| 1. |
- Baldvinsdóttir, Bryndís, et al.
(författare)
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Adverse events during endovascular treatment of ruptured aneurysms : A prospective nationwide study on subarachnoid hemorrhage in Sweden
- 2023
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Ingår i: BRAIN AND SPINE. - : Elsevier. - 2772-5294. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A range of adverse events (AEs) may occur in patients with subarachnoid hemorrhage (SAH). Endovascular treatment is commonly used to prevent aneurysm re-rupture.Research question: The aim of this study was to identify AEs related to endovascular treatment, analyze risk factors for AEs and how AEs affect patient outcome.Material and methods: Patients with aneurysmal SAH admitted to all neurosurgical centers in Sweden during a 3.5-year period (2014-2018) were prospectively registered. AEs related to endovascular aneurysm treatment were thromboembolic events, aneurysm re-rupture, vessel dissection and puncture site hematoma. Potential risk factors for the AEs were analyzed using multivariate logistic regression. Functional outcome was assessed at one year using the extended Glasgow outcome scale.Results: In total, 1037 patients were treated for ruptured aneurysms. Of which, 715 patients were treated with endovascular occlusion. There were 115 AEs reported in 113 patients (16%). Thromboembolic events were noted in 78 patients (11%). Aneurysm re-rupture occurred in 28 (4%), vessel dissection in 4 (0.6%) and puncture site hematoma in 5 (0.7%). Blister type aneurysm, aneurysm smaller than 5 mm and endovascular techniques other than coiling were risk factors for treatment-related AEs. At follow-up, 230 (32%) of the patients had unfavorable outcome. Patients suffering intraprocedural aneurysm re-rupture were more likely to have unfavorable outcome (OR 6.9, 95% CI 2.3-20.9).Discussion and conclusion: Adverse events related to endovascular occlusion of a ruptured aneurysm were seen in 16% of patients. Aneurysm re-rupture during endovascular treatment was associated with increased risk of unfavorable functional outcome.
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| 2. |
- Tobieson, Lovisa, et al.
(författare)
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Akuta vaskulära neurokirurgiska tillstånd kräver snabb hantering
- 2023
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Ingår i: Lakartidningen. - 0023-7205. ; 120
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Forskningsöversikt (refereegranskat)abstract
- Conditions involving intracranial vascular anomalies are increasingly diagnosed, not least incidentally, with the increasing availability of neuroradiological investigations. Acute deterioration and development of symptoms due to a vascular condition could require neurosurgical intervention depending on the nature of the condition and status of the patient. On the other hand, asymptomatic patients with incidental findings require careful consideration and risk assessment when deciding on whether or not to treat the condition, and if so, how. In this review article we provide a summary of some of the most common neurosurgical vascular conditions and outline management considerations in both the acute and elective setting.
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| 3. |
- Svensson, Mikael, et al.
(författare)
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Utarmning och utdöende – tillståndet för rödlistade dagfjärilar och bastardsvärmare
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Under de senaste 150 åren har det svenska landskapet genomgått mycket stora förändringar. Det har lett till förlust av livsmiljöer för många arter och har haft långtgående konsekvenser för vår inhemska fauna och flora. Många arter har minskat dramatiskt och i vissa fall helt försvunnit.När en art väl har börjat minska finns det många faktorer som kan förstärka den negativa trenden. En individrik population kan minska med tiotals, ja kanske hundratals eller tusentals, individer utan att vi märker någon större förändring. Och utan att det har någon större effekt på artens status. Men, ju mindre populationen är desto större genomslag får förlusten av enskilda individer.I takt med att tillgången på lämpliga livsmiljöer minskar ökar risken för att enskilda populationer isoleras och att spridningen mellan lokaler upphör. Klimatförändringar och ökad frekvens av extremväder kan bli ytterligare påfrestning för arter med små populationer och begränsad utbredning.Två artgrupper som drabbats hårt av ett alltmer storskaligt och intensifierat jord- och skogsbruk är dagfjärilar och bastardsvärmare. Av de 117 arter som är bofasta i Sverige är en tredjedel (39 arter) rödlistade och av dessa bedöms 18 arter som hotade. Merparten av arterna är rödlistade på grund av pågående minskning. Tillbakagången av dagfjärilar och bastardsvärmare har accelererat under de senaste 70 åren och särskilt allvarligt är läget för de arter som är knutna till blomrika gräsmarker.Många av de rödlistade dagfjärils- och bastardsvärmar-arterna var vanliga − och i vissa fall mycket vanliga − i det äldre jordbrukslandskapet. Idag finns endast spillror kvar av det landskap som dominerade Sverige så sent som i mitten av 1900-talet, och utarmningen fortsätter. Ett antal arter har minskat så kraftigt att de försvunnit från delar av sina tidigare utbredningsområden och förekomsterna koncentreras nu till områden med särskilt gynnsamma förhållanden. Flera värmegynnade arter har i stort sett försvunnit från södra Sveriges inland och hittas numera endast längs kusterna.De senaste åren befaras två dagfjärilsarter – veronika-nätfjäril och kronärtsblåvinge – ha dött ut nationellt. Ytterligare några arter har minskat i så stor omfattning att de riskerar att försvinna från landet inom en snar framtid. I flera andra europeiska länder är läget betydligt sämre, till exempel har Storbritannien förlorat 4 dag-fjärilsarter, Danmark 13 och Nederländerna 15 arter.Dagfjärilar och bastardsvärmare har komplexa livscykler med olika behov i olika utvecklingsstadier (ägg, larv, puppa och fullbildad fjäril). För att en fjäril ska kunna fullgöra sin livscykel behöver den kunna tillgodose alla sina behov inom flygavstånd. Det räcker med att miljön förändras så att något av behoven inte längre kan uppfyllas för att en art ska försvinna från platsen. Många arter är beroende av rik tillgång på nektarresurser under sin tid som fullbildade och klarar sig därför inte i blomfattiga miljöer. I ett småskaligt och varierat landskap med en mångfald av miljöer är det lättare att tillfredsställa arternas alla behov under samtliga utvecklingsstadier än i dagens intensivt brukade och allt mer utarmade landskap.För att ha en chans att vända trenderna för de röd-listade arterna krävs omfattande insatser. Länsstyrelsernas arbete med riktade åtgärder inom åtgärdsprogram för hotade arter och naturtyper är ett viktigt verktyg i arbetet med att stoppa fortsatt tillbakagång. Men det är långt ifrån tillräckligt. Den riktigt stora utmaningen ligger i att styra om utvecklingen för att förhindra att fler arter hamnar på rödlistan eller dör ut från Sverige.
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| 4. |
- Wikström, T., et al.
(författare)
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Cost-effectiveness of cervical length screening and progesterone treatment to prevent spontaneous preterm delivery in Sweden
- 2022
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Ingår i: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 59:6, s. 778-792
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To estimate the cost-effectiveness of strategies to prevent spontaneous preterm delivery (PTD) in asymptomatic singleton pregnancies, using prevalence and healthcare cost data from the Swedish healthcare context. Methods: We designed a decision analytic model based on the Swedish CERVIX study to estimate the cost-effectiveness of strategies to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy. The model was constructed as a combined decision-tree model and Markov model with a time horizon of 100 years. Four preventive strategies, namely ‘Universal screening’, ‘High-risk-based screening’ (i.e. screening of high-risk women only), ‘Low-risk-based screening’ (i.e. treatment of high-risk population and screening of remaining women) and ‘Nullipara screening’ (i.e. treatment of high-risk population and screening of nulliparous women only), included second-trimester cervical length (CL) screening by transvaginal ultrasound followed by vaginal progesterone treatment in the case of a short cervix. A fifth preventive strategy involved vaginal progesterone treatment of women with previous spontaneous PTD or late miscarriage but no CL screening (‘No screening, treat high-risk group’). For comparison, we used a sixth strategy implying no specific intervention to prevent spontaneous PTD, reflecting the current situation in Sweden (‘No screening’). Probabilities for a short cervix (CL ≤ 25 mm; base-case) and for spontaneous PTD at < 33 + 0 weeks and at 33 + 0 to 36 + 6 weeks were derived from the CERVIX study, and probabilities for stillbirth, neonatal mortality and long-term morbidity (cerebral palsy) from Swedish health data registers. Costs were based on Swedish data, except costs for cerebral palsy, which were based on Danish data. We assumed that vaginal progesterone reduces spontaneous PTD before 33 weeks by 30% and spontaneous PTD at 33–36 weeks by 10% (based on the literature). All analyses were from a societal perspective. We expressed the effectiveness of each strategy as gained quality-adjusted life years (QALYs) and presented cost-effectiveness as average (ACER; average cost per gained QALY compared with ‘No screening’) and incremental (ICER; difference in costs divided by the difference in QALYs for each of two strategies being compared) cost-effectiveness ratios. We performed deterministic and probabilistic sensitivity analysis. The results of the latter are shown as cost-effectiveness acceptability curves. Willingness-to-pay was set at a maximum of 500 000 Swedish krona (56 000 US dollars (USD)), as suggested by the Swedish National Board of Health and Welfare. Results: All interventions had better health outcomes than did ‘No screening’, with fewer screening-year deaths and more lifetime QALYs. The best strategy in terms of improved health outcomes was ‘Low-risk-based screening’, irrespective of whether screening was performed at 18 + 0 to 20 + 6 weeks (Cx1) or at 21 + 0 to 23 + 6 weeks (Cx2). ‘Low-risk-based screening’ at Cx1 was cost-effective, while ‘Low-risk-based screening’ at Cx2 entailed high costs compared with other alternatives. The ACERs were 2200 USD for ‘Low-risk-based screening’ at Cx1 and 36 800 USD for ‘Low-risk-based screening’ at Cx2. Cost-effectiveness was particularly sensitive to progesterone effectiveness and to productivity loss due to sick leave during pregnancy. The probability that ‘Low-risk-based screening’ at Cx1 is cost-effective compared with ‘No screening’ was 71%. Conclusion: Interventions to prevent spontaneous PTD in asymptomatic women with a singleton pregnancy, including CL screening with progesterone treatment of cases with a short cervix, may be cost-effective in Sweden.
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| 5. |
- Djerf, Henrik, et al.
(författare)
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Editor's Choice - Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial
- 2021
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 62:4, s. 576-582
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms aremainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aimof this studywas to investigate its cost effectiveness vs. noninvasive treatment. Methods: One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ5D 3L (TM) questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. Results: The mean cost per patient was (SIC)11 060 in the stent group and (SIC)4 787 in the control group, resulting in a difference of (SIC)6 273 per patient between the groups.The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of (SIC)23 785 per QALY. Conclusion: The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < (SIC)50 000 - (SIC)70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < 20 pound 000 - 30 pound 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.
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| 6. |
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| 7. |
- Tyler, Torbjörn, et al.
(författare)
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Utsådda blommor räddar inte insekterna
- 2021
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Ingår i: Svenska Dagbladet. - 1101-2412.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Om vi vill rädda hotade insektsarter är det miljöer med traditionella ängsväxter som vi behöver mer av, inte fröblandningar av oklart ursprung från handeln. Det skriver flera debattörer.
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| 8. |
- Windmark, Christina, et al.
(författare)
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Cost-Driven Informed Decisions Using Loss Analyses from Production Monitoring
- 2020
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Ingår i: SPS2020 - Proceedings of the Swedish Production Symposium. - 9781614994398 ; 13, s. 119-129
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Konferensbidrag (refereegranskat)abstract
- When embarking a cost reduction strategy, it is important to know what causes the costs, how the costs are connected to value adding and to non-value adding activities, and thereby conduct a knowledge-intensive production development. This paper present a method on how to connect costs to production losses and how they can relate to different cost factor groups. The method uses a digital tool that was designed in collaboration with a medium-sized tool manufacturing company, using several manufacturing operations in sequence. The tool is designed to be used for management monitoring and for strategic decisions. The method uses a performance-based cost model for discrete part manufacturing and incorporates an approximation when dividing the calculated loss costs. To ensure the accuracy of the model a sensitivity analysis was conducted. The result shows that only smaller errors occur due to this approximation and amount to a few percent when extremely high losses are in effect. The novelty of the paper is the variation of the cost model, ensuring that costs can be divided on each of the cost factor groups and investigated performance parameter. In addition, the designed layout of the result presentation in the digital tool, is a further development of the previous presented production performance matrix, which contribute to a comprehensive overview used for production monitoring.
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| 9. |
- Beckman, Linda, 1980-, et al.
(författare)
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Economic Costs of Antidepressant Use: A Population-Based Study in Sweden
- 2019
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Ingår i: Journal of Mental Health Policy and Economics. - Italy. - 1091-4358 .- 1099-176X. ; 22:4, s. 125-130
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prescription of antidepressant drugs (ADs) has increased in recent decades, with rising costs for patients as well as for the health care system. There is sparse evidence of which factors explain the high economic costs and financial burden for the general population. Aims of the study: The aim was to assess individual-level determinants of out-of-pocket and total health care costs of AD use in the Swedish general population. Methods: We randomly sampled 400,000 individuals aged 18+ from Statistics Sweden's population register from 2010 to 2013. Two-part regression models were used for our two primary outcome variables: (i) total health care costs for AD use per year and individual, and (ii) total out-of-pocket costs of AD use per year and individual. Results: Women, the unemployed, unmarried people and residents of big cities have both higher use of ADs and higher associated total health care and out-of-pocket costs. Today, ADs are relatively inexpensive and average cost differences among all groups are therefore minor. The elderly have higher use of ADs, but are more commonly low-volume users and do not have higher total health care or out-of-pocket costs. Discussion and limitations: Groups with relatively low socioeconomic status are at risk of higher costs for antidepressant use. However, given the Swedish system of drug subsidies, differences in financial burden for individuals are minor. The limitations of this study included that we lacked data on diagnosis and could therefore not categorize the reasons for AD consumption. Furthermore, our results may not be generalized to other countries with a lower AD prevalence then Sweden's, since our estimates are dependent on the point prevalence of antidepressant use in the population. Implications for health care provision and use: Groups with higher AD consumption and economic costs may suffer from more severe depression owing to more risk factors and less social support in their surroundings, and may be in greater need of additional treatment and support than other groups. Implications for health policies and further research: Our results offer insight at an aggregate level, and more information on the underlying causes of higher costs is needed to discern the policy implications.
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| 10. |
- Djerf, Henrik, et al.
(författare)
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Cost-effectiveness of revascularization in patients with intermittent claudication.
- 2018
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Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 105:13, s. 1742-1748
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Tidskriftsartikel (refereegranskat)abstract
- Revascularization is a treatment option for patients with intermittent claudication. However, there is a lack of evidence to support its long-term benefits and cost-effectiveness. The aim of this study was to compare the cost-effectiveness of revascularization and best medical therapy (BMT) with that of BMT alone.Data were used from the IRONIC (Invasive Revascularization Or Not in Intermittent Claudication) RCT where consecutive patients with mild-to-severe intermittent claudication owing to aortoiliac or femoropopliteal disease were allocated to either BMT alone (including a structured, non-supervised exercise programme) or to revascularization together with BMT. Inpatient and outpatient costs were obtained prospectively over 24 months of follow-up. Mean improvement in quality-adjusted life-years (QALYs) was calculated based on responses to the EuroQol Five Dimensions EQ-5D-3 L™ questionnaire. Cost-effectiveness was assessed as the cost per QALY gained.A total of 158 patients were randomized, 79 to each group. The mean cost per patient in the BMT group was €1901, whereas it was €8280 in the group treated with revascularization in addition to BMT, with a cost difference of €6379 (95 per cent c.i. €4229 to 8728) per patient. Revascularization in addition to BMT resulted in a mean gain in QALYs of 0·16 (95 per cent c.i. 0·06 to 0·24) per patient, giving an incremental cost-effectiveness ratio of €42 881 per QALY.The costs associated with revascularization together with BMT in patients with intermittent claudication were about four times higher than those of BMT alone. The incremental cost-effectiveness ratio of revascularization was within the accepted threshold for public willingness to pay according to the Swedish National Guidelines, but exceeded that of the UK National Institute for Health and Care Excellence guidelines.
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