title: Compliance and efficiency before and after implementation of a clinical practice guideline for laryngeal carcinomas.
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 Euro 3,207 (95%CI 3,091-3,395) for diagnosis, Euro 3,169 (2,153-4,182), Euro 5,026 (3,996-6,057), Euro 6,458 (5,579-7,337), Euro 8,037 (7,469-8,606), Euro 12,765 (10,763-14,769), Euro 19,227 (16,848-21,605) for treatment of dysplasia, carcinoma in situ, T1, T2, T3 and T4 carcinoma, respectively, and Euro 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.
authors.affiliation: Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus MC, University Medical Centre Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. m.vanagthoven@erasmusmc.nl
authors.forename: Michel
authors.initials: M
authors.lastname: van Agthoven
authors.forename: Hélène A G
authors.initials: HA
authors.lastname: Heule-Dieleman
authors.forename: Paul P
authors.initials: PP
authors.lastname: Knegt
authors.forename: Johannes H A M
authors.initials: JH
authors.lastname: Kaanders
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Baatenburg de Jong
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Henri A M
authors.initials: HA
authors.lastname: Marres
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Manni
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Peter C
authors.initials: PC
authors.lastname: Levendag
authors.forename: Reina E
authors.initials: RE
authors.lastname: Tjho-Heslinga
authors.forename: Joseph M A
authors.initials: JM
authors.lastname: de Jong
authors.forename: Maarten F
authors.initials: MF
authors.lastname: de Boer
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D007822:Laryngeal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D016522:Oncology Service, Hospital / Q000191:economics* / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies