| 1. |
- Ekman, Mattias
(författare)
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Assessing uncertainty in cost-effectiveness analysis by combining resampling of clinical trial data with stochastic modelling : The economic evaluation of bisoprolol for heart failure revisited
- 2001
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this paper is to evaluate the cost-effectiveness of the beta blocker bisoprolol in heart failure by combining resampling of the clinical trial data with stochastic modelling of the expected remaining lifetime for patients alive at the end of the clinical trial. This is a reassessment of an economic evaluation of the beta blocker bisoprolol that has previously been published. The main difference between this study and the previous one lies in the estimation of uncertainty. In the earlier study, the health effects were estimated by combining the survival times from the clinical trial, which the economic evaluation was based on, with a deterministic additional survival time for the patients who were alive at the end of clinical trial. The results were then evaluated by perfonning a sensitivity analysis. In this study, the deterministic modelling of the survival after the end of the clinical trial is replaced by stochastic modelling, and the uncertainty of the experimental data is assessed by a repeated resampling (bootstrap) procedure. The average value ofthe net (monetary) benefit is SEK 101 400 at a value of SEK 450000 per year of life gained. A one-sided confidence interval on the 5% level shows that the net (monetary) benefit is significantly larger than zero.
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| 2. |
- Ekman, Mattias
(författare)
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Consumption and Production by Age in Sweden : Basic Facts and Health Economic Implications
- 2001
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- For cost-effectiveness analysis to be consistent with expected utility maximization, David Meltzer has proposed that the difference between consumption and production should be included as costs in added years of life. In order to obtain an estimate of these costs, average production and consumption figures by age for the general population in Sweden were conlpiled. Production is here defined as the total labour cost, including pre-tax income and pay-roll taxes, but excluding transfer payments such as paid sickleave. Private consumption was mainly estimated from a consumer expenditure survey. Public consumption was estimated from the Swedish national accounts and other government sources. Health care consumption by age was given particular consideration, since these costs are interesting in their own right from a health economic viewpoint. Towards the end of the paper, the reliability and validity of the age distribution of consumption and production is discussed, as well as applications to health economic evaluations.
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| 3. |
- Ekman, Mattias, et al.
(författare)
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Cost effectiveness of bisoprolol in the treatment of chronic congestive heart failure in Sweden : Analysis using data from the cardiac insufficiency bisoprolol study II trial
- 2001
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Ingår i: PharmacoEconomics. - : Springer. - 1179-2027 .- 1170-7690. ; 19:9, s. 901-916
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate the cost effectiveness of adding the P-blocker bisoprolol to standard treatment in patients with congestive heart failure (CHF). Design and setting: A cost-effectiveness study was based on the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), a randomised clinical trial investigating the efficacy of adding bisoprolol to standard therapy of CHF. The cost-effectiveness analysis was carried out from a societal perspective, Methods: Health effects were measured in terms of years of life gained. On the cost side, treatment costs for pharmaceuticals and hospitalisations were included. Data on healthcare resource consumption from CIBIS-II were used and were combined with average Swedish retail prices for medicines, and average costs for hospitalisations based on hospital admissions, in the base case. The costs of added years of life, i.e. consumption net of production during life-years gained were also included. Results: If costs of added years of life were not included, then bisoprolol therapy increased life expectancy at an incremental cost of Swedish kronor (SEK) 13 094 (1999 values) per year of life gained. If costs of added years of life were included, then the incremental cost-effectiveness ratio of bisoprolol therapy was SEK168 858 per year of life gained. Conclusions: For patients with CHF with the characteristics of those in CIBIS-II, the cost effectiveness of bisoprolol therapy compares favourably with that of other cardiovascular therapies.
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| 4. |
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| 5. |
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| 6. |
- Ekman, Mattias, et al.
(författare)
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Kostnadseffektivt att behandlakronisk hjärtsvikt med bisoprolol [Cost-effectiveness of bisoprolol in chronic heart failure]
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 14, s. 646-650
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Kliniska prövningar har visat att betablockerare har gynnsamma effekter på dödlighet och sjuklighet vid kronisk hjärtsvikt.Hjärtsvikt är ett vanligt och allvarligt tillstånd, som dessutom orsakar samhällsekonomiska kostnader på minst 2 miljarder kronor per år.Den kliniska studien CIBIS II, som omfattade 2 647 patienter i funktionsklass III och IV, visade en signifikant minskning av mortaliteten på 32 procent när beta-blockeraren bisoprolol adderades till konventionell hjärtsviktsbehandling.Som ett led i en ekonomisk utvärdering av bisoprolol undersöktes kostnader och hälsoeffekter i samband med behandlingen. Uppgifter om läkemedelsförbrukning och sjukhusinläggningar hämtades från CIBIS II-studien. Uppgifter om patienternas överlevnad är dels hämtade från CIBIS-II-studien, dels baserade på uppgifter från tidigare studier.Den ekonomiska utvärderingen indikerar att behandling av kronisk hjärtsvikt med bisoprolol är ett kostnadseffektivt alternativ.
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| 7. |
- Ekman, Mattias
(författare)
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Studies in health economics : modelling and data analysis of costs and survival
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation consists of six essays in health economics.The first essay, “Economic evaluations in health care: Basic principles and special topics”, serves as an introduction to economic evaluations in health care, including estimations of costs, health effects, and the discount rate. Special topics of interest for the rest of the studies are also discussed, e.g. the role of modelling in cost-effectiveness analysis, and methods for dealing with incomplete observations in clinical trial data. The main theme of the second essay, “Consumption and production by age in Sweden: Basic facts and health economic implications”, is a fairly detailed compilation of consumption and production figures by age in Sweden. The purpose of this is to use the difference between consumption and production in each age group as a measure of the average costs of added years of life in the general population. In economic evaluations of health care interventions, only future costs for related ill-nesses have typically been included in the analysis. However, the health economist David Meltzer has argued that future costs for un-related illnesses and general consumption should also be in-cluded in eco-nomic evaluations. Otherwise, the analysis will not be consistent with expected utility maximiza-tion. The third essay is entitled “The possibility of predicting health care costs in the future from predicted changes in age structure and age specific mortality: The case of Sweden”. Changes in the age structure, especially the growing number of elderly people, have raised concerns about increasing costs for health and elderly care in the future. However, the number of elderly per se is not the main problem, since the growing number of elderly people is a result of better health and hence lower morta-lity. The main purpose of the study is to investigate if future health care costs can be predicted based on forecasts of future changes in age structure and mortality rates. It is shown here that at least in Sweden and in the U.S., there is a linear relationship between age-specific mortality and age-specific health care costs. When these relationships are applied retrospectively to old data, however, the predictions are underestimates of the actual costs. These results are in line with earlier studies, which show that the future age structure is not likely to have a great impact on the future health care costs. The fourth essay is called “Cost effectiveness of bisoprolol in the treatment of chronic congestive heart failure in Sweden: Analysis using data from the Cardiac Insufficiency Bisoprolol Study II” (with Niklas Zethraeus and Bengt Jönsson). Treatment of heart failure with beta blockers was introduced in Sweden already in the 1970s, but it was not until the 1990s that large-scale clinical trials established the efficacy of beta blockers in reducing heart failure mortality. The study consists of an economic evaluation of the beta blocker bisoprolol added to standard treatment of chronic heart failure, compared with placebo added to the same standard treatment. The study raises a number of methodological issues. At the forefront are the inclusion of costs of added years of life, and the question of how to model health effects that extend beyond the clinical trial on which the economic evaluation is based. The results indi-cate that treatment with bisoprolol is cost-effective. A drawback of the analysis in the fourth study was that the expected survival after the end of follow-up was modelled deterministically. This makes it impossible to assess the uncertainty of the cost-effectiveness estimate in a realistic way. The fifth essay is entitled “Assessing uncertainty in cost-effectiveness analysis by combining resampling of clinical trial data with stochastic modelling: The economic evaluation of bisoprolol for heart failure revisited”. Here, the drawback with the fourth study that was mentioned above is addressed by using resamp-ling of the clinical trial data in combination with stochastic modelling of the expected survival after the end of follow-up in the clinical trial. The methodology is inspired by the bootstrap method, which is a simulation technique whereby various statistics, like the mean and variance, can be estimated through repeated resampling from the original sample. The difference from the traditional boot-strap method is that resampling of observations from the clinical trial data is combined with stochastic modelling of the expected remaining lifetime of the patients who were alive at the end of the clinical trial. Cost-effectiveness acceptability curves for treatment of heart failure with bisoprolol were obtained as a result of the analysis. The sixth essay, “Survival analysis techniques for estimating the costs attributable to head and neck cancer in Sweden”, concerns the estimation of average treatment cost attri-butable to a disease when the data contain censored, i.e. incomplete, observations. For various reasons, censored observations are common in medical and epidemiological studies. As a result, the length of the survival time or the size of the costs for those who are alive at the end of follow-up are not exactly known. This is of course problematic if we want to estimate the average survival time or the average cost for all patients, both survivors and non-survivors included. In this study, the Kaplan-Meier sample-average estimator is used for overcoming the problem with censored observations. It is a method that has been proposed specifically for handling censored cost data.
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| 8. |
- Ekman, Mattias
(författare)
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Survival analysis techniques for estimating the costs attributable to head and neck cancer in Sweden
- 2001
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This study concerns statistical methods for estimating the health care cost attributable to a disease for a defined patient. Such estimates may be of value for health economic evaluations. Ways of handling incomplete (or censored) cost and survival data are discussed, with application to data on survival and in-patient resource utilization in head and neck cancer. The database was obtained from the national Swedish cancer registry and includes all patients diagnosed with head and neck cancer in Sweden from 1986 to 1996. The main method of estimating the average in-patient costs attributable to head and neck cancer is the Kaplan-Meier sample-average estimator, which takes account of censored survival and cost data. A parametric analogue to the Kaplan-Meier sampleaverage estimator is also presented. Towards the end, alternative methods are discussed, e.g. the possibility of refining the analysis by taking accooot of explanatory ariables in a regression model. As for the results, the analysis presented in the study suggests that the average in-patient cost attributable to head and neck cancer in Sweden is about SEK 260 000 per patient from diagnosis to death (2001 prices).
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| 9. |
- Ekman, Mattias
(författare)
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The possibility of predicting health care costs in the future from predicted changes in age structure and age-specific mortality : The case of Sweden
- 2002
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- In this paper, the possibility of predicting future health care costs from predicted changes in age structure and age-specific nlortality is explored, based on data for the Swedish population. A linear relationship between age-specific mortality and agespecific health care costs is established for 1997. By combining this relationship with predictions of the future age structure and the future age-specific mortality rates, the Swedish health care costs in 2010 and 2030 are predicted. In order to test the validity of the method, the same methodology is applied retrospectively to data from 1985 in order to predict the health care costs in 1997. The results show that the method gives an underestimation of the actual costs. This should come as no surprise, since international research has shown that the age structure plays a relatively insignificant role for the level of health care expenditures. The most important factor for explaining differences in health care expenditures over time, and across countries, is the level of GDP per capita.
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