| 1. |
- Ennab Vogel, Nicklas, et al.
(författare)
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Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke
- 2024
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Ingår i: Journal of NeuroInterventional Surgery. - : BMJ Publishing Group Ltd. - 1759-8478 .- 1759-8486. ; 16, s. 156-162
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the proven cost effectiveness of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion, treatment within 6 hours from symptom onset remains inaccessible for many patients. We aimed to find the optimal number and location of treatment facilities with respect to the cost effectiveness of MT in patients with AIS, first by the most cost effective implementation of comprehensive stroke centers (CSCs), and second by the most cost effective addition of complementary thrombectomy capable stroke centers (TSCs).Methods: This study was based on nationwide observational data comprising 18 793 patients with suspected AIS potentially eligible for treatment with MT. The most cost effective solutions were attained by solving the p median facility location-allocation problem with the objective function of maximizing the incremental net monetary benefit (INMB) of MT compared with no MT in patients with AIS. Deterministic sensitivity analysis (DSA) was used as the basis of the results analysis.Results: The implementation strategy with seven CSCs produced the highest annual INMB per patient of all possible solutions in the base case scenario. The most cost effective implementation strategy of the extended scenario comprised seven CSCs and four TSCs. DSA revealed sensitivity to variability in MT rate and the maximum willingness to pay per quality adjusted life year gained.Conclusion: The combination of optimization modeling and cost effectiveness analysis provides a powerful tool for configuring the extent and locations of CSCs (and TSCs). The most cost effective implementation of CSCs in Sweden entails 24/7 MT services at all seven university hospitals.
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| 2. |
- Ennab Vogel, Nicklas, 1981-
(författare)
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Optimizing prehospital acute stroke care in the presence of economic constraints
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mechanical thrombectomy (MT) has become standard of care for acute anterior circulation ischaemic stroke due to large vessel occlusion since the launch of second-generation stent retrievers for clinical use nearly a decade ago. Up until recently, the treatment was exclusively performed at university hospitals in Sweden. Sundsvall Regional Hospital joined as the eighth treatment facility in late 2023. Scarce resources of healthcare systems across the world hamper the complete implementation of MT in acute stroke care. Hence, efforts to improve patients’ accessibility to and healthcare providers’ utilization of MT remain prioritized. Methods for determining the optimal number and locations of treatment facilities for MT in economically constrained healthcare systems remain unstudied. The optimal number and locations of ambulance helicopters for prehospital transportation of patients with presumed acute stroke too. The aim of the thesis is to solve constrained optimization problems within the framework of cost-effectiveness analysis for prehospital acute stroke care management of patients with AIS. To fill these knowledge gaps, this thesis takes on an interdisciplinary research approach, and combines health economics, operations research, and medicine to identify cost-effective solutions for location problems with respect to the implementation of MT in the Swedish healthcare system. A comprehensive set of consolidated data based on anonymized, patient-level, nation-wide registry data for a study period of six years underlies analyses. This thesis employs predictive modelling, geographic network analysis, optimization, and decision modelling for economic evaluation within the framework of cost-effectiveness analysis to identify the most cost-effective solutions to implement. The fitting of predictive generalized linear models to four treatment modalities in acute stroke care for patients with acute ischaemic stroke established the linear associations in absolute effect measures between the modified Rankin Scale score at 90 days post-stroke and the time from symptom onset to treatment start with intravenous thrombolysis only, MT only and intravenous thrombolysis plus MT, respectively. With imposed economic constraints, the analysis identified the optimal number and locations of thrombectomy centres for the Swedish healthcare system. Furthermore, it identified the optimal number and locations of ambulance helicopters too. Finally, it was possible to determine the combination of optimally located thrombectomy centres and ambulance helicopters that comprises the most cost-effective solution to implement into the Swedish stroke system of care. This thesis demonstrates that economically constrained optimization of thrombectomy centres and ambulance helicopters in acute stroke systems of care comprises highly cost-effective solutions that entail immense health gains in patients with acute ischaemic stroke. Health economics, operational research and medicine can be combined to create a powerful decision-modelling tool in the evaluation of implementation strategies for prehospital acute stroke systems of care.
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| 3. |
- Ennab Vogel, Nicklas, et al.
(författare)
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Prediction modelling the impact of onset to treatment time on the modified Rankin Scale score at 90 days for patients with acute ischaemic stroke
- 2022
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Ingår i: BMJ Neurology Open. - : BMJ. - 2632-6140. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Shortening the time from stroke onset to treatment increases the effectiveness of endovascular stroke therapies. Aim This study aimed to predict the modified Rankin Scale score at 90 days post-stroke (mRS-90d score) in patients with acute ischaemic stroke (AIS) with respect to four types of treatment: conservative therapy (CVT), intravenous thrombolysis only (IVT), mechanical thrombectomy only (MT) and pretreatment with IVT before MT (IVT+MT). Patients and methods This nationwide observational study included 124 484 confirmed cases of acute stroke in Sweden over 6 years (2012-2017). The associations between onset-to-treatment time (OTT), patient age and hospital admission National Institutes of Health Stroke Scale (NIHSS) score with the five-levelled mRS-90d score were retrospectively studied. A generalised linear model (GLM) was fitted to predict the mRS-90d scores for each patient group. Results The fitted GLM for CVT patients is a function of age and NIHSS score. For IVT, MT and IVT+MT patients, GLMs additionally employed OTT variables. By reducing the mean OTTs by 15 min, the number needed-to-treat (NNT) for one patient to make a favourable one-step shift in the mRS was 30 for IVT, 48 for MT and 21 for IVT+MT. Discussion and conclusion This study demonstrates linear associations of mRS-90d score with OTT for IVT, MT and IVT+MT, and shows in absolute effects measures that OTT reductions for IVT and/or MT produces substantial health gains for patients with AIS. Even moderate OTT reductions led to sharp drops in the NNT. © 2022 Author(s) (or their employer(s)).
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| 4. |
- Ennab Vogel, Nicklas, 1981-, et al.
(författare)
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Sms-livräddare vid akut omhändertagande av patient med hjärtstopp utanför sjukhus - en kostnadseffektivitetsanalys
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sms-livräddare är ett system som utvecklats för att stödja och komplettera befintlig ambulanssjukvård med potentiellt livräddande frivilliginsatser av civila insatspersoner i det akuta omhändertagande av patient vid misstanke om hjärtstopp utanför sjukhus. Systemet koordinerar frivilligt anslutna insatspersoner, så kallade Sms-livräddare, via en särskilt utvecklad mobilapplikation. Rapporten är producerad i syfte att bemöta efterfrågan på hälsoekonomiska utvärderingar av Sms-livräddare som komplement till regionernas befintliga ambulansdirigering vid larm om misstänkt hjärtstopp utanför sjukhus, och på uppdrag av SOS Alarm Sverige AB. Mot bakgrund av tillgängliga data från Hjärtstoppscentrum vid Karolinska Institutet (KI), Heartrunner Sweden AB och Svenska Hjärt-lungräddningsregistret har en förenklad kostnadseffektivitetsanalys av Sms-livräddare som tilläggsintervention till prehospitalt, akut omhändertagande av patient vid misstanke om hjärtstopp utanför sjukhus kunnat genomföras. En kortfattad epidemiologisk översikt av hjärtstopp utanför sjukhus, i riket och på regionnivå ges tillsammans med beskrivning av data på tilldelade uppdrag i Sms-livräddare som tjänat underlag för estimering av hälsoeffektmått och de kostnader som införts analysen. Efterföljande metodbeskrivning redogör för de underliggande antaganden och avgränsningar som påförts modellerna i den förenklade kostnadseffektivitetsanalysen. Rapporten presenterar resultatberäkningar av den förenklade kostnadseffektivitetsanalysen på regionnivå och avslutas med en allmän diskussion av resultatens relevans och begränsningar i estimering av Sms-livräddares kostnadseffektivitet som tilläggsintervention till befintlig ambulansdirigering på regionnivå. Resultaten indikerar att Sms-livräddare är en kostnadseffektiv tilläggsintervention till prehospitalt akut omhändertagandet av hjärtstoppatient utanför sjukhus, och visar att systematiserade och tydligt avgränsade räddningsinsatser av frivilligpersoner i prehospitalt omhändertagande av patient med ett livshotande tillstånd kan ha livsavgörande betydelse för den hjälpsökande i väntan på avancerad akutsjukvård.
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| 5. |
- Lundqvist, Martina, 1986-, et al.
(författare)
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Effects of eating breakfast and school breakfast programmes on children and adolescents : a systematic review
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Background: Breakfast is often described as the most important meal of the day. The regularity of wholesome, daily meal patterns comprised of healthy foods is important for the physical and mental development of children and adolescents. One way to make sure that children and adolescents eat breakfast on a regular basis is to serve it at school. Several published reviews have examined the effects of eating breakfast and studied effects of school breakfast programmes on children and adolescents. Informed decisions of whether to promote eating breakfast or to introduce a school breakfast programme require a broader perspective.The aim was to conduct a systematic review of scientific publications that study the effects potentially relevant for economic evaluations of eating breakfast or implementing school breakfast programmes for children and adolescents.Method: In the systematic literature review, studies were identified by searching the electronic databases PubMed, CINAHL, Web of Science and PsycINFO from January 2000 through October 2017. The following inclusion criteria guided the selection of the identified studies: published articles from peer-reviewed journals with full text in English, studies collecting primary data, quantitative studies, studies performed in countries comparable to Sweden in terms of access and quality of nutrients, economic and social conditions and publications studying at least one of the topics; academic achievement, quality of life and wellbeing, risk factors/morbidity or cognitive performance.Results: Twenty-six studies on eating breakfast and eleven studies on school breakfast programmes fulfilled the inclusion criteria and were judged to be of at least moderate quality were included in the analysis. The results of the review of studies on eating breakfast showed positive and conclusive effects on cognitive performance, academic achievement, quality of life, well-being and risk factors/morbidity. This indicates that eating breakfast is important. The results of the studies on school breakfast varied. Minor positive effects were seen on cognitive performance and academic achievement. Most studies showed no effects and all studies suffered from different methodological weaknesses.Conclusions: The overall assessment of the studies on eating breakfast indicated positive effects. The studies on school breakfast programmes showed minor positive effects, but the majority of the studies showed no effects and all studies suffered from different methodological weaknesses. In order to assess the cost-effectiveness of eating breakfast and of school breakfast programmes we need to know more about how the identified affects influence the societal cost and the individuals gain in quality-adjusted life years both in the short and the long term.
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| 6. |
- Lundqvist, Martina, et al.
(författare)
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Effects of eating breakfast on children and adolescents: A systematic review of potentially relevant outcomes in economic evaluations
- 2019
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Ingår i: Food & Nutrition Research. - : SWEDISH NUTRITION FOUNDATION-SNF. - 1654-6628 .- 1654-661X. ; 63
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Forskningsöversikt (refereegranskat)abstract
- Background: Breakfast is often described as the most important meal of the day. Several studies have focused on examining if breakfast habits have any short-term effects on school attendance, academic achievement, and general health in children and adolescents. Informed decisions of whether to promote eating breakfast or not require a more long-term perspective. Objective: The aim of this study was to conduct a systematic review of scientific publications studying the effects identified as potentially relevant for the economic evaluation of eating breakfast in children and adolescents. Design: A systematic literature review was conducted. Studies were identified by searching the electronic databases PubMed, CINAHL, Web of Science, and PsycINFO between January 2000 and October 2017. The inclusion criteria applied were published articles from peer-reviewed journals with full text in English, quantitative studies collecting primary data with school-aged children, and adolescents aged from 6 to 18 years as participants, performed entirely or partly in countries with advanced economies, except Japan and Taiwan. Results: Twenty-six studies fulfilled the inclusion criteria, and studies that were judged to be of at least moderate quality were included in the analysis. The results of the review of eating breakfast studies showed positive and conclusive effects on cognitive performance, academic achievement, quality of life, well-being and on morbidity risk factors. Conclusions: The overall assessment of the studies indicated positive effects of eating breakfast. How the identified effects influence societal costs and an individuals quality-adjusted life years require further research.
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| 7. |
- Matinrad, Niki, 1986-, et al.
(författare)
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Optimal Dispatch of Volunteers to Out-of-hospital Cardiac Arrest Patients
- 2019
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Ingår i: Proceedings of the 52nd Hawaii International Conference on System Sciences (HICSS), Hawaii, USA, 8th-11th January 2019. - : University of Hawai'i at Manoa. - 9780998133126 ; , s. 4088-4097
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Konferensbidrag (refereegranskat)abstract
- Initiatives with mobile phone dispatched volunteers to out-of-hospital cardiac arrest (OHCA) cases, can be found today in some countries, e.g. Sweden, the Netherlands, Switzerland and Italy. When an OHCA case is reported, an alarm is sent to the registered volunteers’ phones. However, the allocation of which volunteers to send to the automatic external defibrillator (AED) and who to send directly to the patient, is today based on simple rules of thumb. In this paper, we propose a model to optimally select how many and which volunteers to send directly to the patient, and who should pick up and deliver an AED. The results show that the model can help increase the survivability of the patients, compared to simple decision rules.
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