| 1. |
- Hofmarcher, Thomas, et al.
(författare)
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Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden.
- 2015
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Ingår i: Journal of Medical Economics. - : Informa Healthcare. - 1941-837X .- 1369-6998. ; 18:7, s. 492-501
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Iron deficiency is a common but treatable comorbidity in chronic heart failure (CHF) that is associated with impaired health-related quality-of-life (HRQoL). This study evaluates the cost-effectiveness of the intravenous iron preparation ferric carboxymaltose (FCM) for the treatment of iron deficiency in CHF from a Swedish healthcare perspective. METHODS: A cost-effectiveness analysis with a time horizon of 24 weeks was performed to compare FCM treatment with placebo. Data on health outcomes and medical resource use were mainly taken from the FAIR-HF trial and combined with Swedish cost data. An incremental cost-effectiveness ratio (ICER) was calculated as well as the change in per-patient costs for primary care and hospital care. RESULTS: In the FCM group compared with placebo, quality-adjusted life years (QALYs) are higher (difference = 0.037 QALYs), but so are per-patient costs [(difference = SEK 2789 (€303)]. Primary care and hospital care equally share the additional costs, but within hospitals there is a major shift of costs from inpatient care to outpatient care. The ICER is SEK 75,389 (€8194) per QALY. The robustness of the result is supported by sensitivity analyses. CONCLUSIONS: Treatment of iron deficiency in CHF with FCM compared with placebo is estimated to be cost-effective. The ICER in the base case scenario is twice as high as previously thought, but noticeably below SEK 500,000 (€54,300) per QALY, an informal average reference value used by the Swedish Dental and Pharmaceutical Benefits Agency. Increased HRQoL and fewer hospitalizations are the key drivers of this result.
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| 2. |
- Hofmarcher, Thomas, et al.
(författare)
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Cost effectiveness of implementing ESC guidelines for treatment of iron deficiency in heart failure in the Nordic countries
- 2018
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 52:6, s. 348-355
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Guidelines of the European Society of Cardiology (ESC) recommend that ferritin and transferrin saturation should be tested in chronic heart failure (HF) and state that iron treatment with ferric carboxymaltose should be considered in HF patients with iron deficiency to alleviate symptoms and improve exercise tolerance and quality of life. This study evaluates the cost effectiveness of the implementation of this recommendation in four Nordic countries (Denmark, Finland, Norway, and Sweden). Design. We performed a cost-utility analysis comparing ferric carboxymaltose treatment with placebo over a one-year time period in each country. Data on healthcare resource use and health outcomes were taken from the CONFIRM-HF study and combined with country-specific unit costs. Differences in per-patient costs and quality-adjusted life years (QALYs) were calculated. Results. QALYs were higher (increase of 0.050 QALYs per patient) in the iron-treated group compared with placebo. Per-patient costs were lower in all countries (with reductions ranging from €36 to €484). Fewer hospitalizations were one key driver of these results. Another important driver was how well the new routines for iron treatment can be integrated into the current healthcare management of HF. A sensitivity analysis confirmed the results to be robust. Conclusions. Iron deficiency therapy in HF with ferric carboxymaltose compared with placebo is estimated to both improve health-related quality of life and save healthcare costs in all Nordic countries. A well-organized healthcare management of HF patients can enable the implementation of ESC-recommended treatment of iron deficiency without need for additional resources.
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| 3. |
- Hofmarcher, Thomas
(författare)
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Essays in Empirical Labor Economics
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis contributes to empirical research in labor economics. It consists of three self-contained papers.The first paper, The Effect of Paid Vacation on Health: Evidence from Sweden, analyzes the causal effect of paid vacation on health. Using register data on the universe of central government employees in Sweden, I exploit an age-based rule stipulated in the collective agreement covering these employees. The results indicate that no statistically significant changes in health are induced by an increase of three paid vacation days at age 30 and four days at age 40. These findings challenge the anecdotal view of additional paid vacation days as an adequate means to improve workers' health.The second paper, The Effect of Education on Poverty: A European Perspective, studies the causal relationship between education and poverty. I construct a novel database comprising compulsory schooling reforms in 32 European countries and use them as instruments for education. I find economically large poverty-reducing effects of education among people aged 30 to 80. This holds true for both objective and subjective measures of poverty. An additional year of education thus reduces not only the likelihood of being classified as poor but also the likelihood of feeling poor.The third paper, Is There Less Household Specialization in Gay and Lesbian Couples?, examines intra-couple differences in earnings potential as a source of specialization in same-sex and different-sex couples. We find that spouses with a higher earnings potential spend significantly more time on market work and less time on household work than spouses with a lower earnings potential. We observe this pattern in gay, lesbian, and different-sex couples. The effect of intra-couple differences in earnings potential on household specialization does mostly not differ statistically in gay and lesbian couples relative to different-sex couples.
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| 4. |
- Hofmarcher, Thomas, et al.
(författare)
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Societal costs of illegal drug use in Sweden
- 2024
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Ingår i: International journal of drug policy. - : Elsevier. - 0955-3959 .- 1873-4758. ; 123
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Tidskriftsartikel (refereegranskat)abstract
- Background: Illegal drug use is a public health concern with far-reaching consequences for people who use them and for society. In Sweden, the reported use of illegal drugs has been growing and the number of drug-induced deaths is among the highest in Europe. The aim of this study was to provide a comprehensive and up-to-date estimation of the societal costs of illegal drug use in Sweden, relying as much as possible on registry and administrative data. Methods: A prevalence-based cost-of-illness study of illegal drug use in Sweden in 2020 was conducted. A societal approach was chosen and included direct costs (such as costs of health care, social services, and the criminal justice system), indirect costs (such as lost productivity due to unemployment and drug-induced death), and intangible costs (such as reduced quality of life among people who use drugs and their family members). Costs were estimated by combining registry, administrative, and survey data with unit cost data. Results: The estimated societal costs of illegal drug use were 3.7 billion euros in 2020. This corresponded to 355 euros per capita and 0.78 % of the gross domestic product. The direct and intangible costs were of similar sizes, each contributing to approximately 40 % of total costs, whereas indirect costs contributed to approximately 20 %. The largest individual cost components were reduced quality of life among people who use drugs and costs of the criminal justice system. Conclusion: Illegal drug use has a negative impact on the societal aim to create good and equitable health in Sweden. The findings call for evidence-based prevention of drug use and treatment for those addicted. It is important to address the co-morbidity of mental ill-health and drug dependence, to develop low-threshold services and measures for early prevention among children and young adults, as well as to evaluate laws and regulations connected to illegal drug use.
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| 5. |
- Hofmarcher, Thomas, et al.
(författare)
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Specialization in same-sex and different-sex couples
- 2022
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Ingår i: Labour Economics. - : Elsevier BV. - 0927-5371. ; 77
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Tidskriftsartikel (refereegranskat)abstract
- We examine time allocation decisions in same-sex and different-sex couples from a Beckerian comparative advantage perspective. In particular, we estimate the comparative advantage relationship between time spent on either market or household activities and a dummy for being the highest earner in a couple on samples of same-sex and different-sex couples. Using the American Time Use Survey (ATUS), we find that same-sex couples specialize not as much as different-sex couples. We argue that these specialization differences are driven by the most traditional different-sex couples. Without married couples with wives at home taking care of children and husbands working outside the home, which represent at most 20% of all different-sex couples, we find that the highest earner in a couple spends 80 min more per day on market work and 40 min less per day on household work, regardless their sexual orientation. We therefore conclude that, from a comparative advantage perspective, most same-sex and different-sex couples specialize equally.
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| 6. |
- Hofmarcher, Thomas
(författare)
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The Effect of Education on Poverty: A European Perspective
- 2019
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper provides evidence on the causal relationship between education and poverty. I construct a novel database comprising compulsory schooling reforms in 32 European countries and use them as instruments for education. I find economically large poverty-reducing effects of education among people aged 30 to 80. This holds true for both objective measures of poverty (relative income poverty, lack of basic necessities, weak labor market attachment) and a subjective measure of poverty (self-assessed difficulties in making ends meet). An additional year of education thus reduces not only the likelihood of being classified as living in poverty but also the likelihood of considering oneself to live in poverty. Increases in labor force participation and full-time employment as well as better health are potential mechanisms behind these results.
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| 7. |
- Hofmarcher, Thomas
(författare)
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The effect of education on poverty : A European perspective
- 2021
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Ingår i: Economics of Education Review. - : Elsevier BV. - 0272-7757. ; 83
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Tidskriftsartikel (refereegranskat)abstract
- More than 1 in 7 people in Europe live in a household whose income is below the national poverty line, but more than 30% of people consider themselves to live in poverty. This study provides evidence on the causal relationship between education and various dimensions of poverty. I construct a novel database comprising compulsory schooling reforms in 32 European countries and use them as instruments for education. I find economically large poverty-reducing effects of education. This holds true for several objective poverty measures, which are both absolute and relative in nature, and a subjective poverty measure. An additional year of education thus reduces not only the likelihood of being classified as living in poverty but also the likelihood of considering oneself to live in poverty. Increases in labor force participation and full-time employment as well as better health are potential mechanisms behind these results. Notably, countries in Eastern Europe seem to drive the results.
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| 8. |
- Hofmarcher, Thomas
(författare)
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The Effect of Paid Vacation on Health: Evidence from Sweden
- 2017
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This study estimates the causal effect of receiving additional paid vacation days on health. Using register data on the universe of central government employees in Sweden, I exploit an age-based rule stipulated in the collective agreement covering these employees. Identification is achieved by combining a regression discontinuity with a difference-in-differences design to control for time-invariant differences between consecutive birth cohorts and isolate the true effect at two separate discontinuities at ages 30 and 40. The main results indicate no statistically significant changes in health (as proxied by specialized outpatient care visits, inpatient care admissions, and long-term sick leaves) induced by an extension of three paid vacation days at age 30 and four days at age 40. There is no evidence of significant effects by sex, being a (lone) parent, education level, or broad group of diagnoses. These findings challenge the historically grown health argument for additional paid vacation days.
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| 9. |
- Hofmarcher, Thomas
(författare)
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The effect of paid vacation on health : evidence from Sweden
- 2021
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Ingår i: Journal of Population Economics. - : Springer Science and Business Media LLC. - 0933-1433 .- 1432-1475. ; 34:3, s. 929-967
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Tidskriftsartikel (refereegranskat)abstract
- This study estimates the causal effect of paid vacation on health. Using register data on the universe of central government employees in Sweden, I exploit an age-based rule stipulated in the collective agreement covering these employees. I achieve identification by combining a regression discontinuity with a difference-in-differences design to control for time-invariant differences between consecutive birth cohorts and isolate the true effect at two separate discontinuities at ages 30 and 40. The main results indicate that an increase of three paid vacation days at age 30 and four days at age 40 do not cause significant changes in health, as proxied by visits to specialized outpatient care, inpatient admissions, and long-term sick leaves. These findings challenge the anecdotal view of additional paid vacation days as an adequate means to improve workers’ health.
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| 10. |
- Jönsson, Bengt, et al.
(författare)
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Comparator report on patient access to cancer medicines in Europe revisited
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- In a new report, the Swedish Institute for Health Economics (IHE) compares the cancer situation in EU28 plus Norway and Switzerland. The report builds on a previous comparative study conducted in 2005 and provides a comprehensive view of the development of cancer in Europe over the past two decades. The report shows that the number of people diagnosed with cancer continue to increase in Europe, up by 30 percent between 1995 and 2012 due to a growing and aging population. Despite this growth and an increased spending on cancer medicines the overall spending on cancer care has remained stable at around six percent of total health expenditure largely due to a shift towards outpatient care. The report also concludes that there is great difference in access to medicines, in particular between richer and poorer countries but also between countries with similar purchasing power. The access problem requires collaboration between policy makers, payers, regulators, HTA bodies and manufacturers. Local solutions seem most feasible to balance the risk and reward of new treatment options between payers and manufacturers and reflect the affordability levels of different countries.
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| 11. |
- Jönsson, Bengt, et al.
(författare)
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Comparator Report on Patient Access to Cancer Medicines in Europe Revisited - A UK Perspective
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- IHE has published a new comparator report on the cost of cancer and access to cancer medicines. The report is a condensed version of the previously published report, Comparator report on patient access to cancer medicines in Europe revisited (IHE Report 2016:4) and focusing on the UK.The report reveals similar trends in the UK as in the rest of Europe: incidence of cancer is increasing, as is mortality in absolute terms but once demographic factors is accounted for mortality has decreased due to increased survival. However, compared to countries with similar economic status the UK lags behind.
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| 12. |
- Jönsson, Bengt, et al.
(författare)
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The cost and burden of cancer in the European Union 1995–2014
- 2016
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Ingår i: European Journal of Cancer. - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 66, s. 162-170
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an intense debate about the cost of cancer and the value of new treatments. However, there is limited data on the cost of cancer in the European Union (EU) and how costs relate to the burden of disease. This paper presents new estimates on the development of the cost of cancer in the EU 1995–2014, with a focus on the major cost components: total health expenditure, cancer drugs, and production loss due to premature mortality.Methods: Data on overall health expenditure were combined with national disease estimates to derive cancer-specific health expenditure. Data on drug sales were obtained from IMS Health, and epidemiological data were used to calculate life years lost due to cancer.Findings: Health expenditure on cancer increased continuously from €35.7 billion in 1995 to €83.2 billion in 2014 in the EU and spending on cancer drugs from €7.6 billion in 2005 to €19.1 billion in 2014 (current prices). Yet the share of total health expenditure devoted to cancer was mostly constant (around 6 per cent). While expenditures on cancer drugs increased in both absolute and relative terms, other expenditures were stable or decreased, despite increases in cancer incidence driven by a growing and ageing population. Reductions in cancer mortality during working age resulted in decreasing production loss due to premature mortality.Interpretation: Health spending on cancer as a share of total health expenditure is rather low and stable despite the growing incidence and relative burden of cancer. Problems to reallocate funding in health care systems under economic pressure may be one explanation and shifting costs from inpatient to ambulatory care another.
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| 13. |
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| 14. |
- Ringborg, Ulrik, et al.
(författare)
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The Porto European Cancer Research Summit 2021
- 2021
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Ingår i: Molecular Oncology. - : Wiley. - 1574-7891 .- 1878-0261. ; 15:10, s. 2507-2543
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Tidskriftsartikel (refereegranskat)abstract
- Key stakeholders from the cancer research continuum met in May 2021 at the European Cancer Research Summit in Porto to discuss priorities and specific action points required for the successful implementation of the European Cancer Mission and Europe's Beating Cancer Plan (EBCP). Speakers presented a unified view about the need to establish high-quality, networked infrastructures to decrease cancer incidence, increase the cure rate, improve patient's survival and quality of life, and deal with research and care inequalities across the European Union (EU). These infrastructures, featuring Comprehensive Cancer Centres (CCCs) as key components, will integrate care, prevention and research across the entire cancer continuum to support the development of personalized/precision cancer medicine in Europe. The three pillars of the recommended European infrastructures – namely translational research, clinical/prevention trials and outcomes research – were pondered at length. Speakers addressing the future needs of translational research focused on the prospects of multiomics assisted preclinical research, progress in Molecular and Digital Pathology, immunotherapy, liquid biopsy and science data. The clinical/prevention trial session presented the requirements for next-generation, multicentric trials entailing unified strategies for patient stratification, imaging, and biospecimen acquisition and storage. The third session highlighted the need for establishing outcomes research infrastructures to cover primary prevention, early detection, clinical effectiveness of innovations, health-related quality-of-life assessment, survivorship research and health economics. An important outcome of the Summit was the presentation of the Porto Declaration, which called for a collective and committed action throughout Europe to develop the cancer research infrastructures indispensable for fostering innovation and decreasing inequalities within and between member states. Moreover, the Summit guidelines will assist decision making in the context of a unique EU-wide cancer initiative that, if expertly implemented, will decrease the cancer death toll and improve the quality of life of those confronted with cancer, and this is carried out at an affordable cost.
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| 15. |
- Wilking, Nils, et al.
(författare)
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Drug utilization research in the area of cancer drugs
- 2016
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Ingår i: Drug Utilization Research: Methods and Applications. - 9781118949788 ; , s. 315-327
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Bokkapitel (refereegranskat)abstract
- Increased biological understanding of cancer diseases has resulted in a paradigm shift in the medical treatment of cancer. Despite encouraging advances, most cancer types are still incurable and cancer is the second most common cause of death in developed countries.The high price of cancer drugs is a major challenge to equal access and puts heavy strains on public health care payers. After sharp increases in the 2000s, total expenditures on cancer drugs have levelled off due to patent expiration of many expensive and widely used drugs.Cancer drug utilization studies cover a great variety of topics. Four main research areas are patient adherence, physician adherence to guidelines, effectiveness and safety (outcomes research) and access (market uptake).Most cancer drugs are classified under Anatomical Therapeutic Chemical (ATC) group L. The use of defined daily dose (DDD) as a measurement unit is feasible for oral cancer drugs. As most cancer drugs are administered as infusions or injections at hospitals, usage is commonly measured in milligrams.Drug utilization research in the area of cancer is faced with a lack of data. Comparisons are challenging, as prices and population bases vary across regions. The linkage of registries and health care databases that include cancer drug usage will create improved opportunities in the future.
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| 16. |
- Wilking, N., et al.
(författare)
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The cost of cancer in Europe 2018
- 2020
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Ingår i: European Journal of Cancer. - : Elsevier. - 1879-0852 .- 0959-8049. ; 129, s. 41-49
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cancer care is evolving rapidly, and costs and value of new treatments are frequently debated. Up-to-date evidence on the total cost of cancer is needed to inform policy decisions. This study estimates the cost of cancer in Europe in 2018 and extends a previous analysis for 1995–2014. Methods: Cancer-specific health expenditure were derived from national estimates. Data on cancer drug sales were obtained from IQVIA. The productivity loss from premature mortality was estimated from data from Eurostat and the World Health Organization. Estimates of the productivity loss from morbidity and informal care costs were based on previous studies. Findings: The total cost of cancer was €199 billion in Europe (EU-27 plus Iceland, Norway, Switzerland, and the United Kingdom) in 2018. Total costs ranged from €160 per capita in Romania to €578 in Switzerland (after adjustment for price differentials). Health expenditure on cancer care were €103 billion, of which €32 billion were spent on cancer drugs. Informal care costs were €26 billion. The total productivity loss was €70 billion, composed of €50 billion from premature mortality and €20 billion from morbidity. Interpretation: Health expenditure on cancer care were of a similar magnitude as the sum of non-health-care costs in 2018. Over the last two decades, health spending on cancer has increased faster than the increase in cancer incidence. The productivity loss from premature mortality has decreased because of reductions in mortality in the working-age population. Trends in informal care costs and productivity loss from morbidity are uncertain because of lack of comparable data.
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