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- Sandblom, G, et al.
(författare)
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A population-based study of pain and quality of life during the year before death in men with prostate cancer
- 2004
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Ingår i: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 90:6, s. 1163-1168
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Tidskriftsartikel (refereegranskat)abstract
- In order to explore how health-related quality of life changes towards the end of life, a questionnaire including the EuroQOI form and the Brief Pain Inventory form was sent to all men with prostate cancer in the county of Östergötland, Sweden, in September 1999. Responders who had died prior to 1 January 2001 were later identified retrospectively. Of the 1442 men who received the questionnaire, 1243 responded (86.2%). In the group of responders, 167 had died within the study period, 66 of prostate cancer. In multivariate analysis, pain as well as death within the period of study were found to predict decreased quality of life significantly. Of those who died of prostate cancer, 29.0% had rated their worst pain the previous week as severe. The same figure for those still alive was 10.5%. On a visual analogue scale (range 0-100), the mean rating of quality of life for those who subsequently died of prostate cancer was 54.0 (95% confidence interval ±5.2) and those still alive was 70.0 (±1.2). In conclusion, hearth-related quality of life gradually declines during the last year of life in men with prostate cancer. This decline may partly be avoided by an optimised pain management. © 2004 Cancer Research UK.
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- Sennfält, Karin, 1963-, et al.
(författare)
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Comparison of hemodialysis and peritoneal dialysis - A cost-utility analysis
- 2002
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Ingår i: Peritoneal Dialysis International. - 0896-8608 .- 1718-4304. ; 22:1, s. 39-47
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Tidskriftsartikel (refereegranskat)abstract
- ? Objective: Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. ? Design: Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. ? Setting: All dialysis departments in the southeastern health-care region of Sweden. ? Patients: 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study, 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. ? Main Outcome Measures: Cost per life year and cost per quality-adjusted life year. ? Results: The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 - 40 years, a 31% difference in the age group 41 - 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. ? Conclusion: The cost-utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.
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- Sennfält, Karin, 1963-, et al.
(författare)
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Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002
- 2006
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Ingår i: European Urology. - : Elsevier BV. - 0302-2838 .- 1873-7560. ; 49:6, s. 1028-1034
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe the diffusion of six main health technologies used for management of prostate cancer, to estimate the economic consequences of technological changes, and to explore factors behind the diffusion.MethodsData describing the diffusion 1991–2002 were obtained from population-based databases. Costs were obtained from Linköping University Hospital and Apoteket AB. Factors affecting the diffusion of the technologies were explored.ResultsUtilization of technologies with a curative and/or palliative aim has increased over time, except for surgical castration. PSA-tests are used increasingly. The total cost of the study technologies has increased from 20 million euros in 1991 to 65 million euros in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA-tests revealed a profile associated with a rapid/extensive diffusion.ConclusionsSeveral technological changes in the management of prostate cancer have occurred without proven benefits and have contributed to increased costs. There are other factors, besides scientific evidence, that have an impact on the diffusion. Consequently, activities aimed at facilitating an appropriate diffusion of new technologies are needed. The analytical framework used here may be helpful in identifying technologies that are likely to experience inappropriate diffusion and therefore need particular attention.
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- Sennfält, Karin, 1963-
(författare)
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Economic studies of health technology changes in prostate cancer care
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: New health technologies are one of the major drivers of increasing health care costs, although not all technologies have been shown to be effective. Initiation of activities for ensuring an appropriate diffusion of new health technologies is therefore an important task for a society. To ensure a choice of relevant policy actions, it is necessary to have knowledge about what factors affect the rate and extent of diffusion and what consequences can be expected from adopting a new health technology.Aim: The aim of this thesis is to estimate economic consequences and cost-effectiveness of health technology changes and to explore factors affecting the diffusion of health technologies. To elucidate these issues, prostate cancer was used as the subject of study.Material and Methods: The diffusion of six selected technologies for prostate cancer care was analysed and the economic consequences of these technological changes estimated. Data describing the diffusion and costs were obtained from relevant databases. Economic consequences of technological changes in prostate cancer care were also estimated with a cohort approach using 204 men with a diagnosis of prostate cancer who died in 1997-98. Data on health service utilization were extracted from clinical records and the results were compared with those of corresponding cohorts of men who died in 1984-85 or in 1992-93. The cost-effectiveness and expected economic consequences of introduction of prostate cancer screening in Sweden were estimated based on randomized studies in the city of Norrköping (n=9,171) and in the city of Gothenburg (n=20,000). The potential value of a technological change in the treatment of prostate cancer pain was estimated based on data from 1,156 men with a diagnosis of prostate cancer.Results: The utilization of all selected technologies has increased over time with the exception of orchiectomy, which shows a decreasing use. The total cost of these technologies has increased from 200 MSEK in 1991 to 600 MSEK in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA tests revealed a profile associated with a rapid/extensive diffusion. The total health care costs for prostate cancer in Sweden have increased from 610 MSEK in 1984-85 to 970 MSEK in 1997-98, but the average cost per patient has been nearly stable over time. The incremental cost per extra detected localized cancer in a prostate cancer screening programme was estimated at 168,000 SEK and 98,000 SEK, respectively, and per curative aimed treated cancer at 356,000 SEK and 236,000 SEK. Introducing a screening programme for prostate cancer in Sweden would yield 244 MSEK and 92 MSEK, respectively, in additional costs per year for screening and treatment compared to a non-screening strategy. An optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life-years for every man with prostate cancer. A rough estimate for Sweden is a total expected loss of 4,421 QALYs per year at a monetary value of 840 MSEK.Conclusions: Many technological changes occur in prostate cancer care and result in cost increases with minor or uncertain health improvements. A number of factors in addition to cost-effectiveness of the technology influence the diffusion. To ensure an appropriate diffusion of health technologies in society, one necessary condition is a system for early identification and assessment of cost-effectiveness and economic consequences. Another is an appropriate use of decision models populated with data from early clinical trials, epidemiology and costs. The combination of assessment of the costs and effects and identification of the diffusion profile of the technology may facilitate the design of relevant policy actions to promote an effective utilization of health technologies.
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