| 1. |
- Svensson, Hilda, Filosofie doktor, 1979-, et al.
(författare)
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A painful, never ending story : older women's experiences of living with an osteoporotic vertebral compression fracture
- 2016
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Ingår i: Osteoporosis International. - London : Springer London. - 0937-941X .- 1433-2965. ; 27:5, s. 1729-1736
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Tidskriftsartikel (refereegranskat)abstract
- Vertebral compression fractures (VCF) cause pain and decreased physical ability, with no known well-established treatment. The aim of this study was to illuminatethe experience of living with a VCF. The results show that fear and concerns are a major part of daily life. The women's initial contact with health-careproviders should focus on making them feel acknowledged by offering person-centered and tailored support.INTRODUCTION: In the past decade,osteoporotic-related fractures have become an increasingly common and costlypublic health problem worldwide. Vertebral compression fracture (VCF) is the second most common osteoporotic fracture, and patients with VCF describe anabrupt descent into disability, with a subsequent desire to regain independence in everyday life; however, little is known of their situation. The aim of thisstudy was to illuminate the lived experience of women with an osteoporotic VCF.METHODS: Ten women were interviewed during 2012-2013, starting with an open-endedquestion: could you tell me what it is like to live with a vertebral compression fracture? The verbatim transcribed interviews were analyzed using a phenomenological hermeneutical approach.RESULTS: The narrative provided descriptions of living in turmoil and chaos, unable to find stability in their life with little improvement regarding pain and physical function. Shifts from periods of constant pain to periods of fear of constant pain created a loss of confidence and an increased sense of confinement.The structural analysis revealed fear and concerns as the most prominentexperience building on five themes: struggling to understand a deceiving body,breakthrough pain fueling fear, fearing a trajectory into isolation, concerns of dependency, and fearing an uncertain future.CONCLUSIONS: Until researchers find a successful prevention or medical/surgical treatment for osteoporotic VCFs, health-care providers and society abandon these women to remain in a painful and never ending story. © 2015, The Author(s).
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| 2. |
- Svensson, Hilda, Filosofie doktor, 1979-, et al.
(författare)
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The effects of person-centered or other supportive interventions in older women with osteoporotic vertebral compression fractures–a systematic review of the literature
- 2017
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Ingår i: Osteoporosis International. - London : Springer London. - 0937-941X .- 1433-2965. ; 28:9, s. 2521-2540
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Tidskriftsartikel (refereegranskat)abstract
- Vertebral compression fracture (VCF) is a common fragility fracture and the starting point of a lasting, painful, disabling condition. The aim was to summarize the evidence of person-centered/non-medical interventions supporting women with VCF. Results show small numbers of studies with only probable effect onfunction, pain, QoL, fear of falling, and psychological symptoms. The vertebralcompression fracture (VCF) caused by osteoporosis is the third most common fragility fracture worldwide. Previously, it was believed that the pain caused by VCF was self-subsiding within weeks or a few months post-fracture. However, this positive prognosis has been refuted by studies showing that, for the great majority of patients, the VCF was the starting point of a long-lasting, severely painful, and disabling condition. The low number of studies focusing on the experience of the natural course of VCF, and what support is available and how itis perceived by those affected, calls for further investigation. Strengthening older patients' sense of security and increasing confidence in their ownabilities are of great importance for successful rehabilitation following VCF. More research is needed to identify resources, possibilities, and strategies that can assist older patients to reach their goals to improve well-being. The purposeof this systematic review was to identify and summarize the current evidence ofperson-centered or other structured non-medical/non-surgical interventions supporting older women after experiencing an osteoporotic VCF. A systematic literature search was conducted on the MeSH terms encompassing osteoporosis andvertebral compression fractures in the PubMed-MEDLINE and Cumulative Index forNursing and Allied Health Literature (CINAHL) databases during March through June 2015. The initial search identified 8789 articles, but only seven articles (sixrandomized controlled trials and one observational study with a control group)met the inclusion criteria. It became evident from the current study that theavailability of evidence on the effects of non-medical interventions aiming tosupport older women with VCF is limited, to say the least. The trials included inthis review have few limitations and were mainly considered to be of moderatequality. This systematic literature review suggests that non-medical interventions aiming to support older women with VCF might decrease levels ofpain and use of analgesic as well as promote improved physical mobility andfunction. These interventions would probably result in an improved difference in experiences of fear of falling and perceived psychological symptoms, but would only slightly improve quality of life. However, given the nature of the seven studies, potential biases in patient selection, issues around precision with small cohorts, and failure to control for confounders, makes it difficult to drawa definitive conclusion about the significant effects of non-medical interventions. Incurring a VCF is a complex and diverse event, necessitating equally complex interventions to identify new ways forward. However, to date,interventions struggle with a risk of selection bias in that only the needs of the healthiest of the population are addressed and the voices of the remaining majority of the people affected by VCF are unheard. © 2017, The Author(s).
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| 3. |
- Andersson, Jonny K, 1972, et al.
(författare)
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Cost description of clinical examination and MRI in wrist ligament injuries
- 2018
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 52:1, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The total number and cost of wrist MRIs in the catchment area of the Vastra Gotaland Region in Sweden (population 1 723 000) during 1 year was analysed, together with the number and content of referrals. Methods: Six radiology departments reported the numbers and rate of all MRI investigations intended to diagnose wrist ligament injuries (n=411) and other injuries to the wrist. Results: The additional cost of the difference between MRIs and a clinical examination by a hand surgeon, plus indirect costs for patients with suspected wrist ligament injuries, was calculated as 957 000 euros. Conclusions: It is recommended that MRI should only be used in patients in whom there are clinical difficulties in terms of diagnosing wrist ligament injuries. It is suggested that patients with suspected wrist ligament injuries should be referred directly to an experienced hand surgeon, capable of performing a standardised wrist examination and, when needed, diagnostic arthroscopy and final treatment. The proposed algorithm for the diagnosis and treatment of suspected wrist ligament injuries presented in the present study could save time for the patient and for the radiology departments, as well as reducing costs. The ability to implement the early and appropriate treatment of acute ligament injuries could be improved at the same time.
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| 4. |
- Caesar, Ulla, et al.
(författare)
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A sense of being rejected : Patients’ lived experiences of cancelled knee or hip replacement surgery
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundGrowing care queues, reduced access to care and cancelled surgery are realities for some patients being treated with total hip or knee replacement surgery in Sweden.Most of the patients on the waiting lists have experienced pain and limited motion for a varying period of time, with a negative effect on their everyday lives. Overbooked surgical schedules are already contributing to the lengthy waiting times, but, with the addition of cancellations, longer waiting times will increase still further and may affect patients’ well‐being.MethodsIn the present study, we aimed to illuminate the experience of having planned surgery cancelled, based on narratives from 10 participants. The interview transcriptions were analysed using a phenomenological hermeneutic approach.ResultsThe comprehensive analyses revealed that the participants described the agony of being deselected and the additional impression of being excluded. Metaphors of being damaged and feeling physical pain were used and the interpretations referred to the cancellations as unpleasant. Additionally, the important relationship and the trust between the health workers and the patient were negatively affected by the cancellation.ConclusionAfter the cancellation, the participants expressed being vulnerable and from their perspective the cancelled surgery affected them deeply; in fact, much more than the healthcare workers appeared to understand. Therefore, information around the cancellation must be given respectfully and with dignity, in a dialogue between the patient and the healthcare workers. Taken together, to enable an opportunity to be involved in the continued care. The cancellations should be seen as an interruption, in which the patients’ chance of living a pain‐free, active life is postponed.
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| 5. |
- Caesar, Ulla, 1964, et al.
(författare)
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Delayed and cancelled orthopaedic surgery; are there solutions to reduce the complex set of problems? A systematic literature review.
- 2021
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Ingår i: International journal of clinical practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 75:9
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Tidskriftsartikel (refereegranskat)abstract
- Unexpected cancellations of, and delays to, orthopaedic surgery have adverse effects, with a negative impact on hospital performance and undesirable patient outcomes. As cancellations and delays are common, finding measures to prevent them is a matter of urgency.The present systematic review conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook. Peer-reviewed studies reporting on cancellations or delays in patients requiring emergency orthopaedic or planned orthopaedic surgery that compared care action/intervention with no action or traditional care were included. The Grading of Recommendations Assessment, Development and Evaluation used to assess the quality of evidence of the results from the included studies. The objective of the present study was systematically to search and review the literature for qualitative evidence of factors that might reduce cancellations of and delays to orthopaedic surgical procedures.The electronic search yielded 1209 studies and eight articles were included in the performed quality assessment. The heterogeneity of the studies and the lack of calculations and statistics in the studies resulted in no meta-analysis. The result of the quality assessment indicated that the evidence ranked from low to very low across the different outcomes. The main limiting factor, which was the reason for a decrease in quality in some outcomes, was the study designs, which were non-randomised control or retrospective approach. The interventions in the included studies could help to support a reduction in the risk of cancelled and delayed orthopaedic procedures.This systematic literature review has revealed important evidence to help reduce the risk of cancelled and delayed orthopaedic procedures associated with a variety of care action exposures. They include a fast-track pathway, pre-operative guidelines and telephone contact with patients prior to surgery, as well as careful consideration of additional pre-operative tests.
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| 6. |
- Caesar, Ulla, et al.
(författare)
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Incidence and root causes of cancellations for elective orthopaedic procedures : a single center experience of 17,625 consecutive cases.
- 2014
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Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 8:24
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery.METHODS: The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once.RESULTS: Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations.CONCLUSIONS: In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process.
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| 7. |
- Caesar, Ulla, 1964, et al.
(författare)
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Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years
- 2018
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Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 12:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital’s resources permit and/or the patients’ health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. Method The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital’s records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. Result We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. Conclusion A large number of the clinic’s emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.
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| 8. |
- Carlström, Eric, 1957, et al.
(författare)
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The unannounced patient in the corridor - trust, friction and person centered care.
- 2017
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Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 32:1
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Tidskriftsartikel (refereegranskat)abstract
- In this study, a Swedish cancer clinic was studied where three to four unscheduled patients sought support from the hospital on a daily basis for pain and nutrition problems. The clinic was neither staffed nor had a budget to handle such return visits. In order to offer the patients a better service and decrease the workload of the staff in addition to their everyday activities, a multidisciplinary team was established to address the unscheduled return visits. The team was supposed to involve the patient, build trust, decrease the friction, and contribute to a successful rehabilitation process. Data were collected from the patients and the staff. Patients who encountered the team (intervention) and patients who encountered the regular ad hoc type of organization (control) answered a questionnaire measuring trust and friction. Nurses in the control group spent 35% of their full‐time employment, and the intervention group staffed with nurses spent 30% of their full‐time employment in addressing the needs of these return patients. The patients perceived that trust between them and the staff was high. In summary, it was measured as being 4.48 [standard deviation (SD) = 0.82] in the intervention group and 4.41 (SD = 0.79) in the control group using the 5‐point Likert scale. The data indicate that using a multidisciplinary team is a promising way to handle the problems of unannounced visits from patients. Having a team made it cost effective for the clinic and provided a better service than the traditional ad hoc organization.
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| 9. |
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| 10. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Economic evaluation of a person-centred care intervention in head and neck oncology: results from a randomized controlled trial.
- 2019
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Ingår i: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 1433-7339. ; 27:5, s. 1825-1834
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Tidskriftsartikel (refereegranskat)abstract
- Head and neck cancer and its treatment deteriorate quality of life, but symptoms improve with person-centred care. We examined the cost-effectiveness of a person-centred care intervention versus standard medical care.In this randomized clinical trial of a person-centred intervention, patients were planned for outpatient oncology treatment in a Swedish university hospital between 2012 and 2014 and were followed during 1year. Annual healthcare costs were identified from medical records and administrative register data. Productivity costs were calculated from reported sick leave. Health-related quality of life was collected using the EuroQol Group's five-dimension health state questionnaire.Characteristics were similar between 53 patients in the intervention group and 39 control patients. The average total cost was Euro (EUR) 55,544 (95% confidence interval: EUR 48,474-62,614) in the intervention group and EUR 57,443 (EUR 48,607-66,279) among controls, with similar health-related quality of life.This person-centred intervention did not result in increased costs and dominated the standard medical care.ClinicalTrials.gov (registration number: NCT02982746).
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| 11. |
- Koinberg, Ingalill, 1955, et al.
(författare)
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Impact of a person-centered intervention for patients with head and neck cancer: A qualitative exploration
- 2018
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Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: People affected by head and neck cancer (HNC) experience a variety of multifaceted health-related problems during the treatment process, based on both the disease and side effects, several years after the treatment is complete. This study investigated a person-centred intervention using transition theory as a framework. Aim: Thus, the aim of the present study was to explore patients' experience of the transition and person centred care from diagnosis to the end of the treatment period. Methods: Interviews were conducted with 12 persons included in the person-centred intervention group. The patients were recruited from a randomised controlled study. We used a directed deductive content analysis as an analysis method. Results: There was a distinct transition between being a healthy person to being diagnosed with a serious disease. The majority of the participants felt that the diagnosis had put their lives in the balance; they felt both healthy and sick at the same time, and all participants described that their symptoms and side effects were the worst possible and totally unexpected. Of great importance was the health-care plan, comprising self-management goals which were formed in partnership between the patient and the nurse. The participants experienced that their interaction and engagement with lay persons and healthcare professionals supported a gradual acceptance of the situation and a sense of relief with a kind of awareness of the disease. Conclusion: The intervention played a significant role in promoting a healthy transition. Person-centredness and transition theory can help healthcare professionals to be more confident and resourceful in supporting people affected by HNC. © 2018 The Author(s).
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| 12. |
- Larsson, Johanna, et al.
(författare)
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Bacterial contamination of suction catheter tips during aortic valve replacement surgery: a prospective observational cohort study.
- 2015
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Ingår i: Patient safety in surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Bacterial mediastinitis is a severe complication after open heart surgery. The infection causes prolonged hospitalization and an increased mortality risk. Observations from orthopaedic surgery showed that the suction catheter used during surgery is commonly contaminated with bacteria. The aim of this study was to describe the prevalence of suction catheter contamination in cardiac surgery and to study if suction time influences the contamination risk.
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| 13. |
- Pirhonen, Laura, et al.
(författare)
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Effects of person-centred care on health outcomes—A randomized controlled trial in patients with acute coronary syndrome
- 2017
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:2, s. 169-179
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 Elsevier Ireland LtdObjectives To study the effects of person-centred care provided to patients with acute coronary syndrome, using four different health-related outcome measures. Also, to examine the performance of these outcomes when measuring person-centred care. Data and method The data used in this study consists of primary data from a multicentre randomized parallel group, controlled intervention study for patients with acute coronary syndrome at Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention and control group consisted of 94 and 105 patients, respectively. The effect of the intervention on health-related outcomes was estimated, controlling for socio-economic and disease-related variables. Results Patients in the intervention group reported significantly higher general self-efficacy than those in the control group six months after intervention start-up. Moreover, the intervention group returned to work in a greater extent than controls; their physical activity level had increased more and they had a higher EQ-5D score, meaning higher health-related quality of life. These latter effects are not significant but are all pointing towards the beneficial effects of person-centred care. All the effects were estimated while controlling for important socio-economic and disease-related variables. Conclusion The effectiveness of person-centred care varies between different outcomes considered. A statistically significant beneficial effect was found for one of the four outcome measures (self-efficacy). The other measures all captured beneficial, but not significant, effects.
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| 14. |
- Pirhonen, Laura, et al.
(författare)
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Person-Centred Care in Patients with Acute Coronary Syndrome: Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial.
- 2019
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Ingår i: PharmacoEconomics - open. - : Springer Science and Business Media LLC. - 2509-4254 .- 2509-4262. ; 3:4, s. 495-504
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Tidskriftsartikel (refereegranskat)abstract
- Costs associated with an ACS incident are most pronounced in the acute phase but are also considerably long after the initial hospitalisation, partly due to considerable productivity losses, which constitute a substantial part of the economic burden of the disease. Studies suggest that person-centred care may improve health-related quality of life and reduce the costs associated with the disease.The aim of this study was to calculate the cost-effectiveness of a person-centred care intervention compared with usual care in patients with acute coronary syndrome (ACS), in a Swedish setting.Primary data from a randomised controlled trial of a person-centred intervention in patients with ACS was used. The person-centred intervention involved co-creation of a health plan between the patient and healthcare professionals, based on the patient's narrative. Thereafter, goals for the recovery period were set and followed-up continuously throughout the intervention. The clinical data, collected during the randomised controlled trial, was complemented with data from national health registers and the Swedish Social Insurance Agency. The study was conducted at two hospitals situated in a Swedish municipality. Patients were enrolled between June 2011 and February 2014 (192 patients were included in this study; 89 in the intervention group and 103 in the control group). Incremental cost-effectiveness ratios were calculated separately for the age groups<65years and≥65years in order to account for the age of retirement in Sweden. The cost-effectiveness ratios were calculated using health-related quality of life (EQ-5D) and costs associated with healthcare and pharmaceutical utilisation, and productivity losses.Treatment effects and costs differed between those below and those above the age of 65years. The base-case calculations showed that person-centred care was more effective and less costly compared with usual care for patients under 65years of age, while usual care was more effective and less costly in the older age group. Probabilistic sensitivity analyses resulted in a 90% likelihood that person-centred care is cost-effective compared with usual care for patients with ACS under the age of 65years.Person-centred care was found to be cost-effective compared with usual care for patients with acute coronary syndrome under the age of 65years. This clinical trial is registered at Researchweb (ID 65791).
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| 15. |
- Pirhonen, Laura, et al.
(författare)
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The cost-effectiveness of person-centred care provided to patients with chronic heart failure and/or chronic obstructive pulmonary disease
- 2020
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Ingår i: Health Policy OPEN. - : Elsevier BV. - 2590-2296. ; 1
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Tidskriftsartikel (refereegranskat)abstract
- Background Efforts have been made to implement a more person-centred healthcare approach in several countries. The cost-effectiveness of person-centred care is to a large extent unknown, even though it has been demonstrated to decrease total healthcare costs and to be cost-effective in some settings and conditions. The objective of this study is to estimate costs, effects and the overall cost-effectiveness, of person-centred care compared to usual care, for patients with chronic heart failure and/or chronic obstructive pulmonary disease. Methods A randomized controlled trial including patients with chronic heart failure and/or chronic obstructive pulmonary disease was conducted at Sahlgrenska University Hospital in Gothenburg, Sweden. Person-centred care was given as an add-on to usual care for 103 patients, while a control group of 118 patients received usual care. The cost-effectiveness analysis was performed from a healthcare perspective, comparing health-related quality of life to healthcare costs, over a 6-month time horizon. Results Person-centred care was found to be more effective, i.e. improve health-related quality of life, and to result in lower healthcare costs compared to usual care. Probabilistic sensitivity analysis showed that the likelihood of person-centred care being cost effective compared to usual care is 93%, for a SEK 500,000 willingness-to-pay threshold per quality adjusted life year. Conclusion Person-centred care dominated usual care for patients with chronic heart failure and/or chronic obstructive pulmonary disease from a healthcare perspective.
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| 16. |
- Westin, Olof, et al.
(författare)
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Cost-effectiveness analysis of surgical versus non-surgical management of acute Achilles tendon ruptures.
- 2018
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Ingår i: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. - : Springer Science and Business Media LLC. - 1433-7347. ; 26:10, s. 3074-3082
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Tidskriftsartikel (refereegranskat)abstract
- An Achilles tendon rupture is a common injury that typically affects people in the middle of their working lives. The injury has a negative impact in terms of both morbidity for the individual and the risk of substantial sick leave. The aim of this study was to investigate the cost-effectiveness of surgical compared with non-surgical management in patients with an acute Achilles tendon rupture.One hundred patients (86 men, 14 women; mean age, 40years) with an acute Achilles tendon rupture were randomised (1:1) to either surgical treatment or non-surgical treatment, both with an accelerated rehabilitation protocol (surgical n=49, non-surgical n=51). One of the surgical patients was excluded due to a partial re-rupture and five surgical patients were lost to the 1-year economic follow-up. One patient was excluded due to incorrect inclusion and one was lost to the 1-year follow-up in the non-surgical group. The cost was divided into direct and indirect costs. The direct cost is the actual cost of health care, whereas the indirect cost is the production loss related to the impact of the patient's injury in terms of lost ability to work. The health benefits were assessed using quality-adjusted life years (QALYs). Sampling uncertainty was assessed by means of non-parametric boot-strapping.Pre-injury, the groups were comparable in terms of demographic data and health-related quality of life (HRQoL). The mean cost of surgical management was €7332 compared with €6008 for non-surgical management (p=0.024). The mean number of QALYs during the 1-year time period was 0.89 and 0.86 in the surgical and non-surgical groups respectively. The (incremental) cost-effectiveness ratio was €45,855. Based on bootstrapping, the cost-effectiveness acceptability curve shows that the surgical treatment is 57% likely to be cost-effective at a threshold value of €50,000 per QALY.Surgical treatment was more expensive compared with non-surgical management. The cost-effectiveness results give a weak support (57% likelihood) for the surgical treatment to be cost-effective at a willingness to pay per QALY threshold of €50,000. This is support for surgical treatment; however, additionally cost-effectiveness studies alongside RCTs are important to clarify which treatment option is preferred from a cost-effectiveness perspective.I.
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