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Ernstsson O, Heintz E, Nordenskjöld A, Johnson JA, Korkmaz S, Zethraeus N. Association between pulse width and health-related quality of life after electroconvulsive therapy in patients with unipolar or bipolar depression: an observational register-based study. Nord J Psychiatry 2024; 78:137-145. [PMID: 38079191 DOI: 10.1080/08039488.2023.2289915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/12/2023] [Indexed: 02/02/2024]
Abstract
AIMS To examine the association between pulse width and HRQoL measured within one week after electroconvulsive therapy (ECT) and at six-month follow-up in patients with unipolar or bipolar depression. METHODS This was an observational register study using data from the Swedish National Quality Registry for ECT (2011-2019). Inclusion criteria were: age ≥18 years; index treatment for unipolar/bipolar depression; unilateral electrode placement; information on pulse width; EQ-5D measurements before and after ECT. Multiple linear regressions were performed to investigate the association between pulse width (<0.5 ms; 0.5 ms; >0.5 ms) and HRQoL (EQ-5D-3L index; EQ VAS) one week after ECT (primary outcome) and six months after ECT (secondary outcome). RESULTS The sample included 5,046 patients with unipolar (82%) or bipolar (18%) depression. At first ECT session, 741 patients (14.7%) had pulse width <0.5 ms, 3,639 (72.1%) had 0.5 ms, and 666 (13.2%) had >0.5 ms. There were no statistically significant associations between pulse width and HRQoL one week after ECT. In the subsample of patients with an EQ-5D index recorded six months after ECT (n = 730), patients receiving 0.5 ms had significantly lower HRQoL (-0.089) compared to <0.5 ms, after adjusting for demographic and clinical characteristics (p = .011). The corresponding analysis for EQ VAS did not show any statistically significant associations. CONCLUSION No robust associations were observed between pulse width and HRQoL after ECT. On average, significant improvements in HRQoL were observed one week and six months after ECT for patients with unipolar or bipolar disease, independent of the pulse width received.
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Affiliation(s)
- Olivia Ernstsson
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | | | - Seher Korkmaz
- Department of Digitalization and IT, Health and Care Administration, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Björnerstedt J, Almqvist H, Lundin D, Zethraeus N. Validation of overall survival extrapolations made by TLV in the assessment of cost-effectiveness of oncology drugs in Sweden - A pilot study comparing extrapolated and observed life-years gained. J Med Econ 2024; 27:193-200. [PMID: 38225911 DOI: 10.1080/13696998.2024.2304459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
AIM The aim of the study is to assess the accuracy of overall survival (OS) extrapolations in cost-effectiveness analysis made by the Dental and Pharmaceutical Benefits Agency (TLV) to decide on the reimbursement and use of oncology drugs in Sweden. MATERIAL AND METHODS TLV appraisals for oncology drugs were identified during a 5-year period (2013-2017). To be included each appraisal and health economic model must include a TLV base case extrapolation of OS. Further, Kaplan-Meier (KM) estimates on OS from the original and follow-up clinical trials must be available. Potential follow-up trials on OS were identified in ClinicalTrials.gov and the Lund University Libraries databases, and in the Swedish Medical Products Agency (MPA) and the European Medicines Agency (EMA) databases. In cases where the KM estimates were not available, data points from figures published in TLV's appraisals were extracted using the semi-automated tools Digitizelt and WebPlotDigitizer. The accuracy of survival extrapolations was assessed by comparing extrapolated and observed life-years (LYs), using three different measures: 1) difference in LYs between the treatment and control group; 2) LYs in the treatment group, 3) LYs in the control group. RESULTS We study TLV's preferred OS extrapolations and show that on average they overestimate the observed mean gain in LYs by 24%, and underestimate observed LYs by 3% and 11% in the treatment and control group, respectively. CONCLUSIONS We conclude that it is feasible to validate OS extrapolations by comparing extrapolated and observed life-years. Even if survival extrapolations are reasonably accurate for the treatment group, this may still imply that extrapolations of LYs gained deviates to a larger extent. Follow-up studies on OS should be carried out to an increased extent to be able to validate, update and improve OS extrapolations in cost-effectiveness analysis of oncology drugs.
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Affiliation(s)
| | - Hannah Almqvist
- Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden
| | - Douglas Lundin
- Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden
| | - Niklas Zethraeus
- Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Kirketeig T, Söreskog E, Jacobson T, Karlsten R, Zethraeus N, Borgström F. Real-world outcomes in spinal cord stimulation: predictors of reported effect and explantation using a comprehensive registry-based approach. Pain Rep 2023; 8:e1107. [PMID: 38027468 PMCID: PMC10653578 DOI: 10.1097/pr9.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/04/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite advancements in implanted hardware and development of novel stimulation paradigms in Spinal Cord Stimulation (SCS), real world evidence suggests a large variation in patient reported outcomes and a proportion of patients are later explanted due to loss of analgesia. Possible predictors for outcome have been explored in smaller short-term evaluations, but few clinically applicable robust measures for long term outcome have emerged. Methods We performed a comprehensive retrospective study based on an assembled patient-level aggregated database from multiple local and national registries in Sweden. Variables associated with risk of explantation (due to insufficient analgesia) and analgesic effect was analyzed using a Cox regression analysis and an ordered logit regression model, respectively. Results We found the accumulated risk of explantation due to loss of analgesia to be 10% and 21% at two and ten years follow up, respectively. The use of 10 kHz spinal cord stimulation (compared with Tonic waveform; p = 0.003), and being 60 years or older (reference 18-40 years; p = 0.003) were associated with an increased risk of explantation.At a mean follow up at 1 year, 48% of patients reported a pain intensity reduction from baseline of at least 30%. Secondary (p = 0.030) and post-secondary (p = 0.001) education (compared with primary education) was associated with an increased probability of successful patient reported outcomes. Conclusion This study suggests that a higher educational level and being employed are associated with successful treatment outcome in patients with chronic pain treated with SCS in Sweden.
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Affiliation(s)
- Terje Kirketeig
- Akademiska Sjukhuset, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Söreskog
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Rolf Karlsten
- Akademiska Sjukhuset, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Söreskog E, Jacobson T, Kirketeig T, Fritzell P, Karlsten R, Zethraeus N, Borgström F. Impact of spinal cord stimulation on sick leave and disability pension in patients with chronic neuropathic pain: a real-world evidence study in Sweden. Pain 2023; 164:666-673. [PMID: 35972465 PMCID: PMC9916044 DOI: 10.1097/j.pain.0000000000002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/16/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT Current research indicates that spinal cord stimulation (SCS) has a positive short-term impact on outcomes, such as quality of life, pain, and productivity in patients with chronic neuropathic pain. However, there is a need for studies on larger population samples. This study used data from Swedish national registers to analyze change and predictors of sick leave and disability pension 2 years before and after SCS treatment. Patients with SCS implanted between 2006 and 2017, and a reference group consisting of 5 individuals matched to each SCS patient without replacement with respect to age, sex, and region of residence, were included. A difference-in-difference approach was used to compare the average change (2 years after treatment vs 2 years before treatment) in net disability days and indirect cost related to disability days for the SCS group, compared with the average change for the reference group. The results showed that SCS treatment in Sweden is associated with a decrease of 21 disability days and consequent decrease in indirect cost of €4127 in working age patients. Large work loss prior to index date was also demonstrated (average 214 days before 1 year), indicating a significant burden on the patient, employers, and the society at large. The number of disability days varied considerably depending on age, sex, socioeconomic variables, and comorbidities; however, the effect of SCS seemed to have little association with patient characteristics. This economic benefit needs to be considered, as well as the clinical outcome, when evaluating the full societal value of SCS.
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Affiliation(s)
- Emma Söreskog
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Terje Kirketeig
- Akademiska sjukhuset, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Fritzell
- Stockholm Center for Spine Surgery (RKC), Stockholm, Sweden
- Futurum Academy for Health and Care, Ryhov Hospital, Jönköping, Sweden
| | - Rolf Karlsten
- Akademiska sjukhuset, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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5
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Ernstsson O, Hagberg K, Janssen MF, Bonsel GJ, Korkmaz S, Zethraeus N, Heintz E. Health-related quality of life in patients with lower limb amputation - an assessment of the measurement properties of EQ-5D-3L and EQ-5D-5L using data from the Swedish Amputation and Prosthetics Registry. Disabil Rehabil 2022; 44:8471-8479. [PMID: 34932426 DOI: 10.1080/09638288.2021.2015628] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the measurement properties of EQ-5D-3L and EQ-5D-5L in patients with a major lower limb amputation (LLA). METHODS This was a retrospective register-based study using data from the Swedish Amputation and Prosthetics Registry (SwedeAmp). Patients with a six-months follow-up (including either EQ-5D-3L or EQ-5D-5L) after a major unilateral LLA were included. The measurement properties of EQ-5D-3L and EQ-5D-5L were compared in terms of feasibility, response patterns, informativity, and convergent and known-group validity. RESULTS The sample included 700 patients with below-knee amputation (76%), above-knee amputation (18%), or knee disarticulation (7%). Responses to EQ-5D-3L and -5L were similar regarding feasibility (98% completion rate) and the proportion reporting no problems (7% and 6%). Compared to EQ-5D-3L, EQ-5D-5L showed higher absolute and relative informativity in all dimensions, with the largest improvement in the mobility dimension. In the analyses of convergent validity, the EQ-5D-5L generally showed stronger correlations with disease-specific measures. Only EQ-5D-5L was able to discriminate between subgroups with different amputation levels. CONCLUSION The findings support the use of EQ-5D-5L over EQ-5D-3L in patients with an LLA, mainly due to improved informativity and improved convergent and known-group validity.Implications for rehabilitationThe measurement properties of two EQ-5D versions, EQ-5D-3L and EQ-5D-5L, has so far not been evaluated in patients with a lower limb amputation (LLA)The results support the use of EQ-5D-5L over the use of EQ-5D-3L, mainly due to improved informativity and stronger correlations with disease-specific patient-reported outcome measuresThe five-level version of EQ-5D is recommended for future applications of EQ-5D in clinical outcome studies, health economic evaluations, and in the routine follow-up of patients with a major LLAIn the early rehabilitation process six months after an LLA, the majority of patients reported problems with mobility, pain/discomfort, and usual activities.
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Affiliation(s)
- Olivia Ernstsson
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Hagberg
- Advanced Reconstruction of Extremities and Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mathieu F Janssen
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands.,EuroQol Foundation, Rotterdam, the Netherlands
| | - Gouke J Bonsel
- EuroQol Foundation, Rotterdam, the Netherlands.,Department Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Seher Korkmaz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Digitalization and IT, Health and Care Administration, Region Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emelie Heintz
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Naburi HE, Mujinja P, Kilewo C, Biberfeld G, Bärnighausen T, Manji K, Lyatuu G, Urrio R, Zethraeus N, Orsini N, Ekström AM. Health care costs associated with clinic visits for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania. Medicine (Baltimore) 2021; 100:e27828. [PMID: 34797311 PMCID: PMC8601283 DOI: 10.1097/md.0000000000027828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/28/2021] [Indexed: 01/05/2023] Open
Abstract
Early and appropriate antenatal care (ANC) is key for the effectiveness of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). We evaluated the importance of ANC visits and related service costs for women receiving option B+ to prevent mother-to-child transmission (MTCT) of HIV in Tanzania.A cost analysis from a health care sector perspective was conducted using routine data of 2224 pregnant women newly diagnosed with HIV who gave birth between August 2014 and May 2016 in Dar es Salaam, Tanzania. We evaluated risk of infant HIV infection at 12 weeks postnatally in relation to ANC visits (<4 vs ≥4 visits). Costs for service utilisation were estimated through empirical observations and the World Health Organisation Global Price Reporting Mechanism.Mean gestational age at first ANC visit was 22 (±7) weeks. The average number of ANC/prevention of MTCT visits among the 2224 pregnant women in our sample was 3.6 (95% confidence interval [CI] 3.6-3.7), and 57.3% made ≥4 visits. At 12 weeks postnatally, 2.7% (95% CI 2.2-3.6) of HIV exposed infants had been infected. The risk of MTCT decreased with the number of ANC visits: 4.8% (95% CI 3.6-6.4) if the mother had <4 visits, and 1.0% (95% CI 0.5-1.7) at ≥4. The adjusted MTCT rates decreased by 51% (odds ratio 0.49, 95% CI 0.31-0.77) for each additional ANC visit made. The potential cost-saving was 2.2 US$ per woman at ≥4 visits (84.8 US$) compared to <4 visits (87.0 US$), mainly due to less defaulter tracing.Most pregnant women living with HIV in Dar es Salaam initiated ANC late and >40% failed to adhere to the recommended minimum of 4 visits. Improved ANC attendance would likely lead to fewer HIV-infected infants and reduce both short and long-term health care costs due to less spending on defaulter tracing and future treatment costs for the children.
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Affiliation(s)
- Helga Elineema Naburi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Phares Mujinja
- Institute of Public health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Charles Kilewo
- Departments of Obstetrics and Gynaecology, MUHAS, Dar es Salaam, Tanzania
| | - Gunnel Biberfeld
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
- Africa Health Research Institute (AHRI), Mtubatuba, South Africa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Goodluck Lyatuu
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Departments of Obstetrics and Gynaecology, MUHAS, Dar es Salaam, Tanzania
- Management and Development for Health (MDH), Dar es Salaam, Tanzania
| | - Roseline Urrio
- Departments of Obstetrics and Gynaecology, MUHAS, Dar es Salaam, Tanzania
- Management and Development for Health (MDH), Dar es Salaam, Tanzania
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Sundberg A, Wahlberg AC, Zethraeus N, Karampampa K. Observational study of the implementation of telephone advice nursing in Sweden: did callers follow recommendations and did the rate of healthcare visits change? BMJ Open 2021; 11:e051233. [PMID: 34413110 PMCID: PMC8378364 DOI: 10.1136/bmjopen-2021-051233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Telephone advice nursing is introduced in many countries with one key aim being a reduction of avoidable healthcare visits. The aim of this study was to explore whether callers to a telephone advice nursing service followed the telenurses' recommendations, and whether there was a change in the level and trend of the rate of healthcare visits after the introduction of telephone advice nursing. DESIGN Observational study. SETTING Primary and secondary care in Jönköping Region, Sweden. PARTICIPANTS Telephone advice nursing calls, 6:00-23:00, 2014-2015 (n=185 994) and outpatient healthcare visits 2012-2015 (n=6 877 266). PRIMARY OUTCOME Proportion of callers who visited healthcare within the time period advised by the telenurse. SECONDARY OUTCOME Change in level or trend of the overall rate of healthcare visits per 1000 persons and 4-week period after the introduction of telephone advice nursing, with subgroup analysis for primary and secondary care. RESULTS 77% of callers who were recommended either to visit healthcare within 24 hours or to 'wait and see' followed the recommendations. There was no significant change in level (-5.15; 95% CI -15.80 to 5.50; p=0.349) or trend (-0.24; 95% CI -0.86 to 0.38; p=0.448) of the overall rate of visits per 1000 persons and 4-week period after the introduction of telephone advice nursing. For the rate of primary care visits, an increase in level (8.01; 95% CI 6.36 to 9.66; p<0.001) and trend (1.28; 95% CI 1.17 to 1.39; p<0.001) were observed. For the rate of secondary care visits, a decrease in level (-8.77, 95% CI -14.41 to -3.13; p=0.004) and trend (-1.03, 95% CI -1.35 to -0.71; p<0.001) were observed. CONCLUSIONS The introduction of telephone advice nursing may have contributed to a shift in the rate of healthcare visits from secondary to primary care.
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Affiliation(s)
- Amanda Sundberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Korinna Karampampa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Abstract
OBJECTIVE Back pain is the leading cause for years lived with disability globally and among the main reasons for sickness absence (SA) and disability pension (DP). The objective of this study was to explore the occurrence of SA and DP and to estimate productivity losses among individuals with back pain compared with among matched population-based references. DESIGN Explorative prospective cohort study using register microdata. PARTICIPANTS AND SETTING A total of 23 176 people, aged 19-60 years, with a first visit to inpatient or specialised outpatient healthcare for back pain (International Statistical Classification of Diseases and Related Health Problems code M54) in 2010 in Sweden and a matched population-based reference group (n=115 880). OUTCOMES Long-term SA (in SA spells >14 days) and DP and productivity losses, measured in € (2018 prices) by multiplying the SA and DP net days by the societal cost of each such day. RESULTS In the back-pain group, 42% had SA or DP days; in the reference group, the corresponding proportion was 15%. Productivity loss per patient with back pain was €8928 during the 12-month follow-up period; in the reference group, it was €3499 (p<0.0001). CONCLUSIONS SA and DP, leading to excess productivity losses among people with back pain, reflect the challenges these patients are facing to maintain their work capacity. Interventions to promote that individuals with back pain remain in paid work should be a priority in order to address the high costs.
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Affiliation(s)
- Filip Gedin
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Korinna Karampampa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Landfeldt E, Pogoryelova O, Sejersen T, Zethraeus N, Breiner A, Lochmüller H. Economic Costs of Myasthenia Gravis: A Systematic Review. Pharmacoeconomics 2020; 38:715-728. [PMID: 32363541 DOI: 10.1007/s40273-020-00912-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The objective of our study was to conduct a systematic literature review of economic costs (henceforth costs) associated with myasthenia gravis (MG). METHODS We searched MEDLINE (through PubMed), CINAHL, Embase, PsycINFO, and Web of Science for studies reporting costs of MG published from inception up until March 18, 2020, without language restrictions. Two reviewers independently screened records for eligibility, extracted the data, and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Costs were inflated and converted to 2018 United States dollars ($). RESULTS The search identified 16 articles for data extraction and synthesis. Estimates of costs of MG were found for samples from eight countries spanning four continents (Europe, North America, South America, and Asia). Across studies, the mean per-patient annual direct medical cost of illness was estimated at between $760 and $28,780, and cost per hospitalization between $2550 and $164,730. The indirect cost of illness was estimated at $80 and $3550. Costs varied considerably by patient characteristics, and drivers of the direct medical cost of illness included intravenous immunoglobulin and plasma exchange, myasthenic crisis, mechanical ventilatory support, and hospitalizations. CONCLUSIONS We show that the current body of literature of costs of MG is sparse, limited to a few geographical settings and resource categories, mostly dated, and subject to non-trivial variability, both within and between countries. Our synthesis will help researchers and decision-makers identify gaps in the local health economic context of MG and inform future cost studies and economic evaluations in this patient population.
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Affiliation(s)
- Erik Landfeldt
- Department of Women's and Children's Health, Karolinska Vägen 37A, 171 76, Stockholm, Sweden.
| | | | - Thomas Sejersen
- Department of Women's and Children's Health, Karolinska Vägen 37A, 171 76, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Hanns Lochmüller
- Division of Neurology, Department of Medicine, The Ottawa Hospital, and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
- Department of Neuropediatrics and Muscle Disorders, Medical Centre-University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
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Parslow E, Ranehill E, Zethraeus N, Blomberg L, von Schoultz B, Hirschberg AL, Johannesson M, Dreber A. The digit ratio (2D:4D) and economic preferences: no robust associations in a sample of 330 women. J Econ Sci Assoc 2019; 5:149-169. [PMID: 31894199 PMCID: PMC6917633 DOI: 10.1007/s40881-019-00076-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
Many studies report on the association between 2D:4D, a putative marker for prenatal testosterone exposure, and economic preferences. However, most of these studies have limited sample sizes and test multiple hypotheses (without preregistration). In this study we mainly replicate the common specifications found in the literature for the association between the 2D:4D ratio and risk taking, the willingness to compete, and dictator game giving separately. In a sample of 330 women we find no robust associations between any of these economic preferences and 2D:4D. We find no evidence of a statistically significant relation for 16 of the 18 total regressions we run. The two regression specifications which are statistically significant have not previously been reported and the associations are not in the expected direction, and therefore they are unlikely to represent a real effect.
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Affiliation(s)
- Elle Parslow
- Department of Economics, Stockholm School of Economics, P.O Box 6501, 11383 Stockholm, Sweden
| | - Eva Ranehill
- Department of Economics, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Liselott Blomberg
- Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Bo von Schoultz
- Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | | | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, P.O Box 6501, 11383 Stockholm, Sweden
| | - Anna Dreber
- Department of Economics, Stockholm School of Economics, P.O Box 6501, 11383 Stockholm, Sweden
- Department of Economics, University of Innsbruck, Innsbruck, Austria
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11
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Landfeldt E, Zethraeus N, Lindgren P. Standardized Questionnaire for the Measurement, Valuation, and Estimation of Costs of Informal Care Based on the Opportunity Cost and Proxy Good Method. Appl Health Econ Health Policy 2019; 17:15-24. [PMID: 30105745 PMCID: PMC6346077 DOI: 10.1007/s40258-018-0418-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Costs of informal care account for a significant component of total societal costs for many chronic and disabling illnesses. Yet, costs associated with the provision of informal care is seldom included in economic evaluations of new health technologies, increasing the risk of suboptimal decisions on the allocation of resources from the perspective of society. Our objective was to propose a standardized questionnaire for the measurement, valuation, and estimation of caregiver indirect (productivity) and informal care costs as separate mutually exclusive subsets of total costs in cost-of-illness studies and as an input to economic evaluations from the societal perspective. We developed a questionnaire for data collection and step-by-step analysis procedures for resource valuation and cost estimation. Data concerning absenteeism from work and time devoted to informal care were recorded using the recall method. Indirect (productivity) and paid informal care costs were valued and estimated according to the human-capital approach as the loss of production. Unpaid informal care costs were valued and estimated as the loss of leisure time quantified using the opportunity cost and proxy good method. The new questionnaire, titled the Caregiver Indirect and Informal Care Cost Assessment Questionnaire, contains 13 questions regarding caregiver current and previous work status, productivity, and the provision of informal care (stratified by time devoted to household activities, personal care, practical support, and emotional support). The proposed questionnaire should be helpful to inform the design, implementation, and execution of future cost-of-illness studies and economic evaluations from the perspective of society.
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Affiliation(s)
- Erik Landfeldt
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 17177, Stockholm, Sweden.
- Icon plc, Stockholm, Sweden.
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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Lin LW, Teng GG, Lim AYN, Yoong JSY, Zethraeus N, Wee HL. Cost-effectiveness of an adherence-enhancing intervention for gout based on real-world data. Int J Rheum Dis 2018; 22:545-554. [PMID: 30556300 PMCID: PMC6590285 DOI: 10.1111/1756-185x.13446] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/08/2018] [Accepted: 10/23/2018] [Indexed: 12/28/2022]
Abstract
AIM Medication non-adherence influences outcomes of therapies for chronic diseases. Allopurinol is a cornerstone therapy for patients with gout; however, non-adherence to allopurinol is prevalent in Singapore and limits its effectiveness. Between 2008-2010, an adherence-enhancing program was implemented at the rheumatology division of a public tertiary hospital. The cost-effectiveness of this program has not been fully evaluated. With healthcare resources being finite, the value of investing in adherence-enhancing interventions should be ascertained. This study aims to evaluate the cost-effectiveness of this adherence-enhancing program to inform optimal resource allocation toward better gout management. METHOD Adopting a real-world data approach, we utilized patient clinical and financial records generated in their course of routine care. Intervention and control groups were identified in a standing database and matched on nine risk factors through propensity score matching. Cost and effect data were followed through 1-2 years. A decision tree was developed in TreeAge using a societal perspective. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS At an assumed willingness-to-pay threshold of $50 000 USD ($70 000 SGD) per quality-adjusted life year (QALY), the intervention had an 85% probability of being cost-effective compared to routine care. The incremental cost-effectiveness ratio was $12 866 USD per QALY for the base case and ranged from $4 139 to $21 593 USD per QALY in sensitivity analyses. CONCLUSION The intervention is cost-effective in the short-term, although its long-term cost-effectiveness remains to be evaluated.
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Affiliation(s)
- Lydia Wenxin Lin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Gim Gee Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anita Yee Nah Lim
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanne Su-Yin Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Döring N, Zethraeus N, Tynelius P, de Munter J, Sonntag D, Rasmussen F. Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity. Front Endocrinol (Lausanne) 2018; 9:104. [PMID: 29593658 PMCID: PMC5861136 DOI: 10.3389/fendo.2018.00104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.
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Affiliation(s)
- Nora Döring
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Nora Döring,
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jeroen de Munter
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Diana Sonntag
- Medical Faculty of Heidelberg University, Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Mannheim, Germany
- Department of Health Science, University of York, York, United Kingdom
| | - Finn Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
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Gedin F, Skeppholm M, Burström K, Sparring V, Tessma M, Zethraeus N. Effectiveness, costs and cost-effectiveness of chiropractic care and physiotherapy compared with information and advice in the treatment of non-specific chronic low back pain: study protocol for a randomised controlled trial. Trials 2017; 18:613. [PMID: 29273083 PMCID: PMC5741874 DOI: 10.1186/s13063-017-2351-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain is a global public health problem and a leading cause of disability all over the world. The lifetime prevalence of low back pain is 70–80% and a significant proportion of people affected develop chronic low back pain (CLBP). Besides a severe negative impact on people’s health and health-related quality of life, CLBP is associated with substantial costs for society. Medical costs for the management of CLBP and costs for production losses due to absenteeism from work are sizeable. Pharmaceuticals, physical activity, manipulation, and multidisciplinary rehabilitation interventions are examples of widely used treatments for CLBP. However, the scientific basis to recommend the use of one treatment over another is limited and more research is needed to study the effects, costs and cost-effectiveness of treatments for CLBP in clinical practice. The aim of the study is to evaluate the effectiveness (back pain-related functional limitation, back pain intensity, general health, health-related quality of life, and working status), costs (medical costs and costs for production losses) and cost-effectiveness of chiropractic care and physiotherapy when added to information and advice in the treatment of patients with non-specific CLBP in Sweden. Methods/design This is a pragmatic randomised controlled trial, where participants are recruited through six primary care rehabilitation units (PCRUs) in Stockholm County Council, Sweden. Individuals with non-specific CLBP are individually randomised to one of four treatment groups: ‘information and advice’; ‘physiotherapy, and information and advice’; ‘chiropractic care, and information and advice’; or ‘chiropractic care, physiotherapy, and information and advice’. A sample size of 600 participants will be recruited during a period of 33 months. A computer-based questionnaire is used to collect data on back pain-related functional limitation (Oswestry Disability Index), pain intensity (Numeric Rating Scale), general health (self-rated health), health-related quality of life (EQ-5D-3L), and working status (measured as percentage of full-time work). Data will be collected at baseline, and at 3, 6, and 12 months after baseline. Discussion The results from our study should be considered when producing evidence-based guidelines and recommendations on which treatment strategies to use for CLBP. Trial registration ISRCTN registry, ID: ISRCTN15830360. Registered prospectively on 2 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2351-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Filip Gedin
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre, Health Economics and Economic Evaluation Research Group, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Martin Skeppholm
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre, Health Economics and Economic Evaluation Research Group, Tomtebodavägen 18A, 17177, Stockholm, Sweden.,Ryggkirurgiskt Centrum Stockholm AB, Sophiahemmets sjukhus, Box 5605, 11485, Stockholm, Sweden
| | - Kristina Burström
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics, Health Outcomes and Economic Evaluation Research Group, Tomtebodavägen 18A, 17177, Stockholm, Sweden.,Karolinska Institutet, Department of Public Health Sciences, Equity and Health Policy Research Group, Tomtebodavägen 18A, 17177, Stockholm, Sweden.,Stockholm County Council, Health Care Services, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Vibeke Sparring
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Mesfin Tessma
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (LIME), Medical Statistics Unit, Tomtebodavägen 18A, 17177, Stockholm, Sweden
| | - Niklas Zethraeus
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Centre, Health Economics and Economic Evaluation Research Group, Tomtebodavägen 18A, 17177, Stockholm, Sweden.
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Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, Johannesson M, Hirschberg AL. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril 2017; 107:1238-1245. [PMID: 28433366 DOI: 10.1016/j.fertnstert.2017.02.120] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/28/2017] [Accepted: 02/24/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether there is a causal effect of oral contraceptive (OC) treatment on general well-being and depressed mood in healthy women. DESIGN Double-blind, randomized, and placebo-controlled trial. SETTING University hospital. PATIENT(S) Three hundred and forty healthy women aged 18-35 years randomized to treatment, of whom 332 completed the data collection at follow-up evaluation. INTERVENTION(S) A combined OC (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment. MAIN OUTCOME MEASURE(S) Primary outcome measures: global score of Psychological General Well-Being Index (PGWBI) and the Beck Depression Inventory (BDI); secondary outcome measures: six separate dimensions of the PGWBI. RESULT(S) The OC treatment statistically significantly decreased general well-being compared with placebo -4.12 (95% CI, -7.18 to -1.06). Furthermore, OC decreased the following PGWBI dimensions compared with placebo: positive well-being -3.90 (95% CI, -7.78 to -0.01), self-control -6.63 (95% CI, -11.20 to -2.06), and vitality -6.84 (95% CI, -10.80 to -2.88). The effect of OC on depressive symptoms and on the PGWBI dimension depressed mood were not statistically significant. CONCLUSION(S) This study demonstrates a statistically significant reduction in general well-being by a first-choice OC in comparison with placebo in healthy women. We found no statistically significant effects on depressive symptoms. A reduction in general well-being should be of clinical importance.
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Affiliation(s)
- Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Dreber
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Eva Ranehill
- Center for Economic Research, ETH, Zurich, Switzerland; Department of Economics, University of Gothenburg, Gothenburg, Sweden
| | - Liselott Blomberg
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Bo von Schoultz
- Department of Economics, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Döring N, Sonntag D, de Munter J, Tynelius P, Zethraeus N, Rasmussen F. Economic evaluation of an early childhood intervention to prevent obesity: the Primrose study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Zethraeus N, Dreber A, Ranehill E, Blomberg L, Labrie F, von Schoultz B, Johannesson M, Hirschberg AL. Combined Oral Contraceptives and Sexual Function in Women-a Double-Blind, Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab 2016; 101:4046-4053. [PMID: 27525531 DOI: 10.1210/jc.2016-2032] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
CONTEXT There is a lack of knowledge about how oral contraceptives may affect sexual function. OBJECTIVE To determine whether there is a causal effect of oral contraceptives on sexuality. We hypothesized that a widely used pill impairs sexuality. DESIGN A double-blind, randomized, placebo-controlled trial. Enrollment began in February 2012 and was completed in August 2015. SETTING Karolinska University Hospital, Stockholm, Sweden. PARTICIPANTS A total of 340 healthy women, aged 18-35 years, were randomized to treatment, and 332 completed the study. INTERVENTIONS A combined oral contraceptive (150 μg levonorgestrel and 30 μg ethinylestradiol) or placebo for 3 months of treatment. MAIN OUTCOME MEASURES The primary outcome was the aggregate score on the Profile of Female Sexual Function (PFSF). Secondary outcomes were the seven domains of the PFSF, the Sexual Activity Log, and the Personal Distress Scale. RESULTS Overall sexual function was similar in women in the oral contraceptive and placebo groups. The PFSF domains desire (-4.4; 95% confidence interval [CI], -8.49 to -0.38; P = .032), arousal (-5.1; 95% CI, -9.63 to -0.48; P = .030), and pleasure (-5.1; 95% CI, -9.97 to -0.32; P = .036) were significantly reduced in comparison to placebo, whereas orgasm, concern, responsiveness, and self-image were similar between groups. The mean frequency of satisfying sexual episodes and personal distress were also similar between groups. CONCLUSIONS This study shows no negative impact of a levonorgestrel-containing oral contraceptive on overall sexual function, although three of seven sexual function domains were adversely affected.
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Affiliation(s)
- Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Anna Dreber
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Eva Ranehill
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Liselott Blomberg
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Fernand Labrie
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Bo von Schoultz
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Magnus Johannesson
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
| | - Angelica Lindén Hirschberg
- Department of Learning, Informatics, Management and Ethics (N.Z.), Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Economics (A.D., M.J.), Stockholm School of Economics, 113 83 Stockholm, Sweden; Department of Economics (E.R.), University of Zurich, 8006 Zurich, Switzerland; Department of Women's and Children's Health (L.B., B.v.S., A.L.H), Karolinska Institutet, and Department of Obstetrics and Gynecology, Karolinska University Hospital, 171 76 Stockholm, Sweden; and Laval University (F.L.), Quebec City G1V 0A6, Canada
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Blomgren L, Zethraeus N, Johansson G, Jönsson B, Bergqvist D. Cost consequences of preoperative duplex examination before varicose vein surgery: a randomized clinical trial. Phlebology 2016. [DOI: 10.1258/026835506777304728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To investigate the cost consequences of the addition of a duplex scan to the routine clinical examination prior to surgery for varicose veins (VV). Methods: Cost data are based on a prospective study, which randomized 293 VV patients for surgery either with or without a preoperative duplex scan. Costs are collected during a two-year follow-up time and include direct costs for primary surgery and reoperation. Results: The mean cost for the primary operation was SEK 12,827 (€1410) in the duplex group and SEK 9856 (€1083) in the control group ( P<0.001). A significant part of this increase was due to more extensive primary surgery. Costs for redo surgery decreased by SEK 1131 (€124) ( P = 0.011). The mean net cost increase because of duplex is estimated to be SEK 1840 (€202) ( P<0.003). Conclusion: The savings in costs for redo surgery did not offset the costs for preoperative duplex examination before VV surgery during a two-year follow-up period.
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Affiliation(s)
- L Blomgren
- Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
| | - N Zethraeus
- Stockholm School of Economics, Centre for Health Economics, Stockholm, Sweden
| | - G Johansson
- Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
| | - B Jönsson
- Stockholm School of Economics, Centre for Health Economics, Stockholm, Sweden
| | - D Bergqvist
- Department of Surgery, University Hospital, Uppsala, Sweden
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Östensson E, Fröberg M, Leval A, Hellström AC, Bäcklund M, Zethraeus N, Andersson S. Cost of Preventing, Managing, and Treating Human Papillomavirus (HPV)-Related Diseases in Sweden before the Introduction of Quadrivalent HPV Vaccination. PLoS One 2015; 10:e0139062. [PMID: 26398189 PMCID: PMC4580320 DOI: 10.1371/journal.pone.0139062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/07/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Costs associated with HPV-related diseases such as cervical dysplasia, cervical cancer, and genital warts have not been evaluated in Sweden. These costs must be estimated in order to determine the potential savings if these diseases were eradicated and to assess the combined cost-effectiveness of HPV vaccination and cervical cancer screening. The present study aimed to estimate prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts from a societal perspective in Sweden in 2009, 1 year before the quadrivalent HPV vaccination program was implemented. Methods and Materials Data from the Swedish cervical cancer screening program was used to calculate the costs associated with prevention (cytological cervical cancer screening), management (colposcopy and biopsy following inadequate/abnormal cytological results), and treatment of CIN. Swedish official statistics were used to estimate treatment costs associated with cervical cancer. Published epidemiological data were used to estimate the number of incident, recurrent, and persistent cases of genital warts; a clinical expert panel assessed management and treatment procedures. Estimated visits, procedures, and use of medications were used to calculate the annual cost associated with genital warts. Results From a societal perspective, total estimated costs associated with cervical cancer and genital warts in 2009 were €106.6 million, of which €81.4 million (76%) were direct medical costs. Costs associated with prevention, management, and treatment of CIN were €74 million; screening and management costs for women with normal and inadequate cytology alone accounted for 76% of this sum. The treatment costs associated with incident and prevalent cervical cancer and palliative care were €23 million. Estimated costs for incident, recurrent and persistent cases of genital warts were €9.8 million. Conclusion Prevention, management, and treatment costs associated with cervical dysplasia, cervical cancer, and genital warts are substantial. Defining these costs is important for future cost-effectiveness analyses of the quadrivalent HPV vaccination program in Sweden.
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Affiliation(s)
- Ellinor Östensson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Maria Fröberg
- Department of Neurobiology, Care Science and Society, Centre for Family Medicine and Community Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Amy Leval
- Department of Medicine, Infectious Disease Unit, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention for Stockholm County, Stockholm, Sweden
| | - Ann-Cathrin Hellström
- Department of Oncology-Pathology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Bäcklund
- Department of Medicine, Solna (MedS), K2, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Sonia Andersson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Sampaio F, Sarkadi A, Salari R, Zethraeus N, Feldman I. Cost and effects of a universal parenting programme delivered to parents of preschoolers. Eur J Public Health 2015; 25:1035-42. [PMID: 26063699 DOI: 10.1093/eurpub/ckv106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parenting programmes are effective in improving child behaviour and parental well-being, but long follow-up studies of universally offered programmes are scarce. METHODS A cluster randomized controlled trial was conducted to assess the costs and effects of Triple P levels 2-3 on child externalizing behaviours and parental mental health. The programme was offered universally to parents of preschoolers (self-selection allowed). Preschools were randomized to Triple P or a waitlist control. Health outcomes were reduction in externalizing behaviours measured on the Eyberg Child Behaviour Inventory-22 and improvement in parental mental health measured on the Depression Anxiety Stress Scales collected at baseline, 6-, 12- and 18-month follow-up. Child outcomes were based on 355 children aged 3-5 years (child sample) and parental outcomes on 759 parents (parental sample) with baseline data. Costs were collected from a municipality perspective, including 312 children and 488 parents with baseline data in the intervention preschools. RESULTS Sixty-seven (29%) parents attended the intervention. Triple P showed no significant improvement in child externalizing behaviours or parental mental health at either of the follow-up points. Triple P had an average yearly total cost of 3007 Swedish Krona (SEK) (€323) per child or 1922 SEK (€207) per parent. Running Triple P cost 227 SEK (€24) per child or 145 SEK (€16) per parent yearly. CONCLUSION Offering low intensity levels of Triple P with 29% attendance may not be a reasonable use of public resources, as no evidence of improvement in child externalizing behaviours or parental mental health was found.
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Affiliation(s)
- Filipa Sampaio
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Sarkadi
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Raziye Salari
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden 2 Department of Clinical Neuroscience and Stockholm Brain Institute, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- 3 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Inna Feldman
- 1 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Nemes S, Burström K, Zethraeus N, Eneqvist T, Garellick G, Rolfson O. Assessment of the Swedish EQ-5D experience-based value sets in a total hip replacement population. Qual Life Res 2015; 24:2963-70. [DOI: 10.1007/s11136-015-1020-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2015] [Indexed: 11/24/2022]
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Östensson E, Alder S, Elfström KM, Sundström K, Zethraeus N, Arbyn M, Andersson S. Barriers to and facilitators of compliance with clinic-based cervical cancer screening: population-based cohort study of women aged 23-60 years. PLoS One 2015; 10:e0128270. [PMID: 26011051 PMCID: PMC4444356 DOI: 10.1371/journal.pone.0128270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/23/2015] [Indexed: 11/22/2022] Open
Abstract
Objective This study aims to identify possible barriers to and facilitators of cervical cancer screening by (a) estimating time and travel costs and other direct non-medical costs incurred in attending clinic-based cervical cancer screening, (b) investigating screening compliance and reasons for noncompliance, (c) determining women’s knowledge of human papillomavirus (HPV), its relationship to cervical cancer, and HPV and cervical cancer prevention, and (d) investigating correlates of HPV knowledge and screening compliance. Materials and Methods 1510 women attending the clinic-based cervical cancer screening program in Stockholm, Sweden were included. Data on sociodemographic characteristics, time and travel costs and other direct non-medical costs incurred in attending (e.g., indirect cost of time needed for the screening visit, transportation costs, child care costs, etc.), mode(s) of travel, time, distance, companion’s attendance, HPV knowledge, and screening compliance were obtained via self-administered questionnaire. Results Few respondents had low socioeconomic status. Mean total time and travel costs and direct non-medical cost per attendance, including companion (if any) were €55.6. Over half (53%) of the respondents took time off work to attend screening (mean time 147 minutes). A large portion (44%) of the respondents were noncompliant (i.e., did not attend screening within 1 year of the initial invitation), 51% of whom stated difficulties in taking time off work. 64% of all respondents knew that HPV vaccination was available; only 34% knew it was important to continue to attend screening following vaccination. Age, education, and income were the most important correlates of HPV knowledge and compliance; and additional factors associated with compliance were time off work, accompanying companion and HPV knowledge. Conclusion Time and travel costs and other direct non-medical costs for clinic-based screening can be considerable, may affect the cost-effectiveness of a screening program, and may constitute barriers to screening while HPV knowledge may facilitate compliance with screening.
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Affiliation(s)
- Ellinor Östensson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Susanna Alder
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
| | - K. Miriam Elfström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Marc Arbyn
- Belgian Cancer Centre/Unit of Cancer Epidemiology, Scientific Institute of Public Health, J Wytsmanstreet 14, B1050, Brussels, Belgium
| | - Sonia Andersson
- Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska University Hospital-Solna, Karolinska Institutet, Stockholm, Sweden
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Groot-Jensen S, Kiessling A, Zethraeus N, Björnstedt-Bennermo M, Henriksson P. Cost-effectiveness of case-based training for primary care physicians in evidence-based medicine of patients with coronary heart disease. Eur J Prev Cardiol 2015; 23:420-7. [DOI: 10.1177/2047487315583798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/02/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Susanne Groot-Jensen
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
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Sundberg T, Hagberg L, Zethraeus N, Wändell P, Falkenberg T. Integrative medicine for back and neck pain: Exploring cost-effectiveness alongside a randomized clinical pilot trial. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Groot-Jensen S, Kiessling A, Zethraeus N, Bjoernstedt-Bennermo M, Henriksson P. Long-term cost effectiveness of case-based training of evidence-based clinical practice in primary care patients with coronary heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Östensson E, Hellström AC, Hellman K, Gustavsson I, Gyllensten U, Wilander E, Zethraeus N, Andersson S. Projected cost-effectiveness of repeat high-risk human papillomavirus testing using self-collected vaginal samples in the Swedish cervical cancer screening program. Acta Obstet Gynecol Scand 2013; 92:830-40. [DOI: 10.1111/aogs.12143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Ellinor Östensson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska University Hospital-Solna; Karolinska Institute; Stockholm; Sweden
| | - Ann-Cathrin Hellström
- Gynecological Oncology; Radiumhemmet; Department of Oncology; Karolinska Hospital and Institute in Solna; Stockholm; Sweden
| | - Kristina Hellman
- Gynecological Oncology; Radiumhemmet; Department of Oncology; Karolinska Hospital and Institute in Solna; Stockholm; Sweden
| | - Inger Gustavsson
- Department of Immunology, Genetics and Pathology; Rudbeck Laboratory; Uppsala University; Uppsala; Sweden
| | - Ulf Gyllensten
- Department of Immunology, Genetics and Pathology; Rudbeck Laboratory; Uppsala University; Uppsala; Sweden
| | - Erik Wilander
- Department of Pathology and Cytology; Department of Women's and Children's Health; Uppsala University Hospital; Uppsala; Sweden
| | - Niklas Zethraeus
- Medical Management Center (MMC); Department of Learning, Informatics, Management and Ethics (LIME); Karolinska Institute; Stockholm; Sweden
| | - Sonia Andersson
- Department of Women's and Children's Health; Division of Obstetrics and Gynecology; Karolinska University Hospital-Solna; Karolinska Institute; Stockholm; Sweden
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Kocoska-Maras L, Zethraeus N, Rådestad AF, Ellingsen T, von Schoultz B, Johannesson M, Hirschberg AL. A randomized trial of the effect of testosterone and estrogen on verbal fluency, verbal memory, and spatial ability in healthy postmenopausal women. Fertil Steril 2011; 95:152-7. [DOI: 10.1016/j.fertnstert.2010.05.062] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 12/23/2022]
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Östensson E, Fröberg M, Hjerpe A, Zethraeus N, Andersson S. Economic analysis of human papillomavirus triage, repeat cytology, and immediate colposcopy in management of women with minor cytological abnormalities in Sweden. Acta Obstet Gynecol Scand 2010; 89:1316-25. [DOI: 10.3109/00016349.2010.512066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zethraeus N, Petersson CJ, Dozzi M, Borres MP, Vignati G, Fiocchi A. Health-care cost reduction resulting from primary-care allergy testing in children in Italy. Ital J Pediatr 2010; 36:61. [PMID: 20836868 PMCID: PMC2945355 DOI: 10.1186/1824-7288-36-61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 09/13/2010] [Indexed: 11/13/2022] Open
Abstract
Background Allergy places a considerable cost burden on society. Specific immunoglobulin E (spIgE) testing may improve the management of allergy patients. There is therefore a reason to quantify the economic consequences of the use of spIgE testing in the diagnosis of allergic conditions. Methods The expected costs of spIgE testing versus no-testing were calculated using a clinical decision model based on a prospective clinical trial performed in primary care. Results The expected costs per patient over 2 years decreased from 802 euros in the "no-test strategy" to 560 euros in the spIgE "test strategy". Cost savings persisted even after assumptions about the prevalence of allergy and the prices of medications were changed. The "test strategy" increased the percentage of patients correctly diagnosed from 54 to 87%. Conclusions spIgE testing of children with respiratory and/or skin problems in primary care in Italy reduces overall costs to society. These cost savings mostly result from a reduction in the use of medications, particularly corticosteroids. The study indicates that spIgE testing of all children with respiratory and/or skin symptoms would be a cost-effective strategy.
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Affiliation(s)
- Niklas Zethraeus
- Medical Management Centre, Institution for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Lekander I, Borgström F, Ström O, Zethraeus N, Kanis JA. Cost-effectiveness of hormone therapy in the United States. J Womens Health (Larchmt) 2010; 18:1669-77. [PMID: 19857096 DOI: 10.1089/jwh.2008.1246] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To estimate the cost-effectiveness of 5 years of treatment with hormone therapy (HT) compared with no treatment for women with menopausal symptoms in the United States. METHODS A Markov cohort simulation model was used with tunnel techniques to assess the cost-effectiveness of HT in women aged 50 years, based on a societal perspective. Clinical data, where possible, used results taken from the Women Health Initiative (WHI). The model had a lifetime horizon with cycle lengths of 1 year and contained the following disease states: hip fracture, vertebral fracture, wrist fracture, breast cancer, colorectal cancer, coronary heart disease, stroke, and venous thromboembolic events. An intervention was modelled by its impact on the disease risks during and after stopping treatment. The model required data on clinical effects, risks, mortality rates, quality of life weights, and costs. The main outcome of the model was cost per quality-adjusted life-year (QALY) gained on HT compared with no treatment. RESULTS The results indicated that it was cost-effective to treat women with menopausal symptoms with HT in the United States. The severity of menopausal symptoms was the single most important determinant of cost-effectiveness, but HT remained cost-effective even where symptoms were mild or effects on symptom relief were small. CONCLUSIONS Treatment of women with menopausal symptoms with HT is cost-effective.
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Zethraeus N, Kocoska-Maras L, Johannesson M, Hirschberg AL, Von Schoultz B. P848 A randomised trial of the effect of oestrogen and testosterone on economic behaviour. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62338-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lekander I, Borgström F, Ström O, Zethraeus N, Kanis JA. Cost-effectiveness of hormone replacement therapy for menopausal symptoms in the UK. ACTA ACUST UNITED AC 2009; 15:19-25. [PMID: 19237618 DOI: 10.1258/mi.2009.009004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of five-year treatment of hormone replacement therapy (HRT) compared with no treatment for women with menopausal symptoms in the UK. METHOD A Markov cohort simulation model with tunnel techniques was used to assess the cost-effectiveness of HRT in women aged 50 years. For the clinical effects of HRT we used, where possible, results taken from the Women's Health Initiative (WHI). The model had a life-time horizon with cycle lengths of one year and contained the following disease states: hip fracture, vertebral fracture, wrist fracture, breast cancer, colorectal cancer, coronary heart disease, stroke and venous thromboembolic events. An intervention was modelled by its impact on the disease risks during and after stopping treatment. The model was populated with UK-specific data on risks, mortality rates, quality-of-life weights and costs. The main outcome of the model was cost per quality-adjusted life year (QALY) gained of HRT compared with no treatment. RESULTS The results indicated that it was cost-effective to treat women with menopausal symptoms with HRT in the UK. The severity of menopausal symptoms was the single most important determinant of cost-effectiveness, but HRT remained cost-effective even where symptoms were mild or effects on symptom relief were small. CONCLUSIONS Treatment of women with menopausal symptoms with HRT is cost-effective.
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Affiliation(s)
- Ingrid Lekander
- i3 Innovus, Klarabergsviadukten 90 Hus D, Stockholm, Sweden.
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Zethraeus N, Ström O, Borgström F, Kanis JA, Jönsson B. The cost-effectiveness of the treatment of high risk women with osteoporosis, hypertension and hyperlipidaemia in Sweden. Osteoporos Int 2008; 19:819-27. [PMID: 18071650 DOI: 10.1007/s00198-007-0511-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 10/24/2007] [Indexed: 12/24/2022]
Abstract
UNLABELLED This paper assessed the cost-effectiveness of the treatment of high risk women with osteoporosis, hypertension and hyperlipidaemia in Sweden, using one model and a societal perspective. Cost-effective scenarios were found in all these chronic disorders. These findings are of relevance for decisions on the efficient allocation of health care resources. INTRODUCTION There is a need to assess the cost-effectiveness (CE) of treatment of osteoporosis from a societal perspective and to relate this to the CE of interventions in other disease areas. This is of relevance for decisions on the efficient allocation of health care resources within and between disease areas. The purpose of the paper was to estimate the CE of the treatment and prevention of osteoporosis and to put that into the perspective of treating hypertension and hyperlipidaemia. The CE was assessed for different high risk female populations aged 50-80 years. METHODS The estimation of CE was based on a model populated with data for Sweden. RESULTS Compared to no intervention, a 5-year treatment of osteoporosis, hypertension, and hyperlipidaemia, is cost effective for most of the assessed high risk female populations. The cost per gained quality adjusted life year (QALY) for the treatment of a 70-year-old woman never exceeded SEK 330,000 (US$ 44,000), which is generally judged as an acceptable cost for a gained QALY. CONCLUSIONS The study demonstrates that it is possible to produce reliable estimates of the CE of treatments in different disease areas within the context of a single model.
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Affiliation(s)
- N Zethraeus
- Centre for Health Economics, Stockholm School of Economics, P.O. Box 6501, S-113 83 Stockholm, Sweden.
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Ström O, Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Ceder L, Thorngren KG, Sernbo I, Jonsson B. Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden. Acta Orthop 2008; 79:269-80. [PMID: 18484255 DOI: 10.1080/17453670710015094] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture. PATIENTS AND METHODS Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint. RESULTS The mean fracture-related cost 13-18 months after a hip, vertebral, or wrist fracture were estimated to be euro2,422, euro3,628, and euro316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture. INTERPRETATION The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.
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Lekander I, Borgström F, Ström O, Zethraeus N, Kanis JA. Cost effectiveness of hormone therapy in women at high risks of fracture in Sweden, the US and the UK--results based on the Women's Health Initiative randomised controlled trial. Bone 2008; 42:294-306. [PMID: 18053789 DOI: 10.1016/j.bone.2007.09.059] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/16/2007] [Accepted: 09/29/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of the study was to assess the cost effectiveness of hormone therapy (HT) for postmenopausal women without menopausal symptoms at an increased risk of fracture in Sweden, the UK and the US. METHODS Using a state-transition model, the cost effectiveness of 50 year old women was assessed based on a societal perspective and the medical evidence found in the Women Health Initiative (WHI) trials. The model had a lifetime horizon divided into cycle lengths of 1 year and comprised the following disease states: hip fracture, vertebral fracture, wrist fracture, breast cancer, colorectal cancer, coronary heart disease, stroke and venous thromboembolic events. An intervention was modelled by its impact on the disease risks during and after the cessation of treatment. The model required data on clinical effects, risks, mortality rates, quality of life weights and costs valid for Sweden, the UK and the US. The main outcome of the model was cost per QALY gained of HT compared to no treatment. RESULTS The results indicated that HT compared to no treatment was cost-effective for most sub-groups of hysterectomised women, whereas for women with an intact uterus without a previous fracture, HT was commonly dominated by no treatment. Fracture risks were the single most important determinant of the cost effectiveness results. CONCLUSIONS HT is cost-effective in women with a hysterectomy irrespective of prior fracture status. In women with an intact uterus, opposed HT was cost-effective in those with a prior vertebral fracture, but cost-ineffective in women without a prior vertebral fracture. Even though HT is found cost-effective for a selection of osteoporotic women, it is unlikely to be considered for first-line therapy for osteoporosis because bisphosphonates have shown a similar reduction in fracture risks but without an increased risk of adverse events.
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Zethraeus N, Borgström F, Ström O, Kanis JA, Jönsson B. Cost-effectiveness of the treatment and prevention of osteoporosis--a review of the literature and a reference model. Osteoporos Int 2007; 18:9-23. [PMID: 17093892 DOI: 10.1007/s00198-006-0257-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 10/11/2006] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of the paper is to update and review the latest developments related to modelling and economic evaluation of osteoporosis in the period 2002-2005 and further to present a reference model for the assessment of the cost-effectiveness of the prevention and treatment of osteoporosis. DISCUSSION The reference model is intended to be used for fracture specific interventions affecting the risk of fracture. An interface version and an extensive description of the model is available on the internet ( http://www.healtheconomics.se ) and also accessible via the International Osteoporosis Foundation ( http://www.osteofound.org ). The purpose of the reference model is to improve the quality and comparability of cost-effectiveness analysis in the osteoporosis field and to serve as a tool for validation of present and future cost-effectiveness models. The reference model allows the cost-effectiveness analysis to be carried out from a societal perspective including intervention, morbidity and mortality costs. The model has been extensively tested and calibrated, and meets the properties of good decision analytic modelling. The model is a state transition Markov cohort model, which is characterised by a 50-year time horizon divided into one year cycle lengths. The following health states are included: "healthy", "hip fracture", "spine fracture", "wrist fracture", "other fracture", and "dead". CONCLUSION The model is flexible and allows for the estimation of the cost-effectiveness over different ranges for a selected number of variables (e.g., age, fracture risk, cost of intervention).
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Affiliation(s)
- N Zethraeus
- Centre for Health Economics, Stockholm School of Economics, P.O. Box 6501, S-113 83 Stockholm, Sweden.
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Wilking NE, Svedman C, Jönsson B, Zethraeus N. The use of innovative oncology drugs in Europe. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16020 Background: A number of new innovative cancer drugs have recently been approved or are in the process of being approved. Rapid patient access to new innovative drugs is important as it may lead to improved survival. Methods: We have analysed the access and uptake of new oncology drugs in 19 European countries over a 15 year period based on sales data provided by IMS Health. In the study we focus on select, “targeted” drugs that have been introduced over the last 10 years: rituximab, trastuzumab and imatinib. We have also analysed data to assess the composition of the drug “arsenal” used in the selected countries based on % of total sales for cancer drugs introduced before 1993; between1993–1998 and after 1999. Results: We see different patterns of uptake in countries studied, both with respect to speed and level of usage, in relation to use per person dying of the specific cancers.. Fast uptake is seen in Austria, Switzerland and Spain, and slow uptake as well as low usage is seen in Poland, Hungary, Norway and the UK. For example, trastuzumab uptake indicates that countries with the fastest uptake treat the majority of HER2 over expressing metastatic breast cancer patients within 2–3 years after introduction while countries with slow uptake still after 5 years seem to have a large proportion of patients not receiving trastuzumab treatment. On the other hand, for a drug like imatinib the uptake has been more rapid and uniform in most countries. The composition of the cancer drug “arsenal” used also differs significantly in between countries. Conclusions: Patient access to innovative cancer drugs varies significantly between European countries. [Table: see text]
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Affiliation(s)
- N. E. Wilking
- Karolinska Institute, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
| | - C. Svedman
- Karolinska Institute, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
| | - B. Jönsson
- Karolinska Institute, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
| | - N. Zethraeus
- Karolinska Institute, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
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Ytterström-Ahlstedt U, Zethraeus N, Petersson C, Ahlstedt S. Cost-effectiveness Analysis of Using Allergy Tests in Primary Care in Italian Children. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Borgström F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjö K, Thorngren KG, Sernbo I, Rehnberg C, Jönsson B. Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 2006; 17:637-50. [PMID: 16283064 DOI: 10.1007/s00198-005-0015-8] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 09/19/2005] [Indexed: 12/18/2022]
Abstract
This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients' records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros (<euro>), at <euro>14,221, <euro>12,544 and <euro>2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/<euro>]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at <euro>0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived.
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Affiliation(s)
- Fredrik Borgström
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
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Zethraeus N, Borgström F, Jönsson B, Kanis J. Reassessment of the cost-effectiveness of hormone replacement therapy in Sweden: Results based on the Women's Health Initiative randomized controlled trial. Int J Technol Assess Health Care 2005; 21:433-41. [PMID: 16262965 DOI: 10.1017/s0266462305050609] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:The purpose of the study is to reassess the cost-effectiveness of hormone replacement therapy (HRT) based on new medical evidence found in the Women's Health Initiative (WHI). Within a model framework using an individual state transition model, the cost-effectiveness of 50- to 60-year-old women with menopausal symptoms is assessed based on a societal perspective in Sweden.Methods:The model has a 50-year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: coronary heart disease, stroke, venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture, and wrist fracture. An intervention is modeled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality-adjusted life years (QALYs) with and without intervention. The resulting cost per QALY gained is compared with the value of a QALY gained, which is set to SEK 600,000. The model requires data on clinical effects, risks, mortality rates, quality of life weights, and costs valid for Sweden.Results:The cost-effectiveness ratios are estimated at approximately SEK 10,000, which is below the threshold value of cost-effectiveness. On the condition that HRT increases the quality of life weight more than 0.013 units, the therapy is cost-effective.Conclusions:In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.
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Affiliation(s)
- Niklas Zethraeus
- Centre for Health Economics, Stockholm School of Economics, PO Box 6501, SE-113 83 Stockholm, Sweden.
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Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N. Assessment of fracture risk. Osteoporos Int 2005; 16:581-9. [PMID: 15616758 DOI: 10.1007/s00198-004-1780-5] [Citation(s) in RCA: 741] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 09/15/2004] [Indexed: 12/24/2022]
Abstract
The diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD). There are a number of clinical risk factors that provide information on fracture risk over and above that given by BMD. The assessment of fracture risk thus needs to be distinguished from diagnosis to take account of the independent value of the clinical risk factors. These include age, a prior fragility fracture, a parental history of hip fracture, smoking, use of systemic corticosteroids, excess alcohol intake and rheumatoid arthritis. The independent contribution of these risk factors can be integrated by the calculation of fracture probability with or without the use of BMD. Treatment can then be offered to those identified to have a fracture probability greater than an intervention threshold.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
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Kiessling A, Zethraeus N, Henriksson P. Cost of lipid lowering in patients with coronary artery disease by case method learning. Int J Technol Assess Health Care 2005; 21:180-6. [PMID: 15921057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES This investigation was undertaken to study the costs of a Case Method Learning (CML)-supported lipid-lowering strategy in secondary prevention of coronary artery disease (CAD) in primary care. METHODS This prospective randomized controlled trial in primary care with an additional external specialist control group in Södertälje, Stockholm County, Sweden, included 255 consecutive patients with CAD. Guidelines were mailed to all general practitioners (GPs; n=54) and presented at a common lecture. GPs who were randomized to the intervention group participated in recurrent CML dialogues at their primary health-care centers during a 2-year period. A locally well-known cardiologist served as a facilitator. Assessment of low-density lipoprotein (LDL) cholesterol was performed at baseline and after 2 years. Analysis according to intention-to-treat-intervention and control groups (n=88)--was based on group affiliation at baseline. The marginal cost of lipid lowering comprised increased cost of lipid-lowering drugs in the intervention group compared with the primary care control group, cost of attendance of the GP's in the intervention group, and cost of time for preparation, travel, and seminars of the facilitator. Costs are as of 2002 with an exchange rate 1 U.S. dollar = 9.5 SEK (Swedish Crowns). RESULTS Patients in the primary care intervention group had their LDL cholesterol reduced by 0.5 (confidence interval [CI], 0.1-0.9) mmol/L compared with the primary care control group (p < .05). No change occurred in controls. LDL cholesterol in the external specialist control group decreased by 0.6 (CI, 0.4-0.8) mmol/L. The cost of the educational intervention represented only 2 percent of the drug cost. The cost of lipid lowering in the intervention group, including the cost of the educational intervention, was actually lower than that of patients treated at the specialist clinic--106 U.S. dollar per mmol decrease in LDL cholesterol in the intervention group and 153 U.S. dollar per mmol decrease in LDL cholesterol in the specialist group. EuroQol 5D Index, which gives an estimate of global health-related quality of life, was 0.80 (CI, 0.75-0.85) in the present cohort. CONCLUSIONS The additional cost of CML was only 2 percent of the drug cost. Assuming the same gain in life expectancy per millimole decrease in LDL cholesterol as in the 4S-study gives a cost per gained quality-adjusted life year of U.S. dollar 24,000. This finding indicates that the CML-supported lipid-lowering strategy is cost-effective. The low cost of CML in primary care should probably warrant its use in the improvement of the quality of care in other major chronic diseases.
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Affiliation(s)
- Anna Kiessling
- Karolinska Institute and Danderyd University Hospital, Sweden.
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Kanis JA, Borgstrom F, Zethraeus N, Johnell O, Oden A, Jönsson B. Intervention thresholds for osteoporosis in the UK. Bone 2005; 36:22-32. [PMID: 15663999 DOI: 10.1016/j.bone.2004.08.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Revised: 07/26/2004] [Accepted: 08/04/2004] [Indexed: 02/08/2023]
Abstract
The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in women based on data from the UK. We modelled the effects of an intervention costing pound 350 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect (offset time) for a further 5 years. Sensitivity analyses included a range of treatment duration (3-10 years), intervention costs (pound 300-400/year) and offset times (0-15 years). Data on costs and risks were from the UK. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of pound 30,000/QALY gained was used. With the base case ( pound 350 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.1% at the age of 50 years to 9.0% at the age of 85 years. Intervention thresholds were sensitive to the assumed costs and offset time. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. Cost-effective scenarios were found for women at the threshold for osteoporosis from the age of 60 years. Treatment of established osteoporosis was cost-effective irrespective of age. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age and that available treatments can be targeted cost-effectively to individuals from the UK at moderately increased fracture risk.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School, Sheffield, UK.
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Borgström F, Johnell O, Jönsson B, Zethraeus N, Sen SS. Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden. Bone 2004; 34:1064-71. [PMID: 15193554 DOI: 10.1016/j.bone.2003.12.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Revised: 12/01/2003] [Accepted: 12/03/2003] [Indexed: 11/16/2022]
Abstract
BACKGROUND One third of all the hip fractures occur in men. The risk for mortality following hip fracture is higher for men compared to women. The Fracture Intervention Trial (FIT) showed that the bisphosphonate alendronate reduces the risk of fractures and increases bone mineral density (BMD) in osteoporotic women. Similar effects of alendronate were observed in men in some other trials. There are also results demonstrating alendronate to be cost-effective in the treatment of osteoporosis in women. OBJECTIVE To investigate the cost effectiveness of alendronate for male osteoporosis in Sweden by assuming the same relative risk reduction of fractures in men as for women, based on the FIT trial. DESIGN A Markov model earlier used to analyze cost effectiveness of alendronate in treatment of postmenopausal osteoporosis in Sweden was adapted to fit a cohort of Swedish men. Cost effectiveness of alendronate vs. no treatment was assessed by transitioning men in the model over time between different health states. TIME HORIZON The patients were followed from start of intervention until 100 years of age or death. In the base-case alendronate was assumed to have a fracture-risk-reducing effect for 10 years; a treatment duration period of 5 years followed by a 5-year period where the effect declined linearly to zero. RESULTS Taking a societal perspective treating a 71-year-old man (mean age in the FIT) with low BMD and prior vertebral fracture (VFA) with alendronate was found to be associated with a cost of 14,843 per quality adjusted life year (QALY) gained. CONCLUSIONS The results in this study indicate that treating osteoporotic men with alendronate was projected to be cost-effective, under the assumption of the same fracture-risk-reducing effect of alendronate for men as for women.
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Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B. The risk and burden of vertebral fractures in Sweden. Osteoporos Int 2004; 15:20-6. [PMID: 14593450 DOI: 10.1007/s00198-003-1463-7] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Accepted: 05/23/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis.
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Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, WHO Collaborating Centre, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK
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Jönsson L, Borgström F, Zethraeus N. [Cost-effectiveness of alendronate treatment of osteoporosis in Denmark. An economic evaluation based on the Fracture Intervention Trial]. Ugeskr Laeger 2003; 165:4112-6. [PMID: 14619061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Linus Jönsson
- Neurotec, Karolinska Institutet, Stockholm Health Economics, Centre for Health Economics, Stockholm School of Economics, Stockholm.
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Abstract
This study deals with the question of how to model health effects after the cessation of a randomized controlled trial (RCT). By using clinical trial data on severe congestive heart failure patients, we illustrate how survival beyond the cessation of an RCT can be predicted based on parametric survival models. In the analysis, we compare predicted survival and the resulting incremental cost-effectiveness ratio (ICER) of different survival models with actual survival/ICER. Our main finding is that the results are sensitive to the choice of survival model and that an extensive sensitivity analysis in the CE analysis is required.
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Affiliation(s)
- Ulf G Gerdtham
- Department of Community Medicine, Malmö University Hospital, Sweden
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Tidermark J, Zethraeus N, Svensson O, Törnkvist H, Ponzer S. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. 2002. J Orthop Trauma 2003; 17:S17-21. [PMID: 14696773 DOI: 10.1097/00005131-200309001-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Borgström F, Zethraeus N. [Economic assessment based on a clinical study of risedronate. Fracture prevention in elderly women with osteoporosis is cost-effective]. Lakartidningen 2003; 100:36-40. [PMID: 12572135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Based on a clinical study we assessed the cost-effectiveness of treating elderly osteoporotic women with the biphosphonate Risedronat in a Swedish environment. Costs, health effects and risk of fractures were taken from previously published sources. Health effects were measured as Quality adjusted life-years (QALYs) and life-years gained. Results were presented with and without costs of added life-years. The cost-effectiveness was investigated for two patient groups. The first group consisted of elderly osteoporotic women and the second group, which was a subgroup of the first, consisted of elderly osteoporotic women with previous vertebral fractures. The cost per gained QALY, estimated at SEK 277,209 (osteoporotic women) and SEK 16,877 (osteoporotic women with a previous vertebral fracture) respectively, were in both cases below the threshold value of 520,000 SEK, indicating that the treatment was cost-effective in both patient groups. In a sensitivity analysis the cost-effectiveness for the group of osteoporotic women with previous vertebral fractures showed to be stable for variation in the parameters while the group of osteoporotic women showed to be more sensitive for variation in some of the parameters.
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Cleland JGF, Takala A, Apajasalo M, Zethraeus N, Kobelt G. Intravenous levosimendan treatment is cost-effective compared with dobutamine in severe low-output heart failure: an analysis based on the international LIDO trial. Eur J Heart Fail 2003; 5:101-8. [PMID: 12559222 DOI: 10.1016/s1388-9842(02)00246-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Levosimendan, a novel calcium sensitiser, improves cardiac performance and symptoms without increasing oxygen consumption, and decreases the mortality of patients with low-output heart failure. AIMS To estimate the cost-effectiveness of intravenous treatment with levosimendan compared with dobutamine in patients with severe low-output heart failure. METHODS This economic evaluation was based on a European clinical trial (LIDO), in which 203 patients with severe heart failure randomly received a 24 h infusion with either levosimendan or dobutamine. Survival and resource utilisation data were collected for 6 months; survival was extrapolated assuming a mean additional lifetime of 3 years based on data from the Cooperative North Scandinavian Enalapril Survival Study trial. Costs were based on study drug usage and hospitalisation in the 6-month follow-up. A sensitivity analysis on dosage of drug and duration of survival was performed. RESULTS The mean survival over 6 months was 157+/-52 days in the levosimendan group and 139+/-64 days in the dobutamine group (P<0.01). When extrapolated up to 3 years, the gain in life expectancy was estimated at 0.35 years (discounted at 3%). Levosimendan increased the mean cost per patient by 1108, which was entirely due to the cost of the study drug. The incremental cost per life-year saved (LYS) was 3205 at the European level; in the individual countries the cost per LYS ranged between 3091 and 3331. The result was robust in the sensitivity analysis. CONCLUSIONS Although the patients in the levosimendan group were alive for more days and thus at risk of hospitalisation for longer, there was no increase in hospitalisation or hospitalisation costs with levosimendan treatment. The cost per LYS using levosimendan compares favourably with other cost-effectiveness analyses in cardiology.
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Affiliation(s)
- J G F Cleland
- Department of Cardiology, Castle Hill Hospital, Castle Road, Cottingham, University of Hull, Kingston upon Hull HU16 5JQ, UK.
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