| 41. |
- Gruneau, Lina, 1994-, et al.
(författare)
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Precision i hälsoekonomiska utvärderingsresultat och osäkerhet i prioriteringsbeslut
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Tandvårds- och läkemedelsförmånsverket (TLV) genomför på uppdrag av regeringen ett arbete med att utveckla metoder för hälsoekonomiska utvärderingar av precisionsmedicin och betalningsmodeller för avancerade terapiläkemedel (ATMP). TLV redovisar i sin andra rapport inom ramen för uppdraget ett antal nya möjliga metoder som kan användas i en hälsoekonomisk utvärdering för att värdera huruvida de priser som företagen efterfrågar är rimliga i förhållande till läkemedlens nytta. Eftersom hälsoekonomiska utvärderingar alltid är behäftade med osäkerhet i skattningarna är frågan om hur osäkerhet skall analyseras och beskrivas central för precisionsmedicin och ATMP då dataunderlagen ofta är knapphändiga. I en slutsats från ett tidigare arbete om utmaningarna med att utvärdera kostnader och hälsoeffekter inom ramen för precisionsmedicin konstaterades det att osäkerheten i skattningarna av kostnadseffektivitet kommer att öka när patientpopulationerna som utvärderas blir allt mindre. Vidare framgick det i de tidigare arbetena att TLVs ansats för att beskriva och analysera osäkerhet inte alltid är helt tydlig. Som en del i TLVs regeringsuppdrag ingår det att beskriva och tydliggöra osäkerheter i skattningar av kostnadseffektivitet samt hur dessa osäkerhet kan påverka osäkerhet i prioriteringsbeslut och den här rapporten är en del i det arbetet.Rapporten är fristående från den rapport som TLV skrivit inom ramen för regeringsuppdraget men har som mål att ge en kompletterande beskrivning av de osäkerheter som oftast föreligger när hälsoekonomiska utvärderingar utgör en del av ett underlag för prioriteringsbeslut. Förhoppningen är att denna rapport tillsammans med TLVs rapport ska stimulera till fortsatt diskussion om potentiella lösningar för att hantera utmaningar inte bara med precisionsmedicin och ATMP utan även med beslutsfattande under osäkerhet generellt inom hälso- och sjukvården.
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| 42. |
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| 43. |
- Ho, Chan-Mei, et al.
(författare)
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Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Over the next decade, the number of osteoarthritis consultations in health care is expected to increase. Physiotherapists may be considered equally qualified as primary assessors as physicians for patients with knee osteoarthritis. However, economic evaluations of this model of care have not yet been described. To determine whether physiotherapists as primary assessors for patients with suspected knee osteoarthritis in primary care are a cost-effective alternative compared with traditional physician-led care, we conducted a cost-effectiveness analysis alongside a randomized controlled pragmatic trial. Methods Patients were randomized to be assessed and treated by either a physiotherapist or physician first in primary care. A cost-effectiveness analysis compared costs and effects in quality adjusted life years (QALY) for the different care models. Analyses were applied with intention to treat, using complete case dataset, and missing data approaches included last observation carried forward and multiple imputation. Non-parametric bootstrapping was conducted to assess sampling uncertainty, presented with a cost-effectiveness plane and cost-effectiveness acceptability curve. Results 69 patients were randomized to a physiotherapist (n = 35) or physician first (n = 34). There were significantly higher costs for physician visits and radiography in the physician group (p < 0.001 and p = 0.01). Both groups improved their health-related quality of life 1 year after assessment compared with baseline. There were no statistically significant differences in QALYs or total costs between groups. The incremental cost-effectiveness ratio for physiotherapist versus physician was savings of 24,266 euro/lost QALY (societal perspective) and 15,533 euro/lost QALY (health care perspective). There is a 72-80% probability that physiotherapist first for patients with suspected knee osteoarthritis is less costly and differs less than +/- 0.1 in QALY compared to traditional physician-led care. Conclusion These findings suggest that physiotherapist-led care model might reduce health care costs and lead to marginally less QALYs, but confidence intervals were wide and overlapped no difference at all. Health consequences depending on the profession of the first assessor for knee osteoarthritis seem to be comparable for physiotherapists and physicians. Direct access to physiotherapist in primary care seems to lead to fewer physician consultations and radiography. However, larger clinical trials and qualitative studies to evaluate patients' perception of this model of care are needed.
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| 44. |
- Holmberg, Robin, et al.
(författare)
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Ice cleat distribution programmes and ice cleat use among older adults: repeated cross-sectional evidence from 63 municipal interventions in Sweden
- 2022
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Ingår i: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Ice cleats may help prevent ice-related falls in places with icy roads, but there is limited evidence about the association between ice cleat distribution and ice cleat use. Our study examined the association between Swedish municipal distribution programmes and ice cleat use among older adults (65+ years). Methods We combined data on municipal ice cleat distribution programmes (n=63) with repeated cross-sectional self-reports of ice cleat use in Sweden from 2007, 2010, 2014 and 2018. Respondents (n=63 234) were classified as exposed if they lived in a municipality with a programme, belonged to an eligible age group and responded after distribution (n=2507). Dose-response was assessed using distributed ice cleat pairs per capita (mean: 0.38). Linear probability models were used to estimate probability differences in ice cleat use between exposed and unexposed respondents, adjusting for age, sex, country of birth, education, survey wave and municipality. Ineligible age groups living in programme municipalities, who should be unaffected by ice cleat distribution, were used for bias assessment. Results Exposure to ice cleat distribution programmes was associated with 7.5 percentage points (95% CI 4.2 to 10.9) higher self-reported ice cleat use after confounding adjustment. The association was larger in municipalities that distributed one pair of ice cleats per capita (17.3 percentage points (95% CI 11.2 to 23.4)). No association was found among the ineligible age groups (-2.3 (95% CI -5.5 to 1.0)). Conclusion Distributing ice cleats to older adults may help increase their use of ice cleats in settings with icy road conditions.
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| 45. |
- Johansson, Naimi, 1988, et al.
(författare)
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Regional variation in prescription drug spending: Evidence from regional migrants in Sweden
- 2022
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Ingår i: Health Economics. - : Wiley. - 1057-9230 .- 1099-1050. ; 31:9, s. 1862-1877
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Tidskriftsartikel (refereegranskat)abstract
- There is substantial variation in drug spending across regions in Sweden, which can be justified if caused by differences in health need, but an indication of inefficiencies if primarily caused by differences in place-specific supply-side factors. This paper aims to estimate the relative effect of individual demand-side factors and place-specific supply-side factors as drivers of geographical variation in drug spending in Sweden. We use individual-level register data on purchases of prescription drugs matched with demographic and socioeconomic data of a random sample of about 900,000 individuals over 2007-2016. The primary empirical approach is a two-way fixed effect model and an event study where we identify demand- and supply-side effects based on how regional and local migrants change drug spending when moving across regional and municipal borders. As an alternative approach in robustness checks, we also use a decomposition analysis. The results show that the place-specific supply-side effect accounts for only about 5%-10% of variation in drug spending and remaining variation is due to individual demand-side effects. These results imply that health policies to reduce regional variation in drug spending would have limited impact if targeted at place-specific characteristics.
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| 46. |
- Labori, Frida, et al.
(författare)
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Cost-effectiveness analysis of left atrial appendage occlusion in patients with atrial fibrillation and contraindication to oral anticoagulation.
- 2022
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 43:13, s. 1348-1356
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to estimate the cost-effectiveness of percutaneous left atrial appendage occlusion (LAAO) compared to standard stroke prevention care for patients with atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC) in a Swedish healthcare and public sector perspective.We used a combined decision tree and cohort Markov model to estimate costs and quality-adjusted life-years (QALYs) over a lifetime horizon with LAAO compared to standard of care where the treatment effect is based on a recent meta-analysis. According to our analysis, LAAO gives more QALYs than standard of care (7.11 vs. 6.12). Furthermore, LAAO treatment is related to the first-year cost of 14 984 Euro (EUR) and higher average healthcare costs over the lifetime by about 4010 EUR, which gives an incremental cost-effectiveness ratio of LAAO vs. standard of care at 4047 EUR per gained QALY. From a public sector perspective, LAAO reduces average costs due to substantial reductions in long-term care and, thus, implies that LAAO is dominant from a public sector perspective (lower average costs and better health outcomes).From both Swedish healthcare and public sector perspectives, LAAO can be considered cost-effective compared to standard of care for individuals with AF and contraindication to OAC. However, these results must be confirmed in health economic evaluations alongside the ongoing randomized clinical trials.Is left atrial appendage occlusion (LAAO) cost-effective for patients with atrial fibrillation (AF) and contraindication to oral anticoagulation (OAC) compared to the standard of care from a Swedish healthcare and public sector perspective?LAAO is associated with lower cost than the standard of care from a public sector perspective and an incremental cost of 4010 Euro from a healthcare perspective. Furthermore, LAAO is related to better health outcomes than the standard of care.Treatment with LAAO among individuals with AF and contraindication to OAC can be considered as cost-effective compared to the standard of care from a Swedish healthcare and public sector perspective.
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| 47. |
- Larsson, Sofie, et al.
(författare)
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Cost-Effectiveness Analysis of Temocillin Treatment in Patients with Febrile UTI Accounting for the Emergence of Antibiotic Resistance
- 2022
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Ingår i: Applied Health Economics and Health Policy. - : Springer Science and Business Media LLC. - 1175-5652 .- 1179-1896. ; 20:6, s. 835-843
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Tidskriftsartikel (refereegranskat)abstract
- Background Antibiotic resistance has been listed as one of the biggest threats to global health today. A recent study has shown that treating febrile urinary tract infections with temocillin instead of cefotaxime leads to a reduced selection of antibiotic-resistant bacteria. However, a potential challenge with prioritizing temocillin over cefotaxime is the cost consequences. Objective This study aimed to assess the cost effectiveness of using temocillin compared to cefotaxime in treating febrile urinary tract infections in a model that takes the emergence of antibiotic resistance into account. Methods We used a Markov cohort model to estimate the costs and health effects of temocillin and cefotaxime treatment in febrile urinary tract infections in a Swedish setting. Health effects were assessed in terms of quality-adjusted life-years, and the primary outcome was the cost per quality-adjusted life-year gained with temocillin compared to cefotaxime. We used a 5-year time horizon. Results The model results showed that temocillin treatment led to better health outcomes at a higher total cost. The cost per quality-adjusted life-year gained was approximately 38,400 EUR. Results from the sensitivity analysis suggested a 63% probability of temocillin being cost effective at a threshold of 50,000 EUR. Furthermore, results showed that the cost effectiveness of temocillin in febrile urinary tract infections is highly dependent on the drug cost. Conclusions As antibiotic consumption is a driving force of resistance, it is essential to consider the development of resistance when studying the health economic consequences of antibiotic treatments. In doing so, this study found temocillin to be cost effective for febrile urinary tract infections.
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| 48. |
- Larsson, Sofie, et al.
(författare)
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Production loss and sick leave caused by antibiotic resistance: a register-based cohort study
- 2022
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adverse economic consequences of antibiotic resistance, both in health care systems and in society at large, have been estimated to emerge and significantly affect the global economy. To date, most studies of the societal costs of antibiotic resistance have had a macroeconomic perspective, using the number of attributable deaths as a quantifier for production loss. In contrast, there have been few studies of the consequences of antibiotic resistance in terms of the length of sick leave and hence the impact of morbidity on production loss. The aim of our study was to estimate the production loss from ill health caused by antibiotic resistance. Method: To estimate additional production loss due to antibiotic resistance, we used Swedish register-based cohort data to determine days of long-term sick leave (LTSL) for episodes of infection caused by resistant and susceptible bacteria respectively. We collected patient data for four common infection types (bloodstream infection, urinary tract infection, skin and soft tissue infection, and pneumonia), as well as, antibiotic susceptibility test data, and total days of LTSL. We used a two-part model to estimate the number of LTSL days attributable to resistance, and controlled for comorbidities and demographic variables such as age and gender. Results: The results show that antibiotic resistance adds an additional 8.19 days of LTSL compared with a similar infection caused by susceptible bacteria, independent of infection type and resistance type. Furthermore, the results suggest that production loss due to temporary sick leave caused by antibiotic resistance in a working-age population amounts to about 7% of total health care costs attributable to antibiotic resistance in Sweden. Conclusion: Estimating the effect of antibiotic resistance in terms of temporary production loss is important to gain a better understanding of the economic consequences of antibiotic resistance in society and, by extension, enable more effective resource allocation to combat further emergence of resistance. Society's economic costs of antibiotic resistance are, however, probably much greater than those of sick leave due to disease alone.
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| 49. |
- Meulenberg, Vanessa, 1993-, et al.
(författare)
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Minor cutting edge angles of sawing teeth: effect on cutting forces in wood
- 2022
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Ingår i: European Journal of Wood and Wood Products. - : Springer. - 0018-3768 .- 1436-736X. ; 80:5, s. 1165-1173
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Tidskriftsartikel (refereegranskat)abstract
- Optimising the cutting tool geometries can reduce waste while increasing timber yield. The industry is moving towards thin-kerf bandsawing of timber, and therefore, the geometry of the minor cutting edge and minor first flanks of cutting teeth become more important. Six cutting teeth with varying minor cutting edge angles (0°, 2°, 4°, 6°) and minor cutting edge clearance angles (2°, 4°, 6°) were tested by cutting into the heartwood and sapwood of frozen and non-frozen Norway spruce (Picea abies (L.) Karst.) and Scots pine (Pinus sylvestris L.). Single cutting tooth tests were conducted, and the cutting and feeding forces were measured. The cutting forces were higher for Scots pine due to its higher density. Frozen sapwood resulted in higher cutting forces. The feeding force of frozen sapwood stood out as it was highly negative (i.e. self-feeding) compared to frozen heartwood, non-frozen heartwood and non-frozen sapwood. An increase in the minor cutting edge angle and minor cutting edge clearance angles, and therefore more room for elastic spring-back, can lead to up to less friction and 40% lower cutting forces. Higher minor cutting edge angles and minor cutting edge clearance angles resulted in less-negative feeding forces (i.e. less self-feeding) for frozen sapwood but remained relatively unchanged for the other wood conditions.
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| 50. |
- Meulenberg, Vanessa, 1993-, et al.
(författare)
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Minor cutting edge force contribution in wood bandsawing
- 2022
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Ingår i: Journal of Wood Science. - : Springer. - 1435-0211 .- 1611-4663. ; 68
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Tidskriftsartikel (refereegranskat)abstract
- As the sawmill industry is moving towards thinner bandsaws for higher yields, it is important to study the cutting force in more detail. The cutting force can be split into two zones. Zone I concerns the force on the major cutting edge as well as the friction force on the major first flank. Zone II considers the forces on the minor cutting edges as well as the friction forces on the minor first flanks. Zone II cutting can significantly affect the cutting force and has not been studied in great detail. Frozen, non-frozen and dry heartwood of Norway spruce and Scots pine were cut using different tooth geometries and the cutting force was measured. The major cutting edge, clearance, band thickness, minor cutting edge angle and minor cutting edge clearance angle were investigated. The y-intercept of the cutting force–width graph was used as the Zone II force (at this point the Zone I forces are assumed to be zero). The Zone II force contribution to the cutting force was studied. The results show that frozen wood has less elastic spring-back and therefore less Zone II cutting. Dried wood showed a significantly higher degree of Zone II cutting (55−75% contribution to the cutting force). Changing the major cutting edge from 2.87 mm to 1.6 mm resulted in 10–15% higher Zone II force contributions.
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