| 1. |
- Andersson, Bodil, et al.
(författare)
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Fatal Acute Pancreatitis Occurring Outside of the Hospital: Clinical and Social Characteristics.
- 2010
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; Jul 1, s. 2286-2291
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mortality caused by acute pancreatitis in patients admitted to the hospital has been thoroughly investigated, but knowledge regarding outpatient fatalities is far from complete. The purpose of this study was to assess the incidence and clinical characteristics of patients who have died due to acute pancreatitis occurring outside the hospital. METHODS: Deaths caused by acute pancreatitis in the southern part of Sweden during 1994-2008 were identified at the Department of Forensic Medicine, Lund. A retrospective review of all cases was performed. RESULTS: A total of 50 patients were included, representing approximately 50 of 292 (17%) of all deaths due to acute pancreatitis in the region during this period of time. Median age was 54 (47-69) years and the majority-37 (74%)-were men. The main etiology was alcohol, seen in at least 35 (70%) patients. Twelve (24%) patients were obese. The duration of abdominal pain, in evaluable cases, was 3.0 (1.6-6.2) days. Profound signs of pancreatitis were seen in all patients; 35 (70%) had a necrotising disease according to histopathological examination. Pulmonary changes were common, e.g., bronchopneumonia, pleural effusion, or edema, and all but four had fatty liver. Massive intra-abdominal bleeding was seen in one patient. At least eight patients had a mental disorder, and three were homeless. CONCLUSIONS: Fatal acute pancreatitis occurring outside the hospital accounts for a substantial part of all deaths due to the disease. The incidence seems to decline, and no variation in season was seen. Alcohol was the predominant etiology. Many of the patients lived alone and in poor social conditions.
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| 2. |
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| 3. |
- Borg, Sixten, et al.
(författare)
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A maximum likelihood estimator of a Markov model for disease activity in Crohn's disease and ulcerative colitis for annually aggregated partial observations.
- 2010
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Ingår i: Medical Decision Making. - 1552-681X. ; 30:1, s. 42-132
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Tidskriftsartikel (refereegranskat)abstract
- Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases that have a remitting, relapsing nature. During relapse, they are treated with drugs and surgery. The present study was based on individual data from patients diagnosed with CD or UC at Herlev University Hospital, Copenhagen, Denmark, during 1991 to 1993. The data were aggregated over calendar years; for each year, the number of relapses and the number of surgical operations were recorded. Our aim was to estimate Markov models for disease activity in CD and UC, in terms of relapse and remission, with a cycle length of 1 month. The purpose of these models was to enable evaluation of interventions that would shorten relapses or postpone future relapses. An exact maximum likelihood estimator was developed that disaggregates the yearly observations into monthly transition probabilities between remission and relapse. These probabilities were allowed to be dependent on the time since start of relapse and on the time since start of remission, respectively. The estimator, initially slow, was successfully optimized to shorten the execution time. The estimated disease activity model for CD fits well to observed data and has good face validity. The disease activity model is less suitable for UC due to its transient nature through the presence of curative surgery.
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| 4. |
- Borg, Sixten, et al.
(författare)
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Budget impact analysis of surgical treatment for obesity in Sweden
- 2012
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Ingår i: Scandinavian Journal of Surgery. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 101:3, s. 190-197
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Tidskriftsartikel (refereegranskat)abstract
- Background: The recent substantial increase in the number of obese surgeries performed in Sweden has raised concerns about the budget impact.Objective: Our aim in this paper is to present an assessment of the budgetary impact of different policies for surgical intervention for obese and overweight subjects from a healthcare perspective in Sweden.Methods: The model simulates the annual expected treatment costs of obesity related diseases and surgery in patients of different sex, age and Body Mass Index (BMI). Costs evaluated are costs of surgery plus the excess treatment costs that an obese patient has over and above the treatment costs of a normal-weight patient. The diagnoses that are included for costs assessment are diabetes and cardiovascular disease since these diagnoses are the principal diagnoses associated with obesity. Four different scenarios over the number of surgical operations performed each year are simulated and compared: (1) no surgical operation, (2) 3 000 surgical operations in persons with BMI > 40, (3) 4 000 (BMI > 40), and (4) 5 000 (expanded to BMI > 38).Results: Comparing Scenario 2 with Scenario 1 results in a net budget impact of on average SEK 121 million per annum or SEK 40 000 per patient. This implies that 55 percent of the cost of surgery, set equal to SEK 90 000 for each patient, has been offset by a reduction in the excess treatment costs of obesity related diseases. Expanding annual surgery from 3000 to 4000 the cost-offset increased to 58%. By expanding annual surgery further from 4000 to 5000 and at the same time expanding the indication for surgery from BMI > 40 to BMI > 38, no cost-offset is obtained.Conclusion: A cost-minimization strategy for bariatric surgery in Sweden should not expand indication, but rather increase the number of surgeries within the currently accepted indication.
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| 5. |
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| 6. |
- Borg, Sixten, et al.
(författare)
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Cost effectiveness of pomalidomide in patients with relapsed and refractory multiple myeloma in Sweden
- 2016
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Ingår i: Acta Oncologica. - 0284-186X. ; 55:5, s. 554-560
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. Material and methods: We developed a health-economic discrete event simulation model of a patient’s course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. Results: The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (€19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (€81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (€62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental cost-effectiveness ratio is SEK 798 613 (€84 900) per QALY gained. Conclusion: In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.
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| 7. |
- Borg, Sixten, et al.
(författare)
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Obesity and Surgical Treatment - A Cost-Effectiveness Assessment for Sweden
- 2014
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Ingår i: Nordic Journal of Health Economics. - 1892-9729. ; , s. 257-275
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Tidskriftsartikel (refereegranskat)abstract
- The rising trend in the prevalence of obesity has become a major public health concern in many countries during the past decades, partly because being obese is associated with comorbidities and death. The cost of treatment for obesity related diseases has become a heavy burden on the national health care budget in many countries. The treatment options for obesity are mainly weight management therapies in the form of diet and exercise, pharmacological therapy, and surgery. The incidence of bariatric surgery in Sweden has increased eight-fold in the last decade. Our objective was to assess the cost-effectiveness of gastric bypass surgical treatments for obesity in adult patients, in comparison with conventional treatment, in Sweden from a societal perspective. The conventional treatment alternative consisted of the prevalent mixture of non-surgical obesity treatments. A model of individual patients was used to simulate the outcomes of the patients in terms of treatment costs, indirect costs, life years, and quality adjusted life years (QALY) over a lifetime perspective. In patients with a Body Mass Index of 40-44 kg/m2, surgery was estimated to be cost-saving in men and judged cost-effective in women, with an incremental cost per QALY gained of SEK 26 thousand (EUR 3 thousand). The incremental cost associated with gastric bypass decreases with BMI, increases with the patient's age, and is higher in women than in men. Taking patient characteristics and uncertainty in input data and model design into account, the incremental cost is estimated to be at most SEK 160 thousand per QALY gained (about EUR 18 thousand per QALY). In conclusion, gastric bypass surgery appears to be a cost-effective intervention compared to conventional treatment in adult persons with obesity in Sweden.
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| 9. |
- Borg, Sixten, et al.
(författare)
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The cost-effectiveness of treatment with erythropoietin compared to red blood cell transfusions for patients with chemotherapy induced anaemia: a Markov model.
- 2008
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Ingår i: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 1651-226X .- 0284-186X. ; 47:6, s. 1009-1017
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Anaemia is a common complication of chemotherapy. As anaemia can lead to e.g. fatigue, depression, social isolation and chest pain it diminishes physical capacity and quality of life. It is generally accepted that symptomatic anaemia should be corrected. Treatment options include red blood cell transfusion (RBCT), erythropoietin (EPO) administration or a combination of both. OBJECTIVE: The objective of this study was to carry out a cost-effectiveness analysis of treatment with EPO (epoetin alfa), compared to treatment with RBCT for patients with chemotherapy-induced anaemia in Sweden from a health care perspective. METHOD: A model was developed for estimating incremental costs and QALY gains associated with EPO treatment compared to treatment with RBCTs, based on a model commissioned by the UK National Institute for Health and Clinical Excellence and adjusted to reflect Swedish treatment practice. Data regarding patient characteristics, response rates, and RBCT was derived from a Swedish observational study of EPO treatment in cancer patients with chemotherapy related anaemia. Swedish guidelines and unit costs were used throughout the study. A systematic review of EPO for treatment of anaemia associated with cancer was used to estimate QALY gains associated with changes in Hb-concentrations in our model. RESULTS: The model's results validate well to real world data from three major hospitals in Sweden. The cost per QALY gained from administration of EPO was estimated at EUR 24,700 in the base case analysis. Practicing an EPO treatment target Hb-level of 12 g/dl yields a cost per QALY about 40% lower than practicing a Hb-target level of 13 g/dl, which is in agreement with updated recommendations of using a 12 g/dl target. CONCLUSION: The estimated cost per QALY falls well within the range acceptable in Sweden when practicing a Hb-target level of 12 g/dl. The incremental cost of elevating Hb-levels above 13 g/dl is very high in relation to the incremental QALY gain achieved.
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