| 1. |
- Nystrand, Camilla, et al.
(författare)
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Indicated Parenting Interventions and Long Term Outcomes : A Health Economic Modeling Study
- 2018
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 21, s. S76-S76
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Konferensbidrag (refereegranskat)abstract
- Economic evaluations of early interventions for children are augmenting in numbers and a larger focus is put on the longer-term economic returns. However, little is known about the labour market returns from preventive parenting programs. This study estimates the benefits and costs of five parenting interventions: Comet, Connect, the Incredible Years (IY), Cope and bibliotherapy, compared to a waitlist control, for the prevention of persistent externalizing behavior problems in children.
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| 6. |
- Berg, Jenny, et al.
(författare)
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Determinants of Utility Based on the EuroQol Five-Dimensional Questionnaire in Patients with Chronic Heart Failure and Their Change Over Time: Results from the Swedish Heart Failure Registry
- 2015
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Ingår i: Value in Health. - : Wiley: No OnlineOpen / Elsevier. - 1098-3015 .- 1524-4733. ; 18:4, s. 439-448
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is limited information on drivers of utilities in patients with chronic heart failure (CHF). Objectives: To analyze determinants of utility in CHF and drivers of change over 1 year in a large sample from clinical practice. Methods: We included 5334 patients from the Swedish Heart Failure Registry with EuroQol five-dimensional questionnaire information available following inpatient or outpatient care during 2008 to 2010; 3495 had 1-year follow-up data Utilities based on Swedish and UK value sets were derived. We applied ordinary least squares (OLS) and two-part models for utility at inclusion and OLS regression for change over 1 year, all with robust standard errors. We assessed the predictive accuracy of both models using cross-validation. Results: Patients mean age was 73 years, 65% were men, 19% had a left ventricular ejection fraction of 50% or more, 23% had 40% to 49%, 27% had 30% to 39%, and 31% had less than 30%. For both models and value sets, utility at inclusion was affected by sex, age, New York Heart Association class, ejection fraction, hemoglobin, blood pressure, lung disease, diabetes, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, nitrates, antiplatelets, and diuretics. The OLS model performed slightly better than did the two-part model on a population level and for capturing utility ranges. Change in utility over 1 year was influenced by age, sex, and (measured at inclusion) disease duration, New York Heart Association class, blood pressure, ischemic heart disease, lung disease, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and antiplatelets. Conclusions: Utilities in CHF and their change over time are influenced by diverse demographic and clinical factors. Our findings can be used to target clinical interventions and for economic evaluations of new therapies.
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| 7. |
- Bergthorsdottir, R, et al.
(författare)
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Health-Related Quality of Life In Patients With Adrenal Insufficiency Receiving Plenadren Compared With Immediate-Release Hydrocortisone
- 2015
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 18:7
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious studies in patients with primary adrenal insufficiency (PAI) on conventional replacement therapy suggest decreased health-related quality of life (HRQoL), and that patients report more frequently fatigue, increased anxiety and inability to work compared to background population.ObjectivesTo study self-reported health status with EQ-5D in patients with PAI. Patients treated with Plenadren (modified-release hydrocortisone) were compared with patients treated with immediate release hydrocortisone (IRHC) replacement therapy.MethodsThis was a cross-sectional, multi-centre, non-interventional survey of patients with PAI receiving Plenadren or immediate release hydrocortisone (IRHC) replacement.SubjectsOne hundred thirty-four adult patients with PAI of whom 36 (19 females [53%]) were treated with Plenadren and 98 (77 females [79%]) were treated with IRHC, were included.MAIN OUTCOME MEASUREHRQoL described by the EQ-5D, a generic preference-based measure of health.RESULTSPatients on Plenadren and on IRHC had a mean ± SD age of 53.1 ± 12.7 years and 48.0 ± 13.1 years, respectively (P=0.043). The majority of the patients were diagnosed more than 5 years ago (69%). The mean ± SD daily Plenadren and IRHC doses were 27.0 ± 6.8 mg and 26.6 ± 10.9 mg, respectively (P=0.807). 47% of the Plenadren patients had been receiving Plenadren and 82% of the IRHC patients had been receiving IRHC for more than 3 years. Patients receiving Plenadren had better HRQoL measured by the EQ-5D questionnaire compared to patients replaced with IRHC (0.76 ± 0.18 vs 0.68 ± 0.18, respectively [P=0.040]).CONCLUSIONSReplacement therapy with Plenadren in patients with PAI confers measurable benefit on HRQoL relative to IRHC as estimated by the EQ-5D questionnaire, and may therefore be advantageous when compared to IRHC substitution.
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| 12. |
- Caccamisi, Andrea, et al.
(författare)
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PRM92 - Automatic Extraction and Classification of Patients’ Smoking Status from Free Text Using Natural Language Processing
- 2016
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 19:7
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo develop a machine learning algorithm for automatic classification of smoking status (smoker, ex-smoker, non-smoker and unknown status) in EMRs, and validate the predictive accuracy compared to a rule-based method. Smoking is a leading cause of death worldwide and may introduce confounding in research based on real world data (RWD). Information on smoking is often documented in free text fields in Electronic Medical Records (EMRs), but structured RWD on smoking is sparse.Methods32 predictive models were trained with the Weka machine learning suite, tweaking sentence frequency, classifier type, tokenization and attribute selection using a database of 85,000 classified sentences. The models were evaluated using F-Score and Accuracy based on out-of-sample test data including 8,500 sentences. The error weight matrix was used to select the best model, assigning a weight to each type of misclassification and applying it to the models confusion matrices.ResultsThe best performing model was based on the Support Vector Machine (SVM) Sequential Minimal Optimization (SMO) classifier using a polynomial kernel with parameter C equal to 6 and a combination of unigrams and bigrams as tokens. Sentence frequency and attributes selection did not improve model performance. SMO achieved 98.25% accuracy and 0.982 F-Score versus 79.32% and 0.756, respectively, for the rule-based model.ConclusionsA model using machine learning algorithms to automatically classify patients smoking status was successfully developed. This algorithm would enable automatic assessment of smoking status directly from EMRs, obviating the need to extract complete case notes and manual classification.
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| 13. |
- Chen, Gang, et al.
(författare)
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Assessing the Health-Related Quality of Life of Australian Adolescents : An Empirical Comparison of the Child Health Utility 9D and EQ-5D-Y Instruments
- 2015
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 18:4, s. 432-438
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine the performance of two recently developed preference-based instruments-the Child Health Utility 9D (CHU9D) and the EuroQol five-dimensional questionnaire Youth version (EQ-5D-Y)-in assessing the health related quality of life (HRQOL) of Australian adolescents. Methods: An online survey including the CHU9D and the EQ-5D-Y, self-reported health status, and a series of sociodemographic questions was developed for administration to a community-based sample of adolescents (aged 11-17 years). Individual responses to both instruments were translated into utilities using scoring algorithms derived from the Australian adult general population. Results: A total of 2020 adolescents completed the online survey. The mean +/- SD utilities of the CHU9D and the EQ-5D-Y were very similar (0.82 +/- 0.13 and 0.83 +/- 0.19, respectively), and the intraclass correlation coefficient (0.80) suggested good levels of agreement. Both instruments were able to discriminate according to varying levels of self-reported health status (P < 0.001). Although exhibiting good levels of agreement overall, some wide divergences were apparent at an individual level. Conclusions: The study results are encouraging and illustrate the potential for both the CHU9D and the EQ-5D-Y to be more widely used for measuring and valuing the HRQOL of adolescent populations in Australia and internationally. Generating adolescent-specific scoring algorithms pertaining to each instrument and an empirical comparison of the resulting utilities is a natural next step. More evidence is required from the application of the CHU9D and the EQ-5D-Y in specific patient groups in adolescent health settings to inform the choice of instrument for measuring and valuing the HRQOL for the economic evaluation of adolescent health care treatments and services.
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| 16. |
- Coyne, Karin S, et al.
(författare)
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Development and Validation of the AFImpact: An Atrial Fibrillation-Specific Measure of Patient-Reported Health-Related Quality of Life.
- 2017
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Ingår i: Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. - : Elsevier BV. - 1524-4733. ; 20:10, s. 1355-1361
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Tidskriftsartikel (refereegranskat)abstract
- Improvement in health-related quality of life is a key therapeutic goal of disease management in atrial fibrillation (AF).To describe the development of the AFImpact, an AF-specific health-related quality-of-life patient-reported outcome measure.Development and validation of the AFImpact comprised a qualitative stage, consisting of a literature review and concept elicitation interviews (91 patients with AF), item generation, and cognitive debriefing (30 patients with AF), and a quantitative stage, consisting of evaluation of the instrument's psychometric properties (313 patients with AF). Preliminary responsiveness to change was assessed in 118 patients undergoing cardioversion.On the basis of the literature review and concept elicitation interviews, 75 items were generated. Factor analyses guided a reduction to 18 items. Three domains were confirmed: vitality (7 items), emotional distress (8 items), and sleep (3 items). The 18-item AFImpact demonstrated high item convergent and discriminant validity. Cronbach α coefficients showed high internal consistency reliability. Test-retest reliability of individual items in stable patients (n = 33) was satisfactory, with intraclass correlation coefficients ranging from 0.61 to 0.86. All three AFImpact domain scores differentiated patients who reported different levels of overall health, thereby supporting known-groups validity. Scores for each item improved after cardioversion, with effect sizes ranging from -0.19 to -0.65.Psychometric evaluations support the reliability and validity of the AFImpact as a patient-reported outcome instrument to measure the impact of AF, with preliminary results in patients undergoing cardioversion supporting responsiveness to change.
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| 20. |
- Denoncourt, R. N., et al.
(författare)
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Burden of Illness for Patients with Hereditary Attr Amyloidosis with Polyneuropathy Begins with Symptom Onset and Increases with Disease Progression
- 2016
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 19:7, s. A436-A436
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Hereditary ATTR amyloidosis with polyneuropathy (hATTR-PN), also known as familial amyloidotic polyneuropathy (FAP), is an inherited, progressive disease leading to death within 5-15 years. hATTR-PN is due to a mutation in the transthyretin (TTR) gene. Patisiran is an investigational, RNA interference (RNAi) therapeutic targeting TTR. This abstract aims to further characterize hATTR-PN burden of illness.Methods: The ongoing, patisiran Phase 3 APOLLO trial was utilized to collect patient-reported EQ-5D, Norfolk-DN, Rasch-built Overall Disability Scale (R-ODS), and healthcare resource utilization from hATTR-PN patients with symptomatic disease.Results: APOLLO included 225 patients; median age of 62 years (range: 24-82), median neurological impairment score (NIS) of 6-141.6 and representative of the global patient population (19 countries) with a broad range of mutations and disease severities. At baseline, 57 patients had a Polyneuropathy Disability (PND) Score I and 168 patients had a PND Score ≥ II. By FAP Stage, 104 were FAP Stage 1 and 121 were FAP Stage 2. 41 patients (PND Score ≥ II) reported ≥1 hospitalization of ≥3 nights in duration due to hATTR-PN in the 12 months prior to enrollment. Mean EQ-5D scores were 0.76 (PND Score I) and 0.59 (PND Score ≥ II). Patients reported perceived health status on the EQ-VAS with mean scores of 66.9 (PND Score I) and 51.3 (PND Score ≥ II). Mean Norfolk-QoL-DN scores were 35.5 (PND Score I) and 66.0 (PND Score ≥ II). 145 patients (131 PND Score ≥ II) reported they cannot work because of hATTR-PN. Mean R-ODS scores were 40.9 and 25.9 for PND Score I and PND Score ≥ II, respectively.Conclusions: These data, from the largest controlled study of patients with hATTR-PN to date, further demonstrate that patients experience considerable burden of illness early in the course of disease and this burden increases with disease progression.
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| 28. |
- Fawsitt, C. G., et al.
(författare)
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Choice of Prosthetic Implant Combinations in Total Hip Replacement: Cost-Effectiveness Analysis Using UK and Swedish Hip Joint Registries Data
- 2019
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015. ; 22:3, s. 303-312
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prosthetic implants used in total hip replacements (THR) have a range of bearing surface combinations (metal-onpolyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, and metal-on-metal), head sizes (small [<36 mm in diameter] and large [>= 36 mm in diameter]), and fixation techniques (cemented, uncemented, hybrid, and reverse hybrid). These can influence prosthesis survival, patients' quality of life, and healthcare costs. Objectives: To compare the lifetime cost-effectiveness of implants for patients of different age and sex profiles. Methods: We developed a Markov model to compare the cost-effectiveness of various implants against small-head cemented metal-on-polyethylene implants. The probability that patients required 1 or more revision surgeries was estimated from analyses of more than 1 million patients in the UK and Swedish hip joint registries, for men and women younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years and older. Implant and healthcare costs were estimated from local procurement prices, national tariffs, and the literature. Quality-adjusted life-years were calculated using published utility estimates for patients undergoing THR in the United Kingdom. Results: Small-head cemented metal-on-polyethylene implants were the most cost-effective for men and women older than 65 years. These findings were robust to sensitivity analyses. Small-head cemented ceramic-on-polyethylene implants were most cost-effective in men and women younger than 65 years, but these results were more uncertain. Conclusions: The older the patient group, the more likely that the cheapest implants, small-head cemented metal-on-polyethylene implants, were cost-effective. We found no evidence that uncemented, hybrid, or reverse hybrid implants were the most cost-effective option for any patient group. Our findings can influence clinical practice and procurement decisions for healthcare payers worldwide.
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| 34. |
- Geale, Kirk, et al.
(författare)
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Estimating the Value of A New Antibiotic : A Novel Approach Using Esbl As A Case Study
- 2016
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 19:7, s. A422-A423
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Develop a model capable of estimating the value of a new antibiotic for use in treating last-line patients not eligible for, or having failed on, all currently available antibiotic treatments.Methods: Ten annual cohorts of incident last-line patients (total of 314) infected with extended spectrum beta-lactamase (ESBL) -producing bacteria were modelled from the onset of the last-line infection over the course of their remaining life, in a scenario where a new antibiotic was available and one where it was not. Efficacy was measured by mortality, where 5% (95%) of patients died due to the infection in the scenario with(out) a new antibiotic. In the scenario with a new antibiotic, the mortality rate increased by 0.5% annually. Costs including lab tests, hospital stays, and productivity loss were calculated in both scenarios. Quality-adjusted life-years gained (QALYs) were estimated using weights for patients with an infection (0.61) and after recovery (0.84), in addition to disutility incurred by one caregiver per patient (-0.14). Differences in costs, QALYs, deaths, and days off work were calculated between the two arms; costs and QALYs were discounted to the present year. The value of a new antibiotic is reflected in the incremental results.Results: In the last-line ESBL population of 314 patients over 10 years, the availability of a new antibiotic resulted in SEK 20.4 million in cost saving, 2795 QALYs gained, 273 fewer infection-caused deaths, and 2198 fewer days off work.Conclusions: Valuation of a new antibiotic is a high public health priority due to increasing antibiotic resistance and decreasing rates of development of new antibiotics. Access to a new antibiotic for last-line patients provides a large benefit to society, using ESBL as case-study. The results are conservative as they exclude factors that are relatively difficult to estimate such as the risk of an outbreak.
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| 39. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Comparing Methods for Estimating Direct Costs of Adverse Drug Events
- 2017
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 20:10, s. 1299-1310
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate how direct health care costs resulting from adverse drug events (ADEs) and cost distribution are affected by methodological decisions regarding identification of ADEs, assigning relevant resource use to ADEs, and estimating costs for the assigned resources. Methods: ADEs were identified from medical records and diagnostic codes for a random sample of 4970 Swedish adults during a 3-month study period in 2008 and were assessed for causality. Results were compared for five cost evaluation methods, including different methods for identifying ADEs, assigning resource use to ADEs, and for estimating costs for the assigned resources (resource use method, proportion of registered cost method, unit cost method, diagnostic code method, and main diagnosis method). Different levels of causality for ADEs and ADEs contribution to health care resource use were considered. Results: Using the five methods, the maximum estimated overall direct health care costs resulting from ADEs ranged from Sk10,000 (Sk = Swedish krona; similar to(sic)1,500 in 2016 values) using the diagnostic code method to more than Sk3,000,000 (similar to(sic)414,000) using the unit cost method in our study population. The most conservative definitions for ADEs contribution to health care resource use and the causality of ADEs resulted in average costs per patient ranging from Sk0 using the diagnostic code method to Sk4066 (similar to(sic)500) using the unit cost method. Conclusions: The estimated costs resulting from ADEs varied considerably depending on the methodological choices. The results indicate that costs for ADEs need to be identified through medical record review and by using detailed unit cost data. Copyright (C) 2017, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
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| 44. |
- Hoogendoorn, Martine, et al.
(författare)
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Patient Heterogeneity in Health Economic Decision Models for Chronic Obstructive Pulmonary Disease : Are Current Models Suitable to Evaluate Personalized Medicine?
- 2016
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 19:6, s. 800-810
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To assess how suitable current chronic obstructive pulmonary disease (COPD) cost-effectiveness models are to evaluate personalized treatment options for COPD by exploring the type of heterogeneity included in current models and by validating outcomes for subgroups of patients.METHODS: A consortium of COPD modeling groups completed three tasks. First, they reported all patient characteristics included in the model and provided the level of detail in which the input parameters were specified. Second, groups simulated disease progression, mortality, quality-adjusted life-years (QALYs), and costs for hypothetical subgroups of patients that differed in terms of sex, age, smoking status, and lung function (forced expiratory volume in 1 second [FEV1] % predicted). Finally, model outcomes for exacerbations and mortality for subgroups of patients were validated against published subgroup results of two large COPD trials.RESULTS: Nine COPD modeling groups participated. Most models included sex (seven), age (nine), smoking status (six), and FEV1% predicted (nine), mainly to specify disease progression and mortality. Trial results showed higher exacerbation rates for women (found in one model), higher mortality rates for men (two models), lower mortality for younger patients (four models), and higher exacerbation and mortality rates in patients with severe COPD (four models).CONCLUSIONS: Most currently available COPD cost-effectiveness models are able to evaluate the cost-effectiveness of personalized treatment on the basis of sex, age, smoking, and FEV1% predicted. Treatment in COPD is, however, more likely to be personalized on the basis of clinical parameters. Two models include several clinical patient characteristics and are therefore most suitable to evaluate personalized treatment, although some important clinical parameters are still missing.
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| 47. |
- Jansson, Sven-Arne, et al.
(författare)
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Health care consumption and HRQOL in severe asthma in Sweden
- 2017
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Ingår i: Value in Health. - : ELSEVIER SCIENCE INC. - 1098-3015 .- 1524-4733. ; 20:9, s. A513-A513
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Severe asthma is a disabling and costly disease, often poorly controlled despite high-dosage controller medications. The objectives of this analysis were to estimate health care consumption and to investigate health-related quality of life (HRQOL) in a severe asthma cohort, derived from a large-scale population survey in northern Sweden. Methods: Severe asthma was defined by US SARP criteria; high-dosage inhaled corticosteroids (ICS) by GINA 2014 criteria. In total, 32 patients with severe asthma were invited to a clinical examination and structured interview. Retrospective data of all asthma-related direct and indirect resource consumption during the last year were collected following a defined protocol. HRQOL was assessed by four patient-reported outcome measures: two general measures (SF-36; EQ-5D) and two disease-specific measures (SGRQ; ACT). The cohort was divided into two groups —patients with (OCS) or without maintenance oral corticosteroid (non-OCS) treatment. Results: Health care resource utilization was greater in the OCS-group compared with the non-OCS group. Mean annual number of visits to specialist care was 2.0 in the OCS group vs. 0.5 visits in the non-OCS group. Four patients in the OCS group had early retirement vs. none in the non-OCS group. HRQOL was worse in the OCS group, both when measured with general and disease-specific instruments. The Mental and Physical Component Summary scores of the SF-36 in the OCS vs. non-OCS group were 50.1 vs. 40.7 and 55.8 vs. 44.4, respectively. Similarly, the total SGRQ scores indicated worse HRQOL for the OCS-group compared with the non-OCS group (37.0 vs. 27.0). Conclusions: In this severe asthma population, patients treated with maintenance OCS consumed more health care resources, were more frequently early retired, and had worse HRQOL compared with those not receiving maintenance OCS. The results indicate a need for improved treatment for patients with severe asthma on maintenance OCS. Sponsor: AstraZeneca.
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| 50. |
- Jendle, Johan, 1963-, et al.
(författare)
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Switching to insulin degludec is a cost-saving therapy for patients with type 1 and type 2 diabetes in the Swedish setting based on real world data
- 2019
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 22:Suppl. 3, s. 575-576
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The Europe-based, prospective, observational ReFLeCT study recently showed that switching to the ultralong-acting basal insulin analogue degludec (IDeg) was associated with improved glycemic control and reductions in hypoglycemic events versus previous basal insulin therapies in patients with type 1 (T1D) or type 2 diabetes (T2D). The present analysis aimed to assess the impact of thesefindings on long-term cost-effectiveness outcomes in the Swedish setting.Methods: Cost-effectiveness was evaluated separately in patients with T1D and T2D over a 50-year time horizon using the IQVIA CORE Diabetes Model (version 9.0). Patients were assumed to receive IDeg or continue previous insulin therapy (with or without bolus insulin) for 5 years, before all patients intensified to insulin degludec plus bolus insulin for the remainder of their lifetimes. Baseline cohort characteristics were sourced from ReFLeCT where possible. Treatment effects on initiation of IDeg were based on data from ReFLeCT. Costs were estimated from a Swedish societal perspective and expressed in 2018 Swedish krona (SEK).Results: IDeg was associated with improvements in quality-adjusted life expectancy of 0.14 and 0.07 quality-adjusted life years versus continuation of previous insulin therapy in patients with T1D and T2D, respectively, resulting from improved glycemic control and fewer hypoglycemic events. Combined direct and indirect costs were estimated to be SEK 137,020 and SEK 2,009 lower for insulin degludec versus previous insulin therapy in patients with T1D and T2D, respectively, with higher treatment costs offset by cos tsavings from avoidance of diabetes-related complications. IDeg was therefore considered dominant versus continuation of previous insulin therapies for the treatment of both T1D and T2D.Conclusions: Based on real-world evidence, IDeg represents an effective and cost-saving treatment option versus other basal insulin therapies for patients with T1D and T2D in Sweden.
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