| 1. |
- Andersson, Klara, et al.
(författare)
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Socioeconomic outcome and access to care in adults with epilepsy in Sweden: A nationwide cohort study.
- 2020
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Ingår i: Seizure. - : Elsevier BV. - 1532-2688 .- 1059-1311. ; 74, s. 71-76
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Tidskriftsartikel (refereegranskat)abstract
- Epilepsy has well-documented associations with low income and low education levels, but the impact of a patient's socioeconomic standing (SES) on the effects of epilepsy have been less studied.We performed a register-based cross-sectional study and asked if SES was associated with more severe epilepsy or limited access to care in Sweden, where health care is universal, and if socioeconomic outcomes (employment and income) differed for persons with epilepsy (PWE) with different levels of educational attainment. The study cohort consisted of all adult patients with an epilepsy diagnosis in the Swedish patient register in 2000-2015 (n = 126,406) and controls (n = 379,131) matched for age, gender, and place of birth.Somatic and psychiatric comorbidities were more common in PWE, while education and income levels were lower. Among PWE, hospitalizations were more common in persons with lower income or education. Having at least one prescription written by a neurologist in the study period was more common in the high-income and high-education groups. Finally, although low educational attainment was associated with low levels of income and inversely associated with employment in both persons with epilepsy and controls, regression analyses demonstrated that these associations were much more noticeable in cases than controls.We conclude that both the severity and consequences of epilepsy are greater in persons of low SES, even in a country with universal health care. This indicates that universal access may not be sufficient to mitigate socioeconomic inequity in epilepsy.
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| 2. |
- Andersson, Klara, et al.
(författare)
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Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010-2015
- 2021
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:4, s. 383-388
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Tidskriftsartikel (refereegranskat)abstract
- Objective We investigated the correlation between socioeconomic status and the prescription of Valproic acid (VPA) in women of fertile age in Sweden. Methods This is a registered-based cohort study including all women living in Sweden aged 18-45 years in the years 2010-2015, with a diagnosis of epilepsy and no intellectual disability (n = 9143). Data were collected from the National Patient Register, the Drug Prescription Register, and the Longitudinal integration database for health insurance and labor market studies (LISA). Results Women with only 9 years of school were more often prescribed VPA than women with a University degree (12.9% compared to 10.7% in 2015 [p = 0.015]). Similar differences were seen between the lowest and highest income group (16.6% compared to 12.7% in 2015 [p < 0.001]). The odds of having a VPA prescription in 2015 was 1.59 (p < 0.001) in women with 9 years of school compared to women with a University degree, and 1.60 (p < 0.001) in the lowest income group relative to the highest income group after adjusting for age. From 2010 to 2015, the proportion with VPA prescription in the whole cohort diminished with an absolute reduction of -2.2% (p < 0.001). The decrease was similar among the different education and income groups (p = 0.919 and p = 0.280). Significance The results indicate that the increased knowledge on VPA teratogenicity was implemented across socioeconomic strata in the Swedish healthcare system. Women with lower income or education level remained more frequent VPA users. Whether this difference reflects epilepsy type or severity, or socioeconomic disparities, merit further study.
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| 3. |
- Barbieri, Paolo Nicola, et al.
(författare)
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Digitalizing and collecting health data in Sweden
- 2018
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Ingår i: Pharmaceuticals Policy and Law. - 1389-2827. ; 19:3-4, s. 235-245
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Tidskriftsartikel (refereegranskat)abstract
- The use of information technology (IT) in health care has the potential to facilitate care over distance in almost any clinical specialties, reducing time to diagnosis, improve equity of access for patients in remote areas, and improve quality of life and patient satisfaction. In particular, electronic health records (EHRs) offer the possibility of accessing fast and updated patients' information. With the potential of making easier for individuals to be more concern in their own health and care, by increasing contact between individuals and health care providers; but also by providing more efficient support systems for medical staff. In this paper, we present the Swedish current experience and future development in the use of EHRs, in order draw upon such example to apply this methodology for data sharing and collection in other European countries. © 2017 – Network of Centres for Study of Pharmaceutical Law. All rights reserved.
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| 4. |
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| 5. |
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| 6. |
- Bolin, Kristian, et al.
(författare)
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A Dual Approach to the Derivation of Feedback Demand Functions for Capital-Accumulating Agents
- 2024
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- An optimal control model of a consumer is developed that accounts for the consumption of many goods and services, the accumulation of wealth, a state variable that affects instantaneous preferences and wealth accumulation, and contains several canonical models as special cases. Formulas are provided for the feedback consumption functions in terms of certain partial derivatives of a consumer’s lifetime indirect utility function, thereby obviating the need to solve the necessary conditions of Pontryagin or the Hamilton-Jacobi-Bellman equation. The intrinsic qualitative properties of the optimal control model in differential form are derived, and an example of how to implement the results for econometric purposes is provided as well.
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| 7. |
- Bolin, Kristian
(författare)
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An Economic Analysis of Marriage and Divorce
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The first chapter develops a theoretical model of marriage and divorce. The model has two periods and assumes Pareto efficient time allocations. There is a risk of divorce in the second period, which is modeled as exogenously given. The second chapter utilizes the model developed in the previous chapter to analyze the equality between married men and women. Equality is defined as the spouses' relative weights in the objective function of the family. The weights are decided by pre-marriage Nash bargaining. One result is that better career opportunities imply that the family objective function puts more weight on that spouse's preferences. The third chapter also makes use of the model developed in the first chapter. In this chapter the divorce rule, i.e., the rule according to which the economic consequences of divorce are governed, is analyzed. The main result is that the presence of children at divorce - something which preserves the connection between the spouses' preferences - affects the optimal divorce rule. In the absence of children it is not optimal to combine a division of joint property with alimony or child support. In the presence of children it might be optimal to have a rule which says that joint property shall be divided between the spouses and that one spouse shall pay spousal support or child support to the other spouse. The fourth chapter relaxes the assumption that all decisions may be subject to binding agreements between the spouses. Taking the time allocations as individually decided we analyze the rationale for spousal support. We find similarities between spousal support that induces efficient marital behavior and what would be given by the theory of breach of contract if divorce is regarded as breach by one party. In the fifth chapter we continue the approach from the previous chapter, but we assume that the husband dominates, i.e., that he has a first mover advantage in the process which settles the time allocations. We argue that comparative advantages do not constitute a comprehensive explanation for the division of market and household labor between the spouses, but that also the timing of decisions is important. The sixth chapter recognizes that the parents' altruism towards their children has effects on the time allocations. Using the same type of model as in the two previous chapters we show that relative parental altruism may be another explanation for the division of the spouses' time between market and non-market activities. The seventh chapter examines the risk of divorce empirically, using Swedish data. The results are rather surprising as they do not unambiguously support what can be regarded as the prevailing theoretical and empirical knowledge regarding marital stability. For example, we conclude that the female earning capacity of women is not destabilizing the marrige. On the contrary our findings seem to point in the opposite direction. As expected we find that children are stabilizing the marriage, which is in Iine with the conventional wisdom. We also examine the effects of the spouses' time allocations and education levels on marital stability. We find that the time which the wife does not allocate to the market is more important for the marital stability than the time which the husband does not allocate to the market. As regards education only the effect of the husband's education seems to be important. The husband's education level is positively related to the stability of marriage. Rather surprisingly we find that pre-marriage cohabitation seems to be destabilizing for marriage.
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| 8. |
- Bolin, Kristian, et al.
(författare)
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Asthma and allergy: the significance of chronic conditions for individual health behaviour.
- 2002
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Ingår i: Allergy. - : Wiley. - 1398-9995 .- 0105-4538. ; 57:2, s. 115-122
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In health economics, health is regarded as part of an individual's human capital. As such it depreciates over time, and investments in health are made in order to keep the stock of health capital at the desired level. Using this framework for analysis of health-related behaviour and Swedish panel data, we examined whether the presence of asthma or allergy affects perceived health and investments in health. METHODS: A set of panel data for approximately 3800 individuals interviewed repeatedly in 1980/81, 1988/89, and 1996/97 was created from the Swedish biannual survey of living conditions. Self-assessed health was chosen as the indicator of health capital and the reported number of sick days as the indicator of health investment. The presence of asthma or allergy, age, wage rate, wealth, marital status, number of children, exercise and smoking habits, gender, and geographic location of household were all chosen as explanatory variables. An ordered probit model was estimated for the health equation and a Poisson model for the investment equation. RESULTS: We found that both asthmatics and those who suffer from allergy invested more in their health than the general population. We also found that asthmatics reported significantly lower self-assessed health than the general population, while those who suffered from allergy did not differ significantly from the general population regarding their self-assessed health. CONCLUSION: The human capital approach was found suitable for studying the impact of asthma and allergy on individual health behaviour. Health policy measures, which reduce the individual's costs of investing in his or her health, would improve health levels. Because asthmatics were found less healthy than those suffering from allergy, the potential gains would be larger for patients with asthma than for patients with allergy. The issue of whether this would be a cost-effective policy or not would require a different design and, hence, could not be solved within the present study.
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| 9. |
- Bolin, Kristian, et al.
(författare)
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CAPABILITY, HEALTH, AND THE LABOUR MARKET – THE RETIREMENT DECISION
- 2021
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The time of retirement is analyzed in a theoretical framework taking capability and health into account. Capability if formalized as a stock characteristic which determines the attained amounts of a composite good which yields utility. The model is purposely simple and comprises one choice variable – the time of retirement. The core assumption is that inherited capability influences the rate of evolvement of health, and vice versa, and that the rates of change of the stocks differ between the pre- and post-retirement periods. The optimal retirement timing decision is characterized and the effects of the model’s exogenous variables on this decision are examined. We derive refutable comparative statistics results with respect to the model’s exogenous variables, and, for example, show – for a specified version of the model – how the timing of retirement depends on the inherited amounts of capability and health.
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| 10. |
- Bolin, Kristian, et al.
(författare)
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Changes in the health status of the population
- 2008
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Ingår i: Simulating An Ageing Population. A Microsimulation Approach Applied to Sweden. (Contributions to Economic Analysis). ; , s. 85-114
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 11. |
- Bolin, Kristian, et al.
(författare)
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Characteristics of finasteride users in comparison with non-users: a Nordic nationwide study based on individual-level data from Denmark, Finland, and Sweden
- 2020
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Ingår i: Pharmacoepidemiology and Drug Safety. - : Wiley. - 1053-8569 .- 1099-1557. ; 29:4, s. 453-460
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Published epidemiological studies on the association between finasterideuse and the risk of male breast cancer have been inconclusive due to methodologicallimitations including a few male breast cancer cases included. Determinants of malebreast cancer have been studied, but it remains unexplored whether these are alsorelated to finasteride use and thereby constitute potential confounders. This studyaimed to assess whether there are differences between finasteride users andnonusers with regard to numerous potential confounders.Methods: In total, 246 508 finasteride users (≥35 years) were identified in the pre-scription registries of Denmark (1995-2014), Finland (1997-2013), and Sweden(2005-2014). An equal number of nonusers were sampled. The directed acyclic graph(DAG) methodology was used to identify potential confounders for the associationbetween finasteride and male breast cancer. A logistic regression model comparedfinasteride users and nonusers with regard to potential confounders that were mea-surable in registries and population surveys.Results: Finasteride users had higher odds of testicular abnormalities (odds ratio[OR] 1.40; 95% confidence interval [CI] 1.36-1.44), obesity (1.31; 1.23-1.39), exoge-nous testosterone (1.61; 1.48-1.74), radiation exposure (1.22; 1.18-1.27), and diabe-tes (1.07; 1.04-1.10) and lower odds of occupational exposure in perfume industry orin high temperature environments (0.93; 0.87-0.99), living alone (0.89; 0.88-0.91), liv-ing in urban/suburban areas (0.97; 0.95-0.99), and physical inactivity (0.70;0.50-0.99) compared to nonusers.Conclusions: Systematic differences between finasteride users and nonusers werefound emphasizing the importance of confounder adjustment of associationsbetween finasteride and male breast cancer.
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| 12. |
- Bolin, Kristian, et al.
(författare)
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Child Human Capital – The Importance of Parenting Style
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Investments in the human capital of children during their upbringing determine the opportunities available in adulthood. Recognizing that the parent-child interaction plays a significant role in the accumulation of child human capital, we develop a differential game in which the parent may invest directly in child human capital and the child consumes goods that influence the accumulation of their human capital. We compare the accumulation of child human capital between three different parenting styles, formalized as three different solution concepts to the differential game: (i) the parent and the child maximizes a joint utility function (cooperative solution), (ii) the parent announces a strategy dependent on time only (open-loop Stackelberg), (iii) the parent’s strategy depends on the accrued amount of human capital (feedback Stackelberg). We show that under rather general assumptions the open-loop Stackelberg equilibrium is time consistent, and coincides with a feedback Stackelberg equilibrium. Using cooperative parenting as a benchmark, we find that less or more child human capital may be accumulated over the family’s planning horizon under “open-loop Stackelberg” parenting, depending on parental and child preferences for human capital and wealth at the terminal time of the family’s planning horizon, and on the extent to which child consumption influences the accumulation of their human capital. In particular, if the child’s preference for terminal time wealth is strong enough, more human capital will be accumulated under “open-loop Stackelberg” parenting.
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| 13. |
- Bolin, Kristian, et al.
(författare)
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Consumption and Investment Demand when Health Evolves Stochastically
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The health capital model of Grossman (1972) is extended to account for uncertainty in the rate at which a stock of health depreciates. Two versions of the model are contemplated, one with a fully functioning financial market and the other in its absence. The comparative dynamics of the consumption and health-investment demand functions are studied in both models in a general setting, where it is shown that the key to deriving refutable results is to determine how a parameter or state variable affects the lifetime marginal utilities of health and wealth. To add further bite to the results, a stochastic control problem is solved for its feedback consumption and health-investment demand functions, thereby yielding estimable structural demand functions.
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| 14. |
- Bolin, Kristian, et al.
(författare)
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Consumption and Investment Demand when Health Evolves Stochastically
- 2020
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Ingår i: Journal of Economic Dynamics and Control. - : Elsevier BV. - 0165-1889. ; 114
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Tidskriftsartikel (refereegranskat)abstract
- The health capital model of Grossman (1972) is extended to account for uncertainty in the rate at which a stock of health depreciates. Two general versions of the model are contemplated, one with a fully functioning financial market and the other in its absence. The comparative dynamics of the feedback form of the consumption and health-investment demand functions are studied in these general settings, where it is shown that the key to deriving refutable results is to determine how a parameter or state variable affects the expected lifetime marginal utilities of health and wealth. To add further reach to the results, a simplified stochastic control problem is explicitly solved, yielding estimable structural feedback demand functions.
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| 15. |
- Bolin, Kristian, et al.
(författare)
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Cost-effectiveness of varenicline compared with nicotine patches for smoking cessation--results from four European countries.
- 2009
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 19:6, s. 650-654
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of this study was to evaluate and compare the cost-effectiveness of varenicline with nicotine replacement therapy (NRT) for smoking cessation in four European countries (Belgium, France, Sweden and the UK). METHODS: Markov simulations, using the Benefits of Smoking Cessation on Outcomes (BENESCO) model, were performed. We simulated the incidence of four smoking-related morbidities: lung cancer, chronic obstructive pulmonary disease, coronary heart disease and stroke. The model computes quality-adjusted life-years gained and incremental cost-effectiveness ratios. Incremental cost-utility ratios were calculated, adopting a lifetime perspective. Efficacy data were obtained from a randomized open-label trial: Week 52 continuous abstinence rates were 26.1% for varenicline and 20.3% for NRT. RESULTS: The analyses imply that for countries analysed, smoking cessation using varenicline versus NRT was associated with reduced smoking-related morbidity and mortality. The number of morbidities avoided, per 1000 smokers attempting to quit, ranged from 9.7 in Belgium to 6.5 in the UK. The number of quality-adjusted life-years gained, per 1000 smokers, was 23 (Belgium); 19.5 (France); 29.9 (Sweden); and 23.7 (UK). In all base-case simulations (except France), varenicline dominated (more effective and cost saving) NRT regarding costs per quality-adjusted life-year gained; for France the incremental cost-effectiveness ratio was 2803. CONCLUSION: This cost-effectiveness analysis demonstrated that since varenicline treatment was more effective, the result was increased healthcare cost savings in Belgium, Sweden and the UK. Our results suggest that funding varenicline as a smoking cessation aid is justifiable from a healthcare resource allocation perspective.
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| 16. |
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| 17. |
- Bolin, Kristian, et al.
(författare)
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Diabetes, healthcare cost and loss of productivity in Sweden 1987 and 2005-a register-based approach
- 2009
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Ingår i: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 26:9, s. 928-934
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Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to estimate healthcare cost and productivity losses as a result of diabetes and diabetes-related chronic complications in Sweden in 1987 and 2005. Research design and methods Published estimates on relative risks and Swedish age-specific diabetes-prevalence rates were used to calculate the proportions of diabetes-related chronic complications that are attributable to diabetes. These attributable risks were applied to cost estimates for diabetes-related chronic complications based on data from Swedish population registers. Results The estimated total costs for Sweden in 1987 and 2005 were EUR439m and EUR920m, respectively. The increase of 110% was as a result of a 69% increase in the estimated prevalence from 150 000 (1.8% of the population) to 254 000 (2.8%) and of an increase in the estimated annual cost per person diagnosed with diabetes by 24%. Healthcare accounted for 45% of the estimated cost in 1987 and for 37% in 2005. The estimated diabetes-related healthcare cost accounted for approximately 1.0% of total healthcare cost in Sweden in 1987 and for 1.4% in 2005. Diabetes per se accounted for 57% of the healthcare cost in 1987 and for 50% in 2005. The most important chronic complication was cardiovascular disease. Conclusions The cost of diabetes is substantial and increasing even in a fairly low-prevalence country such as Sweden. Measures to curb the increase in prevalence and to improve individual control of his or her diabetes seem to be the most important challenges.
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| 18. |
- Bolin, Kristian, et al.
(författare)
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Early retirement
- 2008
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Ingår i: Simulating An Ageing Population. A Microsimulation Approach Applied to Sweden. (Contributions to Economic Analysis). ; , s. 143-199
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 19. |
- Bolin, Kristian
(författare)
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Economic Evaluation of Smoking-Cessation Therapies: A Critical and Systematic Review of Simulation Models.
- 2012
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 30:7, s. 551-564
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Forskningsöversikt (refereegranskat)abstract
- Background: Smoking is probably the most important among preventable health risks. Health economic evaluation of smoking-cessation interventions, applying a lifetime perspective, is made possible by available epidemiological knowledge. The well established method of performing cost-effectiveness analyses of smoking-cessation interventions involves mathematical modelling (both deterministic and stochastic) of future events important for cost effectiveness. Objectives: This study surveys cost-effectiveness analyses of smoking cessation, with a particular focus on the mathematical modelling and simulation analyses performed. Data Sources: A systematic literature search was performed using the databases MEDLINE, Econlit and Academic Search Complete. Study Selection: Health economic evaluations, published as full-length journal articles, were searched for. Results: 423 studies were identified and 78 were finally included, of which 30 were assessed as being highly relevant, based on the application of simulation modelling. Conclusions: In general, studies are well performed as regards modelling. Common weaknesses include reporting of modelling details; validation of used simulation models; and the handling of structural uncertainty and different types of heterogeneity.
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| 20. |
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| 21. |
- Bolin, Kristian, et al.
(författare)
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Employer investments in employee health - Implications for the family as health producer
- 2002
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Ingår i: Journal of Health Economics. - 1879-1646. ; 21:4, s. 563-583
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Tidskriftsartikel (refereegranskat)abstract
- The model presented in this paper further extends the demand-for-health model in which the family is the producer of health investments, to consider the case in which an employer has incentives for investing in the health of a family member. The household and the employer are assumed to interact strategically in the production of health. The general insight provided is that the conditions which determine the nature of the relationship between the employer and the employee, for instance market conditions, production technologies, taxes, and government regulation, will also affect the allocation of health investments and health capital within the family. (C) 2002 Elsevier Science B.V. All rights reserved.
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| 22. |
- Bolin, Kristian, et al.
(författare)
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Epilepsy in Sweden: health care costs and loss of productivity-a register-based approach.
- 2012
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Ingår i: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598. ; 13:6, s. 819-826
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The objective was to estimate health care costs and productivity losses due to epilepsy in Sweden and to compare these estimates to previously published estimates. METHODS: Register data on health care utilisation, pharmaceutical sales, permanent disability and mortality were used to calculate health care costs and costs that accrue due to productivity losses. By linkage of register information, we were able to distinguish pharmaceuticals prescribed against epilepsy from prescriptions that were prompted by other indications. RESULTS: The estimated total cost of epilepsy in Sweden in 2009 was 441 million, which corresponds to an annual per-patient cost of 8,275. Health care accounted for about 16% of the estimated total cost, and drug costs accounted for about 7% of the total cost. The estimated health care cost corresponded to about 0.2% of the total health care cost in Sweden in 2009. Indirect costs were estimated at 370 million, 84% of which was due to sickness absenteeism. Costs resulting from epilepsy-attributable premature deaths or permanent disability to work accounted for about 1% of the total indirect cost in Sweden in 2009. DISCUSSION: The per-patient cost of epilepsy is substantial. Thus, even though the prevalence of the illness is relatively small, the aggregated cost that epilepsy incurs on society is significant.
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| 23. |
- Bolin, Kristian
(författare)
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Health among long-term survivors of breast cancer-an analysis of 5-year survivors based on the Swedish surveys of living conditions 1979-1995 and the Swedish Cancer Registry 2000
- 2008
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Ingår i: Psycho-Oncology. - : Wiley. - 1099-1611 .- 1057-9249. ; 17:1, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we examine health among breast cancer 5-year survivors. We raise two questions: (1) how do the health level of this survival group compare to the health level of the general population; and (2) how have the health levels among these survivors changed over time. We found that 5-year breast cancer survivors assess their health lower than the general population, and that having being diagnosed in a later year increases health compared to having received the diagnosis at an earlier point in time. This implies that screening and treatment of breast cancer have been successful. Further, we did not find any statistically significant effect of the length of the time spell since diagnosis on health. One reason for this may be that those additional individuals surviving over time as a result of improved treatment therapies have on average lower health levels than those who survived before more efficient medical technologies were introduced.
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| 24. |
- Bolin, Kristian
(författare)
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Health Production
- 2009
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Ingår i: Oxford Handbook of Health Economic. Oxford University Press.
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 25. |
- Bolin, Kristian, et al.
(författare)
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Individual technologies for health - the implications of distinguishing between the ability to produce health investments and the capacity to benefit from those investments
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- People differ in their ability to produce health investments and in their capacity to benefit from such efforts. In this paper, we assume (1) that the individual’s health-investment production function exhibits diminishing returns to scale and (2) that the individual’s capacity to benefit from the investments is diminishing in the stock of health. Previous research has only shown the importance of the first assumption for the health-capital adjustment process. The simultaneous effects go well beyond those results, however. Thus, this paper provides an extended demand-for-health framework that distinguishes between individuals both by their capacities to benefit and by their abilities to produce, when transforming health efforts into health increments. The potential usefulness of this framework for health-policy purposes is demonstrated by solving a numerically specified version of the model, and computing individual welfare effects of medical-care goods changes.
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