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- Borgström, Fredrik, et al.
(författare)
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Fragility fractures in Europe: burden, management and opportunities.
- 2020
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Ingår i: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years.Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6).A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric.Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided.Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.
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- Borgström, Fredrik
(författare)
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Health economics of osteoporosis
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Health economics is concerned about how the scarce resources should most efficiently be allocated to maximise the health outcomes. Health economic evaluation is a method for assessing costs and benefits of alternative treatment strategies for allocating resources to assist decisions aiming at improving efficiency. Osteoporosis is a systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue leading to increased bone fragility and thus an increased risk of fractures. Fractures are a burden to society, with respect to mortality, costs as well as quality of life. There are several treatments available for the prevention and treatment of osteoporosis. The general purpose of this thesis was to develop important aspects of the health economics of osteoporosis. More specifically, the aspects addressed were fracture related costs and quality of life for use in economic evaluation, economic modelling of osteoporosis therapies and health economics as a tool in treatment guidelines and patient selection (intervention thresholds). Data concerning costs and quality of life related to osteoporotic fractures in Sweden was collected in a prospective study that followed hip, vertebral and wrist fracture patients 18 months after fracture. The results for the first year after fracture indicate that hip fracture is associated with the highest costs whereas vertebral fracture leads to the largest loss in quality of life of the three types of fracture. Using computer simulation models the cost-effectiveness was assessed for two drugs: raloxifene and strontium ranelate. The cost-effectiveness of raloxifene compared to no treatment was estimated on Swedish women who were similar in characteristics to the women included in the Multiple Outcomes of Raloxifene study. The study was based on Swedish women who were similar in characteristics to the patients in the Spinal Osteoporosis Therapeutic Intervention study (SOTI) and Treatment Of Peripheral Osteoporosis Study (TROPOS). Compared to no treatment, both drugs were indicated to be cost-effective treatments. Intervention thresholds for osteoporosis can be defined as the ten-year risk of hip fracture at which intervention becomes cost-effective. Based on a Markov cohort model intervention thresholds were estimated for seven countries. The ten-year risk of hip fracture at which treatment becomes cost-effective varied between countries mainly due to differences in the willingness to pay (WTP) for a QALY gained, fracture related costs and intervention costs. Economic evaluation has become an important tool for evaluating the value for money of new medical technologies. However, much of the quality of an economic evaluation relies on the quality of the data used in the analysis. Using a new framework for collecting data on fracture related costs and quality of life this thesis has provided new information on costs and quality of life for fractures in Sweden, which will improve future economic evaluations of osteoporosis therapies. Moreover, this demonstrates that economic evaluation can be a tool for improving the selection of patients in clinical practice who are suitable for treatment, based on a cost-effectiveness criterion.
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- Fritzell, Peter, et al.
(författare)
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Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up :
- 2011
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Ingår i: European spine journal. - : Springer. - 0940-6719 .- 1432-0932. ; 20:7, s. 1001-1011
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Tidskriftsartikel (refereegranskat)abstract
- When low back pain becomes chronic, surgery is sometimes performed. The gold standard today is lumbar fusion (FUS), using a variety of procedures. Total disc replacement (TDR) aimed at motion preservation is increasing in popularity. This randomized controlled health economic study assesses the cost-effectiveness of TDR (Charité/Prodisc/Maverick) compared with instrumented FUS (posterior lumbar fusion (PLF)/posterior lumbar interbody fusion (PLIF). Social and healthcare perspectives after two years are reported. In all, 152 patients were randomized to either TDR (n=80) or FUS (n=72). Cost to society, (total mean cost/patient, Swedish kronor=SEK, standard deviation) for TDR was SEK 599,560 (400,272), and for FUS SEK 685,919 (422,903) (ns). TDR was significantly less costly from a healthcare perspective, SEK 22,996 (43,055- -1,202). Number of days on sick leave among those who returned to work was 185 (146) in the TDR group, and 252 (189) in the FUS group (ns). Using EQ-5D, the total gain in quality adjusted life years (QALYs) over two years was 0.41 units for TDR and 0.40 units for FUS (ns). Based on EQ-5D, the incremental cost effectiveness ratio (ICER) of using TDR instead of FUS was difficult to analyze due to the “non-difference” in treatment outcome, which is why cost/QALY could not be defined. Using cost-effectiveness probabilistic analysis, the net benefit with CI) was found to be SEK 91,359 (-73,643 – 249,114) (ns). Conclusion: It is not possible to state whether TDR or FUS is more cost-effective after two years. Since disc replacement and lumbar fusion are based on different conceptual approaches, it is important to follow these results over time.
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- Jonsson, Emma, et al.
(författare)
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Cost and Health Outcomes Patterns in Patients Treated With Spinal Cord Stimulation Following Spine Surgery : A Register-Based Study
- 2020
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Ingår i: Neuromodulation. - : Elsevier BV. - 1094-7159 .- 1525-1403. ; 23:5, s. 626-633
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveSpinal cord stimulation (SCS), a minimally invasive treatment option for long‐term neuropathic pain, has been shown to be effective in patients with persisting neuropathic pain after spine surgery. However, little is known about the long‐term cost and quality‐of‐life (QoL) patterns in SCS‐treated patients. The aim is to describe the use of SCS, costs, pre‐spine‐surgery and post‐spine‐surgery QoL, and reported pain intensity, in patients who have undergone spine surgery and subsequent SCS implantation. The results will be related to outcome and cost in spine surgery patients in general.Materials and MethodsA research database comprised from six Swedish national and regional registers, and the spine surgery quality‐of‐care register Swespine was utilized. Two cohorts were identified: all patients who had spine surgery (N = 73,765) and patients who had spine surgery and subsequent SCS implantation (N = 239). Costs were analyzed before and after spine surgery for both cohorts, as well as before and after SCS implantation for the second cohort. QoL was explored by estimating patient‐reported outcome measures such as pain intensity, Oswestry Disability Index, and EuroQol‐5Dimensions from spine surgery up to five years post–spine surgery.ResultsIn spine surgery patients, mean QoL and pain intensity levels improved following surgery. Patients subsequently treated with SCS had lower reported QoL and higher costs before the initial spine surgery, and spine surgery did not lead to any substantial improvements, however, costs decreased following SCS implantation in these patients.
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| 8. |
- Jonsson, Emma, et al.
(författare)
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Swedish osteoporosis care
- 2015
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Ingår i: ARCHIVES OF OSTEOPOROSIS. - : Springer Science and Business Media LLC. - 1862-3522 .- 1862-3514. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Mini-abstract The objective of this study was to review and describe the current state of Swedish osteoporosis care and to highlight ongoing challenges. This report encompasses quantitative health outcomes based on Swedish registry data as well as organizational and management aspects. Executive summary Swedish osteoporosis care is characterized by a significant burden of disease, difficulties in identifying high-risk patients, and fragmented pathways for patients in need of secondary fracture prevention. This report aimed to describe the current state, gaps, and challenges in Swedish osteoporosis care, using Swedish national databases, questionnaires, and interviews with healthcare representatives. A secondary aim was to develop quality and process measures to compare differences between counties and to use those measures to describe the interaction between quantitative health outcomes and aspects of care organization and management. In conjunction with fractures, a considerably smaller proportion of men are treated than women, and a smaller proportion of older women are treated compared to younger groups. Between 3 and 16 % of patients receive treatment after a fracture, and the treatment rate in this patient group can likely increase. In addition to an unsatisfactory treatment rate, a limited number of those treated continue treatment throughout the recommended treatment durations, leading to increased risk of fracture. With a substantial variation between counties, there is a clear difficulty to identify non-persistent patients and switch to an alternative treatment. Collaboration around the patient across specialties has been lacking, and systems for secondary prevention have been concentrated to a few counties. However, when this study was conducted, there was a general trend towards implementing regional care programs. This report suggests possible strategies for improving quality of care and, hopefully, it can provide a basis for future evaluations and regional improvement of osteoporosis care in Sweden and other countries.
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| 9. |
- Kanis, John A, et al.
(författare)
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FRAX and its applications to clinical practice
- 2009
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Ingår i: Bone. - : Elsevier BV. - 8756-3282 .- 1873-2763. ; 44:5, s. 734-43
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Tidskriftsartikel (refereegranskat)abstract
- The introduction of the WHO FRAX algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX integrates the influence of several well validated risk factors for fracture with or without the use of BMD. Its use in fracture risk prediction poses challenges for patient assessment, the development of practice guidelines, the evaluation of drug efficacy and reimbursement, as well as for health economics which are the topics outlined in this review.
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| 10. |
- Kirketeig, Terje, et al.
(författare)
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Real-world outcomes in spinal cord stimulation : predictors of reported effect and explantation using a comprehensive registry-based approach
- 2023
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Ingår i: Pain Reports. - : Lippincott Williams & Wilkins. - 2471-2531. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Despite advancements in implanted hardware and development of novel stimulation paradigms in Spinal Cord Stimulation (SCS), real world evidence suggests a large variation in patient reported outcomes and a proportion of patients are later explanted due to loss of analgesia. Possible predictors for outcome have been explored in smaller short-term evaluations, but few clinically applicable robust measures for long term outcome have emerged.Methods: We performed a comprehensive retrospective study based on an assembled patient-level aggregated database from multiple local and national registries in Sweden. Variables associated with risk of explantation (due to insufficient analgesia) and analgesic effect was analyzed using a Cox regression analysis and an ordered logit regression model, respectively.Results: We found the accumulated risk of explantation due to loss of analgesia to be 10% and 21% at two and ten years follow up, respectively. The use of 10 kHz spinal cord stimulation (compared with Tonic waveform; p = 0.003), and being 60 years or older (reference 18-40 years; p = 0.003) were associated with an increased risk of explantation.At a mean follow up at 1 year, 48% of patients reported a pain intensity reduction from baseline of at least 30%. Secondary (p = 0.030) and post-secondary (p = 0.001) education (compared with primary education) was associated with an increased probability of successful patient reported outcomes.Results:We found the accumulated risk of explantation due to loss of analgesia to be 10% and 21% at two and ten years follow up, respectively. The use of 10 kHz spinal cord stimulation (compared with Tonic waveform; p = 0.003), and being 60 years or older (reference 18-40 years; p = 0.003) were associated with an increased risk of explantation.At a mean follow up at 1 year, 48% of patients reported a pain intensity reduction from baseline of at least 30%. Secondary (p = 0.030) and post-secondary (p = 0.001) education (compared with primary education) was associated with an increased probability of successful patient reported outcomes.Conclusion: This study suggests that a higher educational level and being employed are associated with successful treatment outcome in patients with chronic pain treated with SCS in Sweden.
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