| 1. |
- Askling, Helena, et al.
(author)
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Allmän TBE-vaccination ger hälsovinst till rimlig kostnad [Subsidized TBE vaccination appears cost-effective in a life-time perspective]
- 2019
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In: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 116
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Journal article (peer-reviewed)abstract
- Given the setting of Stockholm County, a recently published health-economic analysis shows that the cost per Quality-adjusted life year (QALY) of a free TBE vaccinations program is below generally acceptable cost-effectiveness thresholds in Sweden. A report from the Public Health Agency (PHA), based on similar input data, shows that it is not cost effective to subsidize TBE vaccination in the Stockholm county. The main difference in the two analyses is the time horizon for the analyses; a life-time perspective versus 10-year perspective. Health economics of vaccination strategies should be based on a long time perspective and especially when the disease is more severe in older adults, i.e. TBE. Health-care decision-makers should be aware of the importance of the time horizon for the results when considering these evaluations in prioritization decisions. With a life-time perspective a TBE-vaccination program appears cost-effective.
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| 2. |
- Shedrawy, Jad
(author)
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Cost effectiveness of latent tuberculosis screening among asylum seekers in Stockholm
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Introduction: The burden of tuberculosis (TB) in Sweden is concentrated among migrants from high TB incidence countries. The incident cases in Sweden arise mainly through reactivation of a latent tuberculosis infection (LTBI) acquired in the home country or during transit. Progression from LTBI to active TB disease can be prevented through treatment with anti-tubercular medicines. LTBI screening is therefore offered for asylum seekers and refugees in Sweden as part of a voluntary health examination (HE). Little is known about their experiences of LTBI screening and treatment. In addition, there has been no previous evaluation of the cost-effectiveness of the current LTBI screening policy in Stockholm or Sweden. Aims: The overarching aim of this thesis was to determine the cost-effectiveness of the current strategy of screening for LTBI among asylum seekers in Stockholm. This aim was achieved through the following specific objectives: 1) to assess the methodology of previously published economic models of LTBI screening and to develop an analytical framework, 2) to understand the experiences of asylum seekers with HE, 3) to quantify health-related quality of life (HRQoL) of LTBI patients and to explore the factors influencing it, 4) to quantify the HRQoL of TB patients, and 5) to assess the cost effectiveness of LTBI screening through an economic model. Methods: A qualitative study was designed to explore the experiences of asylum seekers with HE; semi-structured interviews were conducted based on an interview guide. For the HRQoL studies, a HRQoL instrument, EQ-5D, and a mental health screening instrument, RHS-15, were used. For the LTBI patients, a mixed-method design was used, in which a crosssectional survey using the EQ-5D and RHS-15 instruments was combined with qualitative interviews of a subgroup. For the TB patients, a longitudinal study design was used in which a cohort filled the EQ-5D instrument at the beginning and the end of treatment. A literature review was performed to assess the methodology of published economic modelling studies of LTBI screening. Through this review a framework was developed guiding the development of an economic model (a Markov model) to assess the cost effectiveness of the current LTBI screening in Stockholm compared to a hypothetical scenario of no screening. The analysis adopted the societal perspective, and results were presented in term of incremental costeffectiveness ratios (ICERs); taking 500 000 SEK/QALY as a cost-effectiveness threshold. Results: The HE was perceived as available by asylum seekers, with no serious physical or financial accessibility problems. They felt respected and trusted by the healthcare workers. However, information about the Swedish healthcare system was perceived to be incomplete and the HE was seen as non-responsive to their individual needs with main focus on infectious diseases. Among LTBI patients, 38% screened positive for mental health concerns using RHS-15, and 28% scored problems on mental health dimension of EQ-5D. These patients expressed fear of being contagious to others, an ambiguous threat of a vague diagnosis and future uncertainties about developing TB disease. However, LTBI patients had no overall HRQoL decrement. TB patients had a HRQoL utility score of 0,72 at the beginning of treatment, which improved significantly by the end of the treatment to 0,84. The cost effectiveness results showed that ICER is the lowest among the age group 13 to 19 at 303 881 SEK/QALY, which was the only ICER below the 500 000 SEK/QALY threshold. Discussion: Asylum seekers had a generally positive attitude towards HE, including TB and LTBI screening, but also emphasized the need to broaden the focus on all health needs rather than solely focusing on infectious diseases. LTBI patients might have a compromised mental health partly linked to fear of TB disease. Therefore, it can be beneficial to address these concerns as part of LTBI management. TB patients had a compromised HRQoL and a decrement of 0,28 for TB patients is recommended to be used in economic evaluations. LTBI screening among asylum seekers in Stockholm is cost effective in the age group 13 to 19 while it is moderately cost-effective in the age groups 0 to 12 and 20 to 34 years. The latter is mainly due to the restrictive practices of offering treatment for persons over the age of 20 years. Conclusions: Health examination is an acceptable, accessible health service. However, its quality can be improved by broadening the focus beyond infectious disease control. An LTBI diagnosis can be misunderstood as active TB and linked to stigma. The cost-effectiveness analysis showed that screening is cost effective only when preventive treatment is offered. Therefore, due to ethical and economic reasons, LTBI screening should only be performed for asylum seekers who are potentially eligible for LTBI treatment.
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| 3. |
- Shedrawy, Jad, et al.
(author)
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Estimating costs and health outcomes of publicly funded tick-born encephalitis vaccination: A cost-effectiveness analysis
- 2018
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In: Vaccine. - : ELSEVIER SCI LTD. - 0264-410X .- 1873-2518. ; 36:50, s. 7659-7665
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Journal article (peer-reviewed)abstract
- Background: The number of notified cases of Tick-Borne Encephalitis (TBE) in Sweden has been increasing the past years despite the increased use of TBE-vaccine not subsidized by the healthcare system. Stockholm County is a high endemic area and an earlier study has shown that low-income households have lower vaccination coverage even when they are at high risk. This paper aims to determine the cost-effectiveness of a publicly funded TBE vaccination program in Stockholm. Methods: In three different cohorts with individuals aged 3, 40 or 50 years, long-term costs and health outcomes of an out-of-pocket strategy (53% of the cohort is vaccinated on their own expenses) and a structured vaccination program (full cohort is vaccinated covered by the publicly funded health care system), were estimated using a Markov model. The Markov model predicts the costs and effects in term of Quality-adjusted Life Years (QALYs) over a lifetime horizon using a third-party healthcare payer perspective. The primary results are presented as an incremental cost effectiveness ratio (ICER) indicating the additional cost required to achieve one additional QALY with the structured vaccination program. Results: The results show that the structured vaccination program is associated with a gain in QALYs and increased costs compared with an out-of-pocket strategy. The calculated ICERs were 27 761, 99 527 and 160 827 SEK/QALY in cohorts of age 3, 40 and 50, respectively. The sensitivity analyses showed that the results are robust when varying different parameters. Conclusion: Given the setting of Stockholm county, this analysis shows a cost per QALY of a free vaccinations program, especially for children of 3 years old, below generally acceptable cost-effectiveness thresholds in Sweden.
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| 4. |
- Shedrawy, Jad, et al.
(author)
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The burden of disease due to COVID-19 in Sweden 2020–2021: A disability-adjusted life years (DALYs) study
- 2023
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 51:5, s. 673-81
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Journal article (peer-reviewed)abstract
- Background: The burden of COVID-19 disease can be measured in terms of disability-adjusted life years (DALYs), which is composed of two components: the years of life lost through premature death (YLL) and the number of years lived with disability (YLD), adjusted for level of disability. This study measured DALYs due to COVID-19 in Sweden and compared it to the burden of other diseases. Methods: The methodology used in the calculation of DALYs was based on the Global Burden of Disease guidelines. The number of patients diagnosed with mild/moderate, severe or critical COVID-19 and/or post-COVID-19 condition between March 2020 and October 2021 was extracted from national registries and used for YLD calculations. In addition, the numbers of death due to COVID-19 in different age groups were used for the YLL calculation. Results: During the study period, 152,877 DALYs were lost to COVID-19 in Sweden, 99.3% of which was attributed to YLL. Loss of DALYs occurred mainly among the elderly, with 66.8% of DALYs attributed to individuals >70 years old. Compared to other diseases, the burden of COVID-19 in 2020 ranked as the eighth leading cause of DALY lost. Conclusions: Similar to other countries, the burden of COVID-19 in Sweden was concentrated mainly among the elderly, who contributed most of the DALY lost due to premature mortality. Yet, DALY loss remained lower for COVID-19 than for several other diseases. The contribution of YLD to DALYs lost was minimal. However empirical data on the occurrence and disability of post-COVID-19 condition are scarce, and YLD may therefore be underestimated.
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