| 1. |
- 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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| 2. |
- Olofsson, Sara, et al.
(författare)
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Dread and Risk Elimination Premium for the Value of a Statistical Life
- 2019
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Ingår i: Risk Analysis. - : Blackwell Publishing. - 0272-4332 .- 1539-6924. ; 39:11, s. 2391-2407
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Tidskriftsartikel (refereegranskat)abstract
- The value of a statistical life (VSL) is a widely used measure for the value of mortality risk reduction. As VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a "dread disease," which supports the use of a "cancer premium." The objective of this study is to investigate the existence of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest, and amyotrophic lateral sclerosis (ALS). Data were collected from 500 individuals in the Swedish general population of 50-74-year olds using a web-based questionnaire. Preferences were elicited using the contingent valuation method, and a split-sample design was applied to test scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accidents. A premium (92-113%) for cancer was found in relation to road traffic accidents. The premium was higher for cancer with a shorter time from diagnosis to death. A premium was also found for sudden cardiac arrest (73%) and ALS (118%) in relation to road traffic accidents. Eliminating risk was associated with a premium of around 20%. This study provides additional evidence that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.
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| 3. |
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| 4. |
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| 5. |
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| 6. |
- Asuman, Derek, et al.
(författare)
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Labour market consequences of an early-onset disability : the case of cerebral palsy
- 2024
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Ingår i: Applied Economics. - : Informa UK Limited. - 0003-6846 .- 1466-4283. ; 56:11, s. 1309-1326
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Tidskriftsartikel (refereegranskat)abstract
- The labour market consequences of early-onset or congenital disabilities have received little attention in the literature. In this paper, we study the consequences of cerebral palsy (CP), a lifelong early onset disability, and pathways through which it affects labour outcomes. We use data from multiple linked Swedish National Population Registers between 1990 and 2015 and apply both regression and mediation analysis. Our results show, as expected, strong negative consequences of CP on labour outcomes, and that the consequences have increased over time. The social insurance system, we find, compensates for some of the losses through non-work-related benefits. The results also suggest that the direct effects of CP per se have prominent impact on labour market outcomes. Thus, given the same level of mediators, persons with CP will have lower labour outcomes compared to persons without CP. Our results draw attention to the widening labour market consequences of CP in Sweden.
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| 7. |
- Asuman, Derek, et al.
(författare)
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Pain and labor outcomes : A longitudinal study of adults with cerebral palsy in Sweden
- 2023
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Ingår i: Disability and Health Journal. - : Elsevier BV. - 1936-6574 .- 1876-7583. ; 16:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP).Objectives: To estimate the association between pain and labor outcomes for adults with CP in Sweden.Methods: A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings.Results: Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement.Conclusion: Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.& COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 8. |
- Borg, Sixten, et al.
(författare)
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Patient-reported outcome and experience measures for diabetes: development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The Swedish National Diabetes Register (NDR) has developed a diabetes-specific questionnaire to collect information on individuals' management of their diabetes, collaboration with healthcare providers and the disease’s impact on daily life. Our main objective was to develop measures of well-being, abilities to manage diabetes and judgements of diabetes care, and to detect and quantify differences using the NDR questionnaire.Design, setting and participants The questionnaire was analysed with using responses from 3689 participants with type 1 and 2 diabetes, randomly sampled from the NDR population, combined with register data on patient characteristics and cardiovascular and diabetes complication risk factors.Methods We used item response theory to develop scales for measuring well-being, abilities to manage diabetes and judgements of diabetes care (scores). Test–retest reliability on the scale level was analysed with intraclass correlation. Associations between scores and risk factor levels were investigated with subgroup analyses and correlations.Results We obtained scales with satisfactory measurement properties, covering patient reported outcome measures such as general well-being and being free of worries, and patient reported experience measure, for example, access and continuity in diabetes care. All scales had acceptable test–retest reliability and could detect differences between diabetes types, age, gender and treatment subgroups. In several aspects, for example, freedom of worries, type 1 patients report lower than type 2, and younger patients lower than older. Associations were found between some scores and glycated haemoglobin, but none with systolic blood pressure or low-density lipoprotein cholesterol. Clinicians report positive experience of using scores, visually presented, in the patient dialogue.Conclusions The questionnaire measures and detects differences in patient well-being, abilities and judgements of diabetes care, and identifies areas for improvement. To further improve diabetes care, we conclude that patient-reported measures are important supplements to cardiovascular and diabetes complication risk factors, reflecting patient experiences of living with diabetes and diabetes care.
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| 9. |
- Borg, Sixten, et al.
(författare)
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Quality of life in chronic conditions using patient-reported measures and biomarkers: a DEA analysis in type 1 diabetes
- 2019
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Ingår i: Health Economics Review. - : Springer Science and Business Media LLC. - 2191-1991. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background A chronic disease impacts a patient's daily life, with the burden of symptoms and managing the condition, and concerns of progression and disease complications. Such aspects are captured by Patient-Reported Outcomes Measures (PROM), assessments of e.g. wellbeing. Patient-Reported Experience Measures (PREM) assess patients' experiences of healthcare and address patient preferences. Biomarkers are useful for monitoring disease activity and treatment effect and determining risks of progression and complications, and they provide information on current and future health. Individuals may differ in which among these aspects they consider important. We aimed to develop a measure of quality of life using biomarkers, PROM and PREM, that would provide an unambiguous ranking of individuals, without presuming any specific set of importance weights. We anticipated it would be useful for studying needs and room for improvement, estimating the effects of interventions and comparing alternatives, and for developing healthcare with a broad focus on the individual. We wished to examine if efficiency analysis could be used for this purpose, in an application to individuals with type 1 diabetes. Results We used PROM and PREM data linked to registry data on risk factors, in a large sample selected from the National Diabetes Registry in Sweden. Efficiency analysis appears useful for evaluating the situation of individuals with type 1 diabetes. Quality of life was estimated as efficiency, which differed by age. The contribution of different components to quality of life was heterogeneous, and differed by gender, age and duration of diabetes. Observed quality of life shortfall was mainly due to inefficiency, and to some extent due to the level of available inputs. Conclusions The efficiency analysis approach can use patient-reported outcomes measures, patient-reported experience measures and comorbidity risk factors to estimate quality of life with a broad focus on the individual, in individuals with type 1 diabetes. The approach enables ranking and comparisons using all these aspects in parallel, and allows each individual to express their own view of which aspects are important to them. The approach can be used for policy regarding interventions on inefficiency as well as healthcare resource allocation, although currently limited to type 1 diabetes.
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| 10. |
- Brinda, Ethel M., et al.
(författare)
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Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries : World Health Organization Study on Global AGEing and Adult Health
- 2016
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Ingår i: American Journal of Geriatric Psychiatry. - : Elsevier BV. - 1064-7481. ; 24:12, s. 1196-1208
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Tidskriftsartikel (refereegranskat)abstract
- Objective Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. The biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression; to study its associations with health, social, and economic variables; and to investigate socioeconomic inequalities in depression prevalence in LMICs. Methods The authors accessed the World Health Organization Study on Global AGEing and Adult Health Wave 1 data that studied nationally representative samples from six large LMICs (N = 14,877). A computerized algorithm derived depression diagnoses. The authors assessed hypothesized associations using survey multivariate logistic regression models for each LMIC and pooled their risk estimates by meta-analyses and investigated related socioeconomic inequalities using concentration indices. Results Cross-national prevalence of geriatric depression was 4.7% (95% CI: 1.9%–11.9%). Female gender, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, whereas pension support and health insurance showed significant negative associations with geriatric depression. Pro-poor inequality of geriatric depression were documented in five LMICs. Conclusions Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression amongolder people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasized.
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| 11. |
- Burger, Ronelle, et al.
(författare)
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Use of simulated patients to assess hypertension case management at public healthcare facilities in South Africa
- 2020
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Ingår i: Journal of Hypertension. - 1473-5598. ; 38:2, s. 362-367
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Our study aims to evaluate hypertensive case management in South Africa's public health sector using simulated patients.METHOD: Our study describes interactions between hypertensive simulated patients and primary healthcare workers at 39 public sector healthcare facilities in two metropolitan centres in the Eastern and Western Cape Provinces of South Africa. Our analysis focus on 97 interactions where our eight simulated patients tested within range for stage 1 hypertension, that is with SBP 140-159 mmHg and/or DBP 90-99 mmHg. For this subset, we describe how healthcare workers communicated the outcome of the blood pressure test, and whether they follow government guidelines on risk assessment and lifestyle advice.RESULTS: Healthcare workers highlighted the risks associated with hypertension in one out of three cases and stressed the importance of regular monitoring of blood pressure in less than half of cases. Hypertensive patients received advice on all six lifestyle risk factors in 8% of cases. 39% of patients received no lifestyle advice at all. In one out of four cases, hypertensive patients left the facility without a hypertension diagnosis and with no prospect of a follow-up visit.CONCLUSION: Simulated patients can assess the quality of hypertension case management, yielding granular and comprehensive information that can help mobilize resources to improve care. The management of hypertension patients in South African public healthcare facilities is critically insufficient. Given that hypertension is responsible for a rising share of deaths in South Africa and many of these deaths are preventable, urgent intervention is needed.
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| 12. |
- Clarke, Philip M., et al.
(författare)
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Optimal recall length in survey design
- 2008
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Ingår i: Journal of Health Economics. - : Elsevier BV. - 1879-1646 .- 0167-6296. ; 27:5, s. 1275-1284
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Tidskriftsartikel (refereegranskat)abstract
- Self-reported data collected Via Surveys are a key input into a wide range of research conducted by economists. It is well known that Such data are subject to measurement error that arises when respondents are asked to recall past utilisation. Survey designers Must determine the length of the recall period and face a trade-off as increasing the recall period provides more information, but increases the likelihood of recall error. A statistical framework is used to explore this trade-off. Finally we illustrate how optimal recall periods call be estimated using hospital use data from Sweden's Survey of Living Conditions. (c) 2008 Published by Elsevier B.V.
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| 13. |
- Dackehag, Margareta, et al.
(författare)
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Debt and mental health : new insights about the relationship and the importance of the measure of mental health
- 2019
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:3, s. 488-493
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Empirical research suggests that household debt and payment difficulties are detrimental to mental health. Despite well-known measurement problems that may contaminate analyses using subjective self-reported health measures, our knowledge is very limited concerning the effect of payment difficulties on 'objective' measures of mental health. Moreover, few studies use longitudinal data to examine the relationship. This study combines rich survey data and longitudinal data from administrative registers on a representative sample of the Swedish population to examine the relationship between payment difficulties and subjective and objective measures of mental health. METHODS: We use data from a large survey of Swedish inhabitants (The Swedish Living Conditions Surveys) combined with data from administrative registers. We investigate both directions of the relationship between mental ill health and payment difficulties, controlling for previous mental health status and previous experiences of payment difficulties. We compare the association between payment difficulties and a self-reported measure of anxiety with the associations between payment difficulties and objective measures of mental ill health from a register of psychopharmaceutical drug consumption. RESULTS: Payment difficulties associate with subjectively reported mental ill health, but less to psychopharmaca use. For objective measures, we find stronger evidence of a link running from mental ill health to later payment difficulties. CONCLUSIONS: Self-reported and objective measures of mental problems may convey different messages regarding the impact of payment difficulties on mental health. Policy measures depend on whether the primary target group is individuals with severe mental problems or individuals with mild anxiety.
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| 14. |
- Dackehag, Margareta, et al.
(författare)
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Macroeconomic fluctuations and individual use of psychotropic medications : evidence from Swedish administrative data
- 2023
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 33:1, s. 93-98
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A growing literature finds that adult mental health worsens during economic downturns. Current insights on the relationship between macroeconomic fluctuations and psychotropic medication are based on self-reported information or aggregate measures on prescriptions. This study assesses the relationship between local macroeconomic conditions and individual use of psychotropic medication as reported in administrative registers. METHODS : We use local information on unemployment linked to individual-level longitudinal data on detailed psychotropic drug consumption from administrative registers, for individuals in working age (20-65) in Sweden 2006-13. Any psychotropic medication uptake and the related number of redeemed prescriptions are the primary outcomes. Mortality is considered a secondary outcome. RESULTS : Among young men (aged 20-44) and older women (aged 45-65), we find reduced use of psychotropic medication (2-4% compared to the mean) when the local labor market conditions deteriorate. The relationship is driven by reduced use of antidepressants. The same age-gender groups experience a significantly higher risk of mortality in bad times. CONCLUSIONS : This study shows that economic downturns may not only put strain on individuals' mental health but also on their access to psychopharmaceutic treatments.
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| 15. |
- De Graeve, Diana, et al.
(författare)
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Equity in the delivery of health care in Europe and the US
- 2000
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Ingår i: Journal of health economics. - : Elsevier B.V. - 1879-1646 .- 0167-6296. ; 19:5, s. 553-583
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.
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| 16. |
- Erlingsdottir, Gudbjörg, et al.
(författare)
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Det blir inte alltid som planerat. Om nya styrmodeller och deras varierande resultat
- 2010
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Ingår i: SNS Välfärdsrapport. Vårdens utmaningar. - 1653-3909. ; , s. 148-176
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Inom hälso- och sjukvården i Sverige implementeras ständigt nya styrmodeller. Många av dessa ger dock inte avsett resultat. I kapitlet diskuteras varför och hur styrmodeller omtolkas där kvalitetssäkring används som illustrativt exempel.
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| 17. |
- Fischer, M., et al.
(författare)
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Education and health: long-run effects of peers, tracking and years
- 2021
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Ingår i: Economic Policy. - : Oxford University Press (OUP). - 0266-4658 .- 1468-0327. ; 36:105, s. 3-49
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Tidskriftsartikel (refereegranskat)abstract
- We investigate two parallel school reforms in Sweden to assess the long-run health effects of education. One reform only increased years of schooling, while the other increased years of schooling but also removed tracking leading to a more mixed socioeconomic peer group. By differencing the effects of the parallel reforms we separate the effect of de-tracking and peers from that of more schooling. We find that the pure years of schooling reform reduced mortality and improved current health. Differencing the effects of the reforms shows significant differences in the estimated impacts, suggesting that de-tracking and subsequent peer effects resulted in worse health.
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| 18. |
- Gerdtham, Ulf-G, et al.
(författare)
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Do Socioeconomic Factors Really Explain Income-Related Inequalities in Health? : Applying a Twin Design to Standard Decomposition Analysis
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The concentration index and decomposition analysis are commonly used in economics to measure and explain socioeconomic inequalities in health. Such analysis builds on the strong assumption that a health production function can be estimated without substantial bias implying that health is caused by socioeconomic outcomes, which is hard to prove. This article contributes to the decomposition literature by applying a twin design to standard decomposition analysis of socioeconomic health inequalities in Sweden. The twin-based decomposition estimates, which control for unobserved endowments at the twin-pair level, are much lower in magnitude than estimates obtained via typical OLS on the same sample. This demonstrates that OLS-based decompositions are severely upward biased due to underlying confounders, exaggerating the contribution of income and education to health inequality, which in turn limits the usefulness of such decompositions for policy purposes.
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| 19. |
- Gerdtham, Ulf-G., et al.
(författare)
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Equity in Swedish health care reconsidered: new results based on the finite mixture model
- 2001
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Ingår i: Health economics. - : John Wiley & Sons, Ltd. - 1099-1050 .- 1057-9230. ; 10:6, s. 565-572
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Tidskriftsartikel (refereegranskat)abstract
- This paper reconsiders the equity issue in Swedish health care utilization previously analysed by Gerdtham (Health Econ 1997; 6: 303-319) within the framework of the standard two-part model. Departing from the user/non-user distinction, we use the more flexible framework of the finite mixture model that distinguishes between frequent/infrequent users. Our results indicate that the support for the inequity hypothesis reported by Gerdtham is sensitive to model specification and the way standard errors of coefficients are estimated. The new framework offers an alternative perspective on the magnitude of the income-related difference in health care utilization. Copyright © 2001 John Wiley & Sons, Ltd.
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| 20. |
- Gerdtham, Ulf-G, et al.
(författare)
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Equity in the delivery of health care in Sweden
- 1998
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Ingår i: SCANDINAVIAN JOURNAL OF SOCIAL MEDICINE. - : SCANDINAVIAN UNIVERSITY PRESS. - 0300-8037. ; 26:4, s. 259-264
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Tidskriftsartikel (refereegranskat)abstract
- There is mutual agreement that health care should be delivered according to need. In this article, although we employ different specifications for need, we conclude that there is inequity in the delivery of health care in Sweden. Higher income groups visi
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| 21. |
- Gerdtham, Ulf-G, et al.
(författare)
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Health System Effects on Cost Efficiency in the OECD Countries
- 2001
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Ingår i: Applied economics. - : Informa UK Limited. - 1466-4283 .- 0003-6846. ; 33:5, s. 643-647
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates the effects of different health systems on cost efficiency in inpatient health care among the OECD countries. The results indicate that public contract systems are more efficient and that public integrated systems are less efficient than public reimbursement systems.
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| 22. |
- Gerdtham, Ulf G., et al.
(författare)
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Income-related inequality in life-years and quality-adjusted life-years
- 2000
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Ingår i: Journal of Health Economics. - 0167-6296 .- 1879-1646. ; 19:6, s. 1007-1026
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Tidskriftsartikel (refereegranskat)abstract
- We estimate the income-related inequality in Sweden with respect to life-years and quality-adjusted life-years (QALYs). We use a large data set from Sweden with over 40,000 individuals followed up for 10-16 years, to estimate the survival and quality-adjusted survival in different income groups. For both life-years and QALYs, we discover inequalities in health favouring the higher income groups. For men (women) in the youngest age-group (20-29 years), the number of QALYs is 43.7 (45.7) in the lowest income decile and 47.2 (49.0) in the highest income decile. (C) 2000 Elsevier Science B.V.
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| 23. |
- Gerdtham, Ulf-G., et al.
(författare)
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International comparisons of health expenditure: Theory, data and econometric analysis
- 2000
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Ingår i: Handbook of Health Economics. - : Elsevier B.V. - 1574-0064. - 9780444504708 - 0444504702 ; , s. 11-53
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Comparisons of aggregate health expenditure across different countries have become popular over the last three decades as they permit a systematic investigation of the impact of different institutional regimes and other explanatory variables. Over the years, several regression analyses based on cross-section and panel data have been used to explain the international differences in health expenditure. A common result of these studies is that aggregate income appears to be the most important factor explaining health expenditure variation between countries and that the size of the estimated income elasticity is high and even higher than unity which in that case indicates that health care is a “luxury” good. Additional results indicates, for example, that the use of primary care “gatekeepers” lowers health expenditure and also that the way of remunerating physicians in the ambulatory care sector appears to influence health expenditure; capitation systems tend to lead to lower expenditure than fee-for-service systems. Finally, we also list some issues for the future. We demand more efforts on theory of the macroeconomic analysis of health expenditure, which is underdeveloped at least relative to the macroeconometrics of health expenditure. We also demand more replications based on updated data and methods that seeks to unify the many differing results of previous Studies.
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| 24. |
- Gerdtham, Ulf-G., et al.
(författare)
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On stationarity and cointegration of international health expenditure and GDP
- 2000
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Ingår i: Journal of health economics. - : Elsevier B.V. - 1879-1646 .- 0167-6296. ; 19:4, s. 461-475
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Tidskriftsartikel (refereegranskat)abstract
- This paper examines stationarity and cointegration of health expenditure and GDP, for a sample of 21 OECD countries using data for the period 1960–1997, by applying a test battery that allows robust inference to be made on the stationarity and cointegration issue. Trend stationarity and no-cointegration are tested using new country-by-country and panel tests, not previously applied in this setting. New results for country-by-country and panel tests of non-stationarity and cointegration are presented. Our unit root and trend stationarity results indicate that both health expenditure and GDP are non-stationary. The no-cointegration and cointegration results indicate that health expenditure and GDP are cointegrated.
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| 25. |
- Gerdtham, Ulf G., et al.
(författare)
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Price and quantity in international comparisons of health care expenditure
- 1991
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Ingår i: Applied Economics. - : Informa UK Limited. - 0003-6846 .- 1466-4283. ; 23:9, s. 1519-1528
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Tidskriftsartikel (refereegranskat)abstract
- An important omission from earlier cross-national comparisons of health care expenditure has been the failure to distinguish between price and quantity. Using recent data on purchasing power parities, the purpose of this article is to report some preliminary results regarding health care expenditure and quantity across 22 OECD countries. The article concludes that, contrary to what has been suggested in some recent articles, the relative price of health care is not correlated to the aggregate per capita income. The fraction of the national income that is devoted to health care provision increases with the per capita income regardless of whether health care is measured in terms of expenditure or quantity. The relative price of health care has a rationing effect on the quantity of health care that is offered, with a price elasticity close to minus one. The latter finding means that the health care expenditure is not greater in countries with higher prices. Furthermore, the differences in health care expenditure or quantity between countries persist after correction for the relative price and the income level. Part of these differences can be explained by differences in the definition of health care in the various countries.
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| 26. |
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| 27. |
- Gerdtham, Ulf-G, Sundberg, Gun
(författare)
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Sjukvårdens rättvisa fördelning
- 1997
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Ingår i: Ekonomisk Debatt. - : Nationalekonomiska föreningen. ; 25:7, s. 305-306
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 28. |
- 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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| 29. |
- Gerdtham, Ulf G., et al.
(författare)
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The relationship between happiness, health, and socio-economic factors : Results based on Swedish microdata
- 2001
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Ingår i: Journal of Socio-Economics. - : Elsevier Inc. - 1053-5357 .- 1879-1239. ; 30:6, s. 553-557
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates the relationship between happiness (utility) and a host of socio-economic variables in a random sample of over 5,000 individuals from the Swedish adult population. The results show that happiness increases with income, health and education and decreases with unemployment, urbanisation, being single, and male gender. The relationship between age and happiness is U-shaped, with happiness being lowest in the age-group 45-64 years.
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| 30. |
- Gerdtham, Ulf-G., et al.
(författare)
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Trait self-control, exercise and exercise ambition : Evidence from a healthy, adult population
- 2020
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Ingår i: Psychology, Health & Medicine. - : Informa UK Limited. - 1354-8506 .- 1465-3966. ; 25:5, s. 583-592
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Tidskriftsartikel (refereegranskat)abstract
- This study explores if self-control predicts exercise ambition and actual exercise, and if exercise ambition predicts actual exercise. Members and guests at a not-for-profit sports club were invited to participate. 264 individuals completed a self-reported (Self-Control Scale) measure of self-control, and responded to questions about actual exercise as well as exercise ambition prior to their workout. Main Outcome Measures are exercise ambition, actual exercise, and the difference between them. We find that trait self-control predicts both actual exercise and exercise ambition. Exercise ambition also predicts actual exercise. The results suggest a path from self-control, via exercise ambition, to actual exercise. Individuals with relatively low self-control might benefit from some aid in setting goals for their workouts and committing to exercise.
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| 31. |
- Hardardottir, Hjördis, et al.
(författare)
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Parameterizing standard measures of income and health inequality using choice experiments
- 2021
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Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 30:10, s. 2531-2546
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Tidskriftsartikel (refereegranskat)abstract
- When measuring inequality using conventional inequality measures, ethical assumptions about distributional preferences are often implicitly made. In this paper, we ask whether the ethical assumptions underlying the concentration index for income-related health inequality and the Gini index for income inequality are supported in a representative sample of the Swedish population using an internet-based survey. We find that the median subject has preferences regarding income-related health inequality that are in line with the ethical assumptions implied by the concentration index, but put higher weight on the poor than what is implied by the Gini index of income inequality. We find that women and individuals with a poorer health status put higher weight on the poor than men and healthier individuals. Ethically flexible inequality measures, such as the s-Gini index and the extended concentration index, imply that researchers have to choose from a toolbox of infinitely many inequality indices. The results of this paper are indicative of which indices (i.e. which parameter values) reflect the views of the population regarding how inequality should be defined.
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| 32. |
- Heckley, Gawain, et al.
(författare)
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A general method for decomposing the causes of socioeconomic inequality in health
- 2016
-
Ingår i: Journal of Health Economics. - : Elsevier BV. - 0167-6296 .- 1879-1646. ; 48, s. 89-106
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Tidskriftsartikel (refereegranskat)abstract
- We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.
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| 33. |
- Heckley, Gawain, et al.
(författare)
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The health returns of attending university for the marginally eligible student
- 2022
-
Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 31:5, s. 877-903
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Tidskriftsartikel (refereegranskat)abstract
- A key policy question is whether continued expansion of university education is beneficial for the marginally eligible student. In this paper we exploit an arbitrary university eligibility rule combined with regression discontinuity design to estimate the causal effect of university attendance on healthcare utilization amongst young adults in Sweden. We find that the eligibility rule leads to a clear jump in university attendance of between 10% and 14% points for both males and females. 2SLS estimates find that a 10% point increase in university attendance causes a roughly one percentage point increase in hospital admissions due to mental ill health for males, almost exclusively related to alcohol and narcotics. Our findings for females, however, imply the opposite, suggesting that university attendance decreases hospital admissions related to mental health. The results for males sit in contrast to results from previous studies, and suggest that the effect of university education on health for the male student at the margin of eligibility is different to that of the average student.
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| 34. |
- Hompashe, Dumisani MacDonald, et al.
(författare)
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The nurse did not even greet me' : How informed versus non-informed patients evaluate health systems responsiveness in South Africa
- 2021
-
Ingår i: BMJ Global Health. - : BMJ. - 2059-7908. ; 6:4
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients' experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction.METHODS: Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients' exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients' experiences of non-clinical dimensions.RESULTS: We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers' explanations of health conditions.CONCLUSION: Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.
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| 35. |
- Jarl, Johan, et al.
(författare)
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Effects of Kidney Transplantation on Labor Market Outcomes in Sweden
- 2018
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Ingår i: Transplantation. - 0041-1337. ; 102:8, s. 1375-1381
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Kidney transplantation is considered a superior treatment for end-stage renal disease compared with dialysis although little is known about the wider effects, especially on labor market outcomes. The objective is to estimate the treatment effect of kidney transplantation compared with dialysis on labor market outcomes, controlling for the nonrandom selection into treatment. Methods: The average treatment effect is estimated using an inverse-probability weighting regression adjustment approach on all patients in renal replacement therapy 1995 to 2012. Results: Kidney transplantation is associated with a treatment advantage over dialysis on employment, labor force participation, early retirement, and labor income. The probability of being employed 1 year after treatment is 21 (95% confidence interval, 16-25) percentage points higher for transplantation. The positive effect increases to 38 (95% confidence interval, 30-46) percentage points after 5 years, mainly due to worsening outcomes on dialysis. The effect on labor income is mainly mediated through employment probability. The productivity gains of transplantation compared to dialysis amounts to €33 000 over 5 years. Conclusions: Transplantation is superior to dialysis in terms of potential to return to work as well as in terms of labor income and risk of early retirement, after controlling for treatment selection. This positive effect increases over time after transplantation.
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| 36. |
- Jarl, Johan, et al.
(författare)
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Heterogeneity in the associations between common mental disorders and labour outcomes - a population study from southern Sweden
- 2020
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous research has shown that Common Mental Disorders (CMD) are unequally distributed between population subgroups, but we know less about how labour outcomes following such disorders are distributed. Our aim is to investigate how the labour outcomes following a CMD diagnosis differ over sex, age, schooling and country of birth.METHODS: We use a population sample from southern Sweden of patients diagnosed with CMD during calendar years 2009-2011, and a matched general population control group, to study labour market outcomes three years following diagnosis. Logistic regression is used to study the associations between a CMD diagnosis and outcomes in employment, sick leave, and disability pension. Interaction analysis is used to study heterogeneity in these associations.RESULTS: CMD diagnosis is associated with reduced employment and increased odds of sick leave and disability pension. Following a CMD diagnosis, men and higher educated individuals have higher odds of non-employment and sick leave compared to women and the lower educated. Foreign-born individuals have higher odds of non-employment and lower odds of sick leave, compared to individuals born in Sweden. Heterogeneity appears to be present also based on age. Younger age is associated with higher odds of non-employment and disability pension and lower odds of sick leave, following a CMD diagnosis.CONCLUSIONS: Heterogeneity in labour outcomes following a CMD diagnosis sometimes contributes to and sometimes mitigates inequalities in employment, sick leave and disability pension between population subgroups. When developing new strategies to tackle mental ill-health in the population, it may therefore be motivated to consider not only inequalities in the prevalence of mental disorders but also heterogeneity in associated adverse labour outcomes.
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| 37. |
- Kjellsson, Gustav, et al.
(författare)
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The authors respond
- 2016
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Ingår i: Epidemiology. - 1044-3983. ; 27:3, s. 16-17
-
Tidskriftsartikel (refereegranskat)
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| 38. |
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| 39. |
- Linder, Anna, et al.
(författare)
-
Education, immigration and rising mental health inequality in Sweden
- 2020
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 264
-
Tidskriftsartikel (refereegranskat)abstract
- Educational and income gradients in health are well established in the literature but there is need for a better understanding of how mental health inequalities change over time, and what drives the development. We aim to study how psychiatric diagnosis and its income-related inequality have changed over time in Sweden and to make a first attempt at disentangling the development by decomposing any changes in terms of changes in two important demographic characteristics: education and migration background. We use administrative patient data to study psychiatric inpatient diagnosis in the years 1994 and 2011. The study population comprises all individuals aged 31–64 years living in Sweden. Income-related inequalities are measured by the Concentration Index (CI). We decompose changes in the probability of receiving a diagnosis and changes in income-related inequality over time to understand the role of changing demographics. Our results show that over the study period the probability of receiving a psychiatric inpatient diagnosis increased by 12.6%, while the relative and absolute income-related inequalities in diagnosis increased by 48.2% and 66.7% respectively. In 2011, more than half of psychiatric inpatients were found among the poorest fifth of the population. The decomposition results suggest that changes in education and migration background have not played a substantial role in determining these increases. Education levels increased substantially over the study period which would be expected to protect against mental ill-health. Instead, we find that diagnoses have become more concentrated amongst the lowest educated individuals and the lowest income families, groups who appear to be increasingly disadvantaged. The growing proportion of individuals with foreign background in Sweden does, in fact, predict small increases in the probability of diagnosis, while the impact on diagnosis inequality varies depending on the definition of foreign background.
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| 40. |
- Linder, Anna, et al.
(författare)
-
Grading bias and young adult mental health
- 2023
-
Ingår i: Health Economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 32:3, s. 675-696
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Tidskriftsartikel (refereegranskat)abstract
- We study exposure to grading bias and provide novel evidence of its impact on mental health. Grading bias, which we interpret as over-grading, is constructed as the residual of final upper secondary school grades having controlled for results in a standardized test, itself not subject to grading leniency. Grading bias is further isolated by considering only within-school variation in over-grading and controlling for prior grades and school production. Using Swedish individual-level register data for individuals graduating from upper secondary school in the years 2001-2004, we show that over-grading has substantial significant protective impacts on the mental health of young adults, but only among female students. That grades themselves, independent of knowledge, substantially impact the production of health highlights an important health production mechanism, and implies that any changes to the design of grading systems must consider these wider health implications.
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| 41. |
- Linder, Anna, et al.
(författare)
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Inequalities in the economic consequences of depression and anxiety in Europe : a systematic scoping review
- 2020
-
Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 30:4, s. 767-777
-
Forskningsöversikt (refereegranskat)abstract
- Background: Depression and anxiety are associated with adverse outcomes in educational achievements and economic performances. Moreover, the prevalence of these disorders is unequally distributed among different population subgroups. Our objective is to investigate whether the economic consequences of depression and anxiety differ between population subgroups of different gender, socioeconomic status (SES), ethnicity and age, in Europe. Methods: A systematic scoping literature review was performed to identify studies where exposure to depression or anxiety was identified at baseline and consequences in education, sickness absence, disability pension, unemployment and income/earnings were measured at follow-up. Results: Seventeen articles were included in this review and most of these were conducted in the Nordic countries. The consequences of depression and anxiety were stratified by gender in most of the articles. However, only in a few studies, the findings were stratified by SES, age and ethnicity. The negative consequences of depression in educational performance, disability pension and income are larger for men compared to women. Moreover, low SES individuals have more depression- and anxiety-related absence from work than high SES individuals. Conclusion: Our findings imply that the economic consequences of depression differ between population subgroups in Europe. This could have an impact on social stratification, shifting people who experience mental ill-health to lower SES groups or reinforcing an already disadvantaged position. More research is needed on unequal economic consequences of depression and anxiety in different population subgroups in Europe.
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| 42. |
- Lyttkens, Carl Hampus, et al.
(författare)
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Sjukvårdens långsiktiga finansiering
- 2010
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Ingår i: Vårdens utmaningar. - 9789186203580 ; , s. 114-147
-
Bokkapitel (populärvet., debatt m.m.)
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| 43. |
- Nordin, Martin, et al.
(författare)
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IMPACT OF A TERTIARY ELIGIBILITY THRESHOLD ON TERTIARY EDUCATION AND EARNINGS : A DISCONTINUITY APPROACH
- 2020
-
Ingår i: Economic Inquiry. - : Wiley. - 0095-2583 .- 1465-7295. ; 58:1, s. 401-424
-
Tidskriftsartikel (refereegranskat)abstract
- This study uses a discontinuity in the Swedish tertiary eligibility requirement to estimate the probability of enrolling in tertiary education, and the payoff thereof. Regression discontinuity results, show that achieving tertiary eligibility in upper-secondary education, increases the probability of enrolling in tertiary education by around 10–15 and 7 percentage points for students who enrolled on an academic and vocational track, respectively. For academic students, this implies 5% higher earnings for men, while for women it increases the probability of having positive incomes by 2%. Thus, academic students at the margin of tertiary education receive a substantial tertiary education payoff. (JEL I21, I26, I28).
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| 44. |
- Persson, Emma, 1981-, et al.
(författare)
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Effect of type 1 diabetes on school performance in a dynamic world : new analysis exploring Swedish register data
- 2019
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Ingår i: Applied Economics. - : Taylor & Francis Group. - 0003-6846 .- 1466-4283. ; 51:24, s. 2606-2622
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates if the effect of type 1 diabetes mellitus (T1DM) on school performance, documented in prior research, has changed in more recent birth cohorts of children using national Swedish population register data. The issue is of interest because management and treatment of the disease have improved over the last decades and, furthermore, because of changes in the educational grading system. Despite these changes, data indicate a persistent negative effect of T1DM on compulsory and upper secondary school grades with a standardized effect size of −0.109 and −0.070, respectively, and the results appear only marginally smaller compared to earlier findings in cohorts completing school under the previous grading system. Moreover, the results are consistent for alternative model specifications and econometric estimation strategies. Whereas access to new treatment technologies and improved diabetes management strategies has reduced the burden of diabetes in daily life, the results from this study indicate that continued efforts are needed to improve the situation in school for children with T1DM to prevent potential long-term socio-economic consequences.
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| 45. |
- Persson, Sofie, et al.
(författare)
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Healthcare costs of dementia diseases before, during and after diagnosis : Longitudinal analysis of 17 years of Swedish register data
- 2022
-
Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5279 .- 1552-5260. ; 18:12, s. 2560-2569
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: This study examines health-care costs attributed to dementia diseases in the 10 years prior to, during, and 6 years after diagnosis. Methods: Using administrative register data for people diagnosed with dementia (2010–2016) in southern Sweden (n = 21,184), and a comparison group without dementia, health-care costs over 17 years were examined using longitudinal regression analysis. Results: Average annual health-care costs per person were consistently higher before diagnosis in the dementia group (10 years before: Swedish krona (SEK) 2063, P <.005 and 1 year before: SEK8166, P <.005). At diagnosis, health-care costs were more than twice as high (SEK44,410, P <.005). Four to 6 years after diagnosis, there was no significant different in costs compared to comparators. Discussion: Excess health-care cost arise as early as 10 years before a formal diagnosis of dementia, and while there is a spike in cost after diagnosis, health-care costs are no different 4 years after. These findings question currently accepted assumptions on costs of dementia.
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| 46. |
- Persson, Sofie, et al.
(författare)
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Labor market consequences of childhood onset type 1 diabetes
- 2016
-
Ingår i: Economics and Human Biology. - : Elsevier BV. - 1570-677X. ; 23, s. 180-192
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Tidskriftsartikel (refereegranskat)abstract
- This paper examines the effect of the onset of Type 1 Diabetes Mellitus (T1DM) before 15 years of age on labor market outcomes and contributes to the literature on effects of childhood health on adult socioeconomic status. Using national Swedish socioeconomic register data 1991–2010 for 2485 individuals born 1972–1978 with onset of T1DM in 1977–1993, we find that T1DM in childhood has a negative effect on labor market outcomes later in life. Part of the T1DM effect is channeled through occupational field which may be related to both choice and opportunities. Although the magnitude of the effect is only directly generalizable to illnesses with similar attributes as T1DM, the results suggest that causality in the often observed correlation between health and socioeconomic status, at least partly, is explained by an effect running from health to earnings. This has implications for research and policy on strategies to reduce socioeconomic-related health inequality. Our findings also shed light on productivity losses, measured by employment status and earnings due to childhood onset T1DM, which have implications for both the individual and society.
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| 47. |
- Saha, Sanjib, et al.
(författare)
-
Cost-effectiveness of supported employment adapted for people with affective disorders
- 2018
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 72:3, s. 236-239
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. Methods: We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. Results: The cost of IES was €7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. Limitations: Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. Conclusions: Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.
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| 48. |
- Saha, Sanjib, et al.
(författare)
-
Economic evaluation of mindfulness group therapy for patients with depression, anxiety, stress and adjustment disorders compared with treatment as usual
- 2020
-
Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 216:4, s. 197-203
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A randomised controlled trial found that a structured mindfulness group therapy (MGT) programme was as effective as treatment as usual (mostly cognitive-behavioural therapy) for patients with a diagnosis of depression, anxiety or stress and adjustment disorders in Sweden (ClinicalTrials.gov: NCT01476371).AimsTo perform a cost-effectiveness analysis of MGT compared with treatment as usual from both a healthcare and a societal perspective for the trial duration (8 weeks).METHOD: The costs from a healthcare perspective included treatment as usual, medication and costs for providing MGT. The societal perspective included costs from the healthcare perspective plus savings from productivity gains for the trial duration. The effectiveness was measured as quality-adjusted life-years (QALY) using the EQ-5D-5L questionnaire and the UK value set. Uncertainty surrounding the incremental costs and effects were estimated using non-parametric bootstrapping with 5000 replications and presented with 95% confidence intervals and cost-effectiveness acceptability curves.RESULTS: The MGT group had significantly lower healthcare and societal costs (mean differences -€115 (95% CI -193 to -36) and -€112 (95% CI -207 to -17), respectively) compared with the control group. In terms of effectiveness, there was no significant difference in QALY gain (mean difference -0.003, 95% CI -0.0076 to 0.0012) between the two groups.CONCLUSIONS: MGT is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders in Sweden.Declaration of interestNone.
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| 49. |
- Saha, Sanjib, et al.
(författare)
-
Prevention of Cardiovascular Disease and Cancer Mortality by Achieving Healthy Dietary Goals for the Swedish Population : A Macro-Simulation Modelling Study
- 2019
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:5
-
Tidskriftsartikel (refereegranskat)abstract
- The objective is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in Sweden if adults adhere to the official dietary recommendations. We used an age-group and sex-specific epidemiological macro-simulation model to estimate preventable deaths due to the discrepancies between actual intake and recommended intake of changes in food components. Data included in the model are a baseline scenario (actual dietary intake), a counterfactual scenario (recommended intake) and age- and sex-specific mortality for cardiovascular and diet-related cancer diseases together compared with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations was performed to produce the 95% uncertainty intervals (UI). The model predicts that 6405 (95% UI: 5086-7086) deaths could be prevented or delayed if the Swedish population could adhere to official dietary recommendations in a year. More deaths would be saved for men than women. The recommendations for fruits and vegetables could have saved 47% of the deaths, followed by fiber intake (32%). For men, fruits and vegetables could have saved more compared to other dietary components, while for women dietary fiber was the prominent factor. Public health policies should consider ensuring healthy eating practices for the Swedish population.
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| 50. |
- Svensson-Björk, Robert, et al.
(författare)
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Cost-effectiveness analysis of negative pressure wound therapy dressings after open inguinal vascular surgery - The randomised INVIPS-Trial
- 2021
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Ingår i: Journal of Tissue Viability. - : Elsevier BV. - 0965-206X. ; 30:1, s. 95-101
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Tidskriftsartikel (refereegranskat)abstract
- AIM: While the scientific evidence in favour of negative pressure wound therapy (NPWT) dressings on sutured incisions in the prevention of surgical site infections (SSIs) has increased, the cost-effectiveness after vascular surgery has not been evaluated. The aim of this study was to evaluate the cost-effectiveness of NPWT compared to standard dressings for the prevention of SSIs after open inguinal vascular surgery.MATERIALS AND METHODS: Patient data were retrieved from the randomised INVIPS-trial's open arm, which included patients randomised to either NPWT or standard dressings. The patients were surveyed for SSIs for 90 days postoperatively. The patients' individual cost data were included and analysed from a healthcare perspective. The patients' quality of life was measured using the Vascuqol-6 questionnaire pre- and 30 days postoperatively. Cost-effectiveness of NPWT was determined by decreased or equal total costs and a significant reduction in SSI incidence.RESULTS: The mean vascular procedure-related costs at 90 days were €16,621 for patients treated with NPWT (n = 59) and €16,285 for patients treated with standard dressings (n = 60), p = 0.85. The SSI incidence in patients treated with NPWT was 11.9% (n = 7/59) compared to 30.0% (n = 18/60) with standard dressings, p = 0.015. This corresponds to an increased mean cost of €1,853 per SSI avoided. The cost-effectiveness plane of incremental vascular procedure-related costs and difference in Vascuqol-6 score showed that 42% of estimates were in the quadrant where NPWT was dominant.CONCLUSION: NPWT is considered cost-effective over standard dressings in patients undergoing open inguinal vascular surgery due to reduced SSI incidence at no higher costs.
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