Research Project

Cost-Conscious Healthcare - CoCoCare

A ZonMw grant in 2021, launched the project "Learning platform for guideline development: future-proof and sustainable". This 4 years project develops a learning platform that can support and further standardize clinical guideline (developments) in different (para)medical fields, while also including cost-conscious care. The project is a joint effort of the Maastricht School of Health Professions Education (SHE) and the Care and Public Health Research Institute (CAPHRI), research line Creating Value-Based Health Care and the Academic Center of Epileptology Kempenhaeghe Maastricht UMC; in close collaboration with the Knowledge Institute of the Dutch Association of Medical Specialists (KIMS).

With the growing medical possibilities, new questions arise. It is not only a matter of being able to treat, but also of considering the added value of treatment. In deciding the value of treatment, many factors have to be weighed, such as health benefit, quality of life effect and expenses. Medical guidelines can make an important contribution when making such treatment decisions. As such, they have a considerable influence on the quality and effectiveness of healthcare and allow the (future) healthcare professional to be as cost-conscious as possible.


Prof. dr. H.J.M. Majoie
Epilepsiecentrum Kempenhaeghe


Project description
In the Netherlands, health care expenditure is the largest cost item in the national budget; these will increase if policy remains unchanged. (Para)medical guidelines are intended to guide various, often multidisciplinary, decision-making processes and to enable treatment teams to find a balance between quality, effectiveness and costs. Despite the major effect these guidelines have on the behavior of healthcare professionals, we rarely see their development, application and implementation addressed in (para)medical training programs or education.

The aim of this learning platform is to bring about behavioral change in healthcare professionals from a social and patient/care provider perspective.

We do this by optimizing guideline training, creating a community and e-learning platform, developing guideline test cases and – for further development of the training – evaluation through design-oriented research.

Marian Majoie

In this Dutch podcast of Prof.dr. Marian Majoie talks about the importance of High Value Cost Conscious Care and how the CoCoCare training program contributes to this.


Incremental cost-effectiveness ratios for Parkinson’s disease patients comparing advanced therapies to best medical treatment 

Guideline development: Percutaneous Endoscopic gastrostomy in advance dementia patients

Colonna I., Carvalho V.

To the poster >

Research question: In patients with dementia, does percutaneous endoscopic gastrostomy, when compared to oral feeding, reduces mortality? 

Guideline: use of cholinesterase inhibitors and memantine in vascular dementia

Cabreira V., Massano J.

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Research question: Our PICO question was whether ChEI or memantine rather than standard of care (no pharmacological treatment) should be used in patients with vascular dementia to improve important clinically meaningful outcomes such as cognitive functioning, global clinical impression, behaviour and performance of ADL. 
The guideline developers prioritised this question. 
Perspective: Population. 
Guideline development followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. Several outcomes were identified and judgements were made in relation to its importance. Overall, outcomes for cognitive functioning, ADL and global clinical impression were considered to be of critical importance (rating 7-9) while outcomes for behaviour were classified as important (mean rating of 6). Outcomes related to adverse events were also rated and globally were considered to be important, while number of deaths was classified as a critical outcome. 

Rituximab and Cyclophosphamide as Second-line Immunotherapy for Autoimmune Encephalitis

Antonia Lefter, Liviu Cozma, Bogdan Ovidiu Popescu

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The PICO question was the following:
For adult patients (at least 18 years old) with  Autoimmune encephalitis (AE), does treatment with rituximab (375 mg/ once a week for at least 4 weeks or 1 g infused twice, 2 weeks apart), cyclophosphamide (750 mg/ once a month for at least 4 months), or both regimens combined, as opposed to absence of intervention, lead to a better clinical outcome (decrease in the mRS of at least 1 point from onset), or absence of relapses, i.e. exacerbation of previous symptoms or the occurrence of new symptoms.

Guideline: use of pharmacological therapy in the treatment of diabetic peripheral neuropathic pain

Nadezhda Ruzhdii 

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PICO question: wheather pregabalin or gabapentin or duloxetine should be used as first-line treatment instead of standard of treatment (amitriptilin) of diabetic peripheral neuropathic pain.Population: diabetic peripheral neuropatic pain individuals 2) Intervention: pregabalin or gabapentin or duloxetine treatment or standart AMT treatment ; 3) Setting: all countries; 4) Outcome: reduced neuropatic pain. Side symptoms reported in the studies: diarrhoea, dizziness, headache, somnolence and nausea considered as adverse events (AE). Outcomes related to adverse events were rated and considered to be important. Number of deaths was classified as a critical outcome. Guideline development followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group recommendations in population perspective. 

Neuromodulation versus standard care for migraine prophylaxis

Federico Emanuele Pozzi, Nina Vashchenko

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PICO question: should neuromodulation be used in patients with migraine for prophylactic therapy? 
Through a Delphi procedure, we agreed on a set of 6 outcomes for our search, 3 of which were rated critical (days without migraine, intensity of migraine and acute drugs intake) and 3 important (side effects, functional disability and patients’ satisfaction). Guideline development was carried through according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.