| 1. |
- Afentou, Nafsika, et al.
(författare)
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Economic Evaluation of Interventions in Parkinson's Disease : A Systematic Literature Review
- 2019
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Ingår i: Movement Disorders Clinical Practice. - : Wiley. - 2330-1619. ; 6:4, s. 282-290
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Forskningsöversikt (refereegranskat)abstract
- BackgroundParkinson's disease (PD) management comprises of drug treatments, surgery, and physical activity/occupational therapies to relieve PD's symptoms. The aim of this study is twofold; first, to appraise recent economic evaluation studies on PD management in order to update the existing knowledge; and second, to facilitate decision making on PD management by assessing the cost‐effectiveness of all types of PD interventions.MethodsA systematic search for studies published between 2010 and 2018 was conducted. The inclusion and exclusion of the articles were based on criteria relevant to population, intervention, comparison, outcomes, and study design (PICO). The reporting quality of the articles was assessed according to Consolidated Health Economic Evaluation Reporting Standards.ResultsTwenty‐eight articles were included, 10 of which were evaluations of drug treatments, 10 deep brain stimulation (DBS), and eight physical/occupational therapies. Among early‐stage treatments, Ti Ji dominated all physical activity interventions; however, its cost‐effectiveness should be further explored in relation to its duration, intensity, and frequency. Multidisciplinary interventions of joint medical and nonmedical therapies provided slightly better health outcomes for the same costs. In advanced PD patients, adjunct drug treatments could become more cost‐effective if introduced during early PD and, although DBS was more cost‐effective than adjunct drug therapies, the results were time‐bound.ConclusionsConditionally, certain PD interventions are cost‐effective. However, PD progression differs in each patient; thus, the cost‐effectiveness of individually tailored combinations of interventions that could provide more time in less severe disease states and improve patients’ and caregivers’ quality of life, should be further explored.
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| 2. |
- Christian, Carmen S, et al.
(författare)
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Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis
- 2018
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
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| 3. |
- Dackehag, Margareta, et al.
(författare)
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Social assistance and mental health : evidence from longitudinal administrative data on pharmaceutical consumption
- 2020
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Ingår i: Applied Economics. - : Taylor and Francis Ltd.. - 0003-6846 .- 1466-4283. ; 52:20, s. 2165-2177
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Tidskriftsartikel (refereegranskat)abstract
- This paper adds to the small literature on the role of welfare benefits and mental health by studying the relationship between uptake of Social Assistance Benefit (SAB) and objective mental health measures. We use rich longitudinal administrative data on income, unemployment benefits and psychopharmaceutic prescriptions (antidepressants, anxiolytics, and hypnotics) for more than 140,000 Swedes in 2006–2012. Relative to earlier studies focusing on subjective mental health, an advantage of our approach is that we use longitudinal administrative data that do not suffer from non-response, under-reporting and self-justification biases. While we document a strong positive association between SAB and psychopharmaca consumption in ordinary least squares models, fixed effects estimates indicate that most of the association is due to unobserved individual-specific predisposition. Insofar as a relationship remains in the fixed effect models, it is driven by highly educated men. This result is consistent with earlier quantitative studies using survey data and with qualitative research suggesting that SAB uptake may be particularly stigmatizing for individuals with a higher initial socioeconomic position.
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| 4. |
- Eckerlund, Ingemar, et al.
(författare)
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Econometric analysis of variation in cesarean section rates : a cross-sectional study of 59 obstetrical departments in Sweden
- 1998
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press (CUP): HSS Journals. - 1471-6348 .- 0266-4623. ; 14:4, s. 774-787
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as supply-related. A general model including all these regressors was specified, After reducing this model, we were able to explain about one-quarter of the variation, We conclude that the large variation in cesarean section rates indicates inefficiency, due mainly to overutilization, but perhaps also underutilization. It is difficult to calculate the economic consequences or the welfare loss to society, We estimated an additional cost for unnecessary cesarean sections of 13-16 million Swedish crowns (SEK) per year.
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| 5. |
- Eckerlund, Ingemar, et al.
(författare)
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Estimating the effect of cesarean section rate on health outcome : Evidence from Swedish hospital data
- 1999
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 15:1, s. 123-135
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This paper tests the null hypothesis of a zero effect of cesarean section rate on health outcome against the alternative of a positive effect. Using data from 59 hospitals in Sweden from 1988-92, we specify two separate linear regression models for health outcome, one with perinatal mortality, and the other with rate of asphyxia, as dependent variable, We estimate the models by single-year cross-section regressions and as pooled data systems. The null hypothesis cannot be rejected, i.e., we do not find any significant positive effect of cesarean section rate on health outcome. Thus, we conclude that an increase in cesarean section rate does not imply lower perinatal mortality or lower rate of asphyxia. This in turn indicates that the minimum cesarean section rate is optimal.
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| 6. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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A note on the estimation of the equity-efficiency trade-off for QALYs
- 1996
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Ingår i: Journal of health economics. - : Elsevier. - 1879-1646 .- 0167-6296. ; 15:3, s. 359-368
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Tidskriftsartikel (refereegranskat)abstract
- In this note the veil of ignorance approach is tested as a basis for empirically determining the shape of the social welfare function for QALYs. An experiment is carried out where the participants choose between different societies that differ with respect to per capita QALYs and the distribution of QALYs. The answers are analyzed using logistic regression analysis, According to the results the respondents are willing to give up 1 QALY in the group with more QALYs to gain 0.45 QALYs in the group with fewer QALYs,but this trade-off is independent of the size of the difference in QALYs between the groups.
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| 7. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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A note on validating Wagstaff and van Doorslaer's health measure in the analysis of inequalities in health
- 1999
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Ingår i: Journal of health economics. - : Elsevier. - 1879-1646 .- 0167-6296. ; 18:1, s. 117-124
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this note is to validate Wagstaff and van Doorslaer's approach of constructing a continuous health measure to be used in the analysis of inequalities in health. We calculate health concentration indices for Uppsala County in Sweden based on three different health status measures: health measured according to the WvD approach based on a self-assessed categorical health measure, health measured by the rating scale method, and health measured by the time trade-off method. The concentration index does not differ significantly for the three health status measures, and our results thus support the validity of the WvD method.
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| 8. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Drug Expenditure and New Drug Introductions : The Swedish Experience
- 1993
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 4:3, s. 215-225
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Tidskriftsartikel (refereegranskat)abstract
- This article measures the impact of the switch to new and more expensive drugs on the aggregate drug expenditure (both prescription and nonprescription) in Sweden during the period 1974 to 1991, and also on the disaggregated expenditure for 3 medical areas: asthma, hypertension and peptic ulcer disease. During the period studied, nominal drug expenditure increased 6-fold. The retail price index of drugs and the number of prescribed drugs accounted for 51.6 and 5.8% of this increase, respectively. The remaining residual amount accounted for 42.6%. Since the price index of drugs increased more slowly than the overall net price index of goods and services, the relative price of drugs decreased dramatically by about 30%. This means that increases in prices of drugs cannot explain the increase in real inflation-adjusted drug expenditure. We also show that the residual increase can be partly explained by the introduction of new and more expensive drugs. It is therefore argued that economic evaluations which compare the extra costs induced by new drugs with the extra benefits should be undertaken to guide decisions about the prescription of new and more expensive drugs.
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| 9. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Estimating the Causal Impact of Macroeconomic Conditions on Income-Related Mortality
- 2020
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- To-date the macroeconomic conditions-mortality literature on income-related inequality in mortality has relied on subgroup analysis, mainly using income as a stratification variable, but this nearly always causes selection bias yielding results that are hard to interpret. To solve this bad control problem, we apply a novel technique based on recentered influence function regression of overall income-related mortality measures, like the commonly used concentration index. We also highlight the importance of: i) measurement of relative versus absolute inequality; ii) measurement of inequality by population-level statistics of inequality (concentration indices) versus subgroup analysis; iii) measurement of short versus long-term income. We illustrate these issues and our suggested solution using detailed individual-level administrative data from Sweden. Our findings show that there overall is a (insignificant) counter-cyclical impact on mortality and its income-related inequality. During a sub-period of pronounced and significant counter-cyclical mortality we find support for accompanying counter-cyclical income-related inequality, but only when using short-term income.
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| 10. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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New estimates of the demand for health : Results based on a categorical health measure and Swedish micro data
- 1999
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Ingår i: Social science & medicine (1982). - : Elsevier. - 1873-5347 .- 0277-9536. ; 49:10, s. 1325-1332
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we estimate a 'Grossman' model of demand for health based on Swedish micro data. The data set consists of a random sample of over 5000 individuals taken from the Swedish adult population. Health capital is measured by a categorical measure of overall health status, and an ordered probit model is used to econometrically estimate the demand for health equation. The results are consistent with the theoretical predictions and show that the demand for health increases with income and education and decreases with age, male gender, overweight, living in big cities and being single.
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