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Norlin JM, Löfvendahl S, Schmitt-Egenolf M. Health-related quality of life in patients with generalized pustular psoriasis - a Swedish register study. Ann Med 2024; 56:2341252. [PMID: 38738413 PMCID: PMC11095275 DOI: 10.1080/07853890.2024.2341252] [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: 12/22/2022] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Real-world data on health-related quality of life (HRQoL) in generalized pustular psoriasis (GPP) are scarce and studies have been restricted in terms of instruments used for assessments. OBJECTIVE To assess generic and dermatology-specific HRQoL of patients with GPP compared with patients with plaque psoriasis using real-world data from the Swedish National Register for Systemic Treatment of Psoriasis. METHODS Cross-sectional data from 2006 to 2021 including 7041 individuals with plaque psoriasis without GPP and 80 patients with GPP, of which 19% also had plaque psoriasis. Total scores for the EuroQol-5 Dimensions (EQ-5D) and Dermatology Life Quality Index (DLQI), as well as degree of severity within the instruments' dimensions/questions, were compared between patient groups. RESULTS EQ-5D scores were significantly (p < .01) lower (worse) in patients with GPP (mean [standard deviation (SD)] 0.613 [0.346]) vs. patients with plaque psoriasis (mean [SD] 0.715 [0.274]), indicating lower generic HRQoL of patients with GPP. Significantly (p < .01) higher (worse) total DLQI scores were observed for patients with GPP (mean [SD] 10.6 [8.9]) compared with patients with plaque psoriasis (mean [SD] 7.7 [7.1]), with proportionally more patients with GPP having severe (20% vs. 16%) and very severe (17% vs. 8%) problems. The worsened scores for GPP vs. plaque psoriasis were consistent across EQ-5D dimensions and DLQI questions. CONCLUSIONS Individuals with GPP have a considerable impairment in both generic and dermatology-specific HRQoL. The HRQoL was significantly worse in individuals with GPP compared to individuals with plaque psoriasis. The significant HRQoL impairment of GPP shows the potential value of better healthcare interventions for this multisystem disease.
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Affiliation(s)
- Jenny M. Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Sofia Löfvendahl
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
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2
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Kruse C, Lipinski A, Verheyen M, Balzer-Geldsetzer M, Wittenberg M, Lorenzl S, Richinger C, Schmotz C, Tönges L, Woitalla D, Klebe S, Bloem BR, Hommel A, Meissner WG, Laurens B, Boraud T, Foubert-Samier A, Vergnet S, Tison F, Costa N, Odin P, Rosqvist K, Norlin JM, Hjalte F, Schrag A, Dodel R. Care of Late-Stage Parkinsonism: Resource Utilization of the Disease in Five European Countries. Mov Disord 2024; 39:571-584. [PMID: 38425158 DOI: 10.1002/mds.29718] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease that leads to progressive disability. Cost studies have mainly explored the early stages of the disease, whereas late-stage patients are underrepresented. OBJECTIVE The aim is to evaluate the resource utilization and costs of PD management in people with late-stage disease. METHODS The Care of Late-Stage Parkinsonism (CLaSP) study collected economic data from patients with late-stage PD and their caregivers in five European countries (France, Germany, the Netherlands, UK, Sweden) in a range of different settings. Patients were eligible to be included if they were in Hoehn and Yahr stage >3 in the on state or Schwab and England stage at 50% or less. In total, 592 patients met the inclusion criteria and provided information on their resource utilization. Costs were calculated from a societal perspective for a 3-month period. A least absolute shrinkage and selection operator approach was utilized to identify the most influential independent variables for explaining and predicting costs. RESULTS During the 3-month period, the costs were €20,573 (France), €19,959 (Germany), €18,319 (the Netherlands), €25,649 (Sweden), and €12,156 (UK). The main contributors across sites were formal care, hospitalization, and informal care. Gender, age, duration of the disease, Unified Parkinson's Disease Rating Scale 2, the EQ-5D-3L, and the Schwab and England Scale were identified as predictors of costs. CONCLUSION Costs in this cohort of individuals with late-stage PD were substantially higher compared to previously published data on individuals living in earlier stages of the disease. Resource utilization in the individual sites differed in part considerably among these three parameters mentioned. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christopher Kruse
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Anna Lipinski
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Malte Verheyen
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Monika Balzer-Geldsetzer
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Michael Wittenberg
- Coordination Center for Clinical Trials of the Philipps-University Marburg, Marburg, Germany
| | - Stefan Lorenzl
- Department of Palliative Medicine, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Carmen Richinger
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Christian Schmotz
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
- Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | - Dirk Woitalla
- Department of Neurology, St. Josef-Krankenhaus Kupferdreh, Essen, Germany
| | - Stephan Klebe
- Department of Neurology, Essen University Hospital, Essen, Germany
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Adrianus Hommel
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
| | - Wassilios G Meissner
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Brice Laurens
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Thomas Boraud
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Alexandra Foubert-Samier
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Sylvain Vergnet
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - François Tison
- Service de Neurologie des Maladies Neurodégénératives, Bordeaux, France and University of Bordeaux, CNRS, IMN, UMR, Bordeaux, France
| | - Nadège Costa
- Health Economic Unit, Medical Information Department, University Hospital, Toulouse, France
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Rosqvist
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Frida Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Anette Schrag
- Department of Clinical Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - Richard Dodel
- Department of Geriatric Medicine, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Hjalte F, Norlin JM, Alverbäck-Labberton L, Johansson K, Wikström G, Eldhagen P. Health care resource use, diagnostic delay and disease burden in transthyretin amyloid cardiomyopathy in Sweden. Ann Med 2023; 55:2292686. [PMID: 38096896 PMCID: PMC10732175 DOI: 10.1080/07853890.2023.2292686] [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: 04/24/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
AIMS To estimate healthcare resource use and direct healthcare costs of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in Sweden over 12 months across severity stages as defined by the New York Heart Association (NYHA). Secondary to investigate the current diagnostic trajectory for patients with ATTR-CM in Sweden. METHODS A stratified inclusion of patients with a confirmed diagnosis of ATTR-CM in different NYHA classes. Data was extracted from medical records in two cardiology clinics in Sweden. Healthcare resource use data were retrospectively collected for 12 months. RESULTS 38 patients were included, of whom 7 were in NYHA class II, 20 in class III and 4 in class IV. The total cost of health care per patient increased from SEK 69,000 (€6800) in NYHA stage II, SEK 219,000 (€21,500) in NYHA stage III, to SEK 638,000 (€62,900) in stage IV, mainly due to an increase in inpatient stays. Mean time (standard deviation, SD) from any cardiac related diagnosis prior to ATTR-CM diagnosis was 3.5 (3.1) years. CONCLUSIONS Advanced ATTR-CM stages are associated with significant healthcare costs, as patients more often require resource-intensive inpatient care. The current diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years.
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Affiliation(s)
- Frida Hjalte
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | | | | | - Gerhard Wikström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Per Eldhagen
- Department of Medicine Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Löfvendahl S, Norlin JM, Ericson O, Hanno M, Schmitt-Egenolf M. Prolonged Sick Leave Before and After Diagnosis of Generalized Pustular Psoriasis: A Swedish Population-based Register Study. Acta Derm Venereol 2023; 103:adv6497. [PMID: 37707292 PMCID: PMC10512969 DOI: 10.2340/actadv.v103.6497] [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] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/22/2023] [Indexed: 09/15/2023] Open
Abstract
The aim of this study was to analyse sick leave in generalized pustular psoriasis, the most severe form of pustular psoriasis. Prolonged sick leave of >14 days was analysed for 502 patients with generalized pustular psoriasis compared with controls with psoriasis vulgaris and matched controls from the general population. Using data from the Swedish National Patient Register, and the Longitudinal integrated database for health insurance and labour market studies, the study estimated the mean number of sick leave days in the year of first diagnosis of generalized pustular psoriasis (index year) and for 2 years before and after the index year. Patients with generalized pustular psoriasis were on sick leave to a larger extent than both control populations for all study years. The number of sick leave days peaked in the index year and then reduced. Compared with the control populations, sick leave in generalized pustular psoriasis was already higher prior to diagnosis, indicating delayed diagnosis and/or a comorbidity burden.
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Affiliation(s)
- Sofia Löfvendahl
- The Swedish Institute for Health Economics (IHE), Lund, Sweden. Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Oskar Ericson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | | | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå university, Umeå, Sweden.
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Ericson O, Löfvendahl S, Norlin JM, Gyllensvärd H, Schmitt-Egenolf M. Mortality in generalized pustular psoriasis: A population-based national register study. J Am Acad Dermatol 2023; 89:616-619. [PMID: 37230364 DOI: 10.1016/j.jaad.2023.04.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Oskar Ericson
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Sofia Löfvendahl
- The Swedish Institute for Health Economics, Lund, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Comorbidities in palmoplantar pustulosis: a Swedish population-based register study. Br J Dermatol 2023:7191697. [PMID: 37285288 DOI: 10.1093/bjd/ljad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/16/2023] [Accepted: 04/25/2023] [Indexed: 06/09/2023]
Abstract
This study investigated the comorbidity burden of Swedish patients with palmoplantar pustulosis (PPP) vs. the general population and patients with psoriasis vulgaris (PV). We found a significantly higher comorbidity burden in patients with PPP compared with the general population, represented by higher odds for disease across different categories (metabolic, cerebrovascular, cardiovascular, psychiatric). Although patients with PPP and PV showed similar comorbidity burdens overall, the comorbidity profiles differed significantly. Comorbidities such as type 2 diabetes and chronic obstructive pulmonary disorder, which showed both high prevalence (> 5%) in PPP and higher odds than PV, may be of particular importance for the specific comorbidity burden of PPP.
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Affiliation(s)
- Sofia Löfvendahl
- The Swedish Institute for Health Economics (IHE), Lund
- Department of Laboratory Medicine, Lund University, Lund
| | | | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
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7
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Norlin JM, Kellerborg K, Persson U, Åström DO, Hagell P, Martinez‐Martin P, Odin P. Clinical Impression of Severity Index for Parkinson's Disease and Its Association to Health-Related Quality of Life. Mov Disord Clin Pract 2023; 10:392-398. [PMID: 36949801 PMCID: PMC10026279 DOI: 10.1002/mdc3.13649] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 12/27/2022] Open
Abstract
Background Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD) is a simple tool that can easily be used in clinical practice. Few studies have investigated the relationship between health-related quality of life and the CISI-PD. Objective To analyze the association of CISI-PD scores with those of generic (EQ-5D-5L) and Parkinson's disease (PD) disease-specific (Parkinson's Disease Questionnaire-8 [PDQ-8]) health-related quality of life assessments. Methods Persons with idiopathic PD in the Swedish Parkinson's Disease registry with simultaneous registrations of CISI-PD and EQ-5D-5L and/or PDQ-8 were included. Correlations with EQ-5D dimensions were analyzed. The relationships between the CISI-PD, EQ-5D-5L, and PDQ-8 were estimated by linear mixed models with random intercept. Results In the Swedish Parkinson's Disease registry, 3511 registrations, among 2168 persons, fulfilled the inclusion criteria. The dimensions self-care, mobility, and usual activities correlated moderately with the CISI-PD (r s = 0.60, r s = 0.54, r s = 0.57). Weak correlations were found for anxiety/depression and pain/discomfort (r s = 0.39, r s = 0.29) (P values < 0.001). The fitted model included the CISI-PD, age, sex, and time since diagnosis. The CISI-PD had a statistically significant impact on the EQ-5D and PDQ-8 (P values < 0.001). Conclusions The CISI-PD provides a moderate correlation with the EQ-5D and could possibly be useful as a basis for defining health states in future health economic models and serving as outcomes in managed entry agreements. Nonetheless, the limitation of capturing nonmotor symptoms of the disease remains a shortcoming of clinical instruments, including the CISI-PD.
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Affiliation(s)
| | | | - Ulf Persson
- The Swedish Institute for Health EconomicsLundSweden
| | | | - Peter Hagell
- The PRO‐CARE Group, Faculty of Health SciencesKristianstad UniversityKristianstadSweden
- Restorative Parkinson Unit, Division of Neurology, Department of Clinical SciencesLund UniversityLundSweden
| | - Pablo Martinez‐Martin
- Center of Networked Biomedical Research in Neurodegenerative DiseasesCarlos III Institute of HealthMadridSpain
| | - Per Odin
- Restorative Parkinson Unit, Division of Neurology, Department of Clinical SciencesLund UniversityLundSweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and GeriatricsSkåne University HospitalMalmöSweden
- SWEPAR‐netSweden
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Comorbidities in patients with generalized pustular psoriasis: a nationwide population-based register study. J Am Acad Dermatol 2023; 88:736-738. [PMID: 36228948 DOI: 10.1016/j.jaad.2022.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Sofia Löfvendahl
- The Swedish Institute for Health Economics, Lund, Sweden; Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå university, Umeå, Sweden.
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9
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Kellerborg K, Norlin JM, Odin P. The Relationship between PDQ-8 and Costs in Parkinson's Disease-A Swedish Register-Based Study. Mov Disord Clin Pract 2023; 10:231-237. [PMID: 36825055 PMCID: PMC9941938 DOI: 10.1002/mdc3.13630] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Parkinson's disease (PD) is a progressive neurodegenerative disorder associated with substantial costs which increase with progression state. However, few studies have investigated the association between costs and health related quality of life. Objectives To estimate the relationship between costs and health related quality of life, measured by the Parkinson's disease Quality of Life Questionnaire (PDQ)-8 from a societal perspective, partial societal perspective (excluding productivity loss), and a health care perspective. Methods The Swedish Parkinson's Disease registry was linked to health care data registries to estimate annual costs. A generalized linear model was used to assess the relationship between instrument items and costs. Results The results suggest that PDQ-8 captures the increase of costs by PD severity, particularly for costs within the broader societal perspective. From the best to worst PDQ-8 quartile, we observed approximately 7-fold increases within the societal perspective (39,400 to 274,300 SEK) and the partial societal perspective (31,800 to 219,400 SEK), and the increase within the health care perspective more than doubled (21,900 to 49,700 SEK). The PDQ-8 dimensions "mobility," "activities of daily living" and "social support" were associated with high costs in all perspectives. Conclusion Using a disease-specific measure reflecting the patient's perspective, we found an increase of costs with worsening severity of PD, particularly for costs within the broader societal perspective. High costs were associated with not only motor symptoms, but also the dimension "Social support."
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Affiliation(s)
| | | | - Per Odin
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and GeriatricsSkåne University HospitalMalmöSweden
- Restorative Parkinson Unit, Division of Neurology, Department of Clinical Sciences LundLund UniversityLundSweden
- SWEPAR‐netLundSweden
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Norlin JM, Löfvendahl S, Schmitt-Egenolf M. The Use of IL-17 and IL-23 Inhibitors in Swedish Clinical Practice: A Register-Based Analysis. Dermatology 2023; 239:262-266. [PMID: 36516805 PMCID: PMC10015751 DOI: 10.1159/000528007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Interleukin (IL) inhibitors have made completely cleared skin achievable for many patients with moderate to severe psoriasis in clinical trial settings. Few observational studies assess treatment response in accordance with treatment goals in guidelines. OBJECTIVES The aim of the study was to analyze the treatment response of IL-17/IL-23 inhibitors in clinical practice and the proportions of patients that reach the treatment target of the Psoriasis Area and Severity Index (PASI) < 3 and the Dermatology Life Quality Index (DLQI) ≤5. METHODS A longitudinal, observational study based on the Swedish National Registry for Systemic Treatment of Psoriasis, PsoReg. Patients using IL-17/IL-23 inhibitors with assessments of PASI, DLQI, and EQ-5D before (maximum 6 months) and after (3-12 months) initiation of IL-17/IL-23 were included. RESULTS In total, 333 patients using IL-17/IL-23 inhibitors were included. Eighty percent (n = 266) received IL-17 inhibitors, and 20% (n = 67) received IL-23 inhibitors. Sixty-six percent of patients reached both PASI <3 and DLQI ≤5, 23% reached one target, and 11% reached none. The mean (SD) PASI, DLQI, and EQ-5D improvements were 6.75 (6.99), 7.14 (7.97), and 0.126 (0.296), respectively. There was no statistically significant difference in outcomes between IL-17 and IL-23 inhibitor treatment groups. CONCLUSIONS IL-17/IL-23 inhibitors are effective in clinical practice, but there is still an unmet therapeutic need in moderate to severe psoriasis.
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Affiliation(s)
- Jenny M Norlin
- The Swedish Institute of Health Economics (IHE), Lund, Sweden
| | | | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
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Åström DO, Simonsen J, Raket LL, Sgarbi S, Hellsten J, Hagell P, Norlin JM, Kellerborg K, Martinez-Martin P, Odin P. High risk of developing dementia in Parkinson's disease: a Swedish registry-based study. Sci Rep 2022; 12:16759. [PMID: 36202962 PMCID: PMC9537530 DOI: 10.1038/s41598-022-21093-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Dementia have substantial negative impact on the affected individual, their care partners and society. Persons living with Parkinson’s disease (PwP) are also to a large extent living with dementia. The aim of this study is to estimate time to dementia in PD using data from a large quality register with access to baseline clinical and patient reported data merged with Swedish national health registries. Persons with Parkinson’s disease in the Swedish Neuro Registries/Parkinson’s Disease Swedish PD Registry (PARKreg) in Sweden were included and linked to national health registries and matched by sex and age to controls without PD. Time to dementia was analysed with Cox regression models assuming proportional hazards, with time since diagnosis as the underlying time variable. In this large prospective cohort study, PwP had approximately four times higher risk of developing dementia as compared to age and sex-matched controls, a finding which remained after adjusting for potential confounders. The present results underline the high risk of dementia in PD and further emphasize the importance of developing symptomatic and ultimately disease modifying strategies to counteract this part of the non-motor symptomatology in PD.
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Affiliation(s)
| | | | - Lars Lau Raket
- H Lundbeck A/S, Ottiliavej 9, 2500, Valby, Denmark.,Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | - Peter Hagell
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Per Odin
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Economic Burden of Generalized Pustular Psoriasis in Sweden: A Population-Based Register Study. Psoriasis (Auckl) 2022; 12:89-98. [PMID: 35548662 PMCID: PMC9084503 DOI: 10.2147/ptt.s359011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Generalized pustular psoriasis (GPP), which can occur with or without psoriasis vulgaris (PV), is a severe form of pustular psoriasis with potentially life-threatening symptoms. GPP is also associated with several comorbidities, which further adds to the burden of disease. This study investigates the economic burden of disease in patients with GPP. Methods All-cause and GPP-specific healthcare resource use (inpatient stays, physician visits and drug use), as well as associated costs, were compared for year 2015 between GPP patients (n = 914) and two matched control groups representing the general population (n = 4047) and patients with PV but no GPP (n = 2556). Information on resource use for 2015 was obtained from the Swedish National Patient Register and Swedish Prescribed Drug Register, respectively. Results All-cause inpatient stays, physician visits, and use of psoriasis-related drugs were significantly more common among GPP patients compared to both control groups. This difference was reflected in total direct cost for GPP patients (5062 euros/year) which was 3.1 and 1.8 times higher (p < 0.001) compared to the general population and PV controls, respectively. For GPP patients, the share of total cost was 22% for all-cause physician outpatient visits and 40% for all-cause inpatient stays. However, only 6.3% and 11.3% of these costs, respectively, were due to GPP-specific problems. Psoriasis-related drugs constituted 27% of total costs for GPP patients of which a large fraction (86%) was represented by biologics. Conclusion This study demonstrates a higher economic burden for GPP patients compared to both the general population and patients with PV, with inpatient visits and use of biologic drugs as major cost driving factors. Only fractions of the costs for physician visits and inpatient stays were attributable to specific GPP problems, indicating a higher economic burden of GPP-consequences and complications.
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Affiliation(s)
| | - Jenny M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
- Correspondence: Marcus Schmitt-Egenolf, Department of Public Health and Clinical Medicine, Dermatology, Umeå university, Umeå, SE-901 85, Sweden, Tel +46 90 785 2875, Email
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Prevalence and incidence of generalised pustular psoriasis in Sweden - a population-based register study. Br J Dermatol 2022; 186:970-976. [PMID: 34978071 DOI: 10.1111/bjd.20966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Generalised pustular psoriasis (GPP) is a severe form of pustular psoriasis with generalised eruption of sterile pustules, often along with systemic symptoms. There is a scarcity of population-based estimates of GPP prevalence and incidence. OBJECTIVES To estimate i) the prevalence and incidence of GPP in the Swedish general population and ii) the prevalence of psoriasis vulgaris within the GPP population. METHODS We identified cases (2004-2015) with one ICD-10 diagnostic code (base case) for GPP within the Swedish National Patient Register, which covers inpatient and outpatient secondary care. Cases were linked to the Swedish Total Population Register and the point prevalence was estimated as on 31 December 2015. In two alternative analyses we changed case definitions to: 1) requiring two visits (strict case 1), 2) requiring two visits of which one within dermatology/internal medicine (strict case 2). RESULTS The base case point prevalence of GPP was estimated to 9.1/100 000 (women=11.2, men=7.0) and the annual prevalence in 2015 was estimated to 1.53/100 000. Among the GPP population, 43% also had a psoriasis vulgaris code. The incidence of GPP in 2015 was estimated to 0.82/100 000 (women=0.93, men=0.74). The criteria used had an impact on prevalence and incidence estimates; prevalence strict case 1) 3.8/100 000 and incidence strict case 1) 0.42/100 000. CONCLUSIONS Results indicate that the estimated GPP population in Sweden is within the range of previous published estimates. However, the estimates were sensitive to employed GPP case criteria. The findings enhance demands for studies using validated diagnostic algorithms.
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Affiliation(s)
| | - Jenny M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - Marcus Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå university, Umeå, Sweden
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Hjalte F, Norlin JM, Kellerborg K, Odin P. Parkinson's disease in Sweden-resource use and costs by severity. Acta Neurol Scand 2021; 144:592-599. [PMID: 34254292 DOI: 10.1111/ane.13502] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/28/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To estimate resource use and costs, including direct and indirect costs, in relation to levels of severity in individuals with Parkinson's disease (PD) in a Swedish setting. MATERIALS AND METHODS Patients with idiopathic PD registered in the National Parkinson's Disease Patient Registry (PARKreg), with registrations of Hoehn and Yahr (H&Y) and "off time" in the Skåne Region, were included. Annual costs of healthcare contacts, drugs, formal and informal care, and productivity loss associated with PD were estimated using data from PARKreg linked with regional and national healthcare registers between 2013 and 2019. RESULTS In total, 960 patients and 1324 observations (patient-years) were included. Total average cost per patient-year was SEK 168,982 (EUR 15,958) and ranged from SEK 62,404 (EUR 5893) for H&Y stage I to SEK 1,056,324 (EUR 99,755) in H&Y stage V. The dominating part of total costs for early stages were indirect costs accounting for 50-60% while formal care made up for 55% and 81% of total costs in H&Y IV and V, respectively. Total mean costs for formal care, informal care, and productivity loss also increased with increasing off-time. CONCLUSION Advanced and late stages of PD are associated with significant societal costs as patients in those stages often require resource-intensive and costly formal care. Thus, there are potential savings to be made, by optimizing the pharmacological and surgical symptomatic treatment of patients with advanced disease.
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Affiliation(s)
- Frida Hjalte
- The Swedish Institute for Health Economics Lund Sweden
| | | | | | - Per Odin
- Department of Neurology Rehabilitation Medicine, Memory Disorders, and Geriatrics Skåne University Hospital Malmö Sweden
- Department of Clinical Sciences Lund Restorative Parkinson Unit Division of Neurology Lund University Lund Sweden
- SWEPAR‐net Lund Sweden
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Norlin JM, Kellerborg K, Odin P. Patient Utilities in Health States Based on Hoehn and Yahr and Off-Time in Parkinson's Disease: A Swedish Register-Based Study in 1823 Observations. Pharmacoeconomics 2021; 39:1141-1149. [PMID: 34231134 DOI: 10.1007/s40273-021-01056-z] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cost-effectiveness models in Parkinson's disease often include health states based on Hoehn and Yahr (H&Y) and time in 'off'. Few studies have investigated utilities in these health states. OBJECTIVE The aim of this study was firstly to explore utilities in health states based on H&Y and off-time, and secondly to investigate to what extent H&Y and off-time correlated with EQ-5D dimensions. METHODS Patients with idiopathic Parkinson's disease in the National Parkinson's Disease Patient Registry (PARKreg) in Sweden with observations of EQ-5D-3L, H&Y and off-time were included. Correlations with EQ-5D dimensions were analyzed. The relationship between the EQ-5D-3L and H&Y and off-time were estimated by a linear mixed-model with random intercept. RESULTS Among patients in PARKreg, 1823 observations fulfilled inclusion criteria. The dimensions 'self-care', 'mobility' and 'usual activities' correlated moderately with H&Y (rs = 0.45, rs = 0.46, rs = 0.45). Weak correlations were found for 'anxiety/depression' and 'pain/discomfort' (rs = 0.24, rs = 0.22) (p values < 0.001). All dimensions correlated weakly with off-time. The fitted model included H&Y, time in 'off', and sex. All H&Y stages were found to be significant and had large and monotonous impact on EQ-5D. Off-time was not significant, but improved the model goodness of fit. Predicted values ranged from 0.733 to - 0.106. CONCLUSION This study provides utilities for health states reflecting the current modeling practice of interventions targeting motor symptoms in Parkinson's disease. Future research should investigate patient utilities in health states that also capture non-motor symptoms of the disease, as the management of and options for treatments targeting these symptoms increases.
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Affiliation(s)
- Jenny M Norlin
- The Swedish Institute for Health Economics, Råbygatan 2, 223 61, Lund, Sweden.
| | - Klas Kellerborg
- The Swedish Institute for Health Economics, Råbygatan 2, 223 61, Lund, Sweden
| | - Per Odin
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics, Skåne University Hospital, Malmö, Sweden
- Restorative Parkinson Unit, Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- SWEPAR-net, Lund, Sweden
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Arthursson V, Rosén R, Norlin JM, Gralén K, Toth E, Syk I, Thorlacius H, Rönnow CF. Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer. Endosc Int Open 2021; 9:E1512-E1519. [PMID: 34540543 PMCID: PMC8445687 DOI: 10.1055/a-1522-8762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/25/2021] [Accepted: 05/19/2021] [Indexed: 10/28/2022] Open
Abstract
Background and study aims Management of T1 rectal cancer is complex and includes several resection methods, making cost comparisons challenging. The aim of this study was to compare costs of endoscopic and surgical resection and to investigate hypothetical cost scenarios for the treatment of T1 rectal cancer. Patients and methods Retrospective population-based cost minimization study on prospectively collected data on T1 rectal cancer patients treated using endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), open, laparoscopic, or robotic resection, in Skåne County, Sweden (2011-2017). The hypothetical cost scenarios were based on the distribution of high-risk features of lymph node metastases in a national cohort (2009-2017). Results Eighty-five patients with T1 RC undergoing ESD (n = 16), TEM (n = 17), open (n = 35), laparoscopic (n = 9), and robotic (n = 8) resection were included. ESD had a total 1-year cost of 5165 € and was significantly ( P < 0.05) less expensive compared to TEM (14871€), open (21 453 €), laparoscopic (22 488 €) and robotic resection (26 562 €). Risk factors for lymph node metastases were seen in 68 % of 779 cases of T1 rectal cancers included in the national cohort. The hypothetical scenario of performing ESD on all T1 RC had the lowest total 1-year per patient cost compared to all other alternatives. Conclusions This is the first study analyzing total 1-year costs of endoscopic and surgical methods to resect T1 rectal cancer, which showed that the cost of ESD was significantly lower compared to TEM and surgical resection. In fact, based on hypothetical cost scenarios, ESD is still justifiable from a cost perspective even when all high-risk cases are followed by surgery in accordance to guidelines.
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Affiliation(s)
- Victoria Arthursson
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Roberto Rosén
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | | | - Ervin Toth
- Department of Clinical Sciences, Section of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ingvar Syk
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
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Norlin JM, Willis M, Persson U, Andersson E, Pålhagen S, Odin P. Swedish guidelines for device-aided therapies in Parkinson's disease -Economic evaluation and implementation. Acta Neurol Scand 2021; 144:170-178. [PMID: 33899213 DOI: 10.1111/ane.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/25/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The National Board of Health and Welfare in Sweden published the national guidelines for Parkinson's Disease 2016. The aim of this study was to summarize this evidence review and development of the guidelines, focusing on the economic evaluation of device-aided therapies (deep brain stimulation, pump-based infusion of levodopa-carbidopa intestinal gel or apomorphine) for Parkinson's disease, and the rate of implementation after 3 years in Sweden. MATERIAL AND METHODS The evidence review underlying the guidelines-including systematic literature searches of clinical and economic evidence, model-based economic evaluation, and formal analysis and guideline development-was examined, condensed, and translated. The impact of the guidelines was assessed with treatment use statistics from 2009 to 2019. RESULTS All device-aided therapies were assigned high priority. Based on a relatively low proportion of device-aided therapies (30%) in Parkinson's disease, a 5-year increase of 500 patients was recommended. This was estimated to reduce total costs by SEK 14 million (€1.7 million). Follow-up data found an increase of 217 patients between 2017 and 2019, following the same trend as before the guidelines. CONCLUSION Three years after the guidelines were published, the use of device-aided therapies has increased in Sweden, albeit not in pace with recommendations. One reason for slow implementation may be poor incentivization related to budget silos in which the costs for device-aided therapies are borne by the regions but the cost offsets (eg, reduced need for home care) are reaped by local stakeholders.
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Affiliation(s)
| | | | - Ulf Persson
- The Swedish Institute for Health Economics Lund Sweden
| | | | - Sven Pålhagen
- Division of Neurology Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics Skåne University Hospital Malmö Sweden
| | - Per Odin
- Department of Neurology, Rehabilitation Medicine, Memory Disorders, and Geriatrics Skåne University Hospital Malmö Sweden
- Restorative Parkinson Unit Division of Neurology Department of Clinical Sciences Lund Lund University Lund Sweden
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Löfvendahl S, Norlin JM, Schmitt-Egenolf M. Prevalence and incidence of palmoplantar pustulosis in Sweden: a population-based register study. Br J Dermatol 2021; 185:945-951. [PMID: 33792911 DOI: 10.1111/bjd.20087] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a chronic relapsing skin condition characterized by sterile pustules on the palm and soles. Population-based estimates of PPP incidence and prevalence are limited. OBJECTIVES To estimate the prevalence and incidence of PPP in the Swedish general population and to estimate the prevalence of psoriasis vulgaris among the population with PPP. METHODS The Swedish National Patient Register was used, covering all inpatient and outpatient nonprimary care for the Swedish population. We identified cases (2004-2015) with one International Classification of Diseases 10th Revision diagnostic code (base case) for PPP. The point prevalence estimates at the end of this period (31 December 2015) were obtained by linkage to the Swedish Total Population Register. In sensitivity analyses, we used alternative case definitions: (i) requiring two visits and (ii) requiring two visits, one of which was within dermatology or internal medicine. RESULTS The base case prevalence of PPP was estimated to be 147 per 100 000 (women 227, men 68) and the annual prevalence was estimated to 26 per 100 000 in 2015. Among the population of people with PPP, 17% were registered with a diagnostic code for psoriasis vulgaris. The incidence of PPP in 2015 was estimated to be 12·7 per 100 000 (women 18·7, men 6·6). The criteria used had an impact on the prevalence and incidence estimates: strict case 1 gave an overall prevalence of 72 per 100 000 and an incidence of 5·4 per 100 000. CONCLUSIONS The results indicate that the population-based prevalence of PPP may be larger than previously estimated. However, the estimates were sensitive to the employed PPP case criteria. The findings enhance demands for studies using validated diagnostic algorithms potentially also including data from primary care.
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Affiliation(s)
- S Löfvendahl
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - J M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | - M Schmitt-Egenolf
- Department of Public Health and Clinical Medicine, Dermatology, Umeå University, Umeå, Sweden
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Persson U, Norlin JM. Multi-indication and Combination Pricing and Reimbursement of Pharmaceuticals: Opportunities for Improved Health Care through Faster Uptake of New Innovations. Appl Health Econ Health Policy 2018; 16:157-165. [PMID: 29470774 DOI: 10.1007/s40258-018-0377-7] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many pharmaceuticals are effective in multiple indications and the degree of effectiveness may differ. A product-based pricing and reimbursement system with a single price per product is insufficient to reflect the variable values between different indications. The objective of this article is to present examples of actual pricing and reimbursement decisions using current value-based pricing in Sweden and to discuss their implications and possible solutions. The value of several cancer drugs was estimated for various indications based on a willingness-to-pay threshold of 1 million SEK (EUR 104,000) per QALY gained. For some drugs, the estimated value was higher than the drug acquisition cost in several indications, whilst in others, the estimated value was lower than the drug acquisition cost. Drugs used in combination present a special case. If a drug prolongs survival and consequently also a continued use of the anchor drug, the combination use may not be cost effective even at a zero price. In a product-based pricing and reimbursement system, patients may not get access to drugs or access may be delayed and manufacturers may be discouraged to invest in future indications. To overcome these issues, there are several approaches to link price and value. One approach is a "weighted-average" price based on an average of the value across all indications. Another is "multi-indication pricing," which enables price differentiation between indications. However, there are several barriers for applying multi-indication pricing and reimbursement schemes. One barrier is the lack of existing administrative infrastructure to track patients' indications.
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Affiliation(s)
- Ulf Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden.
- Lund Institute of Economic Research, School of Economics and Management, Lund University, Lund, Sweden.
| | - J M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
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Norrlid H, Norlin JM, Holmstrup H, Malmberg I, Sartorius K, Thormann H, Jemec GBE, Ragnarson Tennvall G. Patient-reported outcomes in topical field treatment of actinic keratosis in Swedish and Danish patients. J DERMATOL TREAT 2017; 29:68-73. [PMID: 28658998 DOI: 10.1080/09546634.2017.1329514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/24/2022]
Abstract
Topical treatments in dermatology can be long, complex and lead to nonadherence and nonpersistence to prescribed treatment. Clinical efficacy observed in randomized clinical trials (RCT) may therefore be reduced in real-world clinical practice. The objective of this study was to analyze patient-reported treatment adherence, treatment satisfaction and health-related quality of life (HRQoL) with topical treatments of actinic keratosis (AK) in routine clinical practice in Denmark and Sweden. Adult patients prescribed field-directed topical AK treatments with diclofenac gel, imiquimod or ingenol mebutate per routine clinical practice were eligible for the observational RAPID-ACT study. Data were collected through physician and patient questionnaires that included validated instruments to measure treatment satisfaction (TSQM-9), treatment adherence (MMAS) and HRQoL (EQ-5D-5L, EQ-VAS, AKQoL). In total, 446 patients from Denmark and Sweden were included. Ingenol mebutate patients reported a higher satisfaction with treatment effectiveness compared to patients treated with diclofenac (p = .006) while no other differences in treatment satisfaction could be determined. Treatment adherence was generally high, but higher for ingenol mebutate compared to both diclofenac (p < .001) and imiquimod (p = .007), possibly due to shorter treatment duration. No differences in improved HRQoL were found. More research is needed about the link between treatment adherence and real-world effectiveness.
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Affiliation(s)
- Hanna Norrlid
- a The Swedish Institute for Health Economics , Lund , Sweden
| | - Jenny M Norlin
- a The Swedish Institute for Health Economics , Lund , Sweden
| | | | | | - Karin Sartorius
- c Department of Dermatology , Stockholm South General Hospital (Södersjukhuset) , Stockholm , Sweden
| | | | - Gregor B E Jemec
- e Department of Dermatology , Zealand University Hospital , Roskilde , Denmark.,f Department of Health Sciences , University of Copenhagen , Copenhagen , Denmark
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Hanke WC, Norlin JM, Mark Knudsen K, Larsson T, Stone S. Quality of life in treatment of AK: Treatment burden of ingenol mebutate gel is small and short lasting. J DERMATOL TREAT 2016; 27:450-5. [DOI: 10.3109/09546634.2016.1160024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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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Asche CV, Zografos P, Norlin JM, Urbanek B, Mamay C, Makin C, Erntoft S, Chen CC, Hines DM, Mark Siegel D. Evaluation of Resource Utilization and Treatment Patterns in Patients with Actinic Keratosis in the United States. Value Health 2016; 19:239-248. [PMID: 27021759 DOI: 10.1016/j.jval.2015.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 11/16/2015] [Accepted: 11/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare health care resource utilization and treatment patterns between patients with actinic keratosis (AK) treated with ingenol mebutate gel (IngMeb) and those treated with other field-directed AK therapies. METHODS A retrospective, propensity-score-matched, cohort study compared refill/repeat and adding-on/switching patterns and outpatient visits and prescriptions (health care resource utilization) over 6 months in patients receiving IngMeb versus those receiving imiquimod, 5-fluorouracil, diclofenac sodium, and methyl aminolevulinate or aminolevulinic acid photodynamic therapy (MAL/ALA-PDT). RESULTS The final sample analyzed included four matched treatment cohort pairs (IngMeb and comparator; n = 790-971 per treatment arm). Refill rates were similar except for imiquimod (15% vs. 9% for imiquimod and IngMeb, respectively; P < 0.05). MAL/ALA-PDT treatment repetition rates were higher than IngMeb refill rates (20% vs. 10%; P < 0.05). Topical agent add-on/switch rates were comparable. PDT had higher switch rates than did IngMeb (5% vs. 2%; P < 0.05). The IngMeb cohort had a significantly lower proportion of patients with at least one AK-related outpatient visit during the 6-month follow-up than did any other cohort: versus imiquimod (50% vs. 66%; P < 0.0001), versus 5-fluorouracil (50% vs. 69%; P < 0.0001), versus diclofenac sodium (51% vs. 56%; P = 0.034), and versus MAL/ALA-PDT (50% vs. 100%; P < 0.0001). There were significantly fewer AK-related prescriptions among patients receiving IngMeb than among patients in other cohorts. CONCLUSIONS Results based on the first 6 months after treatment initiation suggested that most field-directed AK therapies had clinically comparable treatment patterns except imiquimod, which was associated with higher refill rates, and PDT, which was associated with significantly more frequent treatment sessions and higher switching rates. IngMeb was also associated with significantly fewer outpatient visits than were other field-directed therapies.
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Affiliation(s)
- Carl V Asche
- Center for Outcomes Research and the Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA; Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.
| | | | | | | | | | | | | | | | | | - Daniel Mark Siegel
- Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA; Long Island Skin Cancer and Dermatologic Surgery, a division of ProHealthCare Associates, Smithtown, NY, USA
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Tennvall GR, Norlin JM, Malmberg I, Erlendsson AM, Hædersdal M. Health related quality of life in patients with actinic keratosis--an observational study of patients treated in dermatology specialist care in Denmark. Health Qual Life Outcomes 2015. [PMID: 26220553 PMCID: PMC4518856 DOI: 10.1186/s12955-015-0295-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Actinic keratosis (AK) is a common skin condition that may progress to non-melanoma skin cancer (NMSC). The disease may influence Health Related Quality of Life (HRQoL), but studies of HRQoL in patients with AK are limited. The purpose of the study was to analyze HRQoL in patients with different severity levels of AK treated in dermatology specialist care using generic and disease-specific HRQoL instruments and to analyze their relationship. Methods AK patients who visited dermatological clinics in Denmark were included in an observational, cross-sectional, study in a multi-center setting. Dermatologists assessed AK severity and patients completed: Actinic Keratosis Quality of Life Questionnaire (AKQoL), Dermatology Life Quality Index (DLQI), and EQ-5D-5 L including EQ-VAS. Differences between categorical subgroups were tested with Wilcoxon rank-sum test. The relationship between instruments was analyzed with the Spearman correlation test. Results A total of 312 patients were included in the analyses. Patients reported impairment in the disease specific HRQoL instrument AKQoL (mean AKQoL 6.7, DLQI 2, EQ-5D-5 L 0.88, and EQ-VAS 79). HRQoL was least affected in patients with mild actinic disease, whereas patients with severe actinic damage suffered from further impaired HRQoL (mean AKQoL 10.1 and DLQI 4.6). Correlations between DLQI and AKQoL were moderate, whereas the correlations between DLQI and EQ-5D-5 L and between AKQoL and EQ-5D-5 L were weak. Conclusions Patients with severe actinic damage showed more impairment in HRQoL than those with mild disease. Correlations between instruments suggest that they are complementary as they measure different aspects of HRQoL and are used for different purposes.
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Affiliation(s)
| | - J M Norlin
- IHE, The Swedish Institute for Health Economics, P.O. Box 2127, SE-220 02, Lund, Sweden.
| | | | - A M Erlendsson
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - M Hædersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
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Norlin JM, Steen Carlsson K, Persson U, Schmitt-Egenolf M. Resource use in patients with psoriasis after the introduction of biologics in Sweden. Acta Derm Venereol 2015; 95:156-61. [PMID: 24819980 DOI: 10.2340/00015555-1895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 11/16/2022] Open
Abstract
The introduction of biologics has changed treatment patterns as well as costs in patients with psoriasis. This study was performed to estimate direct and indirect costs of the psoriasis population in Sweden, and to analyse changes in costs between 2006 and 2009. The study population was identified in national registers. Direct costs included health care visits with primary psoriasis diagnoses in specialist care and drugs relevant for treating psoriasis. Productivity loss, including costs of long-term sick leave and disability pension, was estimated as the difference between psoriasis patients and matched controls from the general population. Total direct cost increased from SEK 348 million (~ €39) in 2006 to SEK 459 million (~ €51) in 2009, whereas the total productivity loss decreased from SEK 1,646 (~ €183) to 1,618 million (~ €180) between 2006 and 2009. Although direct costs, especially for biologic agents, have increased for patients with psoriasis over time, this study indicates that costs related to productivity loss are still more substantial.
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Affiliation(s)
- Jenny M Norlin
- Department of Public Health and Clinical Medicine, Division of Dermatology and Venereology, Umeå University, SE-901 85 Umeå, Sweden
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Ragnarson Tennvall G, Norlin JM, Malmberg I, Erlendsson A, Hædersdal M. Health Related Quality of Life in Patients With Actinic Keratosis - Results From Patients Treated in Dermatology Specialist Care In Denmark. Value Health 2014; 17:A611. [PMID: 27202129 DOI: 10.1016/j.jval.2014.08.2139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Willis M, Erntoft S, Persson S, Norlin JM, Persson U. Willingness-to-pay to access Ingenol Mebutate Gel for Actinic Keratosis Treatment in the U.S. Setting. J Health Econ Outcomes Res 2014; 2:1-14. [PMID: 34430663 PMCID: PMC8341863 DOI: 10.36469/9879] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Currently available topical treatments for actinic keratosis (AK) adversely affect patients' quality of life because of long treatment durations and long-lasting local skin reactions (LSRs), which may result in poor treatment adherence and patient outcomes. Ingenol mebutate gel, a recently introduced treatment for AK, is administered for 2 or 3 days, and LSR's are predicable in onset and duration. Objectives: The objective of the study was to estimate the value of ingenol mebutate gel's shorter treatment duration and tolerability profile to potential patients, versus existing topical treatments (imiquimod 3.75%, imiquimod 5% and diclofenac 3%) in the United States. Methods: The open-ended Contingent Valuation (CV) approach was used to estimate incremental willingness-to-pay (WTP) for ingenol mebutate gel rather than treatment with imiquimod 5%, imiquimod 3.75% and diclofenac 3%. Profiles for each therapy differed in regards to treatment duration, time-to-LSR resolution, and price. Subjects were asked to state their maximum out-of-pocket WTP to receive ingenol mebutate gel instead of each of the three alternatives. Results: 103 subjects provided usable answers. Between 48% and 63% of subjects were willing to pay extra to gain access to treatment with the ingenol mebutate gel profile instead of the comparators, and the mean incremental WTP ranged from $475 to $518. Subjects with experience of topical treatment stated higher WTP for accessing ingenol mebutate gel. Subjects whose most bothersome AK area was the full scalp or forehead also claimed higher WTP for ingenol mebutate gel. Conclusions: Patients diagnosed with AK indicated an unmet need for fast-acting topical treatment with shorter LSR resolution time.
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Affiliation(s)
- Michael Willis
- The Swedish Institute for Health Economics (IHE), Lund, Sweden
| | | | - Sofie Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden; Lund University, Department of Clinical Sciences, Health Economics Unit, Sweden
| | - Jenny M Norlin
- The Swedish Institute for Health Economics (IHE), Lund, Sweden; LEO Pharma A/S, Ballerup, Denmark
| | - Ulf Persson
- The Swedish Institute for Health Economics (IHE), Lund, Sweden; Lund University, Institute for Economic Research, School of Economics, Sweden
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Norlin JM, Steen Carlsson K, Persson U, Schmitt-Egenolf M. Switch to biological agent in psoriasis significantly improved clinical and patient-reported outcomes in real-world practice. Dermatology 2013; 225:326-32. [PMID: 23328678 DOI: 10.1159/000345715] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/07/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although clinical studies have shown efficacy of biological agents in moderate to severe psoriasis, observational studies of real-world effectiveness are rare. OBJECTIVE To analyse the psoriasis area and severity index (PASI) and quality of life by the EQ-5D questionnaire and dermatology quality of life index (DLQI) in psoriasis patients who switched from conventional systemic treatment to biological agents in clinical practice. Furthermore, to analyse patient groups with the highest benefit of biological agents. METHODS Longitudinal, observational study based on the Swedish National Registry for Systemic Treatment of Psoriasis, PsoReg. Outcomes of biological-naïve patients who switched to a biological agent (n = 267) were analysed before switch and at the first follow-up. RESULTS Patients significantly improved in EQ-5D, DLQI and PASI (p < 0.001). Patients with DLQI ≥10 and/or PASI ≥10 had the greatest benefits from biological agents in terms of EQ-5D. CONCLUSIONS Patients with moderate to severe psoriasis benefit from biological agents in clinical practice; the patients with the highest benefits were those with high pretreatment PASI and DLQI scores.
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Affiliation(s)
- Jenny M Norlin
- Division of Dermatology and Venereology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Norlin JM, Elf JL, Svensson PJ, Carlsson KS. A Cost-effectiveness Analysis of Diagnostic Algorithms of Deep Vein Thrombosis at the Emergency Department. Thromb Res 2010; 126:195-9. [DOI: 10.1016/j.thromres.2010.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 04/16/2010] [Accepted: 05/13/2010] [Indexed: 11/16/2022]
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Chess WA, Norlin JM, Jayaratne S. Social work administrators in part-time clinical practice: results of a national survey. Adm Soc Work 1985; 8:29-40. [PMID: 10310793 DOI: 10.1300/j147v08n03_04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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