| 1. |
- Aronsson, Mattias, 1989-
(författare)
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Health Economic Evaluations of Screening Programs - Applications and Method Improvements
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening.The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making.This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations.As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design.In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.
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| 2. |
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| 3. |
- Bernfort, Lars, et al.
(författare)
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Chronic pain in an elderly population in Sweden : Impact on costs and quality of life
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain among elderly people has long been a well-known problem, in terms of both societal costs and the quality of life of affected individuals. To estimate the magnitude of the problems associated with chronic pain in an elderly population, data on both costs and quality of life were gathered. A postal questionnaire was sent out to a stratified sample of 10 000 inhabitants 65 years and older in Linköping and Norrköping. The survey included questions on demographics, habits, and life situation, and different kinds of questions and instruments related to well-being (e.g., quality-of-life and pain-specific questions). In the questionnaire respondents were asked whether they were receiving any help—informal care—from a relative. If they answered yes, they were asked for permission to contact the informal caregiver and to provide contact details. The amount of informal care provided by relatives to persons with chronic pain was investigated by use of a questionnaire directed to the caregiving relatives, containing questions about time spent providing informal care.Data on costs were collected from registers of consumption of health care, drugs, and municipal services.The results of the study showed a very clear association between existence and severity of chronic pain and societal costs. The study population was subdivided into three groups with respect to having chronic pain or not, and a pain intensity during the last week of 0–4 (mild), 5–7 (moderate), or 8–10 (severe) on a scale of 0–10. Taking all costs (health care, drugs, municipal services, and informal care) into account, persons in the severe chronic pain group consumed on average 72% more resources than persons in the moderate chronic pain group and 143% more than those in the no or mild chronic pain group. Differences were most pronounced concerning municipal services and informal care costs.Even more alarming are the results on the quality of life of persons in the different groups. On the EQ-5D index, the average value for persons in the no or mild chronic pain group was 0.82. For those in the moderate chronic pain group the average value was 0.64, and for those in the severe chronic pain group the average value was only 0.38. EQ-VAS resulted in less pronounced but still clearly significant differences.It is concluded that this study, reaching a rather large part of the target population, shows that existence and severity of chronic pain among people 65 years and older affects costs to society and the quality of life of affected individuals in a massive way.
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| 4. |
- Bernfort, Lars, 1967-, et al.
(författare)
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Kostnadseffektivitet av allergen immunterapi : analys och genomgång av kunskapsläget
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Allergier orsakar mycket besvär för drabbade individer och stora kostnader för hälso- och sjukvården och samhället. Tidigare forskning tyder på att allergen immunterapi (AIT) kan vara ett framgångsrikt sätt att behandla personer med allergisk rinit/rinokonjunktivit. Tidigare genomförda hälsoekonomiska studier tyder också på en acceptabel kostnadseffektivitet för AIT jämfört med enbart symtomatisk behandling.Syftet med denna studie var att kartlägga evidensläget för att undersöka möjligheterna att uttala sig om för vilka patienter som AIT är lämpligt, samt när förskrivning kan bedömas som kostnadseffektiv. Grundtanken var att försöka dela in patienter i subgrupper med olika egenskaper, behandlingseffekt och kostnadseffektivitet. Indelningen i subgrupper var i första hand tänkt att baseras på ålder, typ av allergen, symtomens svårighetsgrad och symtomens varaktighet.Tidigt beslutades att evidensläget inte tillåter analys av subkutan (SCIT) och sublingual (SLIT) immunterapi separat, utan dessa behandlas i klump med det förenklade antagandet om en jämn fördelning mellan SCIT och SLIT. Denna analys genomfördes som en modellanalys med antagandet att personer startar AIT-behandling vid 25 års ålder. Det generella resultatet av analysen var att med ett samhällsperspektiv är AIT dominant, dvs. att behandlingen både sparar kostnader och genererar hälsovinster jämfört med enbart symtomatisk behandling. Med ett hälso- och sjukvårdsperspektiv blev kostnadseffektivitetskvoten av AIT jämfört med enbart symtomatisk behandling cirka 245 000 kronor per kvalitetsjusterat levnadsår (QALY).Tillgänglig evidens tillåter tyvärr inte subgruppsanalyser på det sätt som var tänkt. Detta beroende på att behandlingseffekt specificerat på allergentyp, allergins svårighetsgrad och symtomens varaktighet inte analyserats och rapporterats i tidigare publicerade studier. Den enda uppdelningen som befanns vara någorlunda meningsfull var den baserad på ålder. Inte heller avseende denna variabel har skillnader i behandlingseffekt studerats. Däremot antogs olika indirekta kostnader (produktionsförluster) för barn, ungdomar och vuxna. Dessa kostnader saknar betydelse i en analys med hälso- och sjukvårdsperspektiv varför detta resultat inte påverkas. Med ett samhällsperspektiv däremot befanns AIT mest kostnadseffektiv riktad till vuxna (dominant), följt av barn (179 000 kronor/QALY) och ungdomar (245 000 kronor/QALY). För att kunna genomföra en mer komplett kostnadseffektanalys behövs en del information som i dagsläget saknas. Exempel på kunskapsluckor som identifierats är:En meningsfull uppdelning i tillstånd baserat på svårighetsgrad (lindrig/måttlig/svår), utifrån biomarkörer och/eller symtom.Effektiviteten av AIT och dess inverkan på övergångar mellan tillstånd.Livskvalitet och kostnader förknippade med olika tillstånd.Skillnader i behandlingseffektivitet för olika subgrupper (ålder, svårighet och varaktighet av symtom, olika allergener).Evidens som möjliggör jämförelse mellan SCIT och SLIT, när är den ena respektive den andra mest effektiv/kostnadseffektiv?Långtidseffekt av vissa AIT-terapier.
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| 5. |
- Bernfort, Lars, 1967-, et al.
(författare)
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Patienter med diabetes typ 2 och etablerad hjärt-kärlsjukdom i Östergötland : 5-års sjukvårdskonsumtion, kostnad och överlevnad med eller utan behandling med empagliflozin
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Diabetes mellitus typ 2 är en kronisk sjukdom med en prevalens på cirka 4% i Sverige. T2D behandlas genom omläggning av matvanor och viktnedgång, eller om detta inte är tillräckligt med antingen blodsockerreglerande läkemedel eller insulin. Sjukdomen är förknippad med ökad risk för följdsjukdomar, bland annat hjärt-kärlsjuklighet som är i fokus i denna rapport. I EMPA REG Outcome studien analyserades effekterna av att som tillägg till standardbehandling ge den glukossänkande SGLT-2-hämmaren empagliflozin till patienter med T2D och etablerad hjärt-kärlsjukdom. I studien konstaterades att empagliflozin minskade risken för hjärt-kärlhändelser samt gav förbättrad överlevnad. Syftet med denna studie var tudelat. I den första delen gjordes en kartläggning och beräkning av sjukvårdskonsumtion och kostnader för patienter med T2D, med och utan etablerad hjärtkärlsjukdom, i Östergötland under en femårsperiod (2012–2016). I den andra delen beräknades hur kostnader och mortalitet relaterade till hjärt-kärlhändelser skulle påverkas av att behandla patienter med T2D och etablerad hjärt-kärlsjukdom i Östergötland med empagliflozin.Sjukvårdskonsumtion, kostnader och mortalitet i Östergötland kartlades och beräknades med hjälp av nationella och regionala register. Resultaten från EMPA REG Outcome studien tillämpades på kohorten av patienter med T2D och etablerad hjärt-kärlsjukdom i Östergötland för att på så sätt estimera effekterna av behandling med empagliflozin med avseende på sjukvårdskostnader och mortalitet.Kartläggningen visade att i Östergötland fanns 1 januari 2012 18 586 patienter med T2D, varav 5 490 (30%) även hade etablerad hjärt-kärlsjukdom. Patienter med T2D och etablerad hjärt-kärlsjukdom (CVD-kohorten) var jämfört med övriga patienter med T2D i genomsnitt äldre, i större utsträckning män, samt hade längre diabetesduration och sämre njurfunktion. CVD-kohorten hade under uppföljningsperioden signifikant högre sjukvårdskostnader och sämre överlevnad.Förskrivning av empagliflozin till patienter med T2D och etablerad hjärt-kärlsjukdom i Östergötland beräknades resultera i minskade genomsnittliga sjukvårdskostnader per patient motsvarande cirka 4 100 kronor över fem år, varav cirka 2 300 kronor kunde relateras till minskade kostnader på grund av hjärtsvikt. Mot detta ska ställas ökade läkemedelskostnader. Totalt ger behandling med empagliflozin ökade kostnader på cirka 18 000 kronor per patient över fem år. Den stora vinsten av empagliflozin till patienter med T2D och etablerad hjärt-kärlsjukdom utgörs av tydligt minskad mortalitet. I genomsnitt lever en patient behandlad med empagliflozin 96 dagar längre än om empagliflozin inte förskrivs, sett över en femårsperiod.Förskrivning av empagliflozin minskar behovet av andra glukossänkande läkemedel vilket visades av en upptitrering av glukossänkande läkemedel i placebogruppen i EMPA-REG Outcome studien. Obeaktat minskad förskrivning av övriga glukossänkare och insulin leder resultaten till att empagliflozin (jämfört med standardbehandling) beräknas generera hälsovinster till en kostnad av cirka 69 000 kronor per levnadsår, eller 85 000 kronor per kvalitetsjusterat levnadsår, vilket Socialstyrelsen i sina riktlinjer bedömer som en låg kostnad.Slutsatsen är att behandling med empagliflozin i den tämligen utsatta patientgrupp som har T2D och etablerad hjärt-kärlsjukdom är såväl medicinskt effektivt som kostnadseffektivt.
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| 6. |
- Bernfort, Lars, et al.
(författare)
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People in states worse than dead according to the EQ-5D UK value set: would they rather be dead?
- 2018
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Ingår i: Quality of Life Research. - : SPRINGER. - 0962-9343 .- 1573-2649. ; 27:7, s. 1827-1833
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Tidskriftsartikel (refereegranskat)abstract
- Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.
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| 7. |
- Bernfort, Lars, et al.
(författare)
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Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life
- 2015
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Ingår i: Pain. - : Elsevier / Lippincott, Williams andamp; Wilkins. - 0304-3959 .- 1872-6623. ; 156:3, s. 521-527
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.
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| 8. |
- Dong, Huan-Ji, 1981-, et al.
(författare)
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Is excess weight a burden for older adults who suffer chronic pain?
- 2018
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Ingår i: BMC Geriatrics. - : BMC. - 1471-2318 .- 1471-2318. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundObesity and chronic pain are common comorbidities and adversely influence each other. Advanced age is associated with more comorbidities and multi-morbidities. In this study, we investigated the burden of overweight/obesity and its comorbidities and their associations with chronic pain in a random population sample of Swedish older adults.MethodsThe cross-sectional analysis involved a random sample of a population65years in south-eastern Sweden (N=6243). Data were collected from a postal questionnaire that addressed pain aspects, body mass index (BMI), and health experiences. Chronic pain was defined as pain during the previous three months. According to the 0-10 Numeric Rating Scale, pain scored 7 corresponds to severe pain. Binary logistic regression was used to determine the variables associated to pain aspects.ResultsA total of 2633 (42%) reported chronic pain. More obese older adults (BMI 30kg/m(2)) experienced chronic pain (58%) than those who were low-normal weight (BMI amp;lt;25kg/m(2), 39%) or overweight (25BMI amp;lt;30kg/m(2), 41%). Obese elderly more frequently had pain in extremities and lower back than their peers. In the multivariate model, obesity (Odds Ratio (OR) 1.59, 95% Confidence Interval (CI) 1.33-1.91) but not overweight (OR 1.08, 95% CI 0.95-1.22) was associated with chronic pain. Obesity (OR 1.53, 95% CI 1.16-2.01) was also significantly related to severe pain. We also found other comorbidities - i.e., traumatic history (OR 2.52, 95% CI 1.99-3.19), rheumatic diseases (OR 5.21, 95% CI 4.54-5.97), age85years (OR 1.66, 95% CI 1.22-2.25), and depression or anxiety diagnosis (OR 1.83, 95% CI 1.32-2.53) - showed stronger associations with pain aspects than weight status. Conclusion: In older adults, excess weight (BMI 30 or above) is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain. Future studies should investigate the effectiveness of interventions that treat comorbid pain and obesity in older adults.
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| 9. |
- Dragioti, Elena, Ph.D., et al.
(författare)
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A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+cohort
- 2017
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Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 10, s. 2009-2019
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. Objective: This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldestold ages using a new method (APSs) to assess the location of pain on the body. Materials and methods: The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. Results: Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. Conclusion: Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.
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| 10. |
- Dragioti, Elena, Ph.D., et al.
(författare)
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Association of insomnia severity with well-being, quality of life and health care costs: A cross-sectional study in older adults with chronic pain (PainS65+)
- 2018
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Ingår i: European Journal of Pain. - : WILEY. - 1090-3801 .- 1532-2149. ; 22:2, s. 414-425
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInsomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well-being, quality of life and health care costs. MethodsThe sample included 2790 older individuals (median age=76; interquartile range [IQR]=70-82) with chronic pain. The participants completed a postal survey assessing basic demographic data, pain intensity and frequency, height, weight, comorbidities, general well-being, quality of life and the insomnia severity index (ISI). Data on health care costs were calculated as costs per year (Euro prices) and measured in terms of outpatient and inpatient care, pain drugs, total drugs and total health care costs. ResultsThe overall fraction of clinical insomnia was 24.6% (moderate clinical insomnia: 21.9% [95% CI: 18.8-23.3]; severe clinical insomnia: 2.7% [95% CI: 1.6-3.2]). Persons who reported clinical insomnia were more likely to experience pain more frequently with higher pain intensity compared to those reported no clinically significant insomnia. Mean total health care costs were Euro 8469 (95% CI: Euro4029-Euro14,271) for persons with severe insomnia compared with Euro 4345 (95% CI: Euro4033-Euro4694) for persons with no clinically significant insomnia. An association between severe insomnia, well-being, quality of life, outpatient care, total drugs costs and total health care costs remained after controlling for age, sex, pain intensity, frequency, body mass index and comorbidities using linear regression models. ConclusionsOur results determine an independent association of insomnia with low health-related quality of life and increased health care costs in older adults with chronic pain. SignificanceThe concurrence and the severity of insomnia among older adults with chronic pain were associated with decreased well-being and quality of life, and increased health care costs to society.
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