| 1. |
- Blanck, Elin, et al.
(author)
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Self‐efficacy and healthcare costs in patients with chronic heart failure or chronic obstructive pulmonary disease
- 2023
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In: ESC Heart Failure. - 2055-5822.
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Journal article (peer-reviewed)abstract
- Abstract Aims This study aims to explore possible associations between self‐efficacy and healthcare and drug expenditures (i.e. direct costs) in patients with chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) in a study investigating the effects of person‐centred care delivered by telephone. Methods and results This exploratory analysis uses data from an open randomized controlled trial conducted between January 2015 and November 2016, providing remote person‐centred care by phone to patients with CHF, COPD, or both. Patients hospitalized due to worsening of CHF or COPD were eligible for the study. Randomization was based on a computer‐generated list, stratified for age ≥ 75 and diagnosis. At a 6 month follow‐up, 118 persons remained in a control group and 103 in an intervention group. The intervention group received person‐centred care by phone as an addition to usual care. Trial data were linked to register data on healthcare and drug use. Group‐based trajectory modelling was applied to identify trajectories for general self‐efficacy and direct costs. Next, associations between self‐efficacy trajectories and costs were assessed using regression analysis. Five trajectories were identified for general self‐efficacy, of which three indicated different levels of increasing or stable self‐efficacy, while two showed a decrease over time in self‐efficacy. Three trajectories were identified for costs, indicating a gradient from lower to higher accumulated costs. Increasing or stable self‐efficacy was associated with lower direct costs ( P = 0.0013). Conclusions The findings show that an increased or sustained self‐efficacy is associated with lower direct costs in patients with CHF or COPD. Person‐centred phone contacts used as an add‐on to usual care could result in lower direct costs for those with stable or increasing self‐efficacy.
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| 2. |
- Bolin, Kristian, et al.
(author)
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The cost utility of pitolisant as narcolepsy treatment
- 2020
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In: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:4, s. 301-310
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Journal article (peer-reviewed)abstract
- Objectives The cost-effectiveness of available pharmacological treatments for narcolepsy is largely
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| 3. |
- Pirhonen, Laura, et al.
(author)
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Effects of person-centred care on health outcomes—A randomized controlled trial in patients with acute coronary syndrome
- 2017
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 121:2, s. 169-179
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Journal article (peer-reviewed)abstract
- © 2016 Elsevier Ireland LtdObjectives To study the effects of person-centred care provided to patients with acute coronary syndrome, using four different health-related outcome measures. Also, to examine the performance of these outcomes when measuring person-centred care. Data and method The data used in this study consists of primary data from a multicentre randomized parallel group, controlled intervention study for patients with acute coronary syndrome at Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention and control group consisted of 94 and 105 patients, respectively. The effect of the intervention on health-related outcomes was estimated, controlling for socio-economic and disease-related variables. Results Patients in the intervention group reported significantly higher general self-efficacy than those in the control group six months after intervention start-up. Moreover, the intervention group returned to work in a greater extent than controls; their physical activity level had increased more and they had a higher EQ-5D score, meaning higher health-related quality of life. These latter effects are not significant but are all pointing towards the beneficial effects of person-centred care. All the effects were estimated while controlling for important socio-economic and disease-related variables. Conclusion The effectiveness of person-centred care varies between different outcomes considered. A statistically significant beneficial effect was found for one of the four outcome measures (self-efficacy). The other measures all captured beneficial, but not significant, effects.
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| 4. |
- Pirhonen, Laura, et al.
(author)
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Experiences of including costs of added life years in health economic evaluations in Sweden
- 2014
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In: Farmeconomia. Health Economics and Therapeutic Pathways. - : SEEd Medical Publishers. - 1721-6915 .- 2240-256X. ; 15:2, s. 45-53
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Journal article (peer-reviewed)abstract
- It is of importance to include the appropriate costs and outcomes when evaluating a health intervention. Sweden is the only country where the national guidelines of decisions on reimbursement explicitly state that costs of added life years should be accounted for when presenting health economic evaluations. The aim of this article is to, from a theoretical and empirical point of view, critically analyze the Swedish recommendations used by the Dental and Pharmaceutical Benefits Agency (TLV), when it comes to the use of costs of added life years in economic evaluations of health care. The aim is furthermore to analyze the numbers used in Sweden and discuss their impact on the incremental cost‑effectiveness ratios of assessed technologies. If following a societal perspective, based on welfare economics, there is strong support for the inclusion of costs of added life years in health economic evaluations. These costs have a large impact on the results. However this fact may be in conflict with ethical concerns of allocation of health care resources, such as favoring the younger part of the population over the older. It is important that the estimates of production and consumption reflect the true societal values, which is not the case with the values used in Sweden.
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| 5. |
- Pirhonen, Laura
(author)
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Health-economic evaluations of person-centred care
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Person-centred care aims at making the individual partake in the healthcare decisionmaking and at supporting individual health management. This stands in contrast to usual care, which typically has more focus on the particular disease at hand, rather than on the person behind the disease. Interventions in which care is delivered according to the person- centred care approach belong to a larger group of interventions, usually referred to as complex interventions. It is well-known that evaluating such interventions frequently entails methodological challenges. The overall objective of this thesis was to contribute to the field of evaluation of complex interventions, by adding to the emerging, but still rather scarce, knowledge concerning the effects and the cost-effectiveness of personcentred care interventions. An essential part of this endeavor was to examine the effects achieved by person-centred care by applying a range of different outcome measures and methods. The thesis is comprised of four articles, all of which employed data from randomized controlled trials of person-centred care interventions conducted at the University of Gothenburg Centre for Person-Centred Care. In study I the effects of a person-centred care intervention for patients with acute coronary syndrome was estimated. In studies II and III, the cost-effectiveness of person-centred care provided to patients with (i) acute coronary syndrome and (ii) chronic obstructive pulmonary disease and/or chronic heart failure, compared with usual care, was estimated. In study IV, the outcomes observed among patients with acute coronary syndrome receiving person-centred care, or usual care, were projected to a post-trial point in time. A Markov-type health-economic model was constructed and the corresponding long-term cost-effectiveness of person-centred care was calculated. Overall, the results obtained in these studies suggest that personcentred care is both more effective and less costly than usual care, both in the short and in the long-term perspective.
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| 6. |
- Pirhonen, Laura, et al.
(author)
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Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome
- 2020
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In: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7598 .- 1618-7601. ; 21:9, s. 1317-1327
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Journal article (peer-reviewed)abstract
- Background Person-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (<2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown. Objectives To estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (<65) with acute coronary syndrome, using a 2-year and a 5-year time perspective. Methods The mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation. Results Person-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold). Conclusions Person-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.
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| 7. |
- Pirhonen, Laura, et al.
(author)
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Person-Centred Care in Patients with Acute Coronary Syndrome: Cost-Effectiveness Analysis Alongside a Randomised Controlled Trial.
- 2019
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In: PharmacoEconomics - open. - : Springer Science and Business Media LLC. - 2509-4254 .- 2509-4262. ; 3:4, s. 495-504
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Journal article (peer-reviewed)abstract
- Costs associated with an ACS incident are most pronounced in the acute phase but are also considerably long after the initial hospitalisation, partly due to considerable productivity losses, which constitute a substantial part of the economic burden of the disease. Studies suggest that person-centred care may improve health-related quality of life and reduce the costs associated with the disease.The aim of this study was to calculate the cost-effectiveness of a person-centred care intervention compared with usual care in patients with acute coronary syndrome (ACS), in a Swedish setting.Primary data from a randomised controlled trial of a person-centred intervention in patients with ACS was used. The person-centred intervention involved co-creation of a health plan between the patient and healthcare professionals, based on the patient's narrative. Thereafter, goals for the recovery period were set and followed-up continuously throughout the intervention. The clinical data, collected during the randomised controlled trial, was complemented with data from national health registers and the Swedish Social Insurance Agency. The study was conducted at two hospitals situated in a Swedish municipality. Patients were enrolled between June 2011 and February 2014 (192 patients were included in this study; 89 in the intervention group and 103 in the control group). Incremental cost-effectiveness ratios were calculated separately for the age groups<65years and≥65years in order to account for the age of retirement in Sweden. The cost-effectiveness ratios were calculated using health-related quality of life (EQ-5D) and costs associated with healthcare and pharmaceutical utilisation, and productivity losses.Treatment effects and costs differed between those below and those above the age of 65years. The base-case calculations showed that person-centred care was more effective and less costly compared with usual care for patients under 65years of age, while usual care was more effective and less costly in the older age group. Probabilistic sensitivity analyses resulted in a 90% likelihood that person-centred care is cost-effective compared with usual care for patients with ACS under the age of 65years.Person-centred care was found to be cost-effective compared with usual care for patients with acute coronary syndrome under the age of 65years. This clinical trial is registered at Researchweb (ID 65791).
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| 8. |
- Pirhonen, Laura, et al.
(author)
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The cost-effectiveness of person-centred care provided to patients with chronic heart failure and/or chronic obstructive pulmonary disease
- 2020
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In: Health Policy OPEN. - : Elsevier BV. - 2590-2296. ; 1
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Journal article (peer-reviewed)abstract
- Background Efforts have been made to implement a more person-centred healthcare approach in several countries. The cost-effectiveness of person-centred care is to a large extent unknown, even though it has been demonstrated to decrease total healthcare costs and to be cost-effective in some settings and conditions. The objective of this study is to estimate costs, effects and the overall cost-effectiveness, of person-centred care compared to usual care, for patients with chronic heart failure and/or chronic obstructive pulmonary disease. Methods A randomized controlled trial including patients with chronic heart failure and/or chronic obstructive pulmonary disease was conducted at Sahlgrenska University Hospital in Gothenburg, Sweden. Person-centred care was given as an add-on to usual care for 103 patients, while a control group of 118 patients received usual care. The cost-effectiveness analysis was performed from a healthcare perspective, comparing health-related quality of life to healthcare costs, over a 6-month time horizon. Results Person-centred care was found to be more effective, i.e. improve health-related quality of life, and to result in lower healthcare costs compared to usual care. Probabilistic sensitivity analysis showed that the likelihood of person-centred care being cost effective compared to usual care is 93%, for a SEK 500,000 willingness-to-pay threshold per quality adjusted life year. Conclusion Person-centred care dominated usual care for patients with chronic heart failure and/or chronic obstructive pulmonary disease from a healthcare perspective.
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