Skip to main content
    • Aa
    • Aa
  • Get access
    Check if you have access via personal or institutional login
  • Cited by 1
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Helderman, Jan-Kees 2015. Reflecting on ‘The evaluation of lifestyle interventions in the Netherlands’. Health Economics, Policy and Law, Vol. 10, Issue. 04, p. 461.


The evaluation of lifestyle interventions in the Netherlands

  • David R. Rappange (a1) and Werner B. F. Brouwer (a2)
  • DOI:
  • Published online: 02 March 2012

Current investments in preventive lifestyle interventions are relatively low, despite the significant impact of unhealthy behaviour on population health. This raises the question of whether the criteria used in reimbursement decisions about healthcare interventions put preventive interventions at a disadvantage. In this paper, we highlight the decision-making framework used in the Netherlands to delineate the basic benefits package. Important criteria in that framework are ‘necessity’ and ‘cost-effectiveness’. Several normative choices need to be made, and these choices can have an important impact on the evaluation of lifestyle interventions, especially when making these criteria operational and quantifiable. Moreover, the implementation of the decision-making framework may prove to be difficult for lifestyle interventions. Improvements of the decision-making framework in the Netherlands are required to guarantee sound evaluations of lifestyle interventions aimed at improving health.

Corresponding author
*Correspondence to: Werner B.F. Brouwer, Department of Health Policy & Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

A. Avenell , J. Broom , T. J. Brown , A. Poobalan , L. Aucott , S. C. Steran , W. C. Smith , R. T. Jung , M. K. Campbell A. M. Grant (2004), ‘Systematic review of the long-term effects and economic consequences of treatments of obesity and implications for health improvement’, Health Technology Assessment, 8(iii–iv): 1182.

A. Bobinac , N. J. A. van Exel , F. F. H. Rutten W. B. F. Brouwer (2010), ‘Willingness to pay for a QALY: the individual approach’, Value in Health, 13(8): 10461055.

A. Bobinac , W. B. F. Brouwer N. J. A. van Exel (2011b), ‘Societal discounting and growing healthy life expectancy – an empirical investigation’, Health Economics, 20(1): 111119.

W. B. F. Brouwer , L. W. Niessen , M. J. Postma F. F. H. Rutten (2005), ‘Need for differential discounting of costs and health effects in cost effectiveness analyses’, British Medical Journal, 331: 446448.

W. B. F. Brouwer , N. J. A. van Exel , P. H. M. van Baal J. J. Polder (2007), ‘Economics and public health: engaged to be happily married!’, European Journal of Public Health, 17: 122123.

W. B. F. Brouwer , N. J. A. van Exel , R. Baker C. Donaldson (2008), ‘The new myth: the social value of a QALY’, PharmacoEconomics, 26: 14.

K. Claxton , M. Paulden , H. Gravelle , W. B. F. Brouwer A. J. Culyer (2011), ‘Discounting and decision making in the economic evaluation of health-care technologies’, Health Economics 20: 215.

K. Claxton , M. Sculpher M. Drummond (2002), ‘A rational framework for decision making by the National Institute for Clinical Excellence (NICE)’, Lancet, 360: 711715.

E. W. de Bekker-Grob , J. J. Polder , J. P. Mackbach W. J. Meerding (2007), ‘Towards a comprehensive estimate of national spending on prevention’, BMC Public Health, 7: 252.

H.-G. Eichler , S. X. Kong , W. C. Gerth , P. Mavros B. Jönsson (2004), ‘Use of cost-effectiveness analysis in health-care resource allocation decision-making: how are cost-effectiveness tresholds expected to emerge?’, Value in Health, 7: 518528.

T. L. Feenstra , H. H. Hamberg-van Reenen , R. T. Hoogenveen M. P. Rutten-van Molken (2005), ‘Cost-effectiveness of face-to-face smoking cessation interventions: a dynamic modelling study’, Value in Health, 8: 178190.

T. L. Feenstra , P. H. M. van Baal , A. Gandjour W. B. F. Brouwer (2008), ‘Future costs in economic evaluation: a comment on Lee’, Journal of Health Economics, 27: 16451649.

A. M. Garber C. E. Phelps (1997), ‘Economic foundations of cost-effectiveness analysis’, Journal of Health Economics, 16: 131.

H. Gravelle , W. B. F. Brouwer , L. W. Niessen , M. J. Postma F. F. H. Rutten (2007), ‘Discounting in economic evaluations: stepping forward towards optimal decision rules’, Health Economics, 16: 307317.

H. Gravelle D. Smith (2001), ‘Discounting for health effects in cost-benefit and cost-effectiveness analysis’, Health Economics, 10: 587599.

D. W. Haslam W. P. T. James (2005), ‘Obesity’, Lancet, 366: 11971209.

W. H. Herman , T. J. Hoerger , M. Brandle , M. Hicks , S. Sorensen , P. Zhang , R. F. Hamman , R. T. Ackermann , M. M. Engelgau R. E. Ratner , Diabetes Prevention Program Research Group (2005), ‘The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance’, Annals of Internal Medicine, 142: 323332.

R. A. Hirth , M. E. Chernew , E. Miller , A. M. Fendrick W. G. Weissert (2000), ‘Willingness to pay for a quality-adjusted life year: in search of a standard’, Medical Decision Making, 20: 332342.

M. Johannesson (2001), ‘Should we aggregate relative or absolute changes in QALYs?’, Health Economics, 10: 573577.

S. E. Johansson J. Sundquist (1999), ‘Change in lifestyle factors and their influence on health status and all-cause mortality’, International Journal of Epidemiology, 28: 10731080.

E. B. Keeler S. Cretin (1983), ‘Discounting of life-saving and other non-monetary effects’, Manage Science, 29: 300306.

M. A. Koopmanschap , F. F. H. Rutten , B. M. van Ineveld L. van Roijen (1995), ‘The friction cost method for measuring indirect costs of disease’, Journal of Health Economics, 14: 171189.

C. McCabe , K. Claxton A. J. Culyer (2008), ‘The NICE cost-effectiveness threshold: what it is and what that means’, PharmacoEconomics, 26: 733744.

D. Meltzer (1997), ‘Accounting for future costs in medical cost-effectiveness analysis’, Journal of Health Economics, 16: 3364.

D. Meltzer M. Johannesson (1999), ‘Inconsistencies in the “societal perspective” on costs of the panel on cost-effectiveness in health and medicine’, Medical Decision Making, 19: 371377.

C. Mitton C. Donaldson (2004), ‘Health care priority setting: principles, practice and challenges’, Cost Effectiveness and Resource Allocation, 2: 3. Available at:

E. Nord (2005), ‘Concerns for the worse off: fair innings versus severity’, Social Science & Medicine, 60: 257263.

J. A. Nyman (2004), ‘Should the consumption of survivors be included as a cost in cost-utility analysis?’, Health Economics, 13: 417427.

R. H. Lee (2008), ‘Future costs in cost effectiveness analysis’, Journal of Health Economics, 27: 809818.

D. R. Rappange , W. B. F. Brouwer , F. F. H. Rutten P. H. M. van Baal (2010), ‘Lifestyle intervention: from cost savings to value for money’, Journal of Public Health, 32: 440447.

D. R. Rappange , P. H. M. van Baal , N. J. A. van Exel , T. L. Feenstra , F. F. H. Rutten W. B. F. Brouwer (2008), ‘Unrelated medical costs in life-years gained: should they be included in economic evaluations of healthcare interventions?’, PharmacoEconomics, 26: 815830.

M. D. Rawlins A. J. Culyer (2004), ‘National institute for clinical excellence and its value jugdements’, British Medical Journal, 329: 224227.

E. T. Ronckers , W. Groot A. J. H. A. Ament (2005), ‘Systematic review of economic evaluations of smoking cessation: standardizing the cost-effectiveness’, Medical Decision Making, 25: 437448.

S. Saha , U.-G. Gerdtham P. Johansson (2010), ‘Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases’, International Journal of Environmental Research and Public Health, 7: 31503195.

J. Schreyögg , T. Stargardt , M. Velasco-Garrido R. Busse (2005), ‘Defining the “health benefit basket” in nine european countries: evidence from the European Union Health BASKET project’, European Journal of Health Economics, 6, (Supplement 1): 210.

E. A. Stolk , W. B. F. Brouwer J. J. V. van Busschbach (2002), ‘Rationalising rationing: economic and other considerations in the debate about funding of Viagra’, Health Policy, 59: 5363.

E. A. Stolk , G. van Donselaar , W. B. F. Brouwer J. J. V. van Busschbach (2004), ‘Reconciliation of economic concerns and health policy: illustration of an equity adjustment procedure using proportional shortfall’, PharmacoEconomics, 22: 10971107.

E. A. Stolk , A. de Bont , A. R. van Halteren , R. J. Bijlmer M. J. Poley (2009), ‘Role of health technology assessment in shaping the benefits package in the Netherlands’, Expert Reviews of Pharmacoeconomics & Outcomes Research, 9: 8594.

E. A. Stolk , S. J. Pickee , A. H. J. A. Ament J. J. V. Busschbach (2005), ‘Equity in health care prioritisation: an empirical inquiry into social value’, Health Policy, 74: 343355.

P. H. M. van Baal , T. L. Feenstra , R. T. Hoogenveen , G. A. de Wit W. B. F. Brouwer (2007), ‘Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a “perfect” cost-utility ratio’, Health Economics, 16: 421433.

P. H. M. van Baal , J. J. Polder , R. T. Hoogenveen , P. M. Engelfriet , H. C. Boshuizen , T. L. Feenstra , G. A. de Wit W. B. F. Brouwer (2008), ‘Prevention no cure for rising expenditures: lifetime medical costs of obesity’, PLoS Medicine, 5(2): e29 (0242–0249).

M. C. Weinstein W. B. Stason (1977), ‘Foundations of cost-effectiveness analysis for health and medical practices’, New England Journal of Medicine, 296: 716721.

A. Williams (1997), ‘Intergenerational equity: an exploration of the fair innings argument’, Health Economics, 6: 117132.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *