| 1. |
- Afentou, Nafsika, et al.
(författare)
-
Economic Evaluation of Interventions in Parkinson's Disease : A Systematic Literature Review
- 2019
-
Ingår i: Movement Disorders Clinical Practice. - : Wiley. - 2330-1619. ; 6:4, s. 282-290
-
Forskningsöversikt (refereegranskat)abstract
- BackgroundParkinson's disease (PD) management comprises of drug treatments, surgery, and physical activity/occupational therapies to relieve PD's symptoms. The aim of this study is twofold; first, to appraise recent economic evaluation studies on PD management in order to update the existing knowledge; and second, to facilitate decision making on PD management by assessing the cost‐effectiveness of all types of PD interventions.MethodsA systematic search for studies published between 2010 and 2018 was conducted. The inclusion and exclusion of the articles were based on criteria relevant to population, intervention, comparison, outcomes, and study design (PICO). The reporting quality of the articles was assessed according to Consolidated Health Economic Evaluation Reporting Standards.ResultsTwenty‐eight articles were included, 10 of which were evaluations of drug treatments, 10 deep brain stimulation (DBS), and eight physical/occupational therapies. Among early‐stage treatments, Ti Ji dominated all physical activity interventions; however, its cost‐effectiveness should be further explored in relation to its duration, intensity, and frequency. Multidisciplinary interventions of joint medical and nonmedical therapies provided slightly better health outcomes for the same costs. In advanced PD patients, adjunct drug treatments could become more cost‐effective if introduced during early PD and, although DBS was more cost‐effective than adjunct drug therapies, the results were time‐bound.ConclusionsConditionally, certain PD interventions are cost‐effective. However, PD progression differs in each patient; thus, the cost‐effectiveness of individually tailored combinations of interventions that could provide more time in less severe disease states and improve patients’ and caregivers’ quality of life, should be further explored.
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| 2. |
- Christian, Carmen S, et al.
(författare)
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Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis
- 2018
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 15:4
-
Tidskriftsartikel (refereegranskat)abstract
- This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
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| 3. |
- Dackehag, Margareta, et al.
(författare)
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Social assistance and mental health : evidence from longitudinal administrative data on pharmaceutical consumption
- 2020
-
Ingår i: Applied Economics. - : Taylor and Francis Ltd.. - 0003-6846 .- 1466-4283. ; 52:20, s. 2165-2177
-
Tidskriftsartikel (refereegranskat)abstract
- This paper adds to the small literature on the role of welfare benefits and mental health by studying the relationship between uptake of Social Assistance Benefit (SAB) and objective mental health measures. We use rich longitudinal administrative data on income, unemployment benefits and psychopharmaceutic prescriptions (antidepressants, anxiolytics, and hypnotics) for more than 140,000 Swedes in 2006–2012. Relative to earlier studies focusing on subjective mental health, an advantage of our approach is that we use longitudinal administrative data that do not suffer from non-response, under-reporting and self-justification biases. While we document a strong positive association between SAB and psychopharmaca consumption in ordinary least squares models, fixed effects estimates indicate that most of the association is due to unobserved individual-specific predisposition. Insofar as a relationship remains in the fixed effect models, it is driven by highly educated men. This result is consistent with earlier quantitative studies using survey data and with qualitative research suggesting that SAB uptake may be particularly stigmatizing for individuals with a higher initial socioeconomic position.
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| 4. |
- Eckerlund, Ingemar, et al.
(författare)
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Econometric analysis of variation in cesarean section rates : a cross-sectional study of 59 obstetrical departments in Sweden
- 1998
-
Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press (CUP): HSS Journals. - 1471-6348 .- 0266-4623. ; 14:4, s. 774-787
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as supply-related. A general model including all these regressors was specified, After reducing this model, we were able to explain about one-quarter of the variation, We conclude that the large variation in cesarean section rates indicates inefficiency, due mainly to overutilization, but perhaps also underutilization. It is difficult to calculate the economic consequences or the welfare loss to society, We estimated an additional cost for unnecessary cesarean sections of 13-16 million Swedish crowns (SEK) per year.
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| 5. |
- Eckerlund, Ingemar, et al.
(författare)
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Estimating the effect of cesarean section rate on health outcome : Evidence from Swedish hospital data
- 1999
-
Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 15:1, s. 123-135
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This paper tests the null hypothesis of a zero effect of cesarean section rate on health outcome against the alternative of a positive effect. Using data from 59 hospitals in Sweden from 1988-92, we specify two separate linear regression models for health outcome, one with perinatal mortality, and the other with rate of asphyxia, as dependent variable, We estimate the models by single-year cross-section regressions and as pooled data systems. The null hypothesis cannot be rejected, i.e., we do not find any significant positive effect of cesarean section rate on health outcome. Thus, we conclude that an increase in cesarean section rate does not imply lower perinatal mortality or lower rate of asphyxia. This in turn indicates that the minimum cesarean section rate is optimal.
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| 6. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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A note on the estimation of the equity-efficiency trade-off for QALYs
- 1996
-
Ingår i: Journal of health economics. - : Elsevier. - 1879-1646 .- 0167-6296. ; 15:3, s. 359-368
-
Tidskriftsartikel (refereegranskat)abstract
- In this note the veil of ignorance approach is tested as a basis for empirically determining the shape of the social welfare function for QALYs. An experiment is carried out where the participants choose between different societies that differ with respect to per capita QALYs and the distribution of QALYs. The answers are analyzed using logistic regression analysis, According to the results the respondents are willing to give up 1 QALY in the group with more QALYs to gain 0.45 QALYs in the group with fewer QALYs,but this trade-off is independent of the size of the difference in QALYs between the groups.
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| 7. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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A note on validating Wagstaff and van Doorslaer's health measure in the analysis of inequalities in health
- 1999
-
Ingår i: Journal of health economics. - : Elsevier. - 1879-1646 .- 0167-6296. ; 18:1, s. 117-124
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this note is to validate Wagstaff and van Doorslaer's approach of constructing a continuous health measure to be used in the analysis of inequalities in health. We calculate health concentration indices for Uppsala County in Sweden based on three different health status measures: health measured according to the WvD approach based on a self-assessed categorical health measure, health measured by the rating scale method, and health measured by the time trade-off method. The concentration index does not differ significantly for the three health status measures, and our results thus support the validity of the WvD method.
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| 8. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Drug Expenditure and New Drug Introductions : The Swedish Experience
- 1993
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 4:3, s. 215-225
-
Tidskriftsartikel (refereegranskat)abstract
- This article measures the impact of the switch to new and more expensive drugs on the aggregate drug expenditure (both prescription and nonprescription) in Sweden during the period 1974 to 1991, and also on the disaggregated expenditure for 3 medical areas: asthma, hypertension and peptic ulcer disease. During the period studied, nominal drug expenditure increased 6-fold. The retail price index of drugs and the number of prescribed drugs accounted for 51.6 and 5.8% of this increase, respectively. The remaining residual amount accounted for 42.6%. Since the price index of drugs increased more slowly than the overall net price index of goods and services, the relative price of drugs decreased dramatically by about 30%. This means that increases in prices of drugs cannot explain the increase in real inflation-adjusted drug expenditure. We also show that the residual increase can be partly explained by the introduction of new and more expensive drugs. It is therefore argued that economic evaluations which compare the extra costs induced by new drugs with the extra benefits should be undertaken to guide decisions about the prescription of new and more expensive drugs.
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| 9. |
- Gerdtham, Ulf-Göran, et al.
(författare)
-
Estimating the Causal Impact of Macroeconomic Conditions on Income-Related Mortality
- 2020
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- To-date the macroeconomic conditions-mortality literature on income-related inequality in mortality has relied on subgroup analysis, mainly using income as a stratification variable, but this nearly always causes selection bias yielding results that are hard to interpret. To solve this bad control problem, we apply a novel technique based on recentered influence function regression of overall income-related mortality measures, like the commonly used concentration index. We also highlight the importance of: i) measurement of relative versus absolute inequality; ii) measurement of inequality by population-level statistics of inequality (concentration indices) versus subgroup analysis; iii) measurement of short versus long-term income. We illustrate these issues and our suggested solution using detailed individual-level administrative data from Sweden. Our findings show that there overall is a (insignificant) counter-cyclical impact on mortality and its income-related inequality. During a sub-period of pronounced and significant counter-cyclical mortality we find support for accompanying counter-cyclical income-related inequality, but only when using short-term income.
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| 10. |
- Gerdtham, Ulf-Göran, et al.
(författare)
-
New estimates of the demand for health : Results based on a categorical health measure and Swedish micro data
- 1999
-
Ingår i: Social science & medicine (1982). - : Elsevier. - 1873-5347 .- 0277-9536. ; 49:10, s. 1325-1332
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Tidskriftsartikel (refereegranskat)abstract
- In this paper we estimate a 'Grossman' model of demand for health based on Swedish micro data. The data set consists of a random sample of over 5000 individuals taken from the Swedish adult population. Health capital is measured by a categorical measure of overall health status, and an ordered probit model is used to econometrically estimate the demand for health equation. The results are consistent with the theoretical predictions and show that the demand for health increases with income and education and decreases with age, male gender, overweight, living in big cities and being single.
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| 11. |
- Gerdtham, Ulf-Göran, et al.
(författare)
-
Price indices of drugs and the switching to new drugs two empirical examples
- 1998
-
Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 13:1, s. 71-80
-
Tidskriftsartikel (refereegranskat)abstract
- Standard price indices may not account for the price decrease that results when patients switch to pharmaceutical products for which their demand-reservation price exceeds the price of the new product. In a similar way, standard price indices may not account for the price increase that results when patients switch to pharmaceuticals for which the reservation price is below the price of the new drug. This study was designed to assess whether standard pharmaceutical price indices under- or overestimate the real price development resulting from new drug introductions. We illustrate that both situations may occur. In our first example, the switch from a branded to a generic drug, we showed that standard price indices recorded a price increase of about 16%, although the price actually decreased by about 5%. In our second example, the introduction of new formulation of a currently marketed drug, we showed that standard price indices recorded a price increase of about 6%, when the actual price increased by more than 65%.
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| 12. |
- Gerdtham, Ulf-Göran, et al.
(författare)
-
The impact of user charges on the consumption of drugs : Empirical evidence and economic implications
- 1996
-
Ingår i: PharmacoEconomics. - : Springer Nature. - 1179-2027 .- 1170-7690. ; 9:6, s. 478-483
-
Tidskriftsartikel (refereegranskat)abstract
- Expenditure on drugs is increasing rapidly in many countries, and this has led to increased interest in measures to contain drug expenditure. One measure that has been discussed is to increase user charges for prescription drugs. In this article, we consider whether or not raising user charges decreases the consumption of drugs. We also discuss how to judge if increased user charges for drugs are desirable from an economic viewpoint. We conclude that the decision to increase user charges for prescription drugs should not be viewed as an issue of cost containment, but as a matter of balancing the societal costs against the societal benefits of increased user charges.
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| 13. |
- Hardardottir, Hjördis, et al.
(författare)
-
What Kind of Inequality Do You Prefer? Evaluating Measures of Income and Health Inequality Using Choice Experiments
- 2019
-
Annan publikation (övrigt vetenskapligt/konstnärligt)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 inequality in health 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 inequality in health 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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| 14. |
- Heckley, Gawain, et al.
(författare)
-
Could Easier Access to University Improve Health and Reduce Health Inequalities?
- 2018
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper estimates the impact of university education on medical care use and its income related inequality. We do this by exploiting an arbitrary university eligibility rule in Sweden combined with regression discontinuity design for the years 2003-2013 for students who graduated 2003-2005. We find a clear jump in university attendance due to university eligibility. This jump coincides with a positive jump in prescriptions for contraceptives for females but also a positive jump in mental health related hospital admissions for males. Analysis of the inequality impact of tertiary eligibility finds no clear impact on medical care use by socioeconomic status of the parents. The results imply that easing access to university for the lower ability student will lead to an increase in contraceptive use without increasing its socioeconomic related inequality. At the same time, the results highlight that universities may need to do more to take care of the mental health of their least able students.
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| 15. |
- Heckley, Gawain, et al.
(författare)
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The Health Returns of University Eligibility
- 2020
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper exploits an arbitrary university eligibility rule in Sweden combined with regression discontinuity to estimate the impact of university education on health derived demand for medical care. We find a clear jump in university attendance due to university eligibility of between 10 and 14 percentage points. For females this implies a 30-40% drop in self-harm. For males it coincides with reduced use of prescribed pain killers, implying reduced risky behaviour. Males also observe a 30% increase in mental disorders, almost exclusively related to alcohol. The spillovers of university education on to health for the marginal student are therefore significant.
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| 16. |
- Heckley, Gawain, et al.
(författare)
-
The Long-Term Impact of Education on Mortality and Health: Evidence from Sweden
- 2018
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- There is a well-documented large positive correlation between education and health and yet it remains unclear as to whether this is a causal relationship. Potential reasons for this lack of clarity include estimation using different methods, analysis of different populations and school reforms that are different in design. In this paper we assess whether the type of school reform, the instrument and therefore subgroup identified and the modelling strategy impact the estimated health returns to education. To this end we use both Regression Discontinuity and Difference in Differences applied to two Swedish school reforms that are different in design but were implemented across overlapping cohorts born between 1938 and 1954 and follow them up until 2013. We find small and insignificant impacts on overall mortality and its common causes and the results are robust to regression method, identification strategy and type of school reform. Extending the analysis to hospitalisations or self-reported health and health behaviours, we find no clear evidence of health improvements due to increased education. Based on the results we find no support for a positive causal effect of education on health.
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| 17. |
- Heckley, Gawain, et al.
(författare)
-
Too Young to Die: Regression Discontinuity of a Two-Part Minimum Legal Drinking Age Policy and the Causal Effect of Alcohol on Health
- 2018
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This study examines the impact of Sweden’s unique two-part Minimum Legal Drinking Age (MLDA) policy on alcohol consumption and health using regression discontinuity design. In Sweden on-licence purchasing of alcohol is legalised at 18 and off-licence purchasing is legalised later at 20 years of age. We find an immediate and significant 6% jump in participation and a larger increase in number of days drinking at age 18 of about 16% but no large jumps at age 20. No discernible increases in mortality at age 18 or 20 are found but hospital visits due to external causes do see an increase at both 18 and 20 years. Compared to previous findings for single MLDAs the alcohol impacts we find are smaller and the health impacts less severe. The findings suggest that a two-part MLDA can help young adults in their transition to unrestricted alcohol and help contain the negative health impacts that have been observed elsewhere.
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| 18. |
- Jarl, Johan, et al.
(författare)
-
Effects of Kidney Transplantation on Labor Market Outcomes in Sweden
- 2018
-
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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| 19. |
- Jarl, Johan, et al.
(författare)
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Inequalities in labour market consequences of common mental disorders
- 2018
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The burden of mental disorders continues to grow and is now a leading cause of disability worldwide. The prevalence of mental disorders is unequal between population subgroups, and these disorders are associated with unfavourable consequences in social and economic conditions, health and survival. However, how the negative effects of mental disorders are distributed among population subgroups is less studied. Our aim is to investigate how labour market consequences of Common Mental Disorders (CMD) differ over gender, age, education, and country of birth. We use a population sample from southern Sweden of patients diagnosed with CMD 2009-2012 and a matched general population control group with linked register information on employment, long-term sick leave, and disability pension. Logistic regression with interaction effects between CMD and sociodemographic indicators are used to estimate labour market consequences of CMD in the different population subgroups. CMD have a negative impact on all labour market outcomes studied, reducing employment while increasing the risk of long term sick leave and disability pension. However, the associated effect is found to be stronger for men than women, except for disability pension where consequences are similar. Surprisingly, high educated individuals suffer worse labour market consequences than low educated. Consequences of CMD in labour market outcomes are not consistent across different age-groups and country of birth. Inequalities in the labour market consequences of common mental disorders sometimes contributes to, and sometimes mitigates, societal inequalities in employment, long term sick leave and disability pension. 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 inequalities in the consequences of these disorders.
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| 20. |
- Johannesson, Magnus, et al.
(författare)
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A pilot test of using the veil of ignorance approach to estimate a social welfare function for income
- 1995
-
Ingår i: Applied economics letters. - : Informa UK Limited. - 1466-4291 .- 1350-4851. ; 2:10, s. 400-402
-
Tidskriftsartikel (refereegranskat)abstract
- The veil of ignorance approach is tested as a basis for empirically determining the shape of the social welfare function for income. An experiment is carried out where the participants choose between different societies that differ with respect to per capita income and the distribution of income. The answers are analysed using logistic regression analysis. According to the results the respondents are willing to give up Swedish Crowns (SEK) 1 in the group with more income to gain SEK 0.35 in the group with less income, but this tradeoff is independent of the size of the difference in income between the groups.
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| 21. |
- Johannesson, Magnus, et al.
(författare)
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Willingness to pay for antihypertensive therapy - further results
- 1993
-
Ingår i: Journal of health economics. - 1879-1646 .- 0167-6296. ; 12:1, s. 95-108
-
Tidskriftsartikel (refereegranskat)abstract
- A measurement experiment regarding willingness to pay for antihypertensive therapy is reported. A new type of binary willingness to pay question is used, that allows for different degrees of certainty with respect to the responses. Mean willingness to pay is derived from a simple expected utility model and estimated using maximum likelihood methods. The estimated parameters are highly significant, with predicted signs, and imply a mean willingness to pay of about SEK 800 ($130) per month. The explanatory power of the equation that only includes 'certain' yes/no responses is, as expected, much higher than that of the equation where only 'uncertain' responses are included.
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| 22. |
- Linder, Anna, et al.
(författare)
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Adolescent Mental Health: Impact of Introducing Earlier Compulsory School Grades
- 2023
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The prevalence of mental ill-health is increasing among young people in many developed countries, raising concerns about their well-being. Experts have pointed to several potential contributing factors, including a heightened emphasis on educational achievement and performance evaluation, as well as shifting demands in the high-skilled job market. In this paper, we study the effect of introducing earlier grades in compulsory school on child mental health in Sweden. To do so, we exploit a grading reform in Swedish compulsory schools in which grades were introduced at an earlier age, in 6th grade instead of 8th grade as was previously the case. The reform provides a situation where the age at which children receive their first grade is arbitrary depending on if the child is born before or after the year-end. We show that girls who are exposed to one year earlier grades are more likely to be diagnosed with depression or anxiety by the end of compulsory school, controlling for potential age effects in a difference-in-discontinuities setup. We do not find similar effects among boys. Overall, these results imply that girls’ mental well-being may be particularly responsive to educational assessment through grades at earlier ages.
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| 23. |
- Linder, Anna, et al.
(författare)
-
Mental health and its socioeconomic inequality in Sweden: the role of demographic changes over time
- 2018
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Abstract: Our aim is to study trends in mental ill-health and socioeconomic-related mental health inequalities over time in Sweden. We also make a first attempt at disentangling why we see such a development, by decomposing any changes in terms of changes in selected demographic and socioeconomic characteristics among the population. A secondary aim is to consider how different indicators for mental ill-health, as well as different measures of inequality, affect the conclusions we draw. Register data from the Swedish Interdisciplinary Panel and the Swedish Living Conditions Survey (administered by Statistics Sweden) are used to study trends in mental ill-health and mental health inequalities over the years 1994-2011. The study population comprises of working age individuals aged 31-64 living in Sweden. Four indicators of mental ill-health are used in the main analysis: self-reported anxiety, psychiatric inpatient diagnosis, psychiatric outpatient diagnosis and death by suicide. The results show that psychiatric diagnoses (in- and outpatient) increased substantially amongst 31 - 64 year olds between 1994 and 2011. Self-reported anxiety remained stable and suicides decreased. These results show that the different indicators of mental ill-health are not reflective of each other and how we measure mental ill-health largely affect the conclusions we draw. The mental ill-health indicators which suggest there is an increase in mental ill-health (in- and outpatient diagnosis) partly depend on attitudes, help-seeking behaviour and diagnostic practice. Thus, we cannot say that mental ill-health actually has increased. However, all mental ill-health indicators are becoming increasingly concentrated among women and among those not participating in the labour force, and psychiatric diagnoses are increasingly concentrated among those lowest educated. Income-related mental health inequalities in Sweden are substantial, and have increased significantly between 1994 and 2011, both regarding absolute and relative inequalities. More than 30 percent of self-reported anxiety and suicides, and half or all psychiatric in- and outpatient diagnoses, are found among the poorest fifth of the population. The decomposition results show that distributional changes in the population explain the increase in suicide inequality and partly explain the increase in psychiatric inpatient diagnosis inequality. However, overall, only small changes in the level of mental ill-health and mental health inequalities are explained by changes in the population characteristics we study.
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| 24. |
- Lyttkens, Carl Hampus, et al.
(författare)
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Do We Know What We Are Doing? An Exploratory Study on Swedish Health Economists and the EQ-5D
- 2018
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The UK tariff for quality of life associated with the health states in the EQ-5D is probably not consistent with the preferences of Swedish health economists. This is worrying in view of the widespread use of the tariff values and the fact that health economists likely are better able than ordinary citizens to report their preferences for health states in a valid and reliable manner. We suggest this result is taken into account when the EQ-5D instrument is used, and that researchers should be cautious in using the UK (or any other) value sets. Our results also indicate that the variation across citizens in preferences for health may be a more complex issue than previously observed and deserves further study. An intriguing question for the future is to what extent health economists use methods and instruments that they themselves do not believe in.
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| 25. |
- Müller, V., et al.
(författare)
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A measure of alcohol affordability for Sweden : Capturing trends among different demographic groups
- 2023
-
Ingår i: NAD Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 40:3, s. 250-269
-
Tidskriftsartikel (refereegranskat)abstract
- The World Health Organization has rated alcohol abuse as one of the leading risk factors for population health worldwide and emphasises the relevance of alcohol affordability (AA) measures as important instruments to monitor alcohol control policy. The present study suggests an AA index that is suitable for measuring AA in Sweden, where off-premises alcohol is exclusively distributed by Systembolaget, the government-owned chain of liquor stores. Sweden provides uniform off-premises prices for alcohol and extensive register data, which profits the accuracy of this index. By allowing for AA comparisons across types of alcoholic beverages (beer, wine, spirits) and price categories, as well as across population groups (age, sex and family composition), and by being transferable to other Nordic countries with uniform off-premises prices, this study will facilitate governmental monitoring and supervision of the alcohol policy in Nordic countries. The suggested AA index is defined as the ratio of the median equivalised disposable income and the price per litre of 100% ethanol for alcohol, scaled to equal 100% in the base year. The income can be measured for the reviewed population or a subgroup, and the price measure can include all sold alcoholic beverages or separate them by beverage type and/or price category. Thereby, the index measures the number of litres of 100% ethanol that are affordable with the median income. Applying the index to the publicly available data for 2011–2019 from Statistics Sweden and Systembolaget reveals that alcohol in Sweden generally became more affordable, with high-priced alcoholic beverages becoming comparably more affordable than low-priced alcohol. However, low-priced beer became less affordable over the last decade. Future studies may validate the AA index against alcohol consumption.
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| 26. |
- Nordin, Martin, et al.
(författare)
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The Impact of Grade Inflation on Higher Education Enrolment and Earnings
- 2019
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Although grade inflation is unfair and may imply inefficient allocation of human resources, current knowledge of grade inflation effects on individual outcomes is scarce. One explanation is probably the challenge of measuring and estimating causal grade inflation effects. This study examines the consequences of grade inflation at the upper secondary education level on enrolment in higher education and earnings for Sweden. Rigorous diagnostic testing supports our empirical approach. Grade inflation at the school level affects earnings mainly through choice of university and the chosen field of education, rather than through enrolment per se, because attending universities of higher quality and pursuing high-paying fields of education have a substantial impact on earnings. On the other hand, high-skilled students attending upper secondary schools without grade inflation and, unexpectedly, low-skilled women attending "lenient" schools are harmed by this. This causes extensive unfairness and, plausibly, detrimental welfare effects.
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| 27. |
- Saha, Sanjib, et al.
(författare)
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Cost Effectiveness of the Use of Prophylactic Mesh To Prevent Parastomal Hernia After Urinary Diversion with an Ileal Conduit
- 2022
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Ingår i: European Urology Open Science. - : Elsevier BV. - 2666-1691 .- 2666-1683. ; 40, s. 9-15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prophylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial.Objective: To investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective.Design setting and participants: Data on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020.Outcome measurements and statistical analyses: The primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs.Results and limitations: The mean difference in total costs between the mesh and no-mesh groups was -€2047 (95% CI -€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group ( p = 0.001). This indicates that mesh is less costly and more effective compared to no mesh from the health care provider perspective. Subgroup analyses showed that results were more advantageous for women and for patients younger than 71 yr and with less comorbidity than for their counterparts. Conclusions: The use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective.Patient summary: In patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.
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| 28. |
- Saha, Sanjib, et al.
(författare)
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Economic Evaluation of Interventions for Screening of Dementia
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: The objective is to systematically review the literature on economic evaluations of screening interventions for early diagnosis of dementia disorders. METHODS: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: Fourteen studies were identified and broadly fell into two groups: screening without biomarkers and screening using biomarkers. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of biomarkers used. The sensitivity and specificity of screening instruments are one of the important aspects in estimating the cost-effectiveness of the interventions. Cost-effectiveness of non-biomarker based interventions cannot be judged due to lack of information. The biomarkers based screening have the potential to be cost-effective but their effectiveness has to be established first. CONCLUSION: More economic evaluations studies as well as good quality effectiveness studies are required in screening strategies before these can be implemented in the clinical practice.
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| 29. |
- Saha, Sanjib, et al.
(författare)
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Economic Evaluation of Management of Dementia Patients - A Systematic Literature Review
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The objective is to systematically review the literature on economic evaluations of the interventions for the management of dementia and Alzheimer patients in home, hospital or institutional care. Methods: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Twelve studies were identified and there was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of interventions. Interventions for the management of dementia patients are in general, not cost-effective. Interventions at the community and home setting for managing both the dementia patients and caregivers on a large scale may have the potential to save societal resources. Conclusion: More effectiveness studies as well as good quality economic evaluations are required before implementation decisions on management strategies can be made based on cost-effectiveness.
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| 30. |
- Saha, Sanjib, et al.
(författare)
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Economic Evaluation of Nonpharmacological Interventions for Dementia Patients and their Caregivers - A Systematic Literature Review
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The rising prevalence of dementia represents an important public health issue. There is currently no available cure for dementia disorders, only symptom-relieving therapies which can be either pharmacological or non-pharmacological. The number of non-pharmacological interventions for patients with dementia disorders and their caregivers have been increasing in recent years without much knowledge on their cost-effectiveness. The objective is to review the existing evidence on cost-effectiveness of non-pharmacological interventions targeting patients with dementia disorders, their caregivers, and the patient-caregiver dyad. Method: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, ICER) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: We included seventeen studies in this review categorised into three groups: physical exercise, occupational therapy, and psychological/psychosocial treatment. In almost all the studies (except one), economic evaluation was performed for a randomised controlled trial alongside the non-pharmacological intervention or retrospectively. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of intervention. This prevents an informative comparison between most of the studies. However, we found that physical exercise was the most-effective non-pharmacological interventions for patients with dementia. For occupational therapy and psychological/psychosocial interventions we found mixed results although the majority was not cost-effective. Conclusion: More economic evaluations studies are required in non-pharmacological interventions. However, the interventions need to have a strong study design with the intention to perform economic evaluation in parallel.
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| 31. |
- Saha, Sanjib, et al.
(författare)
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Economic Evaluation of Pharmacological Treatments in Dementia Disorders - A Systematic Literature Review
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The objective is to systematically review the literature on economic evaluations of pharmacological treatments of dementia disorders. A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Fourteen studies were included in this review. There was a considerable heterogeneity in methodological approaches, use of simulation models, target populations, study time frames, and perspectives as well as comparators used. Keeping these issues in mind, we find that Cholinesterase Inhibitors (ChEIs), and especially donepezil, are dominating no treatment (i.e. less costly and more effective) for mild to moderate AD patients. For moderate to severe AD patients memantine is cost-effective compared to memantine or ChEIs alone. However, the effect of these drugs on survival is yet not established, which could have a major impact on the cost-effectiveness of these drugs. Conclusion: Pharmaceutical treatments are cost-effective comparing to no treatment for dementia patients. However, more research is required on the long-term effectiveness of these drugs, especially on the effects of drugs on survival.
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| 32. |
- Saha, Sanjib, et al.
(författare)
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In search of an appropriate mix of taxes and subsidies on nutrients and food : A modelling study of the effectiveness on health-related consumption and mortality.
- 2021
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 287
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Tidskriftsartikel (refereegranskat)abstract
- Taxes and subsidies on foods and nutrients have the potential to promote healthier diets and thereby reduce mortality. In this study, we examine the effects of such policy instruments on Swedish public health. Specifically, we estimate the effects of food and nutrient taxes and subsidies on mortality averted and postponed in Sweden, using both demand system estimations and simulation models. We evaluate different Value Added Tax (VAT) reforms. The VAT is raised on food products that are particularly rich in saturated fat or salt and lowered on fruit and vegetables. Our models predict that an increase in the current VAT of 12% on food, to 25% VAT on products rich in saturated fat plus a 0% VAT on fruits and vegetables would result in almost 1100 deaths (95% CI: -832; -1363) averted or postponed in a year in Sweden, while the combination of a 34.4% VAT on products rich in saturated fat and a -10.4% VAT (i.e. a subsidy) on fruits and vegetables would result in almost 2100 (95% CI: -1572; -2311) deaths averted or postponed corresponding to a 4.8% reduction in diet-related annual death. Most of the deaths averted or delayed from this reform would be deaths from coronary heart disease (-1,148, 95% CI: -728; -1586), followed by stroke -641 (95% CI: -408; -887) and diet-related cancer deaths (-288, 95% CI: -11; -435). We find that health-related food taxes and subsidies improve dietary habits as well as reduce the mortality of the Swedish population. However, the effect of these reforms on different socioeconomic classes and which reforms provide the best value for money, i.e., cost-effectiveness of these reforms needs to be established first before implementation.
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| 33. |
- Saha, Sanjib, et al.
(författare)
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Modelling the Effect of Compliance with Nordic Nutrition Recommendations on Cardiovascular Disease and Cancer Mortality in the Nordic Countries
- 2019
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 11:6
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in the Nordic countries, i.e., Sweden, Denmark, Finland, Norway, and Iceland, if adults adhere to the Nordic Nutrition Recommendations (NNR). A sex- and age-group specific epidemiological macro-simulation model was used to estimate the preventable deaths due to the differences between country specific 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 with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations were performed to produce the 95% uncertainty intervals. The model predicts that Iceland would benefit the most by adhering to the NNR, followed by Finland. In all the Nordic countries, the highest benefit would be achieved by adhering to the fruits and vegetable intakes, except Denmark, where a lower recommended intake of salt would provide the highest benefit. For men, fruits and vegetables could have saved more lives compared to other dietary components for all the Nordic countries, while for women, dietary fiber was the most prominent factor, except in Iceland. The Nordic Council should consider policies for promoting healthy eating according to the needs of each country.
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| 34. |
- Saha, Sanjib, et al.
(författare)
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Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation
- 2018
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Ingår i: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598.
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Tidskriftsartikel (refereegranskat)abstract
- A cluster-randomized controlled trial, WorkUp, was conducted for working-aged patients at risk of sick leave or on short-term sick leave due to acute/subacute neck and/or back pain in Sweden. The purpose of WorkUp was to facilitate participants to stay at work or in case of sick leave, return-to-work. The aim of this study was to study whether the WorkUp trial was cost-effective. Patients in the intervention and reference group received structured evidence-based physiotherapy, while patients in the intervention group also received a work place dialogue with the employer as an add-on. The participants, 352 in total, were recruited from 20 physiotherapeutic units in primary healthcare in southern Sweden. The economic evaluation was performed both from a healthcare and a societal perspective with a 12-month time frame with extensive univariate sensitivity analyses. Results were presented as incremental cost–effectiveness ratios (ICER) with outcomes measured as quality-adjusted life-years (QALY) and proportion working for at least 4 weeks in a row without reported sick leave at 12-month follow-up. From the healthcare perspective, the ICER was €23,606 (2013 price year) per QALY gain. From the societal perspective the intervention was dominating, i.e.. less costly and more effective than reference care. Bootstrap analysis showed that the probability of the intervention to be cost-effective at €50,000 willingness-to-pay per QALY was 85% from the societal perspective. Structured evidence-based physiotherapeutic care together with workplace dialogue is a cost-effective alternative from both a societal and a healthcare perspective for acute/subacute neck and/or back pain patients.
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| 35. |
- Spika, Devon, et al.
(författare)
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Put a Bet on It: Can Self-Funded Commitment Contracts Curb Fitness Procrastination?
- 2023
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This paper investigates the use of self-funded commitment contracts to support individuals in achieving their goals of increased physical activity. We compare the effect of soft (non-incentivised) commitment contracts with hard (incentivised) contracts using a randomised experiment with 1629 members of a large gym in Stockholm, Sweden. We find a significant positive impact of being offered a hard contract on monthly visits to the gym and the probability of meeting one's contract goal. Hard and soft commitment contracts increase gym visits by 21% and 8%, respectively, relative to the control group. Trait self-control is negatively associated with the likelihood of accepting a contract and accepting to add stakes. The effect of soft and hard commitment contracts does not, however, differ by trait self-control. Importantly, we find that the effects of both hard and soft contracts were greatest among participants who reported exercising the least at baseline. Our experiment explores the use of a completely self-funded and highly scalable intervention. Our experimental design allows us to shed light on the importance of hard penalties in designing commitment contracts.
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| 36. |
- Spika, Devon, et al.
(författare)
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What Do Demographics Have To Do With It? An Oaxaca-Blinder Decomposition of Changes over Time in Inequalities in Alcohol, Narcotics and Tobacco-Related Ill Health in Sweden
- 2018
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study was to document historical trends and socioeconomic inequalities in ill health outcomes related to alcohol consumption, narcotics use and tobacco smoking over the seventeen years prior to the implementation of the Swedish government’s first strategy for alcohol, narcotics, doping and tobacco (ANDT) in 2011. We also sought to explain the changes over time in terms of changes in the population distribution of selected demographic and socioeconomic characteristics. Our two key research questions, for each of alcohol, narcotics and smoking were: 1) How have trends in a) consumption, inpatient care and deaths, and b) income-related inequalities therein developed over time? 2) To what extent can demographic (gender, age, civil status, foreign background), socioeconomic (parental education, own education) and social characteristics (social isolation, proportion of welfare recipients in the municipality) explain the trends in a) levels of consumption, inpatient care and deaths, and b) income-related inequalities therein? For consumption, we investigated the prevalence of heavy drinking and smoking; data on narcotics use were not available. We used International Classification of Diseases (ICD) codes to identify inpatient care and deaths related to alcohol, narcotics and smoking. In our main analyses we used income as a measure of socioeconomic rank. We performed sensitivity analyses to investigate: i) the use of education as an alternative socioeconomic rank, ii) differences between measures of relative and absolute inequality, and iii) sex-differences in the trends over time. We document increasing pro-poor socioeconomic-related inequalities in all of our outcomes except heavy drinking (which was concentrated among higher income individuals, and did not change significantly) during the study period. This reflects an increasing concentration of smoking, and inpatient care and deaths related to alcohol, narcotics and smoking among low income individuals. We are able to explain some of the change over time by demographic and socioeconomic changes (i.e changes in the distribution of our sample by age, foreign background and educational attainment). However, our findings suggest that most of the change observed was due to external factors, such as changing norms and behaviours, and policy or macroeconomic conditions affecting certain groups more than others. In order to achieve the goal of equality in health, ANDT as a policy area must address the increasing concentration of alcohol-, narcotics- and smoking-related outcomes among the poorest and least educated in our society.
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