| 1. |
- Hedenqvist, Mikael S., et al.
(författare)
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Extrusion of protein plastics
- 2017
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Ingår i: Abstracts of Papers of the American Chemical Society. - : American Chemical Society (ACS). - 0065-7727. ; 253
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Ahlqvist, Margary, et al.
(författare)
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A new reliable tool (PVC assess) for assessment of peripheral venous catheters
- 2010
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 16:6, s. 1108-1115
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Tidskriftsartikel (refereegranskat)abstract
- Rationale and aims To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability. Method The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n = 3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n = 3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability. Results Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa = 0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40). Conclusions The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed.
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| 3. |
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| 4. |
- Chauca Strand, Gabriella, 1995, et al.
(författare)
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Assessment of the clinical and cost-effectiveness evidence in the reimbursement decisions of new cancer drugs
- 2022
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Ingår i: ESMO Open. - : Elsevier. - 2059-7029. ; 7:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aimed to describe the clinical and cost-effectiveness evidence supporting reimbursementdecisions of new cancer drugs and analyze the influence of trial characteristics and the cost per quality-adjusted lifeyears (QALYs) on the likelihood of reimbursement in Sweden.Patients and methods: Data were extracted from all appraisal dossiers for new cancer drugs seeking reimbursement inSweden and claiming added therapeutical value between the years 2010 and 2020. The data were analyzed usingdescriptive statistics, and logistic regression models were also used with the cost per QALY, study design,comparator, and evidence on final outcomes in the clinical trials as predictors of reimbursement.Results: All 60 included appraisals were based on trial evidence that assessed at least one final outcome (overallsurvival [OS] or quality of life [QoL]), although rarely as a primary outcome. Of the appraisals with a final decision(n ¼ 58), 79% were approved for reimbursement. Among the reimbursed drugs, only half had trial evidencedemonstrating improved OS or QoL. Only one drug had trial evidence supporting improvements in both OS andQoL. The average cost per QALY for reimbursed cancer drugs was estimated to be 748 560 SEK (V73 583). A highercost per QALY was found to decrease the likelihood of reimbursement by 9.4% for every 100 000 SEK (V9830)higher cost per QALY (P ¼ 0.03). For cost-effectiveness models without direct evidence of improvements in finaloutcomes, a larger QALY gain was observed compared with those with evidence mainly relying on intermediate andsurrogate outcomes.Conclusions: There are substantial uncertainties in the clinical and cost-effectiveness evidence underlyingreimbursement decisions of new cancer drugs. Decision makers should be cautious of the limited evidence onpatient-centered outcomes and the implications of allocating resources to expensive treatments with uncertainvalue for money.
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| 5. |
- Chauca Strand, Gabriella, 1995, et al.
(författare)
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Cancer Drugs Reimbursed with Limited Evidence on Overall Survival and Quality of Life : Do Follow-Up Studies Confirm Patient Benefits?
- 2023
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Ingår i: Clinical drug investigation. - : Springer. - 1173-2563 .- 1179-1918. ; 43:8, s. 621-633
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Tidskriftsartikel (refereegranskat)abstract
- Background and ObjectiveCancer drug costs have increased considerably within healthcare systems, but many drugs lack quality-of-life (QoL) and overall survival (OS) data at the time of reimbursement approval. This study aimed to review the extent of subsequent literature documenting improvements in OS and QoL for cancer drug indications where no such evidence existed at the time of reimbursement approval.MethodsDrug indications with claims of added therapeutical value but a lack of evidence on OS and QoL that were reimbursed between 2010 and 2020 in Sweden were included for review. Searches were conducted in PubMed and ClinicalTrial.gov for randomized controlled trials examining OS and QoL.ResultsOf the 22 included drug indications, seven were found to have at least one trial with conclusive evidence of improvements in OS or QoL after a mean follow-up of 6.6 years. The remaining 15 drug indications either lacked subsequent randomized controlled trial data on OS or QoL (n = 6) or showed no statistically significant improvements (n = 9). Only one drug demonstrated evidence of improvement in both OS and QoL for its indication.ConclusionsA considerable share of reimbursed cancer drug indications continue to lack evidence of improvement in both OS and QoL. With limited healthcare resources and an increasing cancer burden, third-party payers have strong incentives to require additional post-reimbursement data to confirm any improvements in OS and QoL.
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| 6. |
- Christiansson, Marie-Therese, et al.
(författare)
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En inter-organisatorisk förändringsanalys : utveckling av kund-/leverantörsprocessen
- 1997
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Konferensbidrag (refereegranskat)abstract
- Dagens sätt att göra affärer innebär ett ökat partnerskap och ett ökat datautbyte mellan organisationer i sökandet efter effektivitet och konkurrensfördelar. Affärsrelationer mellan leverantörer och kunder är beroende av att informationen flödar på ett strukturerat sätt mellan deras organisationer för att tillgodose respektive parts informationsbehov, dvs inter-organisatoriska informationssystem (IOIS). En metodutveckling pågår inom VINST-projektet där målet är att utveckla kunskap om och utforma en användbar metod som stöd vid verksamhetsutveckling av inter-organisatorisk karaktär. Denna rapport bygger på en metodprövande aktionsforskning vid en gemensam förändringsanalys som PartnerTech AB och en av deras kunder bedrivit med stöd av FA/SIMMetoden. Den metodtillämpning och metodutveckling som skett analyseras och diskuteras utifrån frågorna; hur en leverantör tillsammans med kunden kan utveckla den gemensamma kund-leverantörsprocessen och hur verksamhetsutvecklare kan använda FA/SIMM för att kartlägga och driva förbättring av inter-organisatoriska processer. Rapporten pekar bl a på behov av anpassade projektstrategier, arbetsformer och notation samt metodkomponenter för interaktionsanalys och uppföljning av åtgärder.
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| 7. |
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| 8. |
- Johansson, Naimi, 1988, et al.
(författare)
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Effects of primary care cost-sharing among young adults : Varying impact across income groups and gender
- 2019
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Ingår i: European Journal of Health Economics. - : Springer. - 1618-7598 .- 1618-7601. ; 20:8, s. 1271-1280
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Tidskriftsartikel (refereegranskat)abstract
- We estimate the price sensitivity in health care among adolescents and young adults, and assess how it varies across income groups and gender, using a regression discontinuity design. We use the age differential cost-sharing in Swedish primary care as our identification strategy. At the 20th birthday, the copayment increases from €0 to approx. €10 per primary care physician visit and close to this threshold the copayment faced by each person is distributed almost as good as if randomized. The analysis is performed using high-quality health care and economic register data of 73,000 individuals aged 18–22. Our results show that the copayment decreases the average number of visits by 7%. Among women visits are reduced by 9%, for low-income individuals by 11%, and for low-income women by 14%. In conclusion, modest copayments have significant utilization effects, and even in a policy context with relatively low income inequalities, the effect is substantially larger in low-income groups and among women.
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| 9. |
- Johansson, Naimi, 1988-, et al.
(författare)
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Place or patient as the driver of regional variation in healthcare spending – Discrepancies by category of care
- 2024
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 342
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Tidskriftsartikel (refereegranskat)abstract
- We study how much regional variation in healthcare spending is driven by place- and patient-specific factors using a random sample of 53,620 regional migrants in Sweden. We find notable differences depending on the category of care, with place-specific factors having a significantly larger impact on specialized outpatient care compared to inpatient and pharmaceutical care. The place effect is estimated to 75% of variation in specialized outpatient care, but 26% or less in variations in inpatient care, and 5% in prescription drug spending. We also find that the empirical estimator has a substantial impact on the estimates of the place-specific effect. The results based on the traditional approach in the literature with two-way fixed effects and event-study models produce much larger estimates of the place-specific effect compared to results based on recently developed heterogeneity-robust models. For total healthcare spending, the traditional two-way fixed effects model estimates a place effect of 78%, while the heterogeneity-robust estimator finds a place effect around 10%. This finding indicates that previous results in this literature, all based on traditional two-way fixed-effects regressions, should be interpreted with care.
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| 10. |
- Johansson, Naimi, 1988-, et al.
(författare)
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Regional variation in health care utilization in Sweden : The importance of demand-side factors
- 2018
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Ingår i: BMC Health Services Research. - London, UK : BioMed Central. - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Differences in health care utilization across geographical areas are well documented within several countries. If the variation across areas cannot be explained by differences in medical need, it can be a sign of inefficiency or misallocation of public health care resources. Methods: In this observational, longitudinal panel study we use regional level data covering the 21 Swedish regions (county councils) over 13 years and a random effects model to assess to what degree regional variation in outpatient physician visits is explained by observed demand factors such as health, demography and socio-economic factors. Results: The results show that regional mortality, as a proxy for population health, and demography do not explain regional variation in visits to primary care physicians, but explain about 50% of regional variation in visits to outpatient specialists. Adjusting for socio-economic and basic supply-side factors explains 33% of the regional variation in primary physician visits, but adds nothing to explaining the variation in specialist visits. Conclusion: 50-67% of regional variation remains unexplained by a large number of observable regional characteristics, indicating that omitted and possibly unobserved factors contribute substantially to the regional variation. We conclude that variations in health care utilization across regions is not very well explained by underlying medical need and demand, measured by mortality, demographic and socio-economic factors.
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