| 1. |
- Nilsson, Kristoffer, et al.
(författare)
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Model-based predictions on health benefits and budget impact of implementing empagliflozin in people with type 2 diabetes and established cardiovascular disease
- 2023
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Ingår i: Diabetes, obesity and metabolism. - : Wiley-Blackwell Publishing Inc.. - 1462-8902 .- 1463-1326. ; 25:3, s. 748-757
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To perform a model-based analysis of the short- and long-term health benefits and costs of further increased implementation of empagliflozin for people with type 2 diabetes and established cardiovascular disease (eCVD) in Sweden.MATERIALS AND METHODS: The validated Institute for Health Economics Diabetes Cohort Model (IHE-DCM) was used to estimate health benefits and 3-years' budget impact, and lifetime costs per quality-adjusted life year (QALY) gained of increased implementation of adding empagliflozin to standard of care (SoC) for people with type 2 diabetes and eCVD in a Swedish setting. Scenarios with 100%/75%/50% implementation were explored. Analyses were based on 30 model cohorts with type 2 diabetes and eCVD (n=131,412 at baseline) from national health data registers. Sensitivity analyses explored the robustness of results.RESULTS: Over 3 years, SoC with empagliflozin (100% implementation) vs. SoC before empagliflozin resulted in 7,700 total life years gained and reductions in cumulative incidence of cardiovascular deaths by 30% and heart failures by 28%. Annual costs increased by 6% from higher treatment costs and increased survival. Half of these benefits and costs are not yet reached with current implementation below 50%. SoC with empagliflozin yielded 0.37 QALYs per person, with an incremental cost-effectiveness ratio of €16,000 EUR per QALY vs. SoC before empagliflozin.CONCLUSIONS: Model simulations using real-world data and trial treatment effects indicated that a broader implementation of empagliflozin, in line with current guidelines for treatment of people with type 2 diabetes and eCVD, would lead to further benefits even in a short-term perspective.
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| 2. |
- Persson, Sofie, et al.
(författare)
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Burden of established cardiovascular disease in people with type 2 diabetes and matched controls : Hospital-based care, days absent from work, costs, and mortality
- 2023
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Ingår i: Diabetes, obesity and metabolism. - : John Wiley & Sons. - 1462-8902 .- 1463-1326. ; 53:3, s. 726-734
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To assess hospital-based care, work absence, associated costs, and mortality in type 2 diabetes with and without established cardiovascular disease (eCVD) compared to matched controls.METHODS: In a population-based cohort study, we analysed individual-level data from national health, social insurance, and socio-economic registers for people with type 2 diabetes diagnosis<70 years and controls (5:1) in Sweden. Regression analysis attributed costs and days absent to eCVD. Mortality was analysed using Cox proportional hazard regression stratified for birthyear and adjusted for sex and education.RESULTS: Thirty percent (n=136 135 of 454 983) of people with type 2 diabetes had ≥1 person-year with eCVD (women 24%; men 34%). The mean annual costs of hospital-based care for diabetes complications were EUR 2 629 (95% confidence interval [CI] 2 601 to 2 657) of which EUR 2 337 (95% CI 2 309 to 2 365) were attributed to eCVD (89%). The highest-costing person-years (10th percentile) were observed in a broad subgroup, 42% of people with type 2 diabetes and eCVD. People with type 2 diabetes had on average 146 days absent (95% CI 145-147) per year of which 68 days (47%; 95% CI 67-70) were attributed to eCVD. Mortality was increased in type 2 diabetes: eCVD hazard rate [HR] 4.63 (95% CI 4.58-4.68), no eCVD HR 1.86 (95% CI 1.84-1.88).CONCLUSIONS: The sizable burden of eCVD, on the individual with type 2 diabetes and the society, calls for efficient management for reducing the risks for those living with eCVD and postponing its onset. This article is protected by copyright. All rights reserved.
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| 3. |
- Steen Carlsson, Katarina, et al.
(författare)
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Atherosclerotic Cardiovascular Disease in Type 2 Diabetes : A Retrospective, Observational Study of Economic and Clinical Burden in Sweden
- 2023
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Ingår i: Diabetes Therapy. - 1869-6953. ; 14:8, s. 1357-1372
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Individuals with type 2 diabetes (T2D) are at high risk of experiencing atherosclerotic cardiovascular disease (ASCVD), which is associated with morbidity, mortality and healthcare resource utilisation. Clinical guidelines recommend the use of glucose-lowering medications with cardiovascular benefits in individuals with T2D and cardiovascular disease, but there is evidence that this is not reflected in clinical practice. We used linked national registry data from Sweden to compare outcomes in people with T2D and ASCVD against matched controls with T2D without ASCVD, over 5 years. Direct costs (inpatient, outpatient and selected drug costs), indirect costs resulting from work absence, early retirement, cardiovascular events and mortality were examined. Methods: Individuals with T2D who were at least 16 years old and were alive and resident in Sweden on 1 January 2012 were identified in an existing database. In four separate analyses, individuals with a record indicating ASCVD according to a broad definition, peripheral artery disease (PAD), stroke or myocardial infarction (MI) before 1 January 2012 were identified using diagnosis and/or procedure codes and propensity score matched 1:1 to controls with T2D and without ASCVD, using covariates for birth, sex and level of education in 2012. Follow-up continued until death, migration from Sweden or the end of the study period in 2016. Results: In total, 80,305 individuals with ASCVD, 15,397 individuals with PAD, 17,539 individuals with previous stroke and 25,729 individuals with previous MI were included. Total mean annual costs per person were €14,785 for PAD (2.7 × costs for controls), €11,397 for previous stroke (2.2 × controls), €10,730 for ASCVD (1.9 × controls) and €10,342 for previous MI (1.7 × controls). Indirect costs and costs of inpatient care were the major cost drivers. ASCVD, PAD, stroke and MI were all associated with an increased likelihood of early retirement, cardiovascular events and mortality. Conclusions: ASCVD is associated with considerable costs, morbidity and mortality in individuals with T2D. These results support structured assessment of ASCVD risk and broader implementation of guideline-recommended treatments in T2D healthcare.
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| 4. |
- Steen Carlsson, Katarina, et al.
(författare)
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Economic burden of atherosclerotic cardiovascular disease : a matched case–control study in more than 450,000 Swedish individuals
- 2023
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Ingår i: BMC Cardiovascular Disorders. - 1471-2261. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To examine direct and indirect costs, early retirement, cardiovascular events and mortality over 5 years in people with atherosclerotic cardiovascular disease (ASCVD) and matched controls in Sweden. Methods: Individuals aged ≥ 16 years living in Sweden on 01 January 2012 were identified in an existing database. Individuals with ASCVD were propensity score matched to controls without ASCVD by age, sex and educational status. We compared direct healthcare costs (inpatient, outpatient and drug costs), indirect costs (resulting from work absence) and the risk of stroke, myocardial infarction (MI) and early retirement. Results: After matching, there were 231,417 individuals in each cohort. Total mean per-person annual costs were over 2.5 times higher in the ASCVD group versus the controls (€6923 vs €2699). Indirect costs contributed to 60% and 67% of annual costs in the ASCVD and control groups, respectively. Inpatient costs accounted for ≥ 70% of direct healthcare costs. Cumulative total costs over the 5-year period were €32,011 in the ASCVD group and €12,931 in the controls. People with ASCVD were 3 times more likely to enter early retirement than controls (hazard ratio [HR] 3.02 [95% CI 2.76–3.31]) and approximately 2 times more likely to experience stroke (HR 1.83 [1.77–1.89]) or MI (HR 2.27 [2.20–2.34]). Conclusion: ASCVD is associated with both economic and clinical impacts. People with ASCVD incurred considerably higher costs than matched controls, with indirect costs resulting from work absence and inpatient admissions being major cost drivers, and were also more likely to experience additional ASCVD events.
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| 5. |
- Skarping, Ida, et al.
(författare)
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The implementation of a noninvasive lymph node staging (NILS) preoperative prediction model is cost effective in primary breast cancer
- 2022
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Ingår i: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 0167-6806 .- 1573-7217. ; 194:3, s. 577-586
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The need for sentinel lymph node biopsy (SLNB) in clinically node-negative (cN0) patients is currently questioned. Our objective was to investigate the cost-effectiveness of a preoperative noninvasive lymph node staging (NILS) model (an artificial neural network model) for predicting pathological nodal status in patients with cN0 breast cancer (BC). Methods: A health-economic decision-analytic model was developed to evaluate the utility of the NILS model in reducing the proportion of cN0 patients with low predicted risk undergoing SLNB. The model used information from a national registry and published studies, and three sensitivity/specificity scenarios of the NILS model were evaluated. Subgroup analysis explored the outcomes of breast-conserving surgery (BCS) or mastectomy. The results are presented as cost (€) and quality-adjusted life years (QALYs) per 1000 patients. Results: All three scenarios of the NILS model reduced total costs (–€93,244 to –€398,941 per 1000 patients). The overall health benefit allowing for the impact of SLNB complications was a net health gain (7.0–26.9 QALYs per 1000 patients). Sensitivity analyses disregarding reduced quality of life from lymphedema showed a small loss in total health benefits (0.4–4.0 QALYs per 1000 patients) because of the reduction in total life years (0.6–6.5 life years per 1000 patients) after reduced adjuvant treatment. Subgroup analyses showed greater cost reductions and QALY gains in patients undergoing BCS. Conclusion: Implementing the NILS model to identify patients with low risk for nodal metastases was associated with substantial cost reductions and likely overall health gains, especially in patients undergoing BCS.
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| 6. |
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| 7. |
- Beckman, Claes, et al.
(författare)
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The Technical and Economic Consequences of Protecting GSM-R in Sweden
- 2016
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Ingår i: 2016 IEEE 83RD VEHICULAR TECHNOLOGY CONFERENCE (VTC SPRING). - : IEEE. - 9781509016983
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Konferensbidrag (refereegranskat)abstract
- A number of protection criteria were implemented by the Swedish regulator PTS in order to protect the GSM-R operations in Sweden. In order to protect the GSM-R receivers from interference and blocking, two different constraints were implemented: First, a limitation of the "out-of-band" emissions from the mobile operators' existing base stations operating in the 900MHz band was implemented. Secondly, a limitation of the aggregated power received over the railroad within the operator's spectrum allocation in the 900 band was added. In this study, the background of these protection criteria is presented and their technical and economic consequences estimated. Regarding "out-of-band" emissions from base stations, four alternative protection levels have been investigated: -92, -95, -98 and -107 dBm. It is found that in order to meet these requirements, safety distances of between 280 and 1200m need to be introduced, which means that between 1500 and 2700 base stations would be needed to be taken out of service. In order to avoid blocking, the received power over the embankment from each base station within the public GSM band would also be needed to be limited. The consequences of limiting the received power levels to either -10, -23 or -40 dBm were here investigated. Given the level of blocking protection, it is found that between 1085 and 2330 base stations within the vicinity of the railway track would be affected and possibly needed to be shut down To avoid causing interference, all operators - with the exception of Hi3G - may limit their "out-of-band" emissions by installing filters on the base stations. The cost of such installations is estimated at 50 000 SEK per base station. Depending on the protection level that is applied, the estimated total cost for the mobile operators is between 67 and 113 million SEK (about 12 million Euros). In order to protect the GSM-R receivers from blocking, some 3500 locomotives would need to be equipped with additional filters at a total cost of around 130 million SEK (about 14 million Euros).
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| 8. |
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| 9. |
- Nilsson, Kristoffer, et al.
(författare)
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Ny Arkitektur. H+, Helsingborg
- 2011
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Ingår i: Arkitektur. ; 2011:3, s. 24-30
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 10. |
- Steen Carlsson, Katarina, et al.
(författare)
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Cardiovascular events, mortality, early retirement and costs in >50 000 persons with chronic heart failure in Sweden
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Ingår i: ESC Heart Failure. - 2055-5822.
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Tidskriftsartikel (refereegranskat)abstract
- Aims: We aimed to examine cardiovascular events (stroke and myocardial infarction [MI]), mortality, early retirement and economic costs over 5 years in people with chronic heart failure (CHF) and matched controls in Sweden. Methods and results: Individuals (aged ≥16 years) living in Sweden on 1 January 2012 were identified in an existing database. Individuals with CHF were propensity score matched to controls without CHF by birth year, sex and educational status. We analysed risks of stroke, MI, mortality and early retirement, and compared direct costs (inpatient care, outpatient care and drug costs) and indirect costs (work absence). After matching, there were 53 520 individuals in each cohort. In each cohort, mean age was 69.0 years (standard deviation 8.2), and 29.7% of individuals were women. People with CHF were significantly more likely than controls to experience stroke (hazard ratio 1.46 [95% confidence interval 1.38–1.56]) and MI (1.61 [1.51–1.71]). All-cause mortality was nearly three-fold higher (2.89 [2.80–2.98]) and the likelihood of early retirement was more than three-fold higher (3.69 [3.08–4.42]). Total mean annual costs per person were €9663 (standard error 38) for people with CHF, of which 53% were direct costs, and €2845 (standard error 19) for controls, of which 40% were direct costs. In people with CHF, inpatient costs comprised 78% of total annual mean direct costs over follow-up, outpatient costs contributed 15% and drug costs contributed 8%. In controls, the corresponding proportions were 71%, 18% and 11%. Conclusions: CHF has a considerable impact on the risk of cardiovascular events and death, early retirement and economic costs. Inpatient admissions and work absence are major contributors to economic costs.
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