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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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- 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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- Lindgren, Peter, et al.
(författare)
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Association between achieving treatment goals for lipid-lowering and cardiovascular events in real clinical practice
- 2005
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Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - : Oxford University Press (OUP). - 1741-8267 .- 1741-8275. ; 12:6, s. 530-534
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is substantial evidence that treatment with lipid-lowering agents can decrease cardiovascular morbidity and total mortality in patients with elevated serum lipid values and/or prior ischaemic heart disease. However, only a minority of these high-risk patients are believed to receive treatment, and among those who do receive pharmaceutical treatment the majority do not reach the therapeutic goal. Our goal was to investigate if this translates to a higher risk of cardiovascular events in real clinical practice. DESIGN: A retrospective cohort study using linkage of electronic medical records, the Swedish national inpatient registry and cause of death registry was performed, enrolling a total of 4976 patients who received treatment with a lipid-lowering agent at any time between 1 January 1993 and 1 December 2001. METHODS: Cox proportional hazards regression was used to evaluate the impact of goal attainment along with potential confounding factors. RESULTS: Patients who reached treatment goals were 24% less likely to suffer a cardiovascular event (relative risk: 0.76, 95% confidence interval: 0.60-0.96) than patients who did not reach treatment goals. A substantial proportion of patients treated with lipid-lowering agents do not achieve the treatment goals. CONCLUSIONS: Failure to reach treatment goals translates into a higher risk of cardiovascular events, and it is thus of importance to ensure that patients reach goals.
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- Zethraeus, Niklas, et al.
(författare)
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Reassessment of the cost-effectiveness of hormone replacement therapy in Sweden : results based on the Women's Health Initiative randomized controlled trial
- 2005
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 21:4, s. 433-441
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study is to reassess the cost-effectiveness of hormone replacement therapy (HRT) based on new medical evidence found in the Women's Health Initiative (WHI). Within a model framework using an individual state transition model, the cost-effectiveness of 50- to 60-year-old women with menopausal symptoms is assessed based on a societal perspective in Sweden. The model has a 50-year time horizon divided into a cycle length of 1 year. The model consists of the following disease states: coronary heart disease, stroke, venous thromboembolic events, breast cancer, colorectal cancer, hip fracture, vertebral fracture, and wrist fracture. An intervention is modeled by its impact on the disease risks during and after the cessation of therapy. The model calculates costs and quality-adjusted life years (QALYs) with and without intervention. The resulting cost per QALY gained is compared with the value of a QALY gained, which is set to SEK 600,000. The model requires data on clinical effects, risks, mortality rates, quality of life weights, and costs valid for Sweden. The cost-effectiveness ratios are estimated at approximately SEK 10,000, which is below the threshold value of cost-effectiveness. On the condition that HRT increases the quality of life weight more than 0.013 units, the therapy is cost-effective. In conclusion, given the new evidence in WHI, there is still a high probability that HRT is a cost-effective strategy for women with menopausal symptoms.
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