| 1. |
- Johannesson, Magnus, et al.
(författare)
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Advantages of using the net-benefit approach for analysing uncertainty in economic evaluation studies
- 2003
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Ingår i: PharmacoEconomics. - : Adis International. - 1179-2027 .- 1170-7690. ; 21:1, s. 39-48
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Tidskriftsartikel (refereegranskat)abstract
- No consensus has yet been reached on how to analyse uncertainty in economic evaluation studies where individual patient data are available for costs and health effects. This paper summarises the available results regarding the analysis of uncertainty on the cost-effectiveness plane and argues for using the net-benefit approach when analysing uncertainty in cost-effectiveness studies. The net-benefit approach avoids the interpretation and statistical problems related to the incremental cost effectiveness ratio and implies several advantages. First, traditional statistical methods can be used for confidence-interval estimation and hypothesis testing. Second, calculation of the optimal sample size and the power of the study are facilitated allowing the correlation between costs and effects to vary within and between patient groups. Third, the use of a Bayesian approach to cost-effectiveness analysis is facilitated. Fourth, a formal relation between cost-effectiveness acceptability curves and statistical inference is provided. Finally, the net-benefit approach gives the Fieller's limits of the confidence interval for the incremental cost-effectiveness ratio in the cost-effectiveness plane. Based on these advantages the net-benefit approach should strongly be considered when analysing uncertainty in cost-effectiveness analyses.
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| 2. |
- Lindberg, Magnus, et al.
(författare)
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Health-related quality of life in patients with psoriasis and atopic dermatitis measured with SF-36, DLQI and a subjective measure of disease activity
- 2000
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Ingår i: Acta dermato-venereologica. - : Acta dermato-venereologica. - 1651-2057 .- 0001-5555. ; 80:6, s. 430-434
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Tidskriftsartikel (refereegranskat)abstract
- The impact of skin diseases on health-related quality of life is considerable. It is important to quantify the patient's perspective of the severity of their disease. Health-related quality of life was measured in 366 patients with skin diseases attending the dermatology outpatient clinic in Uppsala, Sweden, from November 1996 to December 1997, with 1 generic (SF-36) and I disease-specific (DLQI) health-related quality of life instrument, and a subjective measure of disease activity. The SF-36 mean scores were below those of the age- and gendermatched general population in Sweden. No difference in health-related quality of life was found between men and women or between patients with atopic dermatitis and psoriatic patients. However, patients with psoriatic arthritis had significantly poorer health-related quality of life than both patients with atopic dermatitis and psoriatic patients. The estimated correlations between the instruments were in the expected direction and mostly significant. The results confirm that skin diseases have an adverse impact on patients' health-related quality of life.
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| 3. |
- Bleichrodt, Han, et al.
(författare)
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Time Preference for Health: A Test of Stationarity versus Decreasing Timing Aversion
- 2001
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Ingår i: Journal of mathematical psychology. - : Elsevier Inc. - 1096-0880 .- 0022-2496. ; 45:2, s. 265-282
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Tidskriftsartikel (refereegranskat)abstract
- This paper provides a new and more robust test of the descriptive validity of the constant rate discounted utility model in medical decision analysis. The constant rate discounted utility model is compared with two competing theories, Harvey's (1986) proportional discounting model and Loewenstein and Prelec's (1992) hyperbolic discounting model. To compare the various intertemporal models, previous studies on intertemporal preferences for health assumed a specific parametric form of the utility function for life-years and no discounting within the time periods that health states are experienced. The present study avoids such confounding assumptions by focusing on the axiomatic structure of the discounting models. The present study further differs by using choices instead of matching to elicit intertemporal preferences. The experimental results provide support for decreasing timing aversion, the condition underlying the proportional and the hyperbolic discounting model, but they violate stationarity, the central condition of the constant rate discounted utility model. There is some ambiguity whether the violations of stationarity are primarily caused by an immediacy effect. The results confirm violations of stationarity in choice-based elicitations tasks, in contrast with the results from Ahlbrecht and Weber (1997) which supported stationarity in choices over monetary outcomes.
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| 4. |
- Burström, Kristina, et al.
(författare)
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Health-related quality of life by disease and socio-economic group in the general population in Sweden
- 2001
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 55:1, s. 51-69
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Tidskriftsartikel (refereegranskat)abstract
- Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996–1997 Survey of Living Conditions, interviews with a representative sample (16–84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.
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| 5. |
- Burström, Kristina, et al.
(författare)
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Swedish population health-related quality of life results using the EQ-5D
- 2001
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Ingår i: Quality of life research. - : Springer Nature B.V. - 1573-2649 .- 0962-9343. ; 10:7, s. 621-635
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Tidskriftsartikel (refereegranskat)abstract
- Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20-88 years), 63% response rate. Mean RS score ranged from 0.90 (20-29 years) to 0.69 (80-88 years), mean EQ-5D index value ranged from 0.89 (20-29 years) to 0.74 (80-88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p < 0.0001). This difference was 0.03 after controlling also for different diseases (p < 0.0001). In conclusion, our results show that the HRQoL varies greatly between socio-economic and disease groups. Furthermore, after controlling for age, sex and disease, HRQoL is lower in manual than in non-manual groups.[PUBLICATION ABSTRACT]
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| 6. |
- Burström, Kristina, et al.
(författare)
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The value of the change in health in Sweden 1980/81 to 1996/97
- 2003
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Ingår i: Health economics. - : Wiley. - 1099-1050 .- 1057-9230. ; 12:8, s. 637-654
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to estimate the value of the change in health in Sweden 1980/81 to 1996/97. Quality-adjusted life years (QALYs) for men and women at specific ages were estimated for 1980/81, 1988/89 and 1996/97, by combining survival rates and health state scores. Data from the Swedish Survey of Living Conditions (n = 39,966) were used to estimate age-specific health state scores. Responses to selected survey questions were mapped into the EQ-5D measure, using the UK EQ-5D index tariff to derive health state scores. The monetary value of a QALY was assumed to be 100,000 dollars. Life expectancy for infants increased by 3.68 years for males and 2.70 years for females between 1980/81 and 1996/97. Average health status decreased in younger age groups whereas it increased in older age groups. Expected QALYs for infants increased by 2.64 for males and 0.54 for females. With 3% discounting the gain was 0.11 QALYs (11,000 dollars) among males and a loss by 0.58 QALYs (58,000 dollars) among females. The corresponding gain in discounted QALYs for a 75-year-old was 1.15 (115,000 dollars) and 0.80 (80,000 dollars), respectively. It is concluded that older persons have experienced considerable health gains whereas the health gains have been small or non-existent for younger women.
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| 7. |
- Claesson, Lisbeth, 1955, et al.
(författare)
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Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients: the Göteborg 70+ Stroke Study.
- 2000
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Ingår i: Stroke; a journal of cerebral circulation. - : Lippincott Williams & Wilkins. - 1524-4628 .- 0039-2499. ; 31:11, s. 2569-77
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The aim of the present study was to examine resource utilization during a 12-month period after acute stroke in elderly patients randomized to care in an acute stroke unit integrated with a care continuum compared with conventional care in general medical wards. A secondary aim was to describe costs related to the severity of stroke. METHODS: Two hundred forty-nine consecutive patients aged >/=70 years with acute stroke within 7 days before admission, living in their own homes in Göteborg, Sweden, without recognized need of care were randomized to 2 groups: 166 patients were assigned to nonintensive stroke unit care with a care continuum, and 83 patients were assigned to conventional care. There was no difference in mortality or the proportion of patients living at home after 1 year. Main outcomes were costs from inpatient care, outpatient care, and informal care. RESULTS: Mean annual cost per patient was 170, 000 Swedish crowns (SEK) (equivalent to $25,373) and 191,000 SEK ($28,507) in the stroke unit and the general medical ward groups, respectively (P:=NS). Seventy percent of the total cost was for inpatient care, and 30% was for outpatient and informal care. For patients with mild, moderate, and severe stroke, the mean annual costs per patient were 107,000 SEK ($15,970), 263,000 SEK ($39, 254), and 220,000 SEK ($32,836), respectively (P:<0.001). There was no statistical difference in age or nonstroke diagnosis. CONCLUSIONS: The total costs the first year did not differ significantly between the treatment groups in this prospective study. The total annual cost per patient showed a very large variation, which was related to stroke severity at onset and not to age or nonstroke diagnoses. Costs other than those for hospital care constituted a substantial fraction of total costs and must be taken into account when organizing the management of stroke patients. The high variability in costs necessitates a larger study to assess long-term cost effectiveness.
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| 8. |
- Clarke, PM, et al.
(författare)
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On the measurement of relative and absolute income-related health inequality
- 2002
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Ingår i: Social Science and Medicine. - : Elsevier Ltd. - 1873-5347 .- 0277-9536. ; 55:11, s. 1923-1928
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Tidskriftsartikel (refereegranskat)abstract
- In recent work on international comparisons of income-related inequalities in health, the concentration index has been used as a measure of health inequality. A drawback of this measure is that it is sensitive to whether it is estimated with respect to health or morbidity. An alternative would be to use the generalized concentration index that is based on absolute rather than relative health differences. In this methodological paper, we explore the importance of the choice of health inequality measure by comparing the income-related inequality in health status and morbidity between Sweden and Australia. This involves estimating a concentration index and a generalized concentration index for the eight-scale health profile of the Short Form 36 (SF-36) health survey. We then transform the scores for each scale into a measure of morbidity and show that whether the concentration index is estimated with respect to health or morbidity has an impact on the results. The ranking between the two countries is reversed for two of the eight dimensions of SF-36 and within both countries the ranking across the eight SF-36 scales is also affected. However, this change in ranking does not occur when the generalized concentration index is compared and we conclude with the implications of these results for reporting comparisons of income-related health inequality in different populations. (C) 2002 Elsevier Science Ltd. All rights reserved.
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| 9. |
- Ehinger, Magnus, et al.
(författare)
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Influence of CD4 or CD8 deficiency on collagen-induced arthritis
- 2001
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Ingår i: Immunology. - : Wiley. - 0019-2805 .- 1365-2567. ; 103:3, s. 291-300
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Tidskriftsartikel (refereegranskat)abstract
- The role of T cells in the mouse collagen-induced arthritis (CIA) model for rheumatoid arthritis is not clarified, and different results have been reported concerning the role of CD4 and CD8 T cells. To address this issue, we have investigated B10.Q mice deficient for CD4 or CD8. The mice lacking CD4 were found to be less susceptible to disease, but not completely resistant, whereas the CD8 deficiency had no significant impact on the disease. No difference in the development of late occurring relapses was noted. Interestingly, the CD4-deficient mice had a severely reduced response to the glycosylated form of the immunodominant type II collagen (CII) 256–270 peptide whereas the response to the non-glycosylated peptide was not significantly different. Furthermore, CD4-deficient mice had lower antibody responses to CII, explaining the lower disease susceptibility. In comparison with previously reported results, it is apparent that the lack of CD4 molecules has a different impact on CIA if present on different genetic backgrounds, findings that could possibly be related to the occurrence of different disease pathways of CIA in different mouse strains.
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| 10. |
- Ellingsen, Tore, et al.
(författare)
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Is There a Hold-up Problem?
- 2004
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Ingår i: The Scandinavian journal of economics. - : Blackwell Publishing Ltd/Inc. - 1467-9442 .- 0347-0520. ; 106:3, s. 475-494
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Tidskriftsartikel (refereegranskat)abstract
- We report on a hold-up experiment in which unilateral investment is followed by bilateral gaining according to Nash's demand game. Without communication, investment is low and coordination is poor. Unilateral communication facilitates coordination, but not perfectly. Successful coordination predominantly entails "fair" outcomes. Perhaps suprisingly, sellers (investors) do at least as well under buyer communication as under seller communication.
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