| 1. |
- Jönsson, Bengt, et al.
(author)
-
Cost-effectiveness of cholesterol lowering. Results from the Scandinavian Simvastatin Survival Study (4S)
- 1996
-
In: European heart journal. - : Oxford University Press. - 1522-9645 .- 0195-668X. ; 17:7, s. 1001-1007
-
Journal article (peer-reviewed)abstract
- An analysis of the cost-effectiveness of simvastatin was conducted, based on the Scandinavian Simvastatin Survival Study (4S). The total cost of hospitalization in the placebo group was 52.8 million Swedish kronor (SEK) (5.15 million pounds), compared with SEK 36.0 million (3.51 million pounds) in the simvastatin group. This amounts to a 32% reduction, or a saving of SEK 16.8 million (1.6 million pounds) or SEK 7560 (738 pounds) per patient. The net cost per patient for the duration of the study (5.4 years) was SEK 13,540 (1324 pounds). Simvastatin treatment saved an estimated 0.377 undiscounted life years (0.240 life years discounted at 5% per annum). The cost of simvastatin therapy per discounted life-year saved was therefore SEK 56,400 (5502 pounds). Sensitivity analysis, examining the effect of different life expectancies, costs of initiation and monitoring of simvastatin therapy, and discount rates, showed the results to be stable. Conclusion. The cost per life-year saved of simvastatin in the treatment of post-myocardial infarction and angina patients, as determined from 4S data, is well within the range normally considered cost-effective.
|
|
| 2. |
- Jönsson, Bengt, et al.
(author)
-
Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease
- 1997
-
In: The New England journal of medicine. - : Massachusetts Medical Society. - 1533-4406 .- 0028-4793. ; 336:5, s. 332-336
-
Journal article (peer-reviewed)abstract
- Background The Scandinavian Simvastatin Survival Study (4S) showed that lowering cholesterol levels with simvastatin reduces mortality and morbidity in patients with angina pectoris or previous acute myocardial infarction. Before the widespread use of cholesterol-lowering drugs in such patients is recommended, its cost effectiveness should be demonstrated. We estimated the cost effectiveness of simvastatin treatment to lower cholesterol levels in relation to the age, sex, and cholesterol level before treatment of patients with coronary heart disease. Methods We estimated the cost per year of life gained with simvastatin therapy. To model the increased life expectancy, hazard functions from 4S were used. The costs studied included those of the intervention and the direct and indirect costs associated with morbidity from coronary causes. We prepared separate estimates for men and women at various ages (from 35 to 70 years) and total cholesterol levels before treatment (213 to 309 mg per deciliter). Results In the analysis limited to direct costs, the cost of each year of life gained ranged from $3,800 for 70-year-old men with 309 mg of cholesterol per deciliter to $27,400 for 35-year-old women with 213 mg of cholesterol per deciliter. When we included indirect costs, the results ranged from a savings in the youngest patients to a cost of $13,300 per year of life gained in 70-year-old women with 213 mg of cholesterol per deciliter. Conclusions In patients with coronary heart disease, simvastatin therapy is cost effective among both men and women at the ages and cholesterol levels studied.
|
|
| 3. |
- Lissner, Lauren, 1956, et al.
(author)
-
Physical activity levels and changes in relation to longevity. A prospective study of Swedish women
- 1996
-
In: American Journal of Epidemiology. ; 143, s. 54-62
-
Journal article (peer-reviewed)abstract
- Department of Primary Health Care, Göteborg University, Sweden. In 1968-1969, a population-based sample of Swedish women aged 38-60 years was recruited for a health survey, and 20-year survival was later ascertained from national registries. Occupational and leisure-time physical activity data from the baseline and 6-year follow-up examinations were evaluated in relation to all-cause mortality among 1,405 women who were initially free of major diseases. In comparison with being inactive, the mortality relative risk associated with being somewhat active was 0.28 (95% confidence interval 0.17-0.46) for occupational activity and 0.56 (95% confidence interval 0.39-0.82) for leisure-time activity. Being in the most active occupational or leisure activity category further decreased mortality risk to a minor extent. A within-subject decrease in leisure activity over 6 years was also a significant risk factor for all-cause mortality (relative risk = 2.07, relative to no change), although there was no evidence of a benefit from increasing physical activity levels. Since exclusion of early endpoints did not affect the associations in any significant way, underlying illness is unlikely to have played a major role in these analyses. It is concluded that decreases in physical activity as well as low initial levels are strong risk factors for mortality in women, and that their predictive value persists for many years. PMID: 8533747 [PubMed - indexed for MEDLINE]
|
|
| 4. |
- Sjöström, CD, et al.
(author)
-
Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study
- 1999
-
In: Obesity Research. ; 7, s. 477-484
-
Journal article (peer-reviewed)abstract
- Department of Anesthesiology and Intensive Care, University of Göteborg, Sweden. OBJECTIVE: To examine the effect of a large, long standing and intentional weight reduction on the incidence of diabetes, hypertension and lipid disturbances in severely obese individuals as compared to weight-stable obese controls. RESEARCH METHODS AND PROCEDURES: The ongoing prospective SOS (Swedish Obese Subjects) intervention consists of a surgically treated group and a matched control group obtaining conventional obesity treatment. This report is based on 845 surgically treated patients and 845 controls (BMI 41.0+/-4.6 kg/m2 (mean+/-standard deviation [S])) followed for 2 years. RESULTS: Surgically treated patients lost 28+/-15 kg and controls 0.5+/-8.9 kg (p<0.0001). Two-year incidence of hypertension, diabetes, hyperinsulinemia, and lipid disturbances was compared in the two treatment groups. Adjusted odds ratios (95% CI) for the surgically treated group versus controls were 0.38 (0.22, 0.65) for hypertension, 0.02 (0.00, 0.16) for diabetes, 0.10 (0.03, 0.28) for hyperinsulinemia, 0. 10 (0.04, 0.25) for hypertriglyceridemia, 0.28 (0.16, 0.49) for low HDL-cholesterol and 1.24 (0.84, 1.8) for hypercholesterolemia. Compared to controls, the 2-year recovery rates from hypertension, diabetes, hypo-HDL, and hypertriglyceridemia were significantly higher in the surgically treated group. DISCUSSION: Intentional weight loss in the obese causes a marked reduction in the 2-year incidence of hypertension, diabetes and some lipid disturbances. The results suggest that severe obesity can and should be treated. PMID: 10509605 [PubMed - indexed for MEDLINE]
|
|
| 5. |
- Welin, Catharina, 1945, et al.
(author)
-
Myocardial infarction in relation to work, family and life events
- 1995
-
In: Cardiovascular Risk Factors. - 1130-7501. ; 5:1, s. 30-38
-
Journal article (peer-reviewed)abstract
- The relationship between psychosocial factors and nonfatal myocardial infarction (MI) was studied by comparing, controlling for traditional risk factors, consecutive male (n=55) patients, who had had a first MI, with a population sample of 283 men and 129 women. All were <65 years of age. The psychosocial factors were investigated by means of a self-administered questionnaire. Men with MI significantly more often did shift work, reported mental strain at work, reported dissatisfaction with their financial situation, and had experienced more negative life events during the last year, compared to controls. Women with MI more often reported mental strain at work and dissatisfaction with their financial situation compared with controls. After controlling for traditional risk factors (smoking, hypertension, serum cholesterol, and diabetes), all factors were still significantly related to MI among men. Among women, only mental strain at work remained significant. However, there were no differences between MI patients and controls in educational level, overtime or extra work, marital status, or other family circumstances. In multivariate analyses including traditional risk factors and all significant psychosocial factors, mental strain at work emerged as an independent risk factor in both sexes, whereas negative life events during the last year was an independent risk factor in men only.
|
|
