| 1. |
- Alme, Tomas Nordheim, et al.
(författare)
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Chronic fatigue syndromes: real illnesses that people can recover from
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 41:4, s. 372-376
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Tidskriftsartikel (refereegranskat)abstract
- The Oslo Chronic Fatigue Consortium consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brains response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.
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| 4. |
- Kobelt, Gisela, et al.
(författare)
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Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment.
- 2011
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Ingår i: International Journal of Technology Assessment in Health Care. - 1471-6348. ; 27:3, s. 193-200
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] < 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study are used. The model is analyzed as a micro-simulation and results are presented from the societal perspective for Sweden, for 10 years; costs (€2008) and effects are discounted at 3 percent. Sensitivity analysis was performed for the perspective, the time horizon, switching, and dose-reduction.Results: The main analysis conservatively assumes 50 percent switching at discontinuation. The cost per quality-adjusted life-year (QALY) gained with early ETA/MTX treatment is €13,500 (societal perspective, incremental cost of €15,500 and incremental QALYs of 1.15). With 75 percent switching, the cost per QALY gained was €10,400. Over 20 years, the cost per QALY gained was €8,200. Results were further sensitive to the time patients remained on half dose and the perspective.Conclusions and Policy Implications: This study combines clinical trial and clinical practice data to explore cost-effective treatment scenarios in early RA, including the use of biologics. Our results indicate that a situation where a considerable proportion of patients achieve remission, dose-adjustments will increase the cost-effectiveness of treatment.
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| 5. |
- Koenig, Julian, et al.
(författare)
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Cortical thickness and resting-state cardiac function across the lifespan : A cross-sectional pooled mega-analysis
- 2021
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Ingår i: Psychophysiology. - : Wiley. - 0048-5772 .- 1469-8986 .- 1540-5958. ; 58:7
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Tidskriftsartikel (refereegranskat)abstract
- Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting-state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12–87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS—or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between CT and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research.
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| 6. |
- Lekander, Ingrid
(författare)
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Application of Swedish quality register data for use in health economic analyses of chronic conditions
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sweden has many registers to monitor and follow-up healthcare, and combined with the unique personal identification numbers, this represents vast opportunities for register based research. Part of these data sources are the Swedish quality registers, which are set up to monitor the quality of care of specific diseases. Two of these registers that both have good national coverage over time and are used for research purposes are the Swedish Rheumatology Quality Register (SRQ) and the Swedish Stroke Register (Riksstroke). These are set up to monitor the quality of care of patients with rheumatoid arthritis (RA) and stroke, respectively, both diseases being associated with a chronic condition of functional disability. Data from the two quality registers have been used for scientific research in various fields, but to a lesser extent in health economic analyses. Health economics addresses issues relating to the allocation of scarce resources to improve health. This includes resource allocation both within the economy to the healthcare system and within the healthcare system to different activities. Two common health economic approaches are economic evaluations of specific therapies and burden-of-illness studies, taking a broader analytical approach to a disease. The overall aim of this thesis was to study the applicability of quality register data in health economic analyses of chronic conditions. The specific aims were: • To assess the applicability of data from a quality register in economic evaluations of anti-TNF treatment for RA in clinical practice • To assess the applicability of data from a quality register in burden-of-illness studies where health outcomes, resource use and costs of stroke are put in relation to each other Data from the quality registers were used and linked to other relevant data sources to address the aims of this thesis. For the economic evaluations of treatments in RA, health economic models were constructed to enable the analyses. Statistical analyses were performed to allow for hospital comparisons of health outcomes and resource use for stroke, as well as estimating long-term transition probabilities for the health economic model in RA. The papers concluded that: • Anti-TNF therapies have on macro level been used cost-effectively as first-line biological treament for RA in Swedish clinical practice. The cost-effectiveness results did not differ depending on the source of effectiveness data (clinical practice or RCT trial). However, the results were sensitive to the underlying progression rate of the comparator and assumptions made in the model. • The impact of stroke on health outcomes, resources and costs were substantial. There were differences in performance between hospitals in these indicators that could not be explanied by differences in patient mix. The results further indicated that the costs differed by level of functional disability and age, up to two years post stroke. Further, the papers of this thesis demonstrated the valuable contribution of quality register data in health economics in providing a valid base of data and opportunities to: • Assess real life effectiveness of treatments in economic evaluations • Retrieve data on health outcomes and patient characteristics, which are essential in: - Measuring health outcomes and relating them to levels of resource use - Enabling hospital comparisons of performance and performing case-mix adjustment of results - Enabling stratification of cost estimates by level of health outcome - Provide input parameters for future economic evaluations In order to assess the full health economic aspects of chronic conditions, quality registers play an important role, but there is a necessity to combine the quality register data with other registers or other data sources, published literature and potentially also conduct modelling to account for the long-term effects. Nevertheless, any quality register that wants to ensure that the data can be used for health economic analyses and provide valid data for such analyses, should consider to: • Ensure long-term follow-up of the patients (espcecially in chronic conditions) • Collect data on: - Patient characteristics, including the clinical markers important for the patient’s prognosis - Treatments received - Health outcomes that are common as measurements of treatment outcome(e.g in RCTs), as well as estimation of quality of life or utilities - Resource use (quantifyable) outside the healthcare sector, e.g .informal care The quality registers and other register data sources can be utilized to a greater extent in different assessments which share the aim of improving healthcare delivery and increasing its value – either by assessing level of health outcomes, processes and resources used; enabling comparisons between treatments or hospitals; or assessing determinants for different outcomes.
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| 7. |
- Lekander, Ingrid, et al.
(författare)
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Hospital comparison of stroke care in Sweden : a register-based study
- 2017
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Ingår i: BMJ Open. - London, UK : BMJ Publishing Group Ltd. - 2044-6055. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix).METHOD: Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14 125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1 year post-stroke.RESULTS: The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix.CONCLUSION: Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified.
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| 8. |
- Lekander, Ingrid, et al.
(författare)
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Relationship between functional disability and costs one and two years post stroke.
- 2017
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Ingår i: PloS one. - San Francisco, USA : Public Library of Science (PLoS). - 1932-6203. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- Stroke affects mortality, functional ability, quality of life and incurs costs. The primary objective of this study was to estimate the costs of stroke care in Sweden by level of disability and stroke type (ischemic (IS) or hemorrhagic stroke (ICH)).Resource use during first and second year following a stroke was estimated based on a research database containing linked data from several registries. Costs were estimated for the acute and post-acute management of stroke, including direct (health care consumption and municipal services) and indirect (productivity losses) costs. Resources and costs were estimated per stroke type and functional disability categorised by Modified Rankin Scale (mRS).The results indicated that the average costs per patient following a stroke were 350,000SEK/€37,000-480,000SEK/€50,000, dependent on stroke type and whether it was the first or second year post stroke. Large variations were identified between different subgroups of functional disability and stroke type, ranging from annual costs of 100,000SEK/€10,000-1,100,000SEK/€120,000 per patient, with higher costs for patients with ICH compared to IS and increasing costs with more severe functional disability.Functional outcome is a major determinant on costs of stroke care. The stroke type associated with worse outcome (ICH) was also consistently associated to higher costs. Measures to improve function are not only important to individual patients and their family but may also decrease the societal burden of stroke.
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| 9. |
- Lekander, Ingrid, et al.
(författare)
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The Comparison of Trial Data-Based and Registry Data-Based Cost-Effectiveness of Infliximab Treatment for Rheumatoid Arthritis in Sweden Using a Modeling Approach
- 2013
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015. ; 16:2, s. 251-258
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the precision of the predictive cost-effectiveness assessment based on a phase 3 clinical trial with infliximab for the treatment of rheumatoid arthritis in Swedish clinical practice. Methods: Three patient cohorts were identified: the patients included in the infliximab trial (ATTRACT), patients initially treated with infliximab from a Swedish registry (STURE), a subset of these registry patients meeting inclusion criteria for the ATTRACT trial was the third patient cohort; two sets of assumptions in relation to the efficacy data were evaluated: "ATTRACT" (efficacy data over the duration of the trial) and "STURE" (effectiveness data over 10 years). In addition, the impact of including the placebo effect for the comparator was evaluated as a basis for the calculation of cost-effectiveness by using a modeling approach. A health economic model was utilized to estimate the cost per quality-adjusted life-year (QALY) gained. Results: The results for the three patient cohorts ranged from cost saving to a cost per QALY gained of (sic)2,400 and (sic)24,900 to (sic)26,000 when the ATTRACT and STURE assumptions were used, respectively. Sensitivity analyses indicated that the inclusion of placebo effect had the largest effect on the results, increasing the cost per QALY gained to approximately (sic)50,000 for all patient cohorts. Conclusions: The treatment effect of infliximab measured in clinical trials and clinical practice results in comparable cost-effectiveness ratios, as calculated by using a modeling approach, whereas the assumptions made in relation to the effectiveness data and the chosen comparator have a large impact on the results. This reinforces the value of early modeling studies based on randomized clinical trial data, but assumptions made need to be carefully assessed.
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| 10. |
- Lekander, Ingrid, et al.
(författare)
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The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice
- 2013
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Ingår i: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598. ; 14:6, s. 863-873
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs). TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from a,not sign50,000 to a,not sign120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness. These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator.
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