| 1. |
- Ahmad, I., et al.
(författare)
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Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy
- 2022
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 76:2, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- Background The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. Aim This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. Materials and methods From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery angstrom sberg Depression Rating Scale between the Q-ECT and the patient record. Results A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. Conclusions We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.
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| 2. |
- Jendle, Johan, 1963-, et al.
(författare)
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Real-world cost-effectiveness of insulin degludec in type 1 and type 2 diabetes in a Swedish setting
- 2019
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Randomised controlled trials and observational studies have shown lower risk of hypoglycemia in patients with type 1-diabetes (T1D) and type 2-diabetes (T2D) on treatment with insulinde gludec (IDeg) vs insulin glargine 100 units/mL (IGlar). This study assessed cost-effectiveness (C/E) of IDeg vs insulin treatment before switch to IDeg in a Swedish real-world setting in people with T1D and T2D.Materials and methods: ReFLeCT is a prospective, observational study in T1D (n=566) and T2D (n=611) in seven European countries and comprised a four-week baseline period (pre-switch basal insulin) and a 12-month follow-up period (IDeg). Data from ReFLeCT was used to assess C/E of IDeg compared with basal insulin treatment prior to switching to IDeg. Basal insulin unit costs were weighted to represent the basal insulin present at baseline (T1D: IGlar 63.8%, Insulin detemir (IDet) 22.7%, other/missing 13.5%. T2D: IGlar 59.1%, IDet 20.8%, other/missing 20.1%). The Swedish original IGlar price was used as base case. IGlar biosimilar price was used in a sensitivity analysis. Where information on basal insulin at baseline was missing, the lowest basal insulin price (insulin NPH) was used as a conservative approach. C/E was analysed over a 1-year time horizon from a Swedish societal perspective (price level 2019). Only differences with p<0.05 were included in the analysis.Results: Basal and bolus insulin doses at baseline were 25.0 IU and 27.3 IU (T1D) and 37.5 IU and 24.4 IU (T2D). At 12 months estimated basal and bolus insulin dose ratios were 0.91 (95% C.I. 0.83-0.91) and 0.87 (0.83-0.91) for T1D and 0.98 (0.95-1.01) and 0.96 (0.94-1.01) for T2D. For T1D riskratios (RR) for non-severe daytime hypoglycaemia was 0.85 (0.78-0.93), non-severe nocturnal hypoglycaemia 0.63 (0.52-0.76) and severe hypoglycaemia 0.28 (0.14-0.56). Corresponding RR for T2D were 0.56 (0.46-0.69), 0.38 (0.22-0.64) and 2.87 (0.33-24.65). In T1D IDeg was cost-saving compared to previous basal therapy (Table 1). In T2D, IDeg was highly cost-effective, with a cost per quality-adjusted life-year (QALY) of SEK 15,000-24,000 (Table 1). A treatment is considered cost-effective in Sweden if cost/QALY is below SEK 500,000. Sensitivity analyses showed that the results were robust to changes in efficacy and cost parameters in both T1D and T2D.Conclusion: In this C/E-analysis, treatment with IDeg was cost-saving (T1D) or highly cost-effective (T2D) relative to the treatment used before switch in a Swedish setting after one year. C/E of IDeg in clinical practice is driven by lower insulin doses (T1D) and reduced risk of hypoglycaemia (T1D and T2D).
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| 3. |
- Jendle, Johan, 1963-, et al.
(författare)
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Switching to insulin degludec is a cost-saving therapy for patients with type 1 and type 2 diabetes in the Swedish setting based on real world data
- 2019
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 22:Suppl. 3, s. 575-576
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of thesefindings on long-term cost-effectiveness outcomes in the Swedish setting.Methods: Cost-effectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK).Results: IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 quality-adjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cos tsavings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D.Conclusions: Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.
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| 4. |
- Bengtsson, Daniel, 1975-, et al.
(författare)
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Increased Mortality Persists after Treatment of Cushing's Disease: A Matched Nationwide Cohort Study
- 2022
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Ingår i: Journal of the Endocrine Society. - : The Endocrine Society. - 2472-1972. ; 6:6
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Tidskriftsartikel (refereegranskat)abstract
- Context: Whether biochemical remission normalizes life expectancy in Cushing's disease (CD) patients remains unclear. Previous studies evaluating mortality in CD are limited by using the expected number of deaths in the background population instead of the actual number in matched controls. Objective and setting: To study mortality by time-to-event analysis in an unselected nationwide CD patient cohort. Design and participants: Longitudinal data from the Swedish Pituitary Register of 371 patients diagnosed with CD from 1991 to 2018 and information from the Swedish Cause of Death Register were evaluated. Four controls per patient (n = 1484) matched at the diagnosis date by age, sex, and residential area were included. Main outcome measures: Mortality and causes of death. Results: The median diagnosis age was 44 years (interquartile range 32-56), and the median follow-up was 10.6 years (5.7-18.0). At the 1-, 5-, 10-, 15-, and 20-year follow-ups, the remission rates were 80%, 92%, 96%, 91%, and 97%, respectively. Overall mortality was increased in CD patients compared with matched controls [hazard ratio (HR) 2.1 (95% CI 1.5-2.8)1. The HRs were 1.5 (1.02-2.2) for patients in remission at the last follow-up In = 303), 1.7 (1.03-2.8) for those in remission after a single pituitary surgery In = 177), and 5.6 (2.7-11.6) for those not in remission (n = 31). Cardiovascular diseases (32/66) and infections (12/66) were overrepresented causes of death. Conclusions: Mortality was increased in CD patients despite biochemical remission compared to matched controls. The study highlights the importance of careful comorbidity monitoring, regardless of remission status.
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