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Table 1 Description of the case studies

From: Case-studies of displacement effects in Dutch hospital care

Health technology

Description

Left ventricular assist device (LVAD)

LVADs are devices for assisting cardiac circulation. They have been used from 1992 onwards as a ‘bridge to transplant’ for patients with advanced heart failure. During the years, the outcomes of the therapy have steadily improved, such that LVAD can be used as long-term therapy (‘destination’, LVAD is not followed up by a heart transplant).

Fenestrated endovascular aneurysm repair

In this procedure an expandable stent graft is placed within the aorta to treat aortic disease. This minimally-invasive technique is indicated for high-risk patients unfit for open surgery. Fenestrated and branched EVAR (FEVAR) are expensive due to its custom-made graft device.

Expensive oncolytics

In recent years, several relatively expensive oncolytics have been approved for inclusion in the basic benefit package, including pertuzumab, palbociclib, nivolumab, pembrolizumab, atezolizumab, and ibrutinib.

Eylea and Lucentis

Avastin, Eylea and Lucentis are all used for the treatment of various eye diseases. Eylea and Lucentis are both much more expensive than Avastin, but are equally effective for most indications. Eylea and Lucentis are indicated for patients for whom Avastin is not effective, and for patients with diabetic macula edema and vascular occlusion.

Population screening for colon cancer

In 2014, the Netherlands started population screening for colon cancer. People with positive test results are advised to get a colonoscopy in the hospital. Studies have shown that this surveillance is not cost-effective [13].

Robotic surgery

Robotic assisted minimally invasive surgery has been performed in the Netherlands since 2000, as an alternative to ‘pure’ laparoscopy or open procedures for various indications. Despite many studies, there is still no clear-cut evidence regarding the cost-effectiveness.