| 1. |
- Gerdtham, Ulf-Göran, et al.
(författare)
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Drug Expenditure and New Drug Introductions : The Swedish Experience
- 1993
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Ingår i: PharmacoEconomics. - : Springer Science and Business Media LLC. - 1179-2027 .- 1170-7690. ; 4:3, s. 215-225
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Tidskriftsartikel (refereegranskat)abstract
- This article measures the impact of the switch to new and more expensive drugs on the aggregate drug expenditure (both prescription and nonprescription) in Sweden during the period 1974 to 1991, and also on the disaggregated expenditure for 3 medical areas: asthma, hypertension and peptic ulcer disease. During the period studied, nominal drug expenditure increased 6-fold. The retail price index of drugs and the number of prescribed drugs accounted for 51.6 and 5.8% of this increase, respectively. The remaining residual amount accounted for 42.6%. Since the price index of drugs increased more slowly than the overall net price index of goods and services, the relative price of drugs decreased dramatically by about 30%. This means that increases in prices of drugs cannot explain the increase in real inflation-adjusted drug expenditure. We also show that the residual increase can be partly explained by the introduction of new and more expensive drugs. It is therefore argued that economic evaluations which compare the extra costs induced by new drugs with the extra benefits should be undertaken to guide decisions about the prescription of new and more expensive drugs.
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| 2. |
- Johannesson, Magnus, 1964-, et al.
(författare)
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A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention
- 1991
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Ingår i: Médecine et informatique. - Linköping : Linköping University Electronic Press. - 0307-7640. ; 16:4, s. 355-362
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- In this paper a computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention is presented. The computer simulation model was written in Turbo Pascal to be used on an IBM-PC compatible. The model was based on the 8-year logistic multivariate risk equations for coronary heart disease (CHD) and stroke from the Framingham heart study, but the regression coefficients can easily be changed if local data exists. The main advantages of the model are that it is easy to use, transparent, and flexible. The model was mainly developed for scientific purposes, but should be useful also for educational purposes and clinical decision analysis. The modelling approach should also be useful in many other medical areas.
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| 3. |
- Johannesson, Magnus, et al.
(författare)
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A health-economic comparison of diet and drug treatment in obese men with mild hypertension
- 1992
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Ingår i: Journal of hypertension. - : Lippincott-Raven Publishers. - 1473-5598 .- 0263-6352. ; 10:9, s. 1063-1070
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo compare dietary and antihypertensive drug treatment in obese men with mild hypertension in economic terms.DesignA 6-week run-in period followed by randomization to either diet or drug treatment, lasting for 1 year. Blood pressure was measured blindly and serum lipid concentrations assessed at run-in and after 1 year. A computer-based model was used in five cost-effectiveness simulations with different assumptions as to the effect upon coronary heart disease risk from the changes in diastolic blood pressure and cholesterol, both total and high-density lipoprotein. A cost—benefit analysis was also performed, calculated as willingness to pay for treatment, as assessed by questionnaire, minus total cost.SettingOutpatient clinic in city hospital.PatientsSixty-four men aged 40–69 years with body mass index ≥ 26kg/m and a diastolic blood pressure 90–104 mmHg when untreated were recruited (screening after advertisement in newspaper). Exclusion criteria were diabetes mellitus, organ damage secondary to hypertension, and diseases that might have interfered with compliance and the interpretation of results. Sixty-one patients completed the study.InterventionsDietary treatment was based upon weight reduction and sodium restriction. Drug treatment used a stepped-care approach, with atenolol as the drug of first choice.Main outcome measuresLife years gained and willingness to pay.ResultsDrug treatment was the preferred option in three of the five cost-effectiveness simulations. The cost-benefit analysis did not show any difference between the two groups.ConclusionsNon-pharmacological treatment seemed to be less cost-effective than drug treatment. However, more studies and further methodological development are needed to verify this finding.
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| 4. |
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| 5. |
- Johannesson, Magnus, 1964-
(författare)
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Economic evaluation of hypertension treatment
- 1991
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on economic evaluation of hypertension treatment.The purpose of the study was threefold: to calculate the costs ofhypertension treatment at an individual and a national level; to analyse the importance of different methodological issues for the cost-effectiveness of hypertension treatment; and to test the contingent valuation (CV) method in this field. The scope of the thesis is mainly methodological. The thesis includes nine papers. The first two papers are concerned with the cost of antihypertensive therapy. The three following papers deal with the costeffectiveness of hypertension treatment and the last four papers are centred around the CV method.In the cost calculations it is shown that the cost per patient can varyconsiderably between different patient groups, which should be taken intoaccount in economic evaluations. The importance of the cut-off point fortotal treatment costs is also demonstrated. Since a lack of conformity hasbeen noted with respect to several issues in cost-effectiveness analysis, acomputer simulation model is constructed to analyse the importance ofthese issues. The cost-effectiveness of hypertension treatment is shown to be highly sensitive towards different assumptions about the effectiveness of treatment, the outcome measure, the cost concept, the discounting of effects and the duration of therapy. Due to the limits of cost-effectiveness analysis it is important to try other approaches, such as cost-benefit analysis based on the CV method. With the CV method, that is consistent with utility theory and welfare economics, willingness to -pay is measured with survey methods. The CV method is tested in two empirical applications that indicate that it is possible to use the method in this area. The results should be interpreted with caution, however, since the reliability and validity of the method is not yet established.
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| 6. |
- Johannesson, Magnus
(författare)
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Economic Evaluation of Hypertension Treatment
- 1992
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Ingår i: International journal of technology assessment in health care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 8:3, s. 506-523
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Tidskriftsartikel (refereegranskat)abstract
- A computer simulation model shows that the cost-effectiveness of treating hypertension is highly sensitive to different assumptions about the effectiveness of treatment, the outcome measure, the cost concept, the discounting of effects, and the duration of therapy. Cost-effectiveness analysis should be supplemented by another approach–cost-benefit analysis based on the contingent valuation (CV) method (the measurement, by survey, of willingness to pay). The CV method is tested in two empirical applications that indicate that it is possible to use the method in this area. Its results should be interpreted with caution, however, since the reliability and validity of the method is not yet established.
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| 7. |
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| 8. |
- Johannesson, Magnus
(författare)
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Economic evaluation of lipid lowering — A feasibility test of the contingent valuation approach
- 1992
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 20:3, s. 309-320
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Tidskriftsartikel (refereegranskat)abstract
- A large number of cost-effectiveness analyses of treatment of high cholesterol levels have been published the last few years. Due to the Inherent problems of cost-effectiveness analysis of prevention and the specific problems in the case of lipid lowering, it is Important to test alternative approaches. This study reports the results of a pilot study of three benefit measures based on individual preferences. Willingness to pay (WTP), willingness to give up leisure time (WTGT) and maximum acceptable risk (MAR) for lowering cholesterol levels to normal were investigated among persons with hypercholesterolaemia in a postal survey. The respondents were on average prepared to pay about SEK 450 per month, to give up about 7 hours of leisure time per week or to take an immediate mortality risk of about 1.4% to get normal lipid levels. The WTP and WTGT questions seemed to be about equally acceptable, whereas the MAR question performed less well with respect to acceptability. It is concluded that especially WTP deserves further attention, due to Its inherent advantages, since it performed at least as well as the other measures.
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| 9. |
- Johannesson, Magnus, et al.
(författare)
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Economic evaluation of osteoporosis prevention
- 1993
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Ingår i: Health policy. - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 24:2, s. 103-124
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Tidskriftsartikel (refereegranskat)abstract
- In this paper economic evaluation of osteoporosis prevention is discussed. So far economic evaluation in this area has been limited to cost-effectiveness analysis. Four cost-effectiveness analyses of osteoporosis prevention are reviewed. It is noted that the major problem with these studies is the lack of reliable and valid data to base the cost-effectiveness analyses on, which precludes clear-cut conclusions about the cost-effectiveness of osteoporosis prevention. The studies, however, form a basis for future cost-effectiveness analyses in this field and as new data become available it should be possible to improve the accuracy and precision of the analyses. Due to the methodological problems of cost-effectiveness analysis and the decisionmaker approach to economic evaluation, it is also argued that the contingent valuation (CV) method of measuring willingness to pay should be tested in this area. The CV method can be used both to value an actual treatment and the outcome of that treatment and the resulting amount can be compared with the costs (including the costs of externalities) to carry out cost-benefit analysis. It is concluded that a lot of work remains to be done in this area before economic evaluations can give a real contribution to policy, but such work may well be worthwhile due to the importance of this public health problem.
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| 10. |
- Johannesson, Magnus, et al.
(författare)
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From Principle To Public Policy: Using Cost-Effectiveness Analysis
- 1994
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Ingår i: Health Affairs. - : Health Affairs (Project Hope). - 1544-5208 .- 0278-2715. ; 13:3, s. 206-214
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Tidskriftsartikel (refereegranskat)abstract
- Medical technology assessment, which traditionally has involved evaluating whether a technology was safe and effective, has been expanded in recent years to include consideration of cost-effectiveness. While most analysts and policymakers would agree that cost-effectiveness is, in principle, a worthy goal, actually using such a standard in coverage decisions is much more difficult. This Commentary focuses on challenges involved for public payers and what we can realistically expect a cost-effectiveness criterion to accomplish. First, we briefly discuss the cost-effectiveness principle. Second, we address some of the key issues in asserting medical technologies. Finally, we discuss both the opportunities and limitations of cost-effectiveness analysis.
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