| 1. |
- Borg, Sixten, et al.
(författare)
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Cost-Effectiveness and Heterogeneity: Using Finite Mixtures of Disease Activity Models to Identify and Analyze Phenotypes
- 2015
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Heterogeneity in patient populations is an important issue in health economic evaluations, as the cost-effectiveness of an intervention can vary between patient subgroups, and an intervention which is not cost-effective in the overall population may be cost-effective in particular subgroups. Identifying such subgroups is of interest in the allocation of healthcare resources. Our aim was to develop a method for cost-effectiveness analysis in heterogeneous chronic diseases, by identifying subgroups (phenotypes) directly relevant to the cost-effectiveness of an intervention, and by enabling cost-effectiveness analyses of the intervention in each of these phenotypes. We identified phenotypes based on healthcare resource utilization, using finite mixtures of underlying disease activity models: first, an explicit disease activity model, and secondly, a model of aggregated disease activity. They differed with regards to time-dependence, level of detail, and what interventions they could evaluate. We used them for cost-effectiveness analyses of two hypothetical interventions. Allowing for different phenotypes improved model fit, and was a key step towards dealing with heterogeneity. The cost-effectiveness of the interventions varied substantially between phenotypes. Using underlying disease activity models for identifying phenotypes as well as cost-effectiveness analysis appears both feasible and useful in that they guide the decision to introduce an intervention.
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| 2. |
- Burisch, Johan, et al.
(författare)
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Occurrence of anaemia in the first year of inflammatory bowel disease in a European population-based inception cohort : An ECCO-EpiCom study
- 2017
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Ingår i: Journal of Crohn's & Colitis. - : Oxford University Press. - 1873-9946 .- 1876-4479. ; 11:10, s. 1213-1222
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Anaemia is an important complication of inflammatory bowel disease (IBD). The aim of this study was to determine the prevalence of anaemia and the practice of anaemia screening during the first year following diagnosis in a European prospective population-based inception cohort.Methods: Newly diagnosed IBD patients were included and followed prospectively for one year in 29 European and 1 Australian centre. Clinical data including demographics, medical therapy, surgery and blood samples were collected. Anaemia was defined according to the World Health Organization.Results: A total of 1,871 patients (CD: 686, 88%; UC: 1,021, 87%; IBDU 164. 81%) were included in the study. The prevalence of anaemia was higher in CD than in UC patients and overall, 49% of CD and 39% of UC patients had at least one instance of anaemia during the first 12 months after diagnosis. UC patients with more extensive disease and those from Eastern European countries, and CD patients with penetrating disease or colonic disease location, had higher risks of anaemia. CD and UC patients in need of none or only mild anti-inflammatory treatment had a lower risk of anaemia. In a significant proportion of patients, anaemia was not assessed until several months after diagnosis, and in almost half of all cases of anaemia a thorough work-up was not performed.Conclusions: Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.
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| 3. |
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| 4. |
- Gustavsson, Anders, 1964-
(författare)
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Therapy in inflammatory bowel disease
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to study treatment of inflammatory bowel disease with respect to an acute severe attack of ulcerative colitis and endoscopic balloon dilation in stricturing Crohn’s disease.A retrospective follow-up was made in 158 patients who were given intensive intravenous corticosteroid treatment due a severe, moderate, or mild attack of ulcerative colitis between 1975 and 1982. After 10 years, the colectomy frequency in the severe disease group was 64%, and 49% and28% in the moderate and mild groups, respectively. Severity of the original attack did not influence the subsequent clinical course with respect to colectomy.In 2005, a controlled Swedish–Danish trial of infliximab as rescue therapy in an acute severe attack of steroid refractory ulcerative colitis showed that colectomy frequencies after 3 months were lower in infliximab-treated patients (29%) compared to placebo-treated patients (67%). After 3 years, a statistically significantly lower colectomy frequency remained in patients treated with infliximab (50%) compared to placebo (76%).Between 1989 and 2009, 178 patients underwent endoscopic balloon dilation due to intestinal strictures in Crohn’s disease. Seventy-five patients,with a follow-up of 5 years or longer, underwent dilations due to symptomatic strictures only. After 5 years of follow-up, 39/75 (52%) of the patients had undergone no further intervention or one additional dilation only, and 36% had had surgery. The complication frequency was 5.3%, of which 10 patients (1.3%) required surgery. In 83 patients, we studied whether smoking at diagnosis affected the outcome after index dilation. In the group of active smokers, 31/32 (97%) underwent another intervention compared to 18/33 (55%) in never smokers (HR 2.18, 95% CI: 1.22-3.93,p = 0.01). Clinical parameters such as sex, age at diagnosis, age at first dilation, balloon size, localisation of stricture, treatment with azathioprine and treatment period did not influence outcome.
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| 5. |
- Hedin, Charlotte Rose Hawkey, et al.
(författare)
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Effects of Tumor Necrosis Factor Antagonists in Patients With Primary Sclerosing Cholangitis
- 2020
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Ingår i: Clinical Gastroenterology and Hepatology. - : Elsevier BV. - 1542-3565 .- 1542-7714. ; 18:10, s. 2-2304
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Few patients with primary sclerosing cholangitis (PSC) and inflammatory bowel diseases (IBDs) are exposed to tumor necrosis factor (TNF) antagonists because of the often mild symptoms of IBD. We assessed the effects of anti-TNF agents on liver function in patients with PSC and IBD, and their efficacy in treatment of IBD. Methods: We performed a retrospective analysis of 141 patients with PSC and IBD receiving treatment with anti-TNF agents (infliximab or adalimumab) at 20 sites (mostly tertiary-care centers) in Europe and North America. We collected data on the serum level of alkaline phosphatase (ALP). IBD response was defined as either endoscopic response or, if no endoscopic data were available, clinical response, as determined by the treating clinician or measurements of fecal calprotectin. Remission was defined more stringently as endoscopic mucosal healing. We used linear regression analysis to identify factors associated significantly with level of ALP during anti-TNF therapy. Results: Anti-TNF treatment produced a response of IBD in 48% of patients and remission of IBD in 23%. There was no difference in PSC symptom frequency before or after drug exposure. The most common reasons for anti-TNF discontinuation were primary nonresponse of IBD (17%) and side effects (18%). At 3 months, infliximab-treated patients had a median reduction in serum level of ALP of 4% (interquartile range, reduction of 25% to increase of 19%) compared with a median 15% reduction in ALP in adalimumab-treated patients (interquartile range, reduction of 29% to reduction of 4%; P =.035). Factors associated with lower ALP were normal ALP at baseline (P <.01), treatment with adalimumab (P =.090), and treatment in Europe (P =.083). Conclusions: In a retrospective analysis of 141 patients with PSC and IBD, anti-TNF agents were moderately effective and were not associated with exacerbation of PSC symptoms or specific side effects. Prospective studies are needed to investigate the association between use of adalimumab and reduced serum levels of ALP further.
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| 6. |
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| 7. |
- Kalman, Thordis Disa, 1959-
(författare)
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Surgery and stomas in Crohn's disease
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study investigates the evolution of abdominal surgery in treatment of Crohn´s disease (CD) in the era of immunomodulatory drugs and biologicals. It concerns risk of abdominal surgery overall and sub-categories of abdominal surgery, risk of repeat surgery and factors that affect this risk, and risk of getting a stoma. Surgical recurrence is a major clinical problem as repeat procedures are more complex and expose the patients to a higher medical risk both in conjunction with surgery and afterwards. Updated information on abdominal surgery for CD will be of use when making decisions about medical vs surgical interventions.In a nationwide cohort of 21 273 patients with CD during the years 1990-2014, the cumulative incidence of abdominal surgery within five years of diagnosis decreased continuously down to 17.3% for patients diagnosed with CD during the last calendar period of study, 2009–2014. Ileocecal resection was the most common primary procedure. The incidence of colectomy was low in all calendar periods and continuously decreased. The incidence of proctectomy was very low even after decades with the disease, 3.0% for patients diagnosed 1990-1995 with a median follow-up of 21 years. Incidence of repeat abdominal surgery within five years of primary procedure decreased in the 90s down 16.0% in the 1996– 2000 period with a risk of ileocolic reresection of 4.4%. After 2000, despite introduction of biologicals in 1998, no further significant decrease in repeat surgery was observed.In a retrospective review of prospectively maintained databases at three university hospitals, the rate of surgical recurrence for 389 patients with CD who had been treated with a primary ileocecal resection between 2000-2012 was investigated. The patients were operated receiving either a temporary stoma (20%) or a primary anastomosis (80%) with a median follow-up time of 105 months. Patients selected to temporary stoma had a higher prevalence of baseline risk factors usually associated with an increased risk of recurrence such as penetrating disease behaviour. Despite this, there was no difference in long-term surgical recurrence between the one- and two-stage groups; 18% vs 16%.In a retrospective review of prospectively maintained databases at two university hospitals, the effect of smoking cessation on rate of surgical recurrence was assessed. 242 patients were included with a median follow-up of 112 months. Surgical recurrence rate for smokers vs quitters was 16/42 (38%) vs 3/31 (10%); p = 0.02; risk ratio = 3.9 despite a median time for smoking exposure after the primary procedure of three years. Among the non-smokers 28/169 (17%) had a surgical recurrence at last follow-up. 8 out of 11 smoking patients who needed a second resection went on to need a third resection. Of the patients who were free of surgical recurrence at follow-up, those who had quit smoking were significantly less likely to have been put on medical therapy compared with smokers with a risk ratio of 3.2.In an observational study of a nationwide cohort of 19 146 patients with incident CD 2002- 2013 and followed through 2017, the incidence and prevalence of stoma was investigated. The cumulative incidence of stoma formation within five years was 2.4% and remained constant from 2002 and onwards although cumulative ever-use of biologicals increased and time to start with treatment with biologicals decreased. 48% of all stomas were reversed. Ileostomies encompassed about two-thirds of all stomas and risk of stoma was higher among patients with elderly-onset CD and among patients with perianal manifestations of the disease. 28% of the patients who underwent surgery with formation of a stoma had perianal disease. 0.6% of all incident patients had a permanent stoma five years after diagnosis.
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| 8. |
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| 9. |
- Lindgren, Stefan, et al.
(författare)
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Bedömning och behandling av järnbrist hos hjärtsviktspatienter : [Iron deficiency in patients with acute and chronic heart failure - a simple algoritm]
- 2022
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Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 119
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Forskningsöversikt (refereegranskat)abstract
- Iron deficiency, defined as ferritin <100 µg/L or ferritin 100-299 µg/L if the transferrin saturation is <20 %, with or without anaemia is a common comorbidity in patients with acute and chronic heart failure. International and Swedish guidelines recommend treatment of iron deficiency with intravenous iron in patients with symptomatic heart failure and ejection fraction <50 %. Controlled studies document positive effects from treatment with iron carboxymaltose on symptoms, quality of life, functional parameters and risk of hospitalisation. We present a simple algoritm based on published data to help the responsible physician to manage these patients in clinical practice.
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| 10. |
- Lindgren, Stefan, et al.
(författare)
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Järnbrist och järnbristanemi är globala hälsoproblem
- 2015
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Ingår i: Läkartidningen. - 0023-7205. ; 112, s. 1-3
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Tidskriftsartikel (refereegranskat)abstract
- Iron deficiency and iron deficiency anemia are global health problems leading to deterioration in patients' quality of life and more serious prognosis in patients with chronic diseases. The cause of iron deficiency and anemia is ususally a combination of increased loss and decreased intestinal absorption and delivery from iron stores due to inflammation. Oral iron is first line treatment, but often hampered by intolerance. Intravenous iron is safe, and the preferred treatment in patients with chronic inflammation and bowel diseases. The goal of treatment is normalisation of hemoglobin concentration and recovery of iron stores. It is important to follow up treatment to ensure that these objectives are met and also long-term in patients with chronic iron loss and/or inflammation to avoid recurrence of anemia.
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