheter ablation for atrial fibrillation (CA-AF) was commissioned by the Belgian government and performed by the Belgian Health Care Knowledge Centre (KCE). In this context, a systematic review of the economic literature was performed to assess the procedure's value for money.

Methods: A systematic search for economic literature about the cost-effectiveness of CA-AF was performed by consulting various databases: CRD (Centre for Reviews and Dissemination) HTA and CDSR (Cochrane Database of Systematic Reviews) Technology Assessment, websites of HTA institutes, NHS EED (NHS Economic Evaluation Database), Medline (OVID), EMBASE and EconLit. No time or language restrictions were imposed and pre-defined selection criteria were used. The two-step selection procedure was performed by two persons. References of the selected studies were checked for additional relevant citations.

Results: Out of 697 references, seven relevant studies were selected. Based on current evidence and economic considerations, the rationale to support catheter ablation as first-line treatment was lacking.The economic evaluations for second-line catheter ablation included several assumptions that make the results rather optimistic or subject to large uncertainty. First, overall AAD (antiarrhythmic drugs) use after ablation was higher in reality than assumed in the economic evaluations, which had its impact on costs and effects. Second, several models focused on the impact of ablation on preventing stroke. This was questionable because there was no direct hard evidence from RCTs to support this assumption. An indirect impact through stroke on mortality should also be regarded with caution. Furthermore, all models included an impact on quality of life (QoL)/utility and assumed a long-term impact. Unfortunately, none of the RCTs measured QoL with a generic utility instrument and information on the long-term impact on both mortality and QoL was lacking.

Conclusions: Catheter ablation is associated with high initial costs and may lead to life-threatening complications. Its cost-effectiveness depends on the belief one places on the impact on utility and/or preventing stroke, and the duration of these effects. Having no hard evidence for these important variables is rather troublesome. Although the technique is widely spread, the scientific evidence is insufficient for drawing conclusions about the intervention's cost-effectiveness.
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http://dx.doi.org/10.1186/1471-2261-13-78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849361PMC
September 2013

Caution over use of catheter ablation for atrial fibrillation.

BMJ 2013 Sep 6;347:f5277. Epub 2013 Sep 6.

Belgian Health Care Knowledge Centre, Brussels 1000, Belgium.

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http://dx.doi.org/10.1136/bmj.f5277DOI Listing
September 2013

Effectiveness of catheter ablation of atrial fibrillation in Belgian practice: a cohort analysis on administrative data.

Europace 2013 May 6;15(5):663-8. Epub 2013 Feb 6.

Belgian Health Care Knowledge Centre, Brussels, Belgium.

Aim: To assess the outcome and cost of catheter ablation of atrial fibrillation (AF) in Belgium.

Methods And Results: From a nationwide health insurers' database, we retrieved claims data of all patients that underwent a catheter ablation of AF from November 2007 through December 2008. Based on data on reimbursed procedures and drugs, we assessed AF recurrence using different models. Costs related to the index hospitalization were calculated. During the observation period, 830 patients underwent a first catheter ablation of AF. Two-year follow-up data were available for all patients, with an average follow-up of 30.2 months. Seventy-seven percent of patients were treated for paroxysmal AF. Recurrence of AF was defined as the occurrence of one of the following events: a repeat catheter ablation, an electric cardioversion or an antiarrhythmic drug (AAD) prescription, the latter two taking into account a blanking period of 3 months. Atrial fibrillation recurred in 59.8% of patients after 1 year and in 65.9% of them after 2 years. If AAD prescription was considered as an indicator for ablation failure only if it occurred after a 1 month AAD-free period, recurrence of AF occurred in 37.3% of patients after 1 year and in 49.9% after 2 years. Based on the prescription of rate and rhythm control drugs before the ablation, we conclude that up to 15.8% of patients underwent catheter ablation as first-line therapy. Catheter ablation of AF in Belgium on average costs about €9600 for the initial intervention.

Conclusion: Since the effectiveness of catheter ablation of AF appears to be less favourable in real-world practice as compared with results reported in clinical trials, and given the high initial cost of the procedure, we suggest to strictly limiting the intervention to patients in whom it is currently believed to be most beneficial, i.e. those with severely symptomatic and drug-refractory paroxysmal AF with no or minimal structural heart disease.
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http://dx.doi.org/10.1093/europace/eut004DOI Listing
May 2013
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