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Sökning: WFRF:(Svensson Mikael 1980)

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1.
  • Beckman, Linda, 1980-, et al. (författare)
  • Economic Costs of Antidepressant Use: A Population-Based Study in Sweden
  • 2019
  • Ingår i: Journal of Mental Health Policy and Economics. - Italy. - 1091-4358 .- 1099-176X. ; 22:4, s. 125-130
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Prescription of antidepressant drugs (ADs) has increased in recent decades, with rising costs for patients as well as for the health care system. There is sparse evidence of which factors explain the high economic costs and financial burden for the general population. Aims of the study: The aim was to assess individual-level determinants of out-of-pocket and total health care costs of AD use in the Swedish general population. Methods: We randomly sampled 400,000 individuals aged 18+ from Statistics Sweden's population register from 2010 to 2013. Two-part regression models were used for our two primary outcome variables: (i) total health care costs for AD use per year and individual, and (ii) total out-of-pocket costs of AD use per year and individual. Results: Women, the unemployed, unmarried people and residents of big cities have both higher use of ADs and higher associated total health care and out-of-pocket costs. Today, ADs are relatively inexpensive and average cost differences among all groups are therefore minor. The elderly have higher use of ADs, but are more commonly low-volume users and do not have higher total health care or out-of-pocket costs. Discussion and limitations: Groups with relatively low socioeconomic status are at risk of higher costs for antidepressant use. However, given the Swedish system of drug subsidies, differences in financial burden for individuals are minor. The limitations of this study included that we lacked data on diagnosis and could therefore not categorize the reasons for AD consumption. Furthermore, our results may not be generalized to other countries with a lower AD prevalence then Sweden's, since our estimates are dependent on the point prevalence of antidepressant use in the population. Implications for health care provision and use: Groups with higher AD consumption and economic costs may suffer from more severe depression owing to more risk factors and less social support in their surroundings, and may be in greater need of additional treatment and support than other groups. Implications for health policies and further research: Our results offer insight at an aggregate level, and more information on the underlying causes of higher costs is needed to discern the policy implications.
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3.
  • Beckman, Linda, 1980-, et al. (författare)
  • Effects on alcohol use of a Swedish school-based prevention program for early adolescents: a longitudinal study
  • 2017
  • Ingår i: BMC Public Health. - London, United Kingdom : Springer Science and Business Media LLC. - 1471-2458. ; 17
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of the study was to address the lack of evaluations of school-based substance use prevention programs and to conduct a quasi-experimental evaluation of the alcohol use part of the Triad intervention. Methods: Eleven Swedish intervention schools (285 pupils) and three control schools (159 pupils) participated in the evaluation. Baseline measurements were conducted in 2011 before the alcohol part in the prevention program was implemented in the intervention schools (school year 6, ages 12-13). We estimated an Intention-To-Treat (ITT) Difference-in-Difference (DD) model to analyze the effectiveness of the intervention on subsequent alcohol use measured in grades 7, 8 and 9. Results: The main results show no effect on the likelihood of drinking alcohol or drinking to intoxication. Conclusions: The lack of positive effects highlights the need for policy-makers and public health officials need to carefully consider and evaluate prevention programs in order to ensure that they are worthwhile from school, health, and societal perspectives.
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4.
  • Beckman, Linda, 1980-, et al. (författare)
  • Preference-based health-related quality of life among victims of bullying
  • 2016
  • Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 25:2, s. 303-309
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: No previous study has estimated the association between bullying and preference-based health-related quality of life (HRQoL) (“utility”), knowledge of which may be used for cost-effectiveness studies of interventions designed to prevent bullying. Therefore, the aim of the study was to estimate preference-based HRQoL among victims of bullying compared to non-victims. Methods: A cross-sectional survey data collection among Swedish adolescents aged 15–17 years in the first year of upper secondary school was conducted in the city of Gothenburg in Sweden (N = 758). Preference-based HRQoL was estimated with the SF-6D. Regression analyses were conducted to adjust for some individual-level background variable. Results: Mean preference-based health-related quality of life scores were 0.77 and 0.71 for non-victims and victims of bullying, respectively. The difference of 0.06 points was statistically significant (p < 0.05) and robust to inclusion of gender, age, and parental immigrant status. Conclusions: The preference-based HRQoL estimates in this study may be used as an upper bound in economic evaluations of bullying prevention interventions, facilitating a comparison between costs and quality-adjusted life-years.
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5.
  • Beckman, Linda, 1980-, et al. (författare)
  • The cost-effectiveness of the Olweus Bullying Prevention Program : Results from a modelling study
  • 2015
  • Ingår i: Journal of Adolescence. - : Academic Press. - 0140-1971 .- 1095-9254. ; 45, s. 127-137
  • Tidskriftsartikel (refereegranskat)abstract
    • Exposure to bullying affects around 3-5 percent of adolescents in secondary school and is related to various mental health problems. Many different anti-bullying programmes are currently available, but economic evaluations are lacking. The aim of this study is to identify the cost effectiveness of the Olweus Bullying Prevention Program (OBPP). We constructed a decision-tree model for a Swedish secondary school, using a public payer perspective, and retrieved data on costs and effects from the published literature. Probabilistic sensitivity analysis to reflect the uncertainty in the model was conducted. The base-case analysis showed that using the OBPP to reduce the number of victims of bullying costs 131 250 Swedish kronor ((sic)14 470) per victim spared. Compared to a relevant threshold of the societal value of bullying reduction, this indicates that the programme is cost-effective. Using a relevant willingness-to-pay threshold shows that the OBPP is a cost-effective intervention. (C) 2015 The Foundation for Professionals in Services for Adolescents.
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6.
  • Caraballo, Remi, et al. (författare)
  • Structure-activity relationships for lipoprotein lipase agonists that lower plasma triglycerides in vivo
  • 2015
  • Ingår i: European Journal of Medicinal Chemistry. - : Elsevier. - 0223-5234 .- 1768-3254. ; 103, s. 191-209
  • Tidskriftsartikel (refereegranskat)abstract
    • The risk of cardiovascular events increases in individuals with elevated plasma triglyceride (TG) levels, therefore advocating the need for efficient TG-lowering drugs. In the blood circulation, TG levels are regulated by lipoprotein lipase (LPL), an unstable enzyme that is only active as a non-covalently associated homodimer. We recently reported on a N-phenylphthalimide derivative (1) that stabilizes LPL in vitro, and moderately lowers triglycerides in vivo (Biochem. Biophys. Res. Common. 2014, 450, 1063). Herein, we establish structure activity relationships of 51 N-phenylphthalimide analogs of the screening hit 1. In vitro evaluation highlighted that modifications on the phthalimide moiety were not tolerated and that lipophilic substituents on the central phenyl ring were functionally essential. The substitution pattern on the central phenyl ring also proved important to stabilize LPL However, in vitro testing demonstrated rapid degradation of the phthalimide fragment in plasma which was addressed by replacing the phthalimide scaffold with other heterocyclic fragments. The in vitro potency was retained or improved and substance 80 proved stable in plasma and efficiently lowered plasma TGs in vivo. 2015 The Authors. Published by Elsevier Masson SAS.
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7.
  • D’Amico, Valeria, et al. (författare)
  • EU FP7 INFSO-ICT-247223 ARTIST4G, D1.2 Innovative advanced signal processing algorithms for interference avoidance
  • 2010
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • This document provides an overview of the proposed innovations and activities in Task 1.1 of Work Package 1 (WP1) of the ARTIST4G project, related to interference avoidance. Focus is on the technical approaches applicable at the physical layer, which are grouped into four different classes of innovations related to single-cell multi-user MIMO schemes, multi-cell multi-user MIMOschemes, advanced 3D beamforming and enabling functionalities. Descriptions of the proposed innovations are given including basic ideas, potential of performance, simulation results, realization options and possible implementation restrictions.
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8.
  • D’Amico, Valeria, et al. (författare)
  • EU FP7 INFSO-ICT-247223 ARTIST4G, D1.4 Interference Avoidance Techniques and System Design
  • 2012
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • In this document we provide performance assessments of the most promising techniques that were studied within Work Package 1 (WP1) of the ARTIST4G project related to interference avoidance. The results are based on evolved techniques that were identified and classified in deliverable D1.1 and investigated in deliverable D1.2 and D1.3, as well as novel alternative techniques that are introduced and assessed in this document.Based on the insights from these performance results we provide a synthetic perspective over the most promising solutions for interference avoidance. We argue that these solutions can reach a satisfactory trade-off in terms of performance benefits vs complexity of implementation. Some of these techniques are also identified as complementary techniques towards an integrated interference avoidance concept.
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9.
  • Hansson, Emma, 1981, et al. (författare)
  • Gothenburg Breast reconstruction (GoBreast) II protocol: a Swedish partially randomised patient preference, superiority trial comparing autologous and implant-based breast reconstruction.
  • 2024
  • Ingår i: BMJ open. - 2044-6055. ; 14:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Although breast reconstruction is an integral part of breast cancer treatment, there is little high-quality evidence to indicate which method is the most effective. Randomised controlled trials (RCTs) are generally thought to provide the most solid scientific evidence, but there are significant barriers to conducting RCTs in breast reconstruction, making both recruitment and achieving unbiased and generalisable results a challenge. The objective of this study is to compare implant-based and autologous breast reconstruction in non-irradiated patients. Moreover, the study aims to improve the evidence for trial decision-making in breast reconstruction.The study design partially randomised patient preference trial might be a way to overcome the aforementioned challenges. In the present study, patients who consent to randomisation will be randomised to implant-based and autologous breast reconstruction, whereas patients with strong preferences will be able to choose the method. The study is designed as a superiority trial based on the patient-reported questionnaire BREAST-Q and 124 participants will be randomised. In the preference cohort, patients will be included until 62 participants have selected the least popular alternative. Follow-up will be 60 months. Embedded qualitative studies and within-trial economic evaluation will be performed. The primary outcome is patient-reported breast-specific quality of life/satisfaction, and the secondary outcomes are complications, factors affecting satisfaction and cost-effectiveness.The study has been approved by the Swedish Ethical Review Authority (2023-04754-01). Results will be published in peer-reviewed scientific journals and presented at peer-reviewed scientific meetings.NCT06195865.
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10.
  • Persson, Mattias, PhD, 1983-, et al. (författare)
  • The Cost-Effectiveness of the Kiva Antibullying Program : Results from a Decision-Analytic Model
  • 2018
  • Ingår i: Prevention Science. - : Springer. - 1389-4986 .- 1573-6695. ; 19:6, s. 728-737
  • Tidskriftsartikel (refereegranskat)abstract
    • Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the “value for money.” The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to “status quo” (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts
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  • Sangskär, Heléne, 1980, et al. (författare)
  • Safety, effectiveness, women's experience, and economic costs of outpatient induction in women with uncomplicated pregnancies: A systematic review and meta-analyses.
  • 2022
  • Ingår i: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. - : Wiley. - 1879-3479. ; 161:2, s. 343-55
  • Forskningsöversikt (refereegranskat)abstract
    • Induction of labor is increasing worldwide, and some countries have started to introduce outpatient induction in low-risk women.To assess current knowledge concerning the safety, efficacy, women's experience, and economic costs of outpatient induction compared with inpatient induction.Multiple databases were last searched on October 19, 2021. Studies were selected according to our pre-specified inclusion, selection, and exclusion criteria.PICO; P-women with low-risk pregnancy planned for induction of labor. I-Outpatient induction C-Inpatient induction O-Outcomes according to the core outcome set for induction of labor (COSIOL).Pooled in meta-analyses. The certainty of evidence was assessed using the GRADE system.The 20 included studies, including 7956 women, showed an overall low incidence of adverse events and indicated comparable results for inpatient and outpatient induction, but the studies were underpowered for safety-related outcomes. Women's experiences of outpatient induction were mostly positive. Based on three studies, the economic costs consequence is inconclusive.Due to early randomization, heterogenic study design, and underpowered studies regarding safety outcome, the certainty of evidence is very low. It is uncertain whether outpatient induction affects the risk for neonatal and maternal complications.
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  • Zachrisson, Karin, et al. (författare)
  • Long-term outcome of stenting for atherosclerotic renal artery stenosis and the effect of angiographic restenosis.
  • 2018
  • Ingår i: Acta radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 59:12, s. 1438-1445
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Symptomatic renal artery stenosis (RAS) is mainly treated with pharmacological blood pressure control, sometimes with percutaneous transluminal renal angioplasty (PTRA). It is unclear if PTRA benefits these patients over time. Purpose To determine long-term renal function, morbidity, and mortality in patients with symptomatic RAS treated with PTRA, and whether long-term outcomes are associated with angiographic restenosis. Material and Methods Retrospective single-center, long-term follow-up of 57 patients with atherosclerotic RAS treated with PTRA with stent during 1995-2004 and investigated for restenosis with angiography after one year. Outcomes were retrieved from medical records and from mandatory healthcare registries. Mortality rates were related to expected survival in an age- and gender-matched population, using a life-table database. Surviving patients were assessed with blood pressures, laboratory tests, duplex ultrasonography, and radioisotope renography. Results Median follow-up was 11 years 7 months. Major indications for PTRA were therapy-resistant hypertension and declining renal function. Angiographic restenosis at one year was found in 21 of 57 patients (37%). Thirty-six patients (60%) died during follow-up. Main cause of death was cardiovascular events (54%). Mortality was significantly increased, and morbidity and healthcare utilization were high. Hypertension control during follow-up was stable with persistent need for anti-hypertensive medication, and renal function remained moderately reduced with no long-term difference between patients with vs. without restenosis. Conclusion Long-term prognosis after PTRA for atherosclerotic RAS is dismal, with high mortality and morbidity and reduced renal function, despite maintained hypertension control. Restenosis does not appear to affect late outcome.
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14.
  • Abuloha, Sumaya, et al. (författare)
  • A Review of the Cost-Effectiveness Evidence for FDA-Approved Cell and Gene Therapies.
  • 2024
  • Ingår i: Human gene therapy. - 1557-7422.
  • Tidskriftsartikel (refereegranskat)abstract
    • Cell and gene therapy innovations have provided several significant breakthroughs in recent years. However, cell and gene therapies often come with a high upfront cost, raising questions about patient access, affordability, and long-term value. This study reviewed cost-effectiveness analysis studies that have attempted to assess the long-term value of FDA-approved cell and gene therapies. Two reviewers independently searched the Tufts Medical Center Cost-Effectiveness Analysis Registry to identify all studies for FDA-approved cell and gene therapies per January 2023. A data extraction template was used to summarize the evidence in terms of the incremental cost-effectiveness ratio expressed as the cost per Quality-Adjusted Life-Year (QALY) and essential modeling assumptions, combined with a template to extract the adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The review identified 26 CEA studies for seven cell and gene therapies. Around half of the base-case cost-effectiveness results indicated that the cost per QALY was below $100,000-$150,000, often used as a threshold for reasonable cost-effectiveness in the US. However, the results varied substantially across studies for the same treatment, ranging from being considered very cost-effective to far from cost-effective. Most models were based on data from single-arm trials with relatively short follow-ups, and different long-term extrapolations between studies caused large differences in the modeled cost-effectiveness results. In sum, this review showed that despite the high upfront costs, many cell and gene therapies have cost-effectiveness evidence that can support long-term value. Nonetheless, substantial uncertainty regarding long-term value exists because so much of the modeling results are driven by uncertain extrapolations beyond the clinical trial data.
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15.
  • Alkmark, Mårten, 1973, et al. (författare)
  • Induction of labour at 41weeks of gestation versus expectant management and induction of labour at 42weeks of gestation: a cost-effectiveness analysis
  • 2022
  • Ingår i: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 129:13, s. 2157-2165
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To assess the cost-effectiveness of induction of labour (IOL) at 41weeks of gestation compared with expectant management until 42weeks of gestation. Design: A cost-effectiveness analysis alongside the Swedish Post-term Induction Study (SWEPIS), a multicentre, randomised controlled superiority trial. Setting: Fourteen Swedish hospitals during 2016–2018. Population: Women with an uncomplicated singleton pregnancy with a fetus in cephalic position were randomised at 41weeks of gestation to IOL or to expectant management and induction at 42weeks of gestation. Methods: Health benefits were measured in life years and quality-adjusted life years (QALYs) for mother and child. Total cost per birth was calculated, including healthcare costs from randomisation to discharge after delivery, for mother and child. Incremental cost-effectiveness ratios (ICERs) were calculated by dividing the difference in mean cost between the trial arms by the difference in life years and QALYs, respectively. Sampling uncertainty was evaluated using non-parametric bootstrapping. Main outcome measures: The cost per gained life year and per gained QALY. Results: The differences in life years and QALYs gained were driven by the difference in perinatal mortality alone. The absolute risk reduction in mortality was 0.004 (from 6/1373 to 0/1373). Based on Swedish life tables, this gives a mean gain in discounted life years and QALYs of 0.14 and 0.12 per birth, respectively. The mean cost per birth was €4108 in the IOL group (n=1373) and €4037 in the expectant management group (n=1373), with a mean difference of €71 (95%CI −€232 to €379). The ICER for IOL compared with expectant management was €545 per life year gained and €623 per QALY gained. Confidence intervals were relatively wide and included the possibility that IOL had both lower costs and better health outcomes. Conclusions: Induction of labour at 41weeks of gestation results in a better health outcome and no significant difference in costs. IOL is cost-effective compared with expectant management until 42weeks of gestation using standard threshold values for acceptable cost per life year/QALY. Tweetable abstract: Induction of labour at 41weeks of gestation is cost-effective compared with expectant management until 42weeks of gestation.
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16.
  • Andersson, Henrik, et al. (författare)
  • Scale sensitivity and question order in the contingent valuation method
  • 2014
  • Ingår i: Journal of Environmental Planning and Management. - Oxfordshire, United Kingdom : Routledge. - 0964-0568 .- 1360-0559. ; 57:11, s. 1746-1761
  • Tidskriftsartikel (refereegranskat)abstract
    • This study examines the effect on respondents’ willingness to pay to reduce mortality risk by the order of the questions in a stated preference study. Using answers from an experiment conducted on a Swedish sample where respondents’ cognitive ability was measured and where they participated in a contingent valuation survey, it was found that scale sensitivity is strongest when respondents are asked about a smaller risk reduction first (‘bottom-up’ approach). This contradicts some previous evidence in the literature. It was also found that the respondents’ cognitive ability is more important for showing scale sensitivity when respondents are asked about a larger risk reduction first (‘top-down’ approach), also reinforcing the result that a ‘bottom-up’ approach is more consistent with answers in line with theoretical predictions for a larger proportion of respondents.
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17.
  • Andersson, Helen, 1968, et al. (författare)
  • The cost-effectiveness of a two-step blood pressure screening programme in a dental health-care setting
  • 2021
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Hypertension is one of the largest contributors to the disease burden and a major economic challenge for health-care systems. Early detection of persons with high blood pressure can be achieved through screening and has the potential to reduce morbidity and mortality. We evaluate the cost-effectiveness of an opportunistic hypertension screening programme in a dental-care facility for individuals aged 40-75 in comparison to care as usual (the no-screening baseline scenario). Methods A cost-effectiveness analysis (CEA) was carried out from the payer and societal perspectives, and the short-term (from screening until diagnosis has been established) cost per identified case of hypertension and long-term (20 years) cost per quality-adjusted life year (QALY) were reported. Data on the short-term cost were based on a real-world screening programme in which 2025 healthy individuals were screened for hypertension. Data on the long-term cost were based on the short-term outcomes combined with modelling in a Markov cohort model. Deterministic and probabilistic sensitivity analyses were carried out to assess uncertainty. Results The short-term analysis showed an additional cost of 4,800 SEK (470) per identified case of hypertension from the payer perspective and from the societal perspective 12,800 SEK (1,240). The long-term analysis showed a payer cost per QALY of 2.2 million SEK (210,000) and from the societal perspective 2.8 million SEK per QALY (270,000). Conclusion The long-term model results showed that the screening model is unlikely to be cost-effective in a country with a well-developed health-care system and a relatively low prevalence of hypertension.
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18.
  • Andersson, H., et al. (författare)
  • Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety
  • 2016
  • Ingår i: Journal of Environmental Economics and Management. - : Elsevier BV. - 0095-0696 .- 1096-0449. ; 75, s. 41-53
  • Tidskriftsartikel (refereegranskat)abstract
    • This study elicits individual risk preferences in the context of an infectious disease using choice experiments. A main objective is to examine scope sensitivity using a novel approach. Our results suggest that the value of a mortality risk reduction (VSL) is highly sensitive to the survey design. Our results cast doubt on the standard scope sensitivity tests in choice experiments, but also on the validity and reliability of VSL estimates based on stated-preference studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values' central role in policy making. (C) 2015 Elsevier Inc. All rights reserved.
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20.
  • Andrén, Daniela, 1968-, et al. (författare)
  • Part-time sick leave as a treatment method for individuals with musculoskeletal disorders
  • 2012
  • Ingår i: Journal of occupational rehabilitation. - : Springer-Verlag New York. - 1053-0487 .- 1573-3688. ; 22:3, s. 418-426
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: There is increasing evidence that staying active is an important part of a recovery process for individuals on sick leave due to musculoskeletal disorders (MSDs). It has been suggested that using part-time sickleave rather than full-time sick leave will enhance the possibility of full recovery to the workforce, and several countries actively favor this policy. The aim of this paper is to examine if it is beneficial for individuals on sick leave due to MSDs to be on part-time sick leave compared to full-time sick leave.Methods: A sample of 1,170 employees from the RFV-LS (register) database of the Social Insurance Agency of Sweden is used. The effect of being on part-time sick leave compared to full-time sick leave is estimated for the probability of returning to work with full recovery of lost work capacity. A two-stage recursive bivariate probit model is used to deal with the endogeneity problem.Results: The results indicate that employees assigned to part-time sick leave do recover to full work capacity with a higher probability than those assigned to full-time sick leave. The average treatment effect of parttime sick leave is 25 percentage points.Conclusions: Considering that part-time sick leave may also be less expensive than assigning individuals to full-time sick leave, this would imply efficiency improvements from assigning individuals, when possible, to part-time sick leave.
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22.
  • Balogun, F. M., et al. (författare)
  • Stated preferences for human papillomavirus vaccination for adolescents in selected communities in Ibadan, Southwest Nigeria: A discrete choice experiment
  • 2022
  • Ingår i: Human Vaccines & Immunotherapeutics. - : Informa UK Limited. - 2164-5515 .- 2164-554X. ; 18:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Administration of the human papillomavirus (HPV) vaccine in early adolescence is effective in preventing cervical cancer, a common cancer in sub-Saharan Africa. Nigeria is in the pre-introduction era of the HPV vaccine. Understanding the preferences of the population for the vaccine can help design the HPV immunization program to ensure high uptake of the vaccine. This study explored the preferences for the HPV vaccine among stakeholders in selected communities in Ibadan, Nigeria. A discrete choice experiment survey based on six attributes of the HPV vaccine (which were the number of doses, the efficacy of the vaccine, cost of the vaccine, location of the service point, other benefits of the vaccine apart from prevention of cervical cancer and the odds of a side effect from the vaccine) was carried out in five communities. Data were analyzed using conditional and mixed logit models. Seven hundred community members were recruited, 144 (20.7%) were adolescents and 248 (35.4%) were males. In line with expectations, respondents preferred vaccines with higher efficacy, less severe side effects and lower costs. Preference heterogeneity was identified for adolescents that were less price-sensitive and other community members who were less likely to prefer using schools as the service point. The high socioeconomic class preferred a vaccine that also prevents genital warts. There were variabilities in the preferences for the attributes of the HPV vaccine in the study communities. These variabilities need to be considered in the introduction of the HPV vaccine to ensure high uptake of the vaccine.
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24.
  • Bonander, Carl, 1988-, et al. (författare)
  • Model-based economic evaluation of ice cleat distribution programmes for the prevention of outdoor falls among adults from a Swedish societal perspective
  • 2022
  • Ingår i: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 28:2, s. 125-130
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Slipping on snow or ice poses a significant health risk among older adults in Sweden. To combat this problem, about 80 Swedish municipalities have distributed ice cleats to older citizens (65+ years old) over the last decade. This paper details a cost-benefit analysis of such programmes. Materials and methods: We developed a decision-analytical model to estimate the costs and benefits of ice cleat programmes in Swedish municipalities compared with a business-as-usual scenario. The modelled benefits of the programme were based on effect estimates from previous research, data from population and healthcare registers and a survey of attitudes to and actual ice cleat use. The modelled costs of the programme were based on resource use data collected from 34 municipalities with existing ice cleat programmes. We assessed heterogeneity in the potential impact and benefit-to-cost ratios across all Swedish municipalities as a function of the average number of days with snow cover per year. Uncertainty in the cost-benefit results was assessed using deterministic and probabilistic sensitivity analyses. Results: The average benefit-to-cost ratio was 87, ranging from about 40 in low-risk municipalities to 140 in high-risk municipalities, implying that the potential benefits of ice cleat programmes greatly outweigh their costs. Probabilistic and deterministic sensitivity analyses support the robustness of this conclusion to parameter uncertainty and large changes in assumptions about the magnitude of the impact on ice cleat use and injuries. Conclusion: The benefits of distributing ice cleats to older adults appear to outweigh the costs from a Swedish societal perspective.
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25.
  • Bonander, Carl, 1988-, et al. (författare)
  • Universities as engines for regional growth? : Using the synthetic control method to analyze the effects of research universities
  • 2016
  • Ingår i: Regional Science and Urban Economics. - : Elsevier. - 0166-0462 .- 1879-2308. ; 60, s. 198-207
  • Tidskriftsartikel (refereegranskat)abstract
    • Are research universities important for regional growth and development? We study the impact on the regional economy of granting research university status to three former university colleges in three different regions in Sweden. We analyze the development in the treated regions compared to a set of control regions that are created using the synthetic control method. We find small or no effects on the regional economy. Our findings cast doubt on the effectiveness of research universities in fostering regional growth and development We contribute to the existing research by using a more credible identification strategy in assessing the effects of universities on the regional economy compared to what has usually been used in previous studies.
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26.
  • Bonander, Carl, et al. (författare)
  • Using causal forests to assess heterogeneity in cost-effectiveness analysis
  • 2021
  • Ingår i: Health Economics (United Kingdom). - : Wiley. - 1057-9230 .- 1099-1050. ; 30:8, s. 1818-1832
  • Tidskriftsartikel (refereegranskat)abstract
    • We develop a method for data-driven estimation and analysis of heterogeneity in cost-effectiveness analyses (CEA) with experimental or observational individual-level data. Our implementation uses causal forests and cross-fitted augmented inverse probability weighted learning to estimate heterogeneity in incremental outcomes, costs and net monetary benefits, as well as other parameters relevant to CEA. We also show how the results can be visualized in relevant ways for the analysis of heterogeneity in CEA, such as using individual-level cost effectiveness planes. Using a simulated dataset and an R package implementing our methods, we show how the approach can be used to estimate the average cost-effectiveness in the entire sample or in subpopulations, explore and analyze the heterogeneity in incremental outcomes, costs and net monetary benefits (and their determinants), and learn policy rules from the data.
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27.
  • Bornhöft, Lena, et al. (författare)
  • More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment.
  • 2019
  • Ingår i: BMC musculoskeletal disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment.Nurse-assessed patients with MSD (N=55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results.The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis.From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings.ClinicalTrials.gov NCT02218749 . Registered August 18, 2014.
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28.
  • Carvalho, E. de, et al. (författare)
  • EU FP7 INFSO-ICT-317669 METIS, D3.1 Positioning of multi-node/multi-antenna technologies
  • 2013
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • This document describes the research activity in multi-node/multi-antenna technologies within METIS and positions it with respect to the state-of-the-art in the academic literature and in the standardization bodies. Based on the state-of-the-art and as well as on the METIS objectives,we set the research objectives and we group the different activities (or technology components) into research clusters with similar research objectives. The technologycomponents and the research objectives have been set to achieve an ambidextrous purpose. On one side we aim at providing the METIS system with those technological components that are a natural but non-trivial evolution of 4G. On the other side, we aim at seeking for disruptivetechnologies that could radically change 5G with respect to 4G. Moreover, we mapped the different technology components to METIS’ other activities and to the overall goals of theproject.
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29.
  • Chauca Strand, Gabriella, 1995, et al. (författare)
  • Assessment of the clinical and cost-effectiveness evidence in the reimbursement decisions of new cancer drugs
  • 2022
  • Ingår i: ESMO Open. - : Elsevier. - 2059-7029. ; 7:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: This study aimed to describe the clinical and cost-effectiveness evidence supporting reimbursementdecisions of new cancer drugs and analyze the influence of trial characteristics and the cost per quality-adjusted lifeyears (QALYs) on the likelihood of reimbursement in Sweden.Patients and methods: Data were extracted from all appraisal dossiers for new cancer drugs seeking reimbursement inSweden and claiming added therapeutical value between the years 2010 and 2020. The data were analyzed usingdescriptive statistics, and logistic regression models were also used with the cost per QALY, study design,comparator, and evidence on final outcomes in the clinical trials as predictors of reimbursement.Results: All 60 included appraisals were based on trial evidence that assessed at least one final outcome (overallsurvival [OS] or quality of life [QoL]), although rarely as a primary outcome. Of the appraisals with a final decision(n ¼ 58), 79% were approved for reimbursement. Among the reimbursed drugs, only half had trial evidencedemonstrating improved OS or QoL. Only one drug had trial evidence supporting improvements in both OS andQoL. The average cost per QALY for reimbursed cancer drugs was estimated to be 748 560 SEK (V73 583). A highercost per QALY was found to decrease the likelihood of reimbursement by 9.4% for every 100 000 SEK (V9830)higher cost per QALY (P ¼ 0.03). For cost-effectiveness models without direct evidence of improvements in finaloutcomes, a larger QALY gain was observed compared with those with evidence mainly relying on intermediate andsurrogate outcomes.Conclusions: There are substantial uncertainties in the clinical and cost-effectiveness evidence underlyingreimbursement decisions of new cancer drugs. Decision makers should be cautious of the limited evidence onpatient-centered outcomes and the implications of allocating resources to expensive treatments with uncertainvalue for money.
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30.
  • Chauca Strand, Gabriella, 1995, et al. (författare)
  • Cancer Drugs Reimbursed with Limited Evidence on Overall Survival and Quality of Life : Do Follow-Up Studies Confirm Patient Benefits?
  • 2023
  • Ingår i: Clinical drug investigation. - : Springer. - 1173-2563 .- 1179-1918. ; 43:8, s. 621-633
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and ObjectiveCancer drug costs have increased considerably within healthcare systems, but many drugs lack quality-of-life (QoL) and overall survival (OS) data at the time of reimbursement approval. This study aimed to review the extent of subsequent literature documenting improvements in OS and QoL for cancer drug indications where no such evidence existed at the time of reimbursement approval.MethodsDrug indications with claims of added therapeutical value but a lack of evidence on OS and QoL that were reimbursed between 2010 and 2020 in Sweden were included for review. Searches were conducted in PubMed and ClinicalTrial.gov for randomized controlled trials examining OS and QoL.ResultsOf the 22 included drug indications, seven were found to have at least one trial with conclusive evidence of improvements in OS or QoL after a mean follow-up of 6.6 years. The remaining 15 drug indications either lacked subsequent randomized controlled trial data on OS or QoL (n = 6) or showed no statistically significant improvements (n = 9). Only one drug demonstrated evidence of improvement in both OS and QoL for its indication.ConclusionsA considerable share of reimbursed cancer drug indications continue to lack evidence of improvement in both OS and QoL. With limited healthcare resources and an increasing cancer burden, third-party payers have strong incentives to require additional post-reimbursement data to confirm any improvements in OS and QoL.
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31.
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32.
  • Djerf, Henrik, et al. (författare)
  • Absence of Long-Term Benefit of Revascularization in Patients with Intermittent Claudication: Five-Year Results from the IRONIC Randomized Controlled Trial
  • 2020
  • Ingår i: Circulation: Cardiovascular Interventions. - 1941-7640 .- 1941-7632. ; 13:1
  • Tidskriftsartikel (refereegranskat)abstract
    • © 2020 Lippincott Williams and Wilkins. All rights reserved. Background: The long-term benefit of revascularization for intermittent claudication is poorly understood. The aim of this study was to investigate the long-term effectiveness and cost-effectiveness compared with a noninvasive approach. Methods: The IRONIC trial (Invasive Revascularization or Not in Intermittent Claudication) randomized patients with mild-to-severe intermittent claudication to either revascularization + best medical therapy + structured exercise therapy (the revascularization group) or best medical therapy + structured exercise therapy (the nonrevascularization group). The health-related quality of life short form 36 questionnaire was primary outcome and disease-specific health-related quality of life (vascular quality of life questionnaire) and treadmill walking distances were secondary end points. Health-related quality of life has previously been reported superior in the revascularization group at 1- and 2-year follow-up. In this study, the 5-year results were determined. The cost-effectiveness of the treatment options was analyzed from a payer/healthcare standpoint. Results: Altogether, 158 patients were randomized in a 1:1 ratio. Regarding the primary end point, no intergroup differences were observed for the short form 36 sum or domain scores from baseline to 5 years, except for the short form 36 role emotional domain score, with greater improvement in the nonrevascularization group (n=116, P=0.007). No intergroup differences were observed in the vascular quality of life questionnaire total and domain scores (n=116, NS) or in treadmill walking distances (n=91, NS). A revascularization strategy resulted in almost twice the cost per patient compared with a noninvasive treatment approach ($13 098 versus $6965, P=0.02). Conclusions: After 5 years of follow-up, a revascularization strategy had lost its early benefit and did not result in any long-term improvement in health-related quality of life or walking capacity compared to a noninvasive treatment strategy. Revascularization was not a cost-effective treatment option from a payer/healthcare point of view. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01219842.
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33.
  • Djerf, Henrik, et al. (författare)
  • Cost-effectiveness of revascularization in patients with intermittent claudication.
  • 2018
  • Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 105:13, s. 1742-1748
  • Tidskriftsartikel (refereegranskat)abstract
    • Revascularization is a treatment option for patients with intermittent claudication. However, there is a lack of evidence to support its long-term benefits and cost-effectiveness. The aim of this study was to compare the cost-effectiveness of revascularization and best medical therapy (BMT) with that of BMT alone.Data were used from the IRONIC (Invasive Revascularization Or Not in Intermittent Claudication) RCT where consecutive patients with mild-to-severe intermittent claudication owing to aortoiliac or femoropopliteal disease were allocated to either BMT alone (including a structured, non-supervised exercise programme) or to revascularization together with BMT. Inpatient and outpatient costs were obtained prospectively over 24 months of follow-up. Mean improvement in quality-adjusted life-years (QALYs) was calculated based on responses to the EuroQol Five Dimensions EQ-5D-3 L™ questionnaire. Cost-effectiveness was assessed as the cost per QALY gained.A total of 158 patients were randomized, 79 to each group. The mean cost per patient in the BMT group was €1901, whereas it was €8280 in the group treated with revascularization in addition to BMT, with a cost difference of €6379 (95 per cent c.i. €4229 to 8728) per patient. Revascularization in addition to BMT resulted in a mean gain in QALYs of 0·16 (95 per cent c.i. 0·06 to 0·24) per patient, giving an incremental cost-effectiveness ratio of €42 881 per QALY.The costs associated with revascularization together with BMT in patients with intermittent claudication were about four times higher than those of BMT alone. The incremental cost-effectiveness ratio of revascularization was within the accepted threshold for public willingness to pay according to the Swedish National Guidelines, but exceeded that of the UK National Institute for Health and Care Excellence guidelines.
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34.
  • Djerf, Henrik, et al. (författare)
  • Editor's Choice - Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial
  • 2021
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 62:4, s. 576-582
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms aremainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aimof this studywas to investigate its cost effectiveness vs. noninvasive treatment. Methods: One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ5D 3L (TM) questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. Results: The mean cost per patient was (SIC)11 060 in the stent group and (SIC)4 787 in the control group, resulting in a difference of (SIC)6 273 per patient between the groups.The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of (SIC)23 785 per QALY. Conclusion: The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < (SIC)50 000 - (SIC)70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < 20 pound 000 - 30 pound 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.
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35.
  • Dorjdagva, J., et al. (författare)
  • Catastrophic health expenditure and impoverishment in Mongolia
  • 2016
  • Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The social health insurance coverage is relatively high in Mongolia; however, escalation of out-ofpocket payments for health care, which reached 41 % of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia. Methods: We used the data from the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national and The Wold Bank poverty lines are used. Results: About 5.5 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure. At the threshold of 40 % of capacity to pay, 1.1 % of the total household incurred catastrophic health expenditures. About 20,000 people were forced into poverty due to paying for health care. Conclusions: Despite the high coverage of social health insurance, a significant proportion of the population incurred catastrophic health expenditures and was forced into poverty due to out-of-pocket payments for health care.
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36.
  • Dorjdagva, Javkhlanbayar, et al. (författare)
  • Does social health insurance prevent financial hardship in Mongolia? Inpatient care: A case in point
  • 2021
  • Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Protecting people from financial hardship and impoverishment due to health care costs is one of the fundamental purposes of the Mongolian health system. However, the inefficient, oversized hospital sector is considered one of the main shortcomings of the system. The aim of this study is to contribute to policy discussions by estimating the extent of catastrophic health expenditure and impoverishment due to inpatient care at secondary-level and tertiary-level public hospitals and private hospitals. Methods Data were derived from a nationally representative survey, the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. A total of 12,685 households were involved in the study. "Catastrophic health expenditure"is defined as outof- pocket payments for inpatient care that exceed a threshold of 40% of households' nondiscretionary expenditure. The "impoverishment"effect of out-of-pocket payments for inpatient care was estimated as the difference between the poverty level before health care payments and the poverty level after these payments. Results At the threshold of 40% of capacity to pay, 0.31%, 0.07%, and 0.02% of Mongolian households suffered financially as a result of their member(s) staying in tertiary-level and secondary- level public hospitals and private hospitals respectively. About 0.13% of the total Mongolian population was impoverished owing to out-of-pocket payments for inpatient care at tertiary-level hospitals. Out-of-pocket payments for inpatient care at secondary-level hospitals and private hospitals were responsible for 0.10% and 0.09% respectively of the total population being pushed into poverty. Conclusions Although most inpatient care at public hospitals is covered by the social health insurance benefit package, patients who utilized inpatient care at tertiary-level public hospitals were more likely to push their households into financial hardship and poverty than the inpatients at private hospitals. Improving the hospital sector's efficiency and financial protection for inpatients would be a crucial means of attaining universal health coverage in Mongolia.
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37.
  • Dorjdagva, J., et al. (författare)
  • Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia
  • 2017
  • Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 16
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The entire population of Mongolia has free access to primary health care, which is fully funded by the government. It is provided by family health centers in urban settings. In rural areas, it is included in outpatient and inpatient services offered by rural soum (district) health centers. However, primary health care utilization differs across population groups. The aim of this study was to evaluate income-related inequality in primary health care utilization in the urban and rural areas of Mongolia. Methods: Data from the Household Socio-Economic Survey 2012 were used in this study. The Erreygers concentration index was employed to assess inequality in primary health care utilization in both urban and rural areas. The indirect standardization method was applied to measure the degree of horizontal inequity. Results: The concentration index for primary health care at family health centers in urban areas was significantly negative (-0.0069), indicating that utilization was concentrated among the poor. The concentration index for inpatient care utilization at the soum health centers was significantly positive (0.0127), indicating that, in rural areas, higher income groups were more likely to use inpatient services at the soum health centers. Conclusions: Income-related inequality in primary health care utilization exists in Mongolia and the pattern differs across geographical areas. Significant pro-poor inequality observed in urban family health centers indicates that their more effective gatekeeping role is necessary. Eliminating financial and non-financial access barriers for the poor and higher need groups in rural areas would make a key contribution to reducing pro-rich inequality in inpatient care utilization at soum health centers.
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38.
  • Eklund, Elin, 1992, et al. (författare)
  • Quasi-experimental evaluation of municipal ice cleat distribution programmes for older adults in Sweden
  • 2023
  • Ingår i: Injury Prevention. - : BMJ Publishing Group Ltd. - 1353-8047 .- 1475-5785. ; 29:5, s. 378-83
  • Tidskriftsartikel (refereegranskat)abstract
    • IntroductionFall injuries caused by icy road conditions are a prevalent public health problem during winters in Sweden, especially in older populations. To combat this problem, many Swedish municipalities have distributed ice cleats to older adults. While previous research has shown promising results, there is a lack of comprehensive empirical data on the effectiveness of ice cleat distribution. We address this gap by investigating the impact of these distribution programmes on ice-related fall injuries among older adults. MethodsWe combined survey data on ice cleat distribution in Swedish municipalities with injury data from the Swedish National Patient Register (NPR). The survey was used to identify municipalities that have distributed ice cleats to older adults at some point between 2001 and 2019. Data from NPR were used to identify municipality-level data on patients who have been treated for injuries related to snow and ice. We used a triple differences design-a generalisation of difference in differences-that compared ice-related fall injury rates before and after intervention in 73 treatment and 200 control municipalities, with unexposed age groups serving as within-municipality controls. ResultsWe estimate that the average ice cleat distribution programmes reduced ice-related fall injury rates by -0.24 (95% CI -0.49 to 0.02) per 1000 person-winters. The impact estimate was larger in municipalities that distributed more ice cleats (-0.38 (95% CI -0.76 to -0.09)). No similar patterns were found for fall injuries unrelated to snow and ice. ConclusionOur results suggest that ice cleat distribution can decrease the incidence of ice-related injuries among older adults.
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39.
  • Fantini, R, et al. (författare)
  • EU FP7 INFSO-ICT-317669 METIS, D3.2 First performance results for multi-node/multi-antenna transmission technologies
  • 2014
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • This deliverable describes the current results of the multi-node/multi-antenna technologies investigated within METIS and analyses the interactions within and outside Work Package 3. Furthermore, it identifies the most promising technologies based on the current state of obtained results. This document provides a brief overview of the results in its first part. The second part, namely the Appendix, further details the results, describes the simulation alignment efforts conducted in the Work Package and the interaction of the Test Cases. The results described here show that the investigations conducted in Work Package 3 are maturing resulting in valuable innovative solutions for future 5G systems.
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40.
  • Finseraas, Henning, et al. (författare)
  • Do knowledge gains from public information campaigns persist over time? : Results from a survey experiment on the Norwegian pension reform
  • 2017
  • Ingår i: Journal of Pension Economics and Finance. - : Cambridge University Press. - 1474-7472 .- 1475-3022. ; 16:1, s. 108-117
  • Tidskriftsartikel (refereegranskat)abstract
    • Government authorities use resources on information campaigns in order to inform citizens about relevant policy changes. The motivation is usually that individuals sometimes are ill-informed about the public policies relevant for their choices. In a survey experiment where the treatment group was provided with public information material on the social security system, we assess the short- and medium-term knowledge effects. We show that the short run effects of the information on knowledge disappear completely within 4 months. The findings illustrate the limits of public information campaigns to improve knowledge about relevant policy reforms.
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41.
  • Fledsberg, Stephanie, et al. (författare)
  • Lifetime healthcare expenditures across socioeconomic groups in Sweden.
  • 2023
  • Ingår i: European journal of public health. - : Oxford University Press. - 1464-360X .- 1101-1262. ; 33:6, s. 994-1000
  • Tidskriftsartikel (refereegranskat)abstract
    • Individuals of lower socioeconomic status generally have higher healthcare expenditures than individuals of higher socioeconomic status. However, little is known about how expenditures are distributed across socioeconomic groups over a lifetime, once accounting for differences in life expectancy. This study describes how lifetime healthcare expenditures are distributed across age, sex and socioeconomic groups in Sweden while adjusting for differences in life expectancy.Healthcare utilization from 2016 were linked to demographic and socioeconomic data for a random sample of individuals aged 20 and above in the four largest Swedish regions (n=440659). Mortality data were used to estimate income- and sex-specific survival rates. Expected lifetime healthcare expenditures were estimated by combining survival rates with mean healthcare expenditures over age, by sex, and income quintile.We find that expected lifetime healthcare expenditures are highest among the first (lowest) income quintile despite their evident lower life expectancy. Expected lifetime expenditures were 17.9% (16.8%) higher in the first income quintile compared to the fifth (highest) quintile for women (men). Individuals in the first income quintile had higher expected lifetime expenditures for all care categories except for primary care.We conclude that despite a lower life expectancy, the quintile of the lowest socioeconomic status still had higher lifetime healthcare expenditures.
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42.
  • Gamba, Simona, et al. (författare)
  • The impact of cost-sharing on prescription drug demand : evidence from a double-difference regression kink design
  • 2022
  • Ingår i: European Journal of Health Economics. - : Springer. - 1618-7598 .- 1618-7601. ; 23, s. 1591-1599
  • Tidskriftsartikel (refereegranskat)abstract
    • Pharmaceuticals represent the third-largest expenditure item in health care spending in the OECD countries, and cost growth is around 5% per year in many OECD countries. One possible way to contain the rise in pharmaceutical spending is the use of cost-sharing schemes that makes insured individuals directly bear parts of the cost of a drug. This study estimates the price sensitivity of demand for prescription drugs using data on all prescription drug purchases from a random sample of 400,000 Swedes followed from 2010 to 2013. We use a regression kink design (RKD) by exploiting the kinked Swedish cost-sharing scheme to assess the price elasticity. Further, since the cost-sharing scheme has changed over time, we also use a double-difference RKD to account for potential confounding nonlinearities around the kink. Our results indicate that the standard RKD results are biased and exaggerate the price sensitivity. Our preferred double-difference RKD specifications show no or minor price sensitivity (95% CI price elasticity from - 0.12 to 0.02). The results are similar in several sub-group analyses across age groups, sexes, and income quartiles.
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43.
  • Gustavsson, Anders, et al. (författare)
  • Corrigendum to “Cost of disorders of the brain in Europe 2010” [Eur. Neuropsychopharmacol. 21 (2011) 718–779]
  • 2012
  • Ingår i: European Neuropsychopharmacology. - : Elsevier BV. - 0924-977X .- 1873-7862. ; 22:3, s. 237-238
  • Tidskriftsartikel (refereegranskat)abstract
    • The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.
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44.
  • Gustavsson, Anders, et al. (författare)
  • Cost of disorders of the brain in Europe 2010.
  • 2011
  • Ingår i: European Neuropsychopharmacology. - Amsterdam : Elsevier BV. - 0924-977X .- 1873-7862. ; 21:10, s. 718-79
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.AIMS: To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.METHODS: The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.RESULTS: The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.DISCUSSION: This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.RECOMMENDATIONS: Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.
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45.
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46.
  • Hansson, Emma, 1981, et al. (författare)
  • Systematic review of cost-effectiveness in breast reconstruction: deep inferior epigastric perforator flap vs. implant-based breast reconstruction.
  • 2024
  • Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 59
  • Tidskriftsartikel (refereegranskat)abstract
    • There are several techniques for reconstructing breasts after mastectomy, but little scientific evidence for which technique is superior. The aim of this systematic review was to compare the cost-effectiveness of implant-based and autologous reconstruction and to evaluate the overall certainty of evidence, as well as the quality of reporting of the included studies.Studies investigating the cost-effectiveness of breast reconstruction with a deep inferior epigastric perforator (DIEP) flap compared to implant-based reconstruction, meeting criteria defined in a PICO (population, intervention, comparison, and outcome), were included. Medline, PubMed, Embase, Cochrane library, CinahL, EconLit, and NHS EED databases were searched. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence, and the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) 2022 was used to evaluate the quality of reporting.A total of 256 abstracts were retrieved from the search, and after scrutiny, seven studies were included. The findings of this present systematic review should be interpreted with caution as the overall certainty of evidence is low (GRADE ƟƟОО). The included studies suggest that DIEP-flaps are cost-effective compared with implant-based breast reconstruction when the applied cost-effectiveness thresholds of $50,000 to $100,000 per quality-adjusted life years are used. It is noteworthy that no high level evidence exists regarding cost-effeciency, to support recommendations and decision in breast reconstruction. Methodological issues that can be improved in future studies are presented.
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47.
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48.
  • Ho, Chan-Mei, et al. (författare)
  • Physiotherapist or physician as primary assessor for patients with suspected knee osteoarthritis in primary care - a cost-effectiveness analysis of a pragmatic trial
  • 2022
  • Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Over the next decade, the number of osteoarthritis consultations in health care is expected to increase. Physiotherapists may be considered equally qualified as primary assessors as physicians for patients with knee osteoarthritis. However, economic evaluations of this model of care have not yet been described. To determine whether physiotherapists as primary assessors for patients with suspected knee osteoarthritis in primary care are a cost-effective alternative compared with traditional physician-led care, we conducted a cost-effectiveness analysis alongside a randomized controlled pragmatic trial. Methods Patients were randomized to be assessed and treated by either a physiotherapist or physician first in primary care. A cost-effectiveness analysis compared costs and effects in quality adjusted life years (QALY) for the different care models. Analyses were applied with intention to treat, using complete case dataset, and missing data approaches included last observation carried forward and multiple imputation. Non-parametric bootstrapping was conducted to assess sampling uncertainty, presented with a cost-effectiveness plane and cost-effectiveness acceptability curve. Results 69 patients were randomized to a physiotherapist (n = 35) or physician first (n = 34). There were significantly higher costs for physician visits and radiography in the physician group (p < 0.001 and p = 0.01). Both groups improved their health-related quality of life 1 year after assessment compared with baseline. There were no statistically significant differences in QALYs or total costs between groups. The incremental cost-effectiveness ratio for physiotherapist versus physician was savings of 24,266 euro/lost QALY (societal perspective) and 15,533 euro/lost QALY (health care perspective). There is a 72-80% probability that physiotherapist first for patients with suspected knee osteoarthritis is less costly and differs less than +/- 0.1 in QALY compared to traditional physician-led care. Conclusion These findings suggest that physiotherapist-led care model might reduce health care costs and lead to marginally less QALYs, but confidence intervals were wide and overlapped no difference at all. Health consequences depending on the profession of the first assessor for knee osteoarthritis seem to be comparable for physiotherapists and physicians. Direct access to physiotherapist in primary care seems to lead to fewer physician consultations and radiography. However, larger clinical trials and qualitative studies to evaluate patients' perception of this model of care are needed.
  •  
49.
  • Holmberg, Robin, et al. (författare)
  • Ice cleat distribution programmes and ice cleat use among older adults: repeated cross-sectional evidence from 63 municipal interventions in Sweden
  • 2022
  • Ingår i: Injury Prevention. - : BMJ. - 1353-8047 .- 1475-5785.
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction Ice cleats may help prevent ice-related falls in places with icy roads, but there is limited evidence about the association between ice cleat distribution and ice cleat use. Our study examined the association between Swedish municipal distribution programmes and ice cleat use among older adults (65+ years). Methods We combined data on municipal ice cleat distribution programmes (n=63) with repeated cross-sectional self-reports of ice cleat use in Sweden from 2007, 2010, 2014 and 2018. Respondents (n=63 234) were classified as exposed if they lived in a municipality with a programme, belonged to an eligible age group and responded after distribution (n=2507). Dose-response was assessed using distributed ice cleat pairs per capita (mean: 0.38). Linear probability models were used to estimate probability differences in ice cleat use between exposed and unexposed respondents, adjusting for age, sex, country of birth, education, survey wave and municipality. Ineligible age groups living in programme municipalities, who should be unaffected by ice cleat distribution, were used for bias assessment. Results Exposure to ice cleat distribution programmes was associated with 7.5 percentage points (95% CI 4.2 to 10.9) higher self-reported ice cleat use after confounding adjustment. The association was larger in municipalities that distributed one pair of ice cleats per capita (17.3 percentage points (95% CI 11.2 to 23.4)). No association was found among the ineligible age groups (-2.3 (95% CI -5.5 to 1.0)). Conclusion Distributing ice cleats to older adults may help increase their use of ice cleats in settings with icy road conditions.
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50.
  • Holst, Anna, et al. (författare)
  • Cost-effectiveness analysis of internet-mediated cognitive behavioural therapy for depression in the primary care setting : results based on a controlled trial
  • 2018
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To perform a cost-effectiveness analysis of a randomised controlled trial of internet-mediated cognitive behavioural therapy (ICBT) compared with treatment as usual (Tall) for patients with mild to moderate depression in the Swedish primary care setting. In particular, the objective was to assess from a healthcare and societal perspective the incremental cost-effectiveness ratio (ICER) of ICBT versus TaU at 12 months follow-up. Design A cost-effectiveness analysis alongside a pragmatic effectiveness trial. Setting Sixteen primary care centres (PCCs) in south-west Sweden. Participants Ninety patients diagnosed with mild to moderate depression at the PCCs. Main outcome measure ICERs calculated as (Cost(ICBT)-Cost(TaU))/(Health outcome(ICBT)-Health outcome(TaU))=Delta Cost/Delta Health outcomes, the health outcomes being changes in the Beck Depression Inventory-II (BDI-II) score and quality-adjusted life-years (QALYs). Results The total cost per patient for ICBT was 4044 Swedish kronor (SEK) ((sic)426) (healthcare perspective) and SEK47679 ((sic)5028) (societal perspective). The total cost per patient for TaU was SEK4434 ((sic)468) and SEK50 343 ((sic)5308). In both groups, the largest cost was associated with productivity loss. The differences in cost per patient were not statistically significant. The mean reduction in BDI-ll score was 13.4 and 13.8 units in the ICBT and Tall groups, respectively. The mean QALYs per patient was 0.74 and 0.79 in the ICBT and TaU groups, respectively. The differences in BDI-11 score reduction and mean QALYs were not statistically significant. The uncertainty of the study estimates when assessed by bootstrapping indicated that no firm conclusion could be drawn as to whether ICBT treatment compared with Tall was the most cost-effective use of resources. Conclusions ICBT was regarded to be as cost-effective as TaU as costs, health outcomes and cost-effectiveness were similar for ICBT and TaU, both from a healthcare and societal perspective.
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