| 1. |
- Murley, Chantelle, et al.
(författare)
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Excess costs of multiple sclerosis : a register-based study in Sweden
- 2023
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Ingår i: European Journal of Health Economics. - : Springer. - 1618-7598 .- 1618-7601. ; 24, s. 1357-1371
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Population-based estimates of the socioeconomic burden of multiple sclerosis (MS) are limited, especially regarding primary healthcare. This study aimed to estimate the excess costs of people with MS that could be attributed to their MS, including primary healthcare.Methods: An observational study was conducted of the 2806 working-aged people with MS in Stockholm, Sweden and 28,060 propensity score matched references without MS. Register-based resource use was quantified for 2018. Annual healthcare costs (primary, specialised outpatient, and inpatient healthcare visits along with prescribed drugs) and productivity losses (operationalised by sickness absence and disability pension days) were quantified using bottom-up costing. The costs of people with MS were compared with those of the references using independent t-tests with bootstrapped 95% confidence intervals (CIs) to isolate the excess costs of MS from the mean difference.Results: The mean annual excess costs of MS for healthcare were €7381 (95% CI 6991–7816) per person with MS with disease-modifying therapies as the largest component (€4262, 95% CI 4026–4497). There was a mean annual excess cost for primary healthcare of €695 (95% CI 585–832) per person with MS, comprising 9.4% of the excess healthcare costs of MS. The mean annual excess costs of MS for productivity losses were €13,173 (95% CI 12,325–14,019) per person with MS, predominately from disability pension (79.3%).Conclusions: The socioeconomic burden of MS in Sweden from healthcare consumption and productivity losses was quantified, updating knowledge on the cost structure of the substantial excess costs of MS.
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| 2. |
- Teni, Fitsum Sebsibe
(författare)
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Activity restrictions, treatment and work disability among people with multiple sclerosis
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Multiple sclerosis (MS) is a disease that commonly occurs among individuals of working age. Its symptoms are heterogeneous and affect people with MS (PwMS) considerably in different aspects of their lives. Disease-modifying therapies (DMTs) have helped a lot in the improvement of health and work productivity. However, studies on the impact of MS in different facets of life as well as the long-term DMT use trends in relation to corresponding changes in work disability measures such as sickness absence and/or disability pension (SADP) as well as work ability are lacking. So, the present thesis aimed at increasing knowledge on activity restrictions, trends in disease-modifying therapy use, and associated work disability among PwMS in Sweden. Methods: In studies I and IV, data were collected in a cross-sectional survey among PwMS in Sweden in 2021. Among them, 4052 who responded to the questions on restrictions on the four domains of work, family, leisure activities, and contact with friends/acquaintances were included in the analysis. In study II, 1923 PwMS with MS onset during 2007-2010 were included in a longitudinal register-based study to assess the DMT use trajectories over 10 years and the associated trends in SADP days for over 11 years. A similar study was conducted in study III among 1395 PwMS with DMT start/decision time of 2014/2015 assessing DMT use trajectories for 5 years and the associated SADP days for 7 years (from two years before treatment start). In study IV, utilizing the same survey material as study I, a total of 4103 PwMS were included in the study of how DMT use and work ability are associated as well as the role of other factors. For the analyses, in study I, multinomial logistic regression analysis was performed to assess predictors of reporting restrictions in the work and private life domains. In study II and III, sequence analysis was used to describe the sequences of DMT use over the follow-up time and to identify clusters of DMT use. The factors associated with cluster belonging were assessed using multinomial regression analyses conducted in each study. In assessing the trends in SADP by cluster, generalized estimating equations (GEE) were used in study II while zero-inflated negative binomial regression analysis was conducted in study III. In study IV, linear regression analyses were conducted to assess the association between DMT use and work ability score (WAS) and the role of additional socio-demographic, clinical, and self-reported health variables. Results: About two-thirds of the 4052 PwMS in study I reported some form of restriction in the work (64.3%), family (61.3%), leisure activities (68.9%), and contact with friends/acquaintances (59.7%) domains. Tiredness/fatigue was the most-limiting symptom in half (49.5%) of the PwMS. Neurologically normal PwMS (expanded disability status scale (EDSS) score of zero) still reported restrictions in the four life domains ranging from 39.6% (friends/acquaintances) to 45.7% (leisure activities). Overall, older PwMS, women, those with lower levels of education, people with progressive forms of MS, with invisible limiting symptoms and higher EDSS scores had higher odds of restrictions in the work and private life domains. In study II, four clusters of DMT use trajectories were identified: long-term non-high-efficacy DMTs (38.6%), escalation to high-efficacy DMTs (31.2%), delayed start and escalation to high-efficacy DMTs (15.4%), and discontinued/ no DMT (14.2%). Younger ages, higher EDSS scores, progressive MS, and higher frequency of DMT switch were generally associated with being in clusters other than long-term-non-high-efficacy. The trends in SADP showed fewer mean SADP days among PwMS in the long-term non-high-efficacy DMT cluster than in the others about 9 years after MS onset. The GEE models on SADP trends showed comparable findings to the descriptive statistics. Similarly, in study III among 1395 PwMS also four clusters of DMT use trajectories were identified. These include long-term non-high-efficacy DMTs (34.6%), long-term high-efficacy DMTs (41%), escalation to high-efficacy DMTs (15.8%), and discontinued/no DMTs (8.5%) clusters. Progressive MS and higher EDSS scores were associated with the clusters other than the long-term non-high-efficacy one. Individuals in the long-term high-efficacy DMTs cluster had a higher likelihood of being on SADP. However, starting high-efficacy DMTs showed a larger decline in SADP days than other clusters. In study IV, among the 4103 PwMS, just over half reported good (37.0%) or excellent (16.3%) WAS. The association of DMT use and WAS showed that PwMS on non-high-efficacy DMTs had higher WAS than those on high-efficacy and those not on DMTs but explaining only 1.24% of the variation in WAS. Occupation, EDSS score, fatigue, and health-related quality of life (HRQoL) explained high proportions of the variance in WAS. Conclusions: The thesis showed that PwMS experience substantial levels of restrictions to their work and private lives, which were often associated with symptoms such as fatigue. Restrictions were also experienced among PwMS considered neurologically normal. The thesis also described long-term trajectories of DMT use and associated SADP days in two studies with different cohorts, showing the recent trend toward initiation of high-efficacy DMTs becoming more common. Trends of SADP days across clusters were stable and lower in the long-term non-high-efficacy DMTs cluster. Higher work ability was noted among PwMS on non-high-efficacy DMTs despite very low explanatory power. The important roles of occupation, disability, fatigue, and HRQoL were also observed.
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| 3. |
- Teni, Fitsum Sebsibe
(författare)
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Health-related quality of life of different patient groups in Swedish national quality registers : longitudinal studies of EQ-5D data and application of different value sets
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: EQ-5D data on patients’ health-related quality of life (HRQoL) are collected in roughly 40% of about 100 National Quality Registers (NQRs) in Sweden. The aim of the thesis was to increase knowledge on the use of the EQ-5D-3L in assessing HRQoL of patients in different NQRs and to compare different value sets used to describe HRQoL. Methods: In Study I, data on patients from 11 NQRs with spine surgery, hip arthroplasty, knee arthroplasty, ankle surgery, anterior cruciate ligament, osteoarthritis, fractures, heart failure, respiratory failure, psoriasis, and rheumatology were included. A total of 266,241 patients from the NQRs and 49,169 members of the general population were included. In Study II, 69,290 patients in the Swedish Hip Arthroplasty Register at baseline and 1-year follow-up, and 21,305 patients at 6-year follow-up were included. Data on demographic and clinical characteristics and EQ-5D-3L data were retrieved in both studies. In Study I, descriptive analyses, Paretian Classification of Health Change (PCHC) and a two-level random intercept model of the impact of diagnoses on EQ VAS scores were performed. EQ-5D-3L indices were calculated using eight value sets from Sweden, Germany, Denmark, and the UK. One-way analysis of variance was used to assess the discriminative ability of the value sets across American Society of Anaesthesiologists (ASA) classes. Results: In Study I, the pain/discomfort dimension was the dimension with the highest proportion of problems reported both in most registers and in the general population. The highest proportion of improved category of PCHC were reported by patients from the ankle, hip, knee, and spine registers. The two-level random intercept models of EQ VAS score, as predicted by diagnoses, showed patients in most registers, with the exception of fractures, had lower scores than the general population at baseline and at 1-year follow-up. In Study II, all value sets were able to discriminate HRQoL among the ASA classes, and showed the predictive ability of ASA classes on HRQoL. Conclusion: Both studies demonstrated the importance of the EQ-5D-3L instrument in providing HRQoL data to complement clinical data. The studies documented HRQoL of different patient groups and demonstrated the consistency of the EQ-5D-3L dimensions and the EQ VAS score. All the value sets used to summarize EQ-5D-3L data showed that ASA classes predicted HRQoL and demonstrated ability to differentiate across ASA classes.
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| 4. |
- Teni, Fitsum Sebsibe, et al.
(författare)
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Inequality and heterogeneity in health-related quality of life : findings based on a large sample of cross-sectional EQ-5D-5L data from the Swedish general population
- 2022
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Ingår i: Quality of Life Research. - : Springer. - 0962-9343 .- 1573-2649. ; 31:3, s. 697-712
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to investigate inequality and heterogeneity in health-related quality of life (HRQoL) and to provide EQ-5D-5L population reference data for Sweden.Methods: Based on a large Swedish population-based survey, 25,867 respondents aged 30‒104 years, HRQoL is described by sex, age, education, income, economic activity, health-related behaviours, self-reported diseases and conditions. Results are presented by EQ-5D-5L dimensions, respondents rating of their overall health on the EQ visual analogue scale (EQ VAS), VAS index value and TTO (time trade-off) index value allowing for calculation of quality-adjusted life years (QALYs). Ordinary Least Squares and multivariable logistic regression analyses were used to study inequalities in observed EQ VAS score between socioeconomic groups and the likelihood to report problems on the dimensions, respectively, adjusted for confounders.Results: In total, 896 different health states were reported; 24.1% did not report any problems. Most problems were reported with pain/discomfort. Women reported worse HRQoL than men, and health deteriorated with age. The strongest association between diseases and conditions and EQ VAS score was seen for depression and mental health problems. There was a socioeconomic gradient in HRQoL; adjusting for health-related behaviours, diseases and conditions slightly reduced the differences between educational groups and income groups, but socioeconomic inequalities largely remained.Conclusion: EQ-5D-5L population reference (norms) data are now available for Sweden, including socioeconomic differentials. Results may be used for comparisons with disease-specific populations and in health economic evaluations. The observed socioeconomic inequality in HRQoL should be of great importance for policy makers concerned with equity aspects.
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| 5. |
- Teni, Fitsum Sebsibe, et al.
(författare)
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Longitudinal study of patients' health-related quality of life using EQ-5D-3L in 11 Swedish National Quality Registers
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare problems reported in the five EQ-5D-3L dimensions and EQ VAS scores at baseline and at 1-year follow-up among different patient groups and specific diagnoses in 11 National Quality Registers (NQRs) and to compare these with the general population.DESIGN: Longitudinal, descriptive study.PARTICIPANTS: 2 66 241 patients from 11 NQRs and 49 169 participants from the general population were included in the study.PRIMARY AND SECONDARY OUTCOME MEASURES: Proportions of problems reported in the five EQ-5D-3L dimensions, EQ VAS scores of participants' own health and proportions of participants and mean/median EQ VAS score in the Paretian Classification of Health Change (PCHC) categories.RESULTS: In most of the included registers, and the general population, problems with pain/discomfort were the most frequently reported at baseline and at 1-year follow-up. Mean EQ VAS score (SD) ranged from 45.2 (22.4) among disc hernia patients to 88.1 (15.3) in wrist and hand fracture patients at baseline. They ranged from 48.9 (20.9) in pulmonary fibrosis patients to 83.3 (17.4) in wrist and hand fracture patients at follow-up. The improved category of PCHC, improvement in at least one dimension without deterioration in any other, accounted for the highest proportion in several diagnoses, corresponding with highest improvement in mean EQ VAS score.CONCLUSIONS: The study documented self-reported health of several different patient groups using the EQ-5D-3L in comparing with the general population. This demonstrated the important role of patient-reported outcomes in routine clinical care, to assess and follow-up health status and progress within different groups of patients. The EQ-5D-3L descriptive system and EQ VAS have an important role in providing a 'common denominator', allowing comparisons across NQRs and specific diagnoses.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04359628).
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| 6. |
- Teni, Fitsum Sebsibe, et al.
(författare)
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Recent trends in disease-modifying therapy use and associated sickness absence and disability pension among people with multiple sclerosis in Sweden
- 2024
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Ingår i: Multiple Sclerosis Journal. - 1352-4585 .- 1477-0970. ; 30:3, s. 419-431
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Tidskriftsartikel (refereegranskat)abstract
- Background: Disease-modifying therapies (DMTs) have led to improved health and work productivity among people with multiple sclerosis (PwMS). Objectives: To describe trajectories of recent DMT use and their association with sickness absence and/or disability pension (SADP) among PwMS in Sweden. Methods: A longitudinal register-based study was conducted among 1395 PwMS with treatment start in 2014/2015. While DMT use over 5 years was assessed using sequence analysis resulting in four clusters, a 7-year (Y-2 toY(4)) trend of SADP was analyzed using zero-inflated negative binomial regression. Results: Four clusters of DMT use trajectories were identified: long-term non-high-efficacy (483, 34.6%), long-term high-efficacy (572, 41%), escalation (221, 15.8%), and discontinuation (119, 8.5%). Progressive MS and higher expanded disability status scale scores were associated with the escalation, long-term high-efficacy, or discontinuation clusters. PwMS in the long-term high-efficacy and escalation clusters had higher likelihood of being on SADP. However, PwMS initiating high-efficacy DMTs demonstrated steeper decline in SADP than others. Conclusion: Using sequence analysis, this study showed recent DMT use trajectories among PwMS where initiation of high-efficacy DMTs has become more common. The trend of SADP was stable and lower in those using non-high-efficacy DMTs and larger improvements were shown in those initiating high-efficacy DMTs.
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| 7. |
- Teni, Fitsum Sebsibe, et al.
(författare)
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Self-reported restrictions in different life domains and associated factors among people with multiple sclerosis in Sweden
- 2023
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 30:7, s. 1843-1853
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: The heterogeneous symptoms of multiple sclerosis (MS) can considerably impact the lives of people with MS (PwMS). The aim of this study was to describe the extent of restrictions in different life domains that PwMS experience in relation to their symptoms and level of disability. Methods: A cross-sectional survey was conducted among working-age PwMS in Sweden. The 4052 participants who answered the questions on restrictions in work and private life domains (family, leisure activities, and contact with friends/acquaintances) were included. Predictors of restrictions in the four domains were determined through multinomial logistic regression. Results: Approximately one-third of the PwMS reported no restrictions in the domains of work (35.7%), family (38.7%), leisure activities (31.1%) or contact with friends/acquaintances (40.3%), the remaining participants reported moderate to severe restrictions. Tiredness/fatigue was the most commonly reported most-limiting symptom (49.5%). PwMS with Expanded Disability Status Scale (EDSS) scores of zero reported restrictions in life domains ranging from 39.6% (friends/acquaintances) to 45.7% (leisure activities). Age, sex, education, type of living area, MS type, type of most-limiting symptom, and EDSS score predicted restrictions in work and private life domains. Conclusions: Most PwMS reported similar levels of restrictions in both their work and private lives. Restrictions in these life domains were also reported by PwMS with low disability levels (EDSS = 0) and were often associated with invisible symptoms such as fatigue. Even in a contemporary MS cohort, close to 90% of PwMS report limitations due to MS.
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