| 1. |
- Aronsson, Mattias, et al.
(författare)
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Differences between hypothetical and experience-based value sets for EQ-5D used in Sweden: Implications for decision makers
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE PUBLICATIONS LTD. - 1403-4948 .- 1651-1905. ; 43:8, s. 848-854
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Tidskriftsartikel (refereegranskat)abstract
- Aims: A number of value sets are available today for converting EQ-5D questionnaire responses to quality-adjusted life year-weights used in health economic evaluations. The aim of this study is to analyse the differences between the commonly used hypothetical UK value set and the newly introduced Swedish experience-based value set and to evaluate health economic implications of such differences on policy decisions. Methods: Differences between the two value sets were studied using two methods: a comparison of health states and improvements as well as an empirical comparison. In the comparison of health states and improvements, the valuations of all EQ-5D states and all pure improvements were compared. In the empirical study, a database of 23,925 individuals was used to identify patient groups that could be affected by the implementation of the Swedish experience-based value set. Results: The comparison of health states and possible improvements showed that only three health states were assigned a lower quality-adjusted life year-weight and most improvements were given smaller absolute values if the experience-based value set was used. The empirical comparison showed that severe conditions were assigned higher values when using the experience-based value set. Conclusions: The Swedish experience-based value set seems to render a higher estimated level of health-related quality of life in virtually all health conditions compared to the hypothetical UK value set. In extension, health-related quality of life enhancing interventions are likely to be given higher priority in decision-making situations where hypothetical values are used to construct quality-adjusted life year-weights. In situations where experience-based quality-adjusted life year-weights are used, life-prolonging interventions would be prioritised.
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| 2. |
- 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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| 3. |
- 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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| 4. |
- 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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| 5. |
- 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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| 6. |
- Ekdahl, Anne W, et al.
(författare)
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Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study) : A Randomized Controlled Trial
- 2015
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1538-9375 .- 1525-8610. ; 16:6, s. 497-503
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.DESIGN: Assessor-blinded, single-center randomized controlled trial.SETTING: AGU in an acute hospital in southeastern Sweden.PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371£ (39,947£) and 30,490£ (31,568£; P = .432).CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.
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| 7. |
- Ekdahl, Anne W., et al.
(författare)
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Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months
- 2016
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Ingår i: Journal of the American Medical Directors Association. - : ELSEVIER SCIENCE INC. - 1525-8610 .- 1538-9375. ; 17:3, s. 263-268
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. Design: Randomized, controlled, assessor-blinded, single-center trial. Setting: A geriatric ambulatory unit in a municipality in the southeast of Sweden. Participants: Community-dwelling individuals aged >= 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). Intervention: Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. Outcome measures: Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. Results: Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P =.026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P =.01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P =.43). Conclusions: CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGAs superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs. (c) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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| 8. |
- Ekerstad, Niklas, et al.
(författare)
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Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care
- 2017
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Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1176-9092 .- 1178-1998. ; 12, s. 1239-1248
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Tidskriftsartikel (refereegranskat)abstract
- Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P amp;lt; 0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P amp;lt; 0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). Conclusion: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.
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| 9. |
- Ekerstad, Niklas, 1969-, et al.
(författare)
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Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?
- 2017
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Ingår i: Clinical Interventions in Aging. - : DOVE MEDICAL PRESS LTD. - 1178-1998 .- 1176-9092. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.
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| 10. |
- Ekerstad, Niklas, 1969-, et al.
(författare)
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Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients
- 2018
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 19:10, s. 871-8
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective. Design: Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups. Intervention: Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit. Setting and Participants: A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female. Measures: The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up. Results: We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was -3226 US dollars (95% CI: -6167 to -285). Conclusion: The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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