| 1. |
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| 2. |
- Agreus, L, et al.
(författare)
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The cost of gastro-oesophageal reflux disease, dyspepsia and peptic ulcer disease in Sweden
- 2002
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Ingår i: PharmacoEconomics (Auckland). - 1170-7690 .- 1179-2027. ; 20:5, s. 347-355
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Tidskriftsartikel (refereegranskat)abstract
- Background and objective: Dyspepsia, peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (GORD) involve a substantial cost to Swedish society. There is a lack of up-to-date nationwide cost estimates after 1985. This study was conducted to present a comprehensive and updated cost analysis and study the change over time of the national cost of these disorders. Design and setting: Primarily, data from National Swedish databases and secondly, data from databases from the County of Uppsala for 1997 were used for the calculations and estimations. Perspective: Swedish societal perspective. Results: The total cost to Swedish society of dyspepsia, PUD and GORD in 1997 was $US424 million, or $US63 per adult. Direct costs totalled $US258 million (61%) while indirect costs totalled $US166 million (39%). The highest proportions of costs were due to drugs and sick leave, these being 37 and 34%, respectively. Conclusions: The cost of dyspepsia and GORD is substantial for patients, health providers and society. Since 1985, drug costs have increased substantially while the cost of sick leave has decreased.
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| 3. |
- Berggren, Fredrik
(författare)
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Assessing the use of retrospective databases in conducting economic evaluations of drugs : the case of asthma
- 2004
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Ingår i: PharmacoEconomics. - 1179-2027. ; 22:12, s. 771-791
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Forskningsöversikt (refereegranskat)abstract
- When evaluating drug substances, the traditional clinical study setting does not allow scope for observing real-life behaviour since all alternative actions are determined beforehand. However, a study based on prospective or retrospective databases containing real-life data can examine how patients and physicians behave in a real-world setting and can investigate the relationship between the introduction of a drug and the amount of healthcare used in actual practice. We reviewed the quality and potential policy application of published retrospective database studies in which an economic evaluation of the use of drugs in asthma was conducted. A search in literature databases found 16 such studies, which were reviewed and evaluated according to a published checklist. No article fulfilled all the criteria for a ‘good’ economic evaluation. The results of many of the evaluations may be informative, but not transparent enough to deliver policy conclusions. This may limit the use of the currently published retrospective database studies as a base for policy decision, compared with randomised controlled trials, despite the additional value of these database analyses when well conducted. A greater transparency when presenting material and results is therefore called for, to increase the usefulness of database studies.
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| 4. |
- Berggren, Fredrik, et al.
(författare)
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Cost effectiveness of nasal budesonide versus surgical treatment for nasal polyps
- 2003
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Ingår i: PharmacoEconomics. - 1179-2027. ; 21:5, s. 351-356
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To conduct a cost-effectiveness study of nasal budesonide versus surgical treatment in the management of nasal polyps. Design and methods: A decision-tree model reflecting two different treatment strategies for nasal polyps in Sweden was developed. The first strategy was initial polypectomy, performed under three different sets of circumstances: inpatient functional endoscopic surgery, outpatient evulsion with sedation, or outpatient evulsion with local anaesthesia; all treatments were followed by intranasal treatment with budesonide (Rhinocort(R)) 128mug twice daily. The second strategy was initial intranasal treatment with budesonide 128mug twice daily. Perspective: Healthcare provider perspective. Outcome measures and results: After 1 month, treatment with nasal budesonide was classified as a success (82.5%) or a failure (17.5%) based on clinical study data. In cases of success, the treatment was continued, and in cases of failure, polypectomy was undertaken, followed by budesonide 128mug twice daily. Treatments were evaluated after 4 months using prices from the Central Hospital in Skovde, Sweden. The expected reduction in cost from using initial nasal budesonide treatment compared with the different alternatives of polypectomy were 9760 Swedish kronors (SEK) for inpatient functional endoscopic surgery, SEK2747 for outpatient evulsion with sedation, and SEK672 for outpatient evulsion with anaesthesia (1998 values). Nasal budesonide 128 mug twice daily treatment for nasal polyps revealed a potential reduction in costs of 53% compared with the primary surgery approach. Conclusion: Initial treatment of nasal polyps with nasal budesonide provides lower costs than treatment with initial polypectomy with maintained effectiveness.
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| 5. |
- Blumenschein, Karen, et al.
(författare)
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Economic Evaluation in Healthcare: A Brief History and Future Directions
- 1996
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Ingår i: PharmacoEconomics. - : Springer Nature. - 1179-2027 .- 1170-7690. ; 10:2, s. 114-122
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Tidskriftsartikel (refereegranskat)abstract
- Over the last decade there-has been tremendous interest in economic evaluations of healthcare programmes, especially in the pharmaceutical field. Economic evaluations started about 30 years ago as rather crude analyses, in which the-value of improved health was measured in terms of increased labour production. Now, more refined methods are available to measure health changes in terms of quality-adjusted life-years gained or willingness to pay. It is important to continue this development, and major fields for future work include the incorporation of quality-of-life measurements into economic evaluations and the linking of cost-effectiveness and cost-benefit analyses into a unified framework of economic evaluation. How to incorporate distributional issues is another important area. Finally, it seems crucial to further explore the link between economic evaluation and decision making, since the purpose of economic evaluations is to affect decision making.
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| 6. |
- 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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| 7. |
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| 8. |
- Bolin, Kristian, et al.
(författare)
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The Cost Effectiveness of Newer Epilepsy Treatments A Review of the Literature on Partial-Onset Seizures
- 2012
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Ingår i: PharmacoEconomics (Auckland). - : Springer Science and Business Media LLC. - 1170-7690 .- 1179-2027. ; 30:10, s. 903-923
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Forskningsöversikt (refereegranskat)abstract
- Background and Objective: Epilepsy is one of the most common neurological disorders, affecting more than 3 million people in Europe. This paper reviews the published evidence regarding the cost effectiveness of second-generation antiepileptic drugs (AEDs). Methods: A systematic literature search was performed, using the databases Academic Search Complete, Econlit, EMBASE and MEDLINE. Health economic evaluations of newer (second-generation) AEDs, published as full-length journal articles, were searched for. We focused on evaluations of newer AEDs as treatment for partial-onset seizures. 470 studies were initially identified and 19 were finally included. Information regarding (i) AEDs studied, (ii) cost effectiveness, and (iii) a variety of health economic modelling specifics was extracted from each study. Then, the included studies were summarized and a quality assessment was performed, according to the British Medical Journal's guidelines for economic studies. Results: The results were as follows: (i) the cost per additional QALY for newer AEDs used as adjunctive treatment, compared with standard therapy, ranged between $US19 139 (levetiracetam) and $US57 210 (pregabalin) [year 2010 values]; no cost-effectiveness evidence was identified for felbamate, eslicarbazepine, oxcarbazepine or tiagabine; and (ii) all studies met at least 60% of the British Medical Journal's guidelines criteria, and seven studies were found to satisfy more than 80% of the criteria. Guidelines criteria not met involve inadequate reporting of input data and modelling details, including validation and availability of models used for cost-effectiveness calculations. Conclusions: Although failure to meet good practice guidelines influences the reliability of the presented evidence adversely, a sufficient number of the included studies were found to comply enough with the guidelines in order for the qualitative content of the cost-effectiveness results that some of the newer AEDs are cost effective to be reliable. In fact, this conclusion is likely to be relatively robust, since the effect of improved seizure control on labour market performance was not included in the base-case results in any of the included studies and improved seizure control need only to have a moderate effect on sickness absenteeism in order for the corresponding treatment to be cost effective even when willingness to pay for an additional QALY is low. However, the cost effectiveness of newer AEDs has only been studied for a small number of settings, and hence future studies incorporating additional settings are needed.
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| 9. |
- Borgstrom, F, et al.
(författare)
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Cost effectiveness of raloxifene in the treatment of osteoporosis in Sweden - An economic evaluation based on the MORE study
- 2004
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Ingår i: PharmacoEconomics. - : Adis Data Information BV.. - 1179-2027 .- 1170-7690. ; 22:17, s. 1153-1165
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Multiple Outcomes of Raloxifene Evaluation (MORE) study showed that treatment with raloxifene reduces the risk of vertebral fracture and breast cancer in postmenopausal women with osteoporosis. Objective: Based on the MORE study the aim of the present study was to assess the cost effectiveness of raloxifene (compared with no treatment) for the treatment of osteoporosis in postmenopausal women in Sweden. Design: A revised version of a previously developed computer simulation model was used. The impact of the risk-reducing effect of raloxifene on vertebral fractures and breast cancer on cost effectiveness was analysed using a clinical and a morphometric definition of vertebral fracture. Benefits of raloxifene treatment were measured in quality-adjusted life-years (QALYs) and life-years gained. The study estimated the cost effectiveness mainly from a healthcare perspective but the cost effectiveness taking a societal perspective was also analysed. Results: Intervention costs (in Swedish kronor [SEK] and euros [E], year 2001 values) in postmenopausal women with a relative risk of vertebral fracture of 2 were SEK372 000 (E40 000) SEK303 000 (E33 000) and SEK263 000 (E28 000) per QALY for women aged 60, 70 and 80 years, at start of treatment, respectively, when the clinical vertebral definition was used. The cost effectiveness using a clinical morphometric vertebral fracture definition was similar to the cost effectiveness using a clinical vertebral fracture definition. Conclusions: In relation to accepted threshold values for cost per QALY in Sweden, this model indicates, with its underlying assumptions and data that raloxifene (compared with no treatment) is cost effective for the treatment of postmenopausal women at an increased risk of vertebral fracture. from the Swedish healthcare and societal perspectives.
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| 10. |
- Burstrom, K., et al.
(författare)
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Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States
- 2020
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Ingår i: Pharmacoeconomics. - : Springer Science and Business Media LLC. - 1170-7690 .- 1179-2027. ; 38, s. 839-856
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objective Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. Methods In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondent's current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). Results A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Conclusions Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.
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| 11. |
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| 12. |
- Caro, J. Jaime, et al.
(författare)
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Decision-Analytic Models: Current Methodological Challenges
- 2014
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 32:10, s. 943-950
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Tidskriftsartikel (refereegranskat)abstract
- Modelers seeking to help inform decisions about insurance (public or private) coverage of the cost of pharmaceuticals or other health care interventions face various methodological challenges. In this review, which is not meant to be comprehensive, we cover those that in our experience are most vexing. The biggest challenge is getting decision makers to trust the model. This is a major problem because most models undergo only cursory validation; our field has lacked the motivation, time, and data to properly validate models intended to inform health care decisions. Without documented, adequate validation, there is little basis for decision makers to have confidence that the model's results are credible and should be used in a health technology appraisal. A fundamental problem for validation is that the models are very artificial and lack sufficient depth to adequately represent the reality they are simulating. Typically, modelers assume that all resources have infinite capacity so any patient needing care receives it immediately; there are no waiting times or queues, contrary to the common experience in actual practice. Moreover, all the patients enter the model simultaneously at time zero rather than over time as happens in actuality; differences between patients are ignored or minimized and structural modeling choices that make little sense (e.g., using states to represent events) are forced by commitment to a technique (and even to specific spreadsheet software!). The resulting structural uncertainty is rarely addressed, because methods are lacking and even probabilistic analysis of parameter uncertainty suffers from weak consideration of correlation and arbitrary distribution choices. Stakeholders must see to it that models are fit for the stated purpose and provide the best possible estimates given available data-the decisions at stake deserve nothing less.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Edney, Laura C., et al.
(författare)
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Empirical Estimates of the Marginal Cost of Health Produced by a Healthcare System: Methodological Considerations from Country-Level Estimates
- 2022
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Ingår i: PharmacoEconomics (Auckland). - : ADIS INT LTD. - 1170-7690 .- 1179-2027. ; 40:1, s. 31-43
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Forskningsöversikt (refereegranskat)abstract
- Many health technology assessment committees have an explicit or implicit reference value (often referred to as a threshold) below which new health technologies or interventions are considered value for money. The basis for these reference values is unclear but one argument is that it should be based on the health opportunity costs of funding decisions. Empirical estimates of the marginal cost per unit of health produced by a healthcare system have been proposed to capture the health opportunity costs of new funding decisions. Based on a systematic search, we identified eight studies that have sought to estimate a reference value through empirical estimation of the marginal cost per unit of health produced by a healthcare system for England, Spain, Australia, The Netherlands, Sweden, South Africa and China. We review these eight studies to provide an overview of the key methodological approaches taken to estimate the marginal cost per unit of health produced by the healthcare system with the aim to help inform future estimates for additional countries. The lead author for each of these papers was invited to contribute to the current paper to ensure all the key methodological issues encountered were appropriately captured. These included consideration of the key variables required and their measurement, accounting for endogeneity of spending to health outcomes, the inclusion of lagged spending, discounting and future costs, the use of analytical weights, level of disease aggregation, expected duration of health gains, and modelling approaches to estimating mortality and morbidity effects of health spending. Subsequent research estimates for additional countries should (1) carefully consider the specific context and data available, (2) clearly and transparently report the assumptions made and include stakeholder perspectives on their appropriateness and acceptability, and (3) assess the sensitivity of the preferred central estimate to these assumptions.
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| 17. |
- Ekman, Mattias, et al.
(författare)
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Cost effectiveness of bisoprolol in the treatment of chronic congestive heart failure in Sweden : Analysis using data from the cardiac insufficiency bisoprolol study II trial
- 2001
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Ingår i: PharmacoEconomics. - : Springer. - 1179-2027 .- 1170-7690. ; 19:9, s. 901-916
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate the cost effectiveness of adding the P-blocker bisoprolol to standard treatment in patients with congestive heart failure (CHF). Design and setting: A cost-effectiveness study was based on the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), a randomised clinical trial investigating the efficacy of adding bisoprolol to standard therapy of CHF. The cost-effectiveness analysis was carried out from a societal perspective, Methods: Health effects were measured in terms of years of life gained. On the cost side, treatment costs for pharmaceuticals and hospitalisations were included. Data on healthcare resource consumption from CIBIS-II were used and were combined with average Swedish retail prices for medicines, and average costs for hospitalisations based on hospital admissions, in the base case. The costs of added years of life, i.e. consumption net of production during life-years gained were also included. Results: If costs of added years of life were not included, then bisoprolol therapy increased life expectancy at an incremental cost of Swedish kronor (SEK) 13 094 (1999 values) per year of life gained. If costs of added years of life were included, then the incremental cost-effectiveness ratio of bisoprolol therapy was SEK168 858 per year of life gained. Conclusions: For patients with CHF with the characteristics of those in CIBIS-II, the cost effectiveness of bisoprolol therapy compares favourably with that of other cardiovascular therapies.
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| 18. |
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| 19. |
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| 20. |
- Gerdtham, Ulf, et al.
(författare)
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Estimating the Cost of Diabetes Mellitus-Related Events from Inpatient Admissions in Sweden Using Administrative Hospitalization Data
- 2009
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Ingår i: PharmacoEconomics. - 1179-2027. ; 27:1, s. 81-90
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: To estimate short- and long-term costs of inpatient hospitalization in Sweden for major diabetes mellitus-related events. Materials and methods: Costs were estimated using administrative hospital data from the Swedish National Board of Health and Welfare, which is linked to the Swedish National Diabetes Register. Data were available for 179 749 patients with diabetes in Sweden from 1998 to 2003 (mean and median duration of 6 years' follow-up). Costing of inpatient admissions was based on Nordic diagnosis-related groups (NordDRG). Multiple regression analysis (linear and generalizing estimating equation models) was used to estimate inpatient care costs controlling for age, sex and co-morbidities. The data on hospitalizations were converted to costs (E) using 2003 exchange rates. Results: The average annual costs (linear model) associated with inpatient admissions for a 60-year-old male in the year the first event first occurred were as follows: (sic)6488 (95% CI 5034, 8354) for diabetic coma; (sic)6850 (95% CI 6514, 7204) for heart failure; (sic)7853 (95% CI 7559, 8144) for non-fatal stroke; (sic)8121 (95% CI 7104, 9128) for peripheral circulatory complications; (sic)8736 (95% CI 8474, 9001) for non-fatal myocardial infarction (MI); (sic) 10 360 (95% CI 10 085, 10 643) for ischaemic heart disease; (sic) 11411 (95% CI 10 298, 12 654) for renal failure; and (sic)14 949 (95% CI 13 849, 16 551) for amputation. On average, the costs were higher when co-morbidity was accounted for (e.g. MI with co-morbidity was twice as costly as MI alone). Conclusions: Average hospital inpatient costs associated with common diabetes-related events can be estimated using panel data regression methods. These could assist in modelling of long-term costs of diabetes and in evaluating the cost effectiveness of improving care.
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| 21. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Drug Expenditure and New Drug Introductions : The Swedish Experience
- 1993
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 4:3, s. 215-225
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Tidskriftsartikel (refereegranskat)abstract
- This article measures the impact of the switch to new and more expensive drugs on the aggregate drug expenditure (both prescription and nonprescription) in Sweden during the period 1974 to 1991, and also on the disaggregated expenditure for 3 medical areas: asthma, hypertension and peptic ulcer disease. During the period studied, nominal drug expenditure increased 6-fold. The retail price index of drugs and the number of prescribed drugs accounted for 51.6 and 5.8% of this increase, respectively. The remaining residual amount accounted for 42.6%. Since the price index of drugs increased more slowly than the overall net price index of goods and services, the relative price of drugs decreased dramatically by about 30%. This means that increases in prices of drugs cannot explain the increase in real inflation-adjusted drug expenditure. We also show that the residual increase can be partly explained by the introduction of new and more expensive drugs. It is therefore argued that economic evaluations which compare the extra costs induced by new drugs with the extra benefits should be undertaken to guide decisions about the prescription of new and more expensive drugs.
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| 22. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Price indices of drugs and the switching to new drugs two empirical examples
- 1998
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 13:1, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- Standard price indices may not account for the price decrease that results when patients switch to pharmaceutical products for which their demand-reservation price exceeds the price of the new product. In a similar way, standard price indices may not account for the price increase that results when patients switch to pharmaceuticals for which the reservation price is below the price of the new drug. This study was designed to assess whether standard pharmaceutical price indices under- or overestimate the real price development resulting from new drug introductions. We illustrate that both situations may occur. In our first example, the switch from a branded to a generic drug, we showed that standard price indices recorded a price increase of about 16%, although the price actually decreased by about 5%. In our second example, the introduction of new formulation of a currently marketed drug, we showed that standard price indices recorded a price increase of about 6%, when the actual price increased by more than 65%.
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| 23. |
- Gerdtham, Ulf G., et al.
(författare)
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The effect of changes in treatment patterns on drug expenditure
- 1998
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Ingår i: PharmacoEconomics. - : Springer Nature. - 1179-2027 .- 1170-7690. ; 13:1 PART II, s. 127-134
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates the effects of changes in drug therapy on drug expenditure in Sweden between 1990 and 1995. Analyses have been carried out for both the aggregate drug expenditure and for drug expenditure according to the main groups of the Anatomical Therapeutic Chemical (ATC) classification system. Changes in expenditure can be divided into 3 components: the price of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. The aggregate real drug expenditure increased by 50% between 1990 and 1995. The relative retail price index of drugs decreased by 9% and the quantity index measured in terms of defined daily doses increased by 27%. The remaining residual increased by 30%. This implies that, if the residual had been unchanged during the study period, the aggregate expenditure would have increased by only 15%. The results also show that the size of the residual varies substantially across different ATC groups. The increase in the residual was largest for drugs that affect the nervous system (ATC group N); the residual increased by 86%. From the observed changes in residual values, it can be concluded that the underlying factor responsible for the increase in drug expenditure in Sweden is changes in drug therapy from less expensive to more expensive drugs.
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| 24. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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The impact of user charges on the consumption of drugs : Empirical evidence and economic implications
- 1996
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Ingår i: PharmacoEconomics. - : Springer Nature. - 1179-2027 .- 1170-7690. ; 9:6, s. 478-483
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Tidskriftsartikel (refereegranskat)abstract
- Expenditure on drugs is increasing rapidly in many countries, and this has led to increased interest in measures to contain drug expenditure. One measure that has been discussed is to increase user charges for prescription drugs. In this article, we consider whether or not raising user charges decreases the consumption of drugs. We also discuss how to judge if increased user charges for drugs are desirable from an economic viewpoint. We conclude that the decision to increase user charges for prescription drugs should not be viewed as an issue of cost containment, but as a matter of balancing the societal costs against the societal benefits of increased user charges.
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| 25. |
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| 26. |
- Ghatnekar, Ola, et al.
(författare)
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Medical Resource Utilization and Cost of HIV-Related Care in the Highly Active Antiretroviral Therapy Era at a University Clinic in Sweden.
- 2010
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 28:S1, s. 49-57
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Little is known regarding healthcare costs for HIV/AIDS patients in the era of highly active antiretroviral therapy (HAART) and subgroups of patients according to the severity and progression of HIV infection in Sweden. The objective of this study is therefore to describe the direct medical resource use and cost of healthcare for HIV patients at a university clinic in Sweden. Methods: A patient registry database for HIV treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, between 2000 and 2005 provided information on patient characteristics, antiretroviral drugs and dosages, tests and diagnostic procedures, outpatient visits and inpatient stays. The review used publicly available unit costs with a county council perspective, expressed in 2006 Euros. Results: Two hundred and eighty-five patients with a mean age of 38 years in 2000 (64% men) were followed for 1368 patient-years. They had a mean (median) of 6.3 (0) inpatient days, 4.1 (3.7) physician visits, 4.2 (3.8) nurse visits, 2.6 (0.7) counsellor visits and 11.5 (7.7) tests and diagnostic procedures per patient-year. Only 12 deaths were recorded during the study period, and the proportion of treated patients with successful treatment (HIV-RNA <50copies/mL) increased from 74% to 92% during the period. The mean cost per patient-month amounted to &U20AC;1069. The main cost driver was HIV drugs (51%), followed by inpatient stays (including hospitalizations for opportunistic infections; 22%), outpatient physician, nurse or therapist visits (19%) and diagnostics and tests (7%). All non-drug costs increased with a decreasing CD4 cell count. Conclusions: Overall, approximately half of the direct costs of HIV treatment were not related to antiretroviral treatment. The non-antiretroviral costs were inversely correlated with HIV-induced immune deficiency.
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| 27. |
- Heintz, Emelie, et al.
(författare)
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Is There a European View on Health Economic Evaluations? Results from a Synopsis of Methodological Guidelines Used in the EUnetHTA Partner Countries
- 2016
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Ingår i: PharmacoEconomics (Auckland). - : ADIS INT LTD. - 1170-7690 .- 1179-2027. ; 34:1, s. 59-76
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this study were to review current methodological guidelines for economic evaluations of all types of technologies in the 33 countries with organizations involved in the European Network for Health Technology Assessment (EUnetHTA), and to provide a general framework for economic evaluation at a European level. Methodological guidelines for health economic evaluations used by EUnetHTA partners were collected through a survey. Information from each guideline was extracted using a pre-tested extraction template. On the basis of the extracted information, a summary describing the methods used by the EUnetHTA countries was written for each methodological item. General recommendations were formulated for methodological issues where the guidelines of the EUnetHTA partners were in agreement or where the usefulness of economic evaluations may be increased by presenting the results in a specific way. At least one contact person from all 33 EUnetHTA countries (100 %) responded to the survey. In total, the review included 51 guidelines, representing 25 countries (eight countries had no methodological guideline for health economic evaluations). On the basis of the results of the extracted information from all 51 guidelines, EUnetHTA issued ten main recommendations for health economic evaluations. The presented review of methodological guidelines for health economic evaluations and the consequent recommendations will hopefully improve the comparability, transferability and overall usefulness of economic evaluations performed within EUnetHTA. Nevertheless, there are still methodological issues that need to be investigated further.
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| 28. |
- Henriksson, Freddie
(författare)
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Applications of economic models in healthcare: the introduction of pioglitazone in Sweden
- 2002
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Ingår i: PharmacoEconomics. - : Springer. - 1179-2027 .- 1170-7690. ; 20:Supplement 1, s. 43-53
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Recension (refereegranskat)abstract
- Type 2 diabetes mellitus (T2DM) is a common disorder that is estimated to affect approximately 100 million people worldwide. Forecasts have suggested a substantial increase in incidence, mainly in Asia, Africa and North America. Thus, an increasing number of people with diabetes-related complications will have to be cared for in the future. This development will be a major health problem for the people affected, as well as a major health economic challenge for many countries. Thiazolidinediones represent a new class of drugs with a novel mechanism of action that addresses the root cause of T2DM. Their mode of action targets the core defect of T2DM, namely, insulin resistance. One of these drugs, pioglitazone, was recently approved by the Swedish authorities. To evaluate the cost effectiveness of this new drug, a published mathematical simulation model was used. This model was adapted to Swedish conditions, and local Swedish unit costs were put into the model. Modelling is necessary when performing economic evaluations in diabetes because of the complexity of the disease and its long time horizon. The cost-effectiveness analyses showed that the cost per life-year gained with pioglitazone combination therapy compared with current treatment ranged from 37,000 Swedish kronor (SEK) to SEK149,000. Although there is no threshold value for cost effectiveness in Sweden, the values presented would normally be regarded as cost effective in the Swedish healthcare system. Modelling studies are a good starting point, but long-term naturalistic studies are needed to establish the cost effectiveness of these new drugs.
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| 29. |
- Henriksson, Martin, et al.
(författare)
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A Systematic Review of Cost-Effectiveness Models in Type 1 Diabetes Mellitus
- 2016
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Ingår i: PharmacoEconomics (Auckland). - : ADIS INT LTD. - 1170-7690 .- 1179-2027. ; 34:6, s. 569-585
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Forskningsöversikt (refereegranskat)abstract
- Critiques of cost-effectiveness modelling in type 1 diabetes mellitus (T1DM) are scarce and are often undertaken in combination with type 2 diabetes mellitus (T2DM) models. However, T1DM is a separate disease, and it is therefore important to appraise modelling methods in T1DM. This review identified published economic models in T1DM and provided an overview of the characteristics and capabilities of available models, thus enabling a discussion of best-practice modelling approaches in T1DM. A systematic review of Embase(A (R)), MEDLINEA (R), MEDLINEA (R) In-Process, and NHS EED was conducted to identify available models in T1DM. Key conferences and health technology assessment (HTA) websites were also reviewed. The characteristics of each model (e.g. model structure, simulation method, handling of uncertainty, incorporation of treatment effect, data for risk equations, and validation procedures, based on information in the primary publication) were extracted, with a focus on model capabilities. We identified 13 unique models. Overall, the included studies varied greatly in scope as well as in the quality and quantity of information reported, but six of the models (Archimedes, CDM [Core Diabetes Model], CRC DES [Cardiff Research Consortium Discrete Event Simulation], DCCT [Diabetes Control and Complications Trial], Sheffield, and EAGLE [Economic Assessment of Glycaemic control and Long-term Effects of diabetes]) were the most rigorous and thoroughly reported. Most models were Markov based, and cohort and microsimulation methods were equally common. All of the more comprehensive models employed microsimulation methods. Model structure varied widely, with the more holistic models providing a comprehensive approach to microvascular and macrovascular events, as well as including adverse events. The majority of studies reported a lifetime horizon, used a payer perspective, and had the capability for sensitivity analysis. Several models have been developed that provide useful insight into T1DM modelling. Based on a review of the models identified in this study, we identified a set of best in class methods for the different technical aspects of T1DM modelling.
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| 30. |
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| 31. |
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| 32. |
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| 33. |
- Johannesson, Magnus, et al.
(författare)
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Advantages of using the net-benefit approach for analysing uncertainty in economic evaluation studies
- 2003
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Ingår i: PharmacoEconomics. - : Adis International. - 1179-2027 .- 1170-7690. ; 21:1, s. 39-48
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Tidskriftsartikel (refereegranskat)abstract
- No consensus has yet been reached on how to analyse uncertainty in economic evaluation studies where individual patient data are available for costs and health effects. This paper summarises the available results regarding the analysis of uncertainty on the cost-effectiveness plane and argues for using the net-benefit approach when analysing uncertainty in cost-effectiveness studies. The net-benefit approach avoids the interpretation and statistical problems related to the incremental cost effectiveness ratio and implies several advantages. First, traditional statistical methods can be used for confidence-interval estimation and hypothesis testing. Second, calculation of the optimal sample size and the power of the study are facilitated allowing the correlation between costs and effects to vary within and between patient groups. Third, the use of a Bayesian approach to cost-effectiveness analysis is facilitated. Fourth, a formal relation between cost-effectiveness acceptability curves and statistical inference is provided. Finally, the net-benefit approach gives the Fieller's limits of the confidence interval for the incremental cost-effectiveness ratio in the cost-effectiveness plane. Based on these advantages the net-benefit approach should strongly be considered when analysing uncertainty in cost-effectiveness analyses.
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| 34. |
- Johannesson, Magnus
(författare)
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Avoiding Double-Counting in Pharmacoeconomic Studies
- 1997
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Ingår i: PharmacoEconomics. - : Springer International Publishing. - 1179-2027 .- 1170-7690. ; 11:5, s. 385-388
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Tidskriftsartikel (refereegranskat)abstract
- In cost-utility analyses of pharmaceutical treatments, the costs are measured in monetary terms and the effects are measured as quality-adjusted life years (QALYs) gained. QALYs are constructed by assigning life years a quality weight between 0 (dead) and 1 (full health). A potential problem in cost utility analysis is that some consequences, in principle, can be included both in the costs and in the quality adjustment, which can lead to double-counting. This article outlines the double-counting problem in cost- utility analysis. It shows that the potential for double-counting depends on how healthcare and income losses resulting from disease are financed, and on how the questions that assess the quality weights are phrased. Double- counting can be avoided by telling respondents to assume that healthcare costs and income losses are fully reimbursed when quality weights are assessed. The quality weights would then capture the change in health and leisure, and the other consequences could be included in the cost estimation.
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| 35. |
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| 36. |
- Johannesson, Magnus
(författare)
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Economic Evaluation of Drugs and Its Potential Uses in Policy Making
- 1995
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 8:3, s. 190-198
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Tidskriftsartikel (refereegranskat)abstract
- Interest in the economic evaluation of drug treatments is steadily increasing, but the impact of such evaluations on decisions concerning the use of drugs is unclear. In this article I examine different decision and policy situations where economic evaluations of drug treatments could potentially be used. Economic evaluations may be used as an aid to the development of treatment guidelines, decisions within healthcare organisations. and decisions relating to approval, reimbursement and pricing. Economic evaluations appear to be most useful in the development of treatment guidelines and as an aid to reimbursement decisions. The incentive to use economic evaluations embodied in the healthcare system is also important. It is argued that it is too early to introduce regulations that require the use of economic evaluations in, for example, reimbursement decisions. A more cautious approach might be preferred, where economic evaluations are used more selectively until the methodology and the field have developed further.
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| 37. |
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| 38. |
- Johannesson, Magnus
(författare)
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The Cost Effectiveness of Hypertension Treatment in Sweden
- 1995
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 7:3, s. 242-250
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to carry out an analysis of the cost effectiveness of antihypertensive drug treatment in different patient groups in Sweden. The cost effectiveness ratios were estimated as net costs (treatment costs minus reduced costs of cardiovascular morbidity) divided by the number of life-years gained (the increase in life expectancy). The analysis was based on the reduction of coronary heart disease and stroke in the most recent meta-analysis of antihypertensive treatment, to which Swedish cost data were applied. We found that the cost per life-year gained decreases with age for both men and women. and is relatively low for middle-aged and older patients, even when the diastolic blood pressure (DBP) range is 90 to 94mm Hg. In conclusion. the results indicate that, in Sweden antihypertensive treatment is generally cost effective in middle-aged and older patients with a DBP of ≥Omm Hg. However. it is questionable whether it is generally cost effective to treat younger patients with mild hypertension.
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| 39. |
- Johansson, Gunnar, et al.
(författare)
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Cost effectiveness of budesonide/formoterol for maintenance and reliever therapy versus salmeterol/fluticasone plus salbutamol in the treatment of asthma
- 2006
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Ingår i: PharmacoEconomics (Auckland). - : Springer Science and Business Media LLC. - 1170-7690 .- 1179-2027. ; 24:7, s. 695-708
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Budesonide/formoterol (Symbicort) Maintenance And Reliever Therapy (SMART) is an effective and well tolerated treatment option for patients with asthma. We compared the cost effectiveness from a societal perspective of this one-inhaler regimen with that of maintenance salmeterol/fluticasone propionate (Seretide) plus salbutamol (albuterol) as needed (Seretide) Fixed Combination [SFC]). STUDY DESIGN: A cost-effectiveness analysis was performed based on effectiveness and resource-utilisation data collected prospectively in a randomised, 12-month study performed in 2143 patients in 16 countries. Resource utilisation data were pooled and unit costs (euro, year 2003 values) from Italy, France, the UK and Germany were used to generate estimates of direct and total costs per patient per year and cost per severe exacerbation avoided. METHODS: Adolescents and adults with asthma (n = 2143; mean forced expiratory volume in 1 second [FEV(1)] 73% predicted; mean inhaled corticosteroid [ICS] dose 884 microg/day) were randomised to SMART or SFC. The effectiveness measure used was the number of severe exacerbations per patient per year. Direct costs included medication use (budesonide/formoterol 160microg/4.5microg or salmeterol/fluticasone 50microg/100microg, 50microg/250microg or 50microg/500microg plus salbutamol) and nonmedication-related resource use, including days in hospital, emergency room visits, specialist or primary care physician visits and other healthcare provider contacts. Indirect costs, including the number of days when the patient or their carer was unable to attend to their normal daily activities, were also assessed. The study assumed a European societal perspective (i.e. including direct and indirect costs). RESULTS: Treatment with SMART resulted in significantly fewer severe exacerbations per patient per year compared with SFC (0.24 vs 0.31 events per patient per year; p = 0.0025). Resource use was low in both groups. Medication costs accounted for the majority of the total costs. The increased effectiveness of SMART was achieved at a reduced or similar cost compared with SFC. SMART dominated when German unit costs were applied (i.e. there was a statistically significant reduction in both costs and number of exacerbations). In all other countries, the incremental cost-effectiveness ratios showed that there was a reduction in mean total cost per exacerbation avoided; however, this difference was not statistically significant. CONCLUSION: This analysis demonstrates that, compared with SFC, SMART may be cost effective from a societal perspective for the treatment of patients with asthma in Italy, Germany, France and the UK. SMART provided a reduction in the number of severe exacerbations per patient per year, at no statistically significant increase in cost - or even at a lower cost - compared with SFC plus as-needed reliever salbutamol.
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| 40. |
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| 41. |
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| 42. |
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| 43. |
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| 44. |
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| 45. |
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| 46. |
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| 47. |
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| 48. |
- Karlsson, Göran, et al.
(författare)
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The Decision Rules of Cost-Effectiveness Analysis
- 1996
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 9:2, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- It has become increasingly popular to carry out cost-effectiveness analyses in economic evaluations of healthcare programmes. Cost-effectiveness analysis is based on the maximisation of the health effects for a given amount of resources. However, many published studies fail to report the results of cost-effectiveness analysis in a way that is consistent with this underlying aim. The aim of this article is to demonstrate the decision rules of cost-effectiveness analysis in an easily accessible way for practitioners in the field. A hypothetical example is used to demonstrate the decision rules of cost-effectiveness analysis, and we also show how to estimate the appropriate incremental cost-effectiveness ratios and how to exclude dominated alternatives. It is then shown how fixed budgets or predetermined prices per effectiveness unit can be used as decision rules to maximise health effects and to determine which programmes to implement on the basis of incremental cost-effectiveness ratios. We hope that the article will contribute towards an increased understanding and application of the appropriate decision rules of cost-effectiveness analysis, so that the results of cost-effectiveness analyses can be interpreted meaningfully by decision makers.
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| 49. |
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| 50. |
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