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- Annersten Gershater, Magdalena, et al.
(författare)
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Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency
- 2021
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Taylor & Francis. - 1473-7167 .- 1744-8379. ; 21:2, s. 277-284
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities.AIM: To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer.METHOD: Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age - 81(75-96); diabetes type 2-98.7%; male/female - 49/51%; living with a spouse - 47%; nursing home 16%; or with home nursing 64%.RESULT: Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, auto-amputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing.CONCLUSION: Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.
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- de Mattos, Livia Teixeira, et al.
(författare)
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Consumption of antidepressants and economic austerity in Brazil
- 2022
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Taylor & Francis Group. - 1473-7167 .- 1744-8379. ; 22:8, s. 1221-1229
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe consumption of antidepressants in Brazil through dispensing data from pharmacy retail outlets, in between 2011 and 2017, and explore the relationship between consumption patterns and changing economic context during this period. Methods A time-series analysis of dispensing data from pharmacy retail outlets was carried out considering 10 commonly used antidepressants. DDDs/1000 inhabitants/year for each drug were calculated for each quarter. Ttime-series graphs were constructed to analyze the volumes of drugs purchasedRelationship between economic context and consumption was assessed using the following indicators: annual percent change in Gross Domestic Product (GDP), public debt (% of GDP), and annual net savings (in billions of Brazilian reais - BRL). Results Overall consumption of antidepressants increased over the study period despite a sharp fall of -3.55% in annual percent change in GDP, negative net annual savings of -53.568 BRL, and an increase in public debt exceeding 32% of the GDP during the economic crisis of 2015. Conclusion Consumption of antidepressants from pharmacy retail outlets increased even within a context of economic crisis, which may be a reflection of the disease burden in Brazil. Health budget cuts due to the economic crisis may be directing users to out-of-pocket expenses, deepening social inequalities.
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- Flynn, Terry N
(författare)
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Valuing citizen and patient preferences in health : recent developments in three types of best-worst scaling.
- 2010
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Informa UK Limited. - 1744-8379 .- 1473-7167. ; 10:3, s. 259-67
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Tidskriftsartikel (refereegranskat)abstract
- There is increased interest in the use of best-worst scaling (BWS) as a method of preference elicitation in health. However, the method is undergoing rapid development in several fields, making dissemination of new insights challenging. Furthermore, there are two types of BWS that have hitherto received little interest in health, but that are uniquely placed to address certain issues. This article offers an update of the state of play of BWS, presents original research to illustrate new methods of analysis and introduces to health researchers some issues on the research frontier.
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- Godman, B., et al.
(författare)
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Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden : Global relevance
- 2009
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Ingår i: Expert Review of Pharmacoeconomics and Outcomes Research. - : Informa UK Limited. - 1473-7167 .- 1744-8379. ; 9:1, s. 65-83
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Tidskriftsartikel (refereegranskat)abstract
- It is a continual challenge trying to improve the quality of prescribing while concurrently trying to address increasing pharmaceutical development, utilization and expenditure. National and regional reforms and initiatives in Sweden have moderated growth in ambulatory drug expenditure to 2.7% per annum in recent years despite increasing volumes. National reforms include mandatory generic substitution and value-based pricing alongside devolution of drug budgets to the regions. Regional initiatives include strengthening the role of the regional Drug and Therapeutic Committees, further budget devolution as well as strategies incorporating prescribing guidance and monitoring coupled with financial incentives. The extent and nature of the regional initiatives vary depending on their characteristics. In this article, we compare initiatives undertaken in two major counties, Stockholm and Östergötland, and their outcomes. Outcomes include annual drug budget savings while achieving agreed quality as well as increased adherence to prescribing targets and guidance; the latter associated with savings. Appraising these multifaceted reforms can provide guidance to other countries and regions in view of their diversity. Future steps must incorporate measures to improve the utilization of new expensive drugs, which should include horizon scanning and forecasting activities as well as post-launch activities involving monitoring of prescribing and registries. This may well require cooperation with other European countries.
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- Hagell, Peter
(författare)
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Feasibility and linguistic validity of the Swedish version of the PDQ-39.
- 2005
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Taylor & Francis. - 1473-7167 .- 1744-8379. ; 5:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- The Parkinson's Disease Questionnaire - 39 is the most widely used disease-specific health status questionnaire for Parkinson's disease. Evaluations of various language versions have focused on psychometric properties, whereas documented evaluations regarding linguistic validity, respondent burden and questionnaire content are largely lacking. Work with the Swedish Parkinson's Disease Questionnaire - 39 has taken these aspects into account, which has resulted in a linguistically revised version which is currently being evaluated. Initial observations indicate that the revision rectified linguistic but not nonlinguistic problems, and that its feasibility in terms of respondent burden in more advanced disease can be challenged. There are also indications for the need for content improvements. These experiences are discussed along with their implications.
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- Hagell, Peter
(författare)
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Feasibility and linguistic validity of the Swedish version of the PDQ-39
- 2005
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Ingår i: Expert Review of Pharmacoeconomics & Outcomes Research. - : Informa UK Limited. - 1473-7167 .- 1744-8379. ; 5:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- The Parkinson’s Disease Questionnaire – 39 is the most widely used disease-specific health status questionnaire for Parkinson’s disease. Evaluations of various language versions have focused on psychometric properties, whereas documented evaluations regarding linguistic validity, respondent burden and questionnaire content are largely lacking. Work with the Swedish Parkinson’s Disease Questionnaire – 39 has taken these aspects into account, which has resulted in a linguistically revised version which is currently being evaluated. Initial observations indicate that the revision rectified linguistic but not nonlinguistic problems, and that its feasibility in terms of respondent burden in more advanced disease can be challenged. There are also indications for the need for content improvements. These experiences are discussed along with their implications.
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- Henriksson, Martin, et al.
(författare)
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Cost-effectiveness of ticagrelor in acute coronary syndromes
- 2013
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Expert Reviews (formerly Future Drugs). - 1473-7167 .- 1744-8379. ; 13:1, s. 9-18
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Tidskriftsartikel (refereegranskat)abstract
- Ticagrelor is a reversibly binding oral P2Y(12) inhibitor, which belongs to a novel chemical class of antiplatelet agents named cyclopentyl-triazolo-pyrimidines. Ticagrelor administered with acetylsalicylic acid has been shown to reduce the rate of the composite end point of death from vascular causes, myocardial infarction or stroke without an increase in the rate of overall major bleeding compared with clopidogrel plus acetylsalicylic acid in patients with acute coronary syndromes. In addition to these clinical findings, it has been shown that the cost per quality-adjusted life year with ticagrelor is below the generally acceptable thresholds for cost-effectiveness compared with clopidogrel. Healthcare decision-makers need to consider the costs and cost-effectiveness when prioritizing treatments among scarce healthcare resources. This is of particular importance in cases similar to ticagrelor, where the novel treatment is expected to improve effectiveness at a higher acquisition cost. In this article, the authors review and discuss the health-economic evidence of ticagrelor.
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| 32. |
- Karlsson, Martin, et al.
(författare)
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Health, happiness, inequality
- 2010
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Ingår i: Expert Review of Pharmacoeconomics & Outcomes Research. - : Informa UK Limited. - 1473-7167 .- 1744-8379. ; 10:1, s. 497-500
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- At the beginning of June 2010, the conference 'Health. Happiness. Inequality. Modelling the Pathways between Income Inequality and Health' was held in Darmstadt, Germany. Invited speakers and presenters traveled from all over the world; and researchers from several different subdisciplines were represented at the conference. The common denominator of participants was an interest in how societal income inequality affects individual health and life satisfaction. New and fascinating research results were presented and participants engaged in many interesting discussions.
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- Lindström, Martin
(författare)
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Social capital, social class and tobacco smoking
- 2008
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Ingår i: Expert Review of Pharmacoeconomics and Outcomes Research. - : Informa UK Limited. - 1473-7167 .- 1744-8379. ; 8:1, s. 81-89
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Forskningsöversikt (refereegranskat)abstract
- In all developed and some developing countries there are socioeconomic status (SES) differences in tobacco smoking. People with a low of education, manual occupation, low income as well as the unemployed are daily smokers to a higher extent than those with high SES. People with low SES also stop smoking to a lesser extent in many developed countries. Several theories have been proposed to account for SES differences in health. Social capital concerns the relationships of trust, participation and reciprocity among individuals, groups and institutions in a society that may enhance health and health-related behaviors. The-materialist standpoint concerns material conditions. Studies with ecological, individual and multilevel study design, mostly cross-sectional studies, suggestthat both (individual level) social capital and material factors are related to tobacco smoking, although multilevel studies concerning contextual level social capital are few and mostly, at least in adult populations, fail to demonstrate associations. There is also a want or longitudinal studies to investigate the associations between social capital and material conditions, smoking initiation, smoking continuation as well as smoking cessation, since cross-sectional studies analyze only prevalence data. More sophisticated multilevel studies are needed to investigate the association between social capital and material, conditions, and tobacco smoking in SES groups in different social contexts.
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- Paxling, Björn, 1980-, et al.
(författare)
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Internet-delivered treatments with or without therapist input : Does the therapist factor have implications for efficacy and cost?
- 2007
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Informa UK Limited. - 1473-7167 .- 1744-8379. ; 7:3, s. 291-297
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Tidskriftsartikel (refereegranskat)abstract
- Psychiatric problems such as mood and anxiety disorders are highly prevalent and are associated with high societal costs and individual suffering. Evidence-based psychological treatments obtain good results but are not available to the required extent due to the lack of practitioners with adequate training. One way to solve this problem is to provide minimal-contact self-help treatments, for example, with the assistance of computers. Recently, internet-delivered cognitive-behavioral treatment has been tested in a series of controlled trials. However, the interventions come in many forms with different levels and kinds of therapist input, which have implications for the costs of the treatments and possibly their effectiveness. In this review we found evidence for a strong correlation between therapist input and outcome. While emerging evidence attests to the efficacy of internet-delivered treatment when at least minimal therapist guidance is provided, most studies in the field have not included a formal evaluation of cost-effectiveness. Future research needs are discussed. © 2007 Future Drugs Ltd.
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- Rencz, Fanni, et al.
(författare)
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Cost-utility of biological treatment sequences for luminal Crohn's disease in Europe
- 2017
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Ingår i: Expert review of pharmacoeconomics & outcomes research. - : Taylor & Francis. - 1473-7167 .- 1744-8379. ; 17:6, s. 597-606
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study aims to compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn's disease in nine European countries.METHODS: A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied.RESULTS: The bsIFX versus conventional therapy resulted in the most favourable incremental cost-utility ratios (ICURs) ranging from €34,580 (Hungary) to €77,062/QALY (Sweden). Compared to bsIFX, the bsIFX-ADA sequence was more cost-effective than the bsIFX-VEDO sequence with ICURs varying between €70,277 (France) and €162,069/QALY (Germany). The ICURs of the bsIFX-ADA-VEDO sequence versus the bsIFX-ADA strategy were between €206,266 (The Netherlands) and €363,232/QALY (Spain).CONCLUSION: We are the first to compare cost-effectiveness of multiple biological sequences for luminal Crohn's disease. Based on our findings, bsIFX can be recommended as a first-line treatment in patients unresponsive to conventional treatments. While biological sequences only slightly differ in their associated health gains, their costs vary greatly. The bsIFX-ADA-VEDO seems to be the most cost-effective sequence of the available biologics across Europe.
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