1.
Saha, Sanjib, et al.
(författare)
Are lifestyle interventions in primary care cost-effective? : An analysis based on a Markov model, differences-in-differences approach and the Swedish Björknäs study
2013
Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:11
Tidskriftsartikel (refereegranskat) abstract
Background: Lifestyle interventions affect patients' risk factors for metabolic syndrome (MeSy), a pre-stage to cardiovascular diseases, diabetes and related complications. An effective lifestyle intervention is the Swedish Bjorknas intervention, a 3-year randomized controlled trial in primary care for MeSy patients. To include future disease-related cost and health consequences in a cost-effectiveness analysis, a simulation model was used to estimate the short-term (3-year) and long-term (lifelong) cost-effectiveness of the Bjorknas study. Methodology/Principal Findings: A Markov micro-simulation model was used to predict the cost and quality-adjusted life years (QALYs) for MeSy-related diseases based on ten risk factors. Model inputs were levels of individual risk factors at baseline and at the third year. The model estimated short-term and long-term costs and QALYs for the intervention and control groups. The cost-effectiveness of the intervention was assessed using differences-in-differences approach to compare the changes between the groups in the health care and societal perspectives, using a 3% discount rate. A 95% confidence interval (CI), based on bootstrapping, and sensitivity analyses describe the uncertainty in the estimates. In the short-term, costs are predicted to increase over time in both groups, but less in the intervention group, resulting in an average cost saving/reduction of US$-700 (in 2012, US $ 1= six point five seven SEK) and US$-500, in the societal and health care perspectives. The long-term estimate also predicts increased costs, but considerably less in the intervention group: US$-7,300 (95% CI: US$-19,700 to US $-1,000) in the societal, and US$-1,500 (95% CI: US$-5,400 to US$ 2,650) in the health care perspective. As intervention costs were US$ 211 per participant, the intervention would result in cost saving. Furthermore, in the long-term an estimated 0.46 QALYs (95% CI: 0.12 to 0.69) per participant would be gained.
2.
Gerdtham, Ulf-G., et al.
(författare)
Trait self-control, exercise and exercise ambition : Evidence from a healthy, adult population
2020
Ingår i: Psychology, Health & Medicine. - : Informa UK Limited. - 1354-8506 .- 1465-3966. ; 25:5, s. 583-592
Tidskriftsartikel (refereegranskat) abstract
This study explores if self-control predicts exercise ambition and actual exercise, and if exercise ambition predicts actual exercise. Members and guests at a not-for-profit sports club were invited to participate. 264 individuals completed a self-reported (Self-Control Scale) measure of self-control, and responded to questions about actual exercise as well as exercise ambition prior to their workout. Main Outcome Measures are exercise ambition, actual exercise, and the difference between them. We find that trait self-control predicts both actual exercise and exercise ambition. Exercise ambition also predicts actual exercise. The results suggest a path from self-control, via exercise ambition, to actual exercise. Individuals with relatively low self-control might benefit from some aid in setting goals for their workouts and committing to exercise.
3.
4.
Burstrom, K., et al.
(författare)
Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States
2020
Ingår i: Pharmacoeconomics. - : Springer Science and Business Media LLC. - 1170-7690 .- 1179-2027. ; 38, s. 839-856
Tidskriftsartikel (refereegranskat) abstract
Background and Objective Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. Methods In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondent's current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). Results A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Conclusions Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.
5.
Gerdtham, Ulf, et al.
(författare)
Do life-saving regulations save lives ?
2002
Ingår i: Journal of Risk and Uncertainty. - : Springer Nature. - 1573-0476 .- 0895-5646. ; 24:3, s. 231-249
Tidskriftsartikel (refereegranskat) abstract
Life-saving regulations may be counter-productive since they have an indirect mortality effect through the reduction in disposable income. This paper estimates the effect of income on mortality, controlling for the initial health status and a host of personal characteristics. The analysis is based on a random sample of the adult Swedish population of over 40,000 individuals followed up for 10-17 years. The income loss that will induce an expected fatality is estimated to be $6.8 million when the costs are borne equally among all adults, $8.4 million when the costs are borne proportionally to income and $9.8 million when the costs are borne progressively to income.
6.
Gerdtham, Ulf, et al.
(författare)
The Determinants of Health in Sweden
2002
Ingår i: Individual Decisions for Health. - New York : Routledge. - 9780415273930 - 0415273935 ; , s. 113-127
Bokkapitel (övrigt vetenskapligt/konstnärligt)
7.
Asuman, Derek, et al.
(författare)
Pain and labor outcomes : A longitudinal study of adults with cerebral palsy in Sweden
2023
Ingår i: Disability and Health Journal. - : Elsevier BV. - 1936-6574 .- 1876-7583. ; 16:3
Tidskriftsartikel (refereegranskat) abstract
Background: Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP).Objectives: To estimate the association between pain and labor outcomes for adults with CP in Sweden.Methods: A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings.Results: Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement.Conclusion: Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.& COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
8.
Clarke, PM, et al.
(författare)
A note on the decomposition of the health concentration index
2003
Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 12:6, s. 511-516
Tidskriftsartikel (refereegranskat) abstract
In recent work, the concentration index has been widely used as a measure of income-related health inequality. The purpose of this note is to illustrate two different methods for decomposing the overall health concentration index using data collected from a Short Form (SF-36) survey of the general Australian population conducted in 1995. For simplicity, we focus on the physical functioning scale of the SF-36. Firstly we examine decomposition 'by component' by separating the concentration index for the physical functioning scale into the ten items on which it is based. The results show that the items contribute differently to the overall inequality measure, i.e. two of the items contributed 13% and 5%, respectively, to the overall measure. Second, to illustrate the 'by subgroup' method we decompose the concentration index by employment status. This involves separating the population into two groups: individuals currently in employment; and individuals not currently employed. We find that the inequality between these groups is about five times greater than the inequality within each group. These methods provide insights into the nature of inequality that can be used to inform policy design to reduce income related health inequalities. Copyright (C) 2002 John Wiley Sons, Ltd.
9.
Clarke, PM, et al.
(författare)
On the measurement of relative and absolute income-related health inequality
2002
Ingår i: Social Science and Medicine. - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 55:11, s. 1923-1928
Tidskriftsartikel (refereegranskat) abstract
In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a measure of health inequality. A drawback of this measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health inequality measure by comparing the income-related inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health inequality in different populations. (C) 2002 Elsevier Science Ltd. All rights reserved.
10.
Dackehag, Margareta, et al.
(författare)
Debt and mental health : new insights about the relationship and the importance of the measure of mental health
2019
Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:3, s. 488-493
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Empirical research suggests that household debt and payment difficulties are detrimental to mental health. Despite well-known measurement problems that may contaminate analyses using subjective self-reported health measures, our knowledge is very limited concerning the effect of payment difficulties on 'objective' measures of mental health. Moreover, few studies use longitudinal data to examine the relationship. This study combines rich survey data and longitudinal data from administrative registers on a representative sample of the Swedish population to examine the relationship between payment difficulties and subjective and objective measures of mental health. METHODS: We use data from a large survey of Swedish inhabitants (The Swedish Living Conditions Surveys) combined with data from administrative registers. We investigate both directions of the relationship between mental ill health and payment difficulties, controlling for previous mental health status and previous experiences of payment difficulties. We compare the association between payment difficulties and a self-reported measure of anxiety with the associations between payment difficulties and objective measures of mental ill health from a register of psychopharmaceutical drug consumption. RESULTS: Payment difficulties associate with subjectively reported mental ill health, but less to psychopharmaca use. For objective measures, we find stronger evidence of a link running from mental ill health to later payment difficulties. CONCLUSIONS: Self-reported and objective measures of mental problems may convey different messages regarding the impact of payment difficulties on mental health. Policy measures depend on whether the primary target group is individuals with severe mental problems or individuals with mild anxiety.
