3. User conditionsThis questionnaire was developed by the Institute for Medical Technology Assessment (iMTA),Erasmus University Rotterdam. The questionnaire may be used on the following conditions.Permission for usePermission to use the questionnaire <strong>and</strong> manual must be obtained in advance. To apply for suchpermission, contact the address provided at the bottom of the page, or complete <strong>and</strong> submit theenclosed registration form to the same. In principle, permission for use will be granted. There areno financial conditions attached to use of the questionnaire. However, the following conditionsmust be observed when using the questionnaire, whether such use is for commercial or scientificpurposes.Conditions for use• The copyright notice on the title page must be reproduced in cases where thequestionnaire is largely or wholly used as is. If an altered version of the questionnaire isused, this version should be stated as source material.• The source is required to be explicitly stated in all publications as follows: Hakkaart-vanRoijen L, <strong>Short</strong> <strong>Form</strong>- <strong>Health</strong> <strong>and</strong> <strong>Labour</strong> <strong>Questionnaire</strong>. Institute for Medical TechnologyAssessment, Erasmus University Rotterdam.• The liability notice printed on the title page must always be included when using themanual <strong>and</strong> questionnaire.• Changes are permitted to be made to the questionnaire without prior consent. However, itshould be very clear that these changes were made by the user.• The user shall indemnify the Institute for Medical Technology Assessment, ErasmusUniversity Rotterdam <strong>and</strong> the author of this edition against claims from third partiesarising from <strong>and</strong>/or related to the use of this edition by the user, in the event of changes<strong>and</strong> or translation, or due to errors, omissions <strong>and</strong> misinterpretations or anyconsequences of this.• To assess the use of the questionnaire <strong>and</strong> the purpose to which this is used, please fillin the registration form as fully as possible (see appendix III).• A copy of all manuscripts, articles or other publications featuring this questionnaire orcontaining results obtained with the help of this instrument shall be made available to theauthor.• For the purpose of further (validation) studies, we may request the user – in consultation– to place part of the research at the disposal of the authors, specifically the scores forthe individual questions in the questionnaire, as (if gathered) those for the questions onsex, age, diagnosis, living situation, educational attainment <strong>and</strong> work status. The datamade available on the basis of the three preceding items will be treated confidentially bythe authors.For questions <strong>and</strong> comments, please Consultation:Dr. L. Hakkaart-van RoijenInstitute for Medical Technology AssessmentErasmus University RotterdamPostbox 17383000 DR RotterdamTel: +31 10 4088555E-mail: hakkaart@bmg.eur.nl17
4. References1. Nederl<strong>and</strong>se richtlijnen voor farmaco economisch onderzoek.(Dutch guidelines forpharmaco economic research). Amstelveen: Ziekenfondsraad; 1999.2. Severens J, Mulder J, Laheij R, AL AV. Precision <strong>and</strong> accuracy in measuring absencefrom work as a basis for calculating productivity costs in The Netherl<strong>and</strong>s. Soc Sci Med.2000;51(2):243-9.3. Koopmanschap M, Rutten F. A practical guide for calculating indirect costs of disease.Pharmacoeconomics. 1996;10 (5):460-6.4. Tan SS, Bouwmans C, Hakkaart- van Roijen L. H<strong>and</strong>leiding voor kostenonderzoek.Methoden en referentieprijzen voor economische evaluaties. [<strong>Manual</strong> for cost research, methods<strong>and</strong> reference prices for economic evaluations in health care]. Diemen: <strong>Health</strong> Insurance Board2010 (in press)5. Drummond M. Cost of illness studies: a major headache? Pharmacoeconomics.1992;2:1-4.6. Vacatures in Nederl<strong>and</strong> 2008, De vacaturemarkt en personeelwerving in beeldAmsterdam: CWI. Oktober 2008.7. Onzekerheid over werktijdvermindering op de middenlange termijn. Den Haag: CentraalPlan Bureau (CBP); 1987.8. Koning J, Tuyl F. De relatie tussen arbeidstijd, productie en werk. Rotterdam Nederl<strong>and</strong>sEconomisch Instituut; 1984.9. Osterhaus J, Gutterman D, Plachetka J. <strong>Health</strong> care resource <strong>and</strong> labor costs of migraineheadache in the US. Pharmacoeconomics. 1992;2(1):67-76.10. Brouwer W, Koopmanschap M, Rutten F. Productivity losses without absence:measurement validation <strong>and</strong> empirical evidence. <strong>Health</strong> Policy. 1999;48(1):13-27.18