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- Berg, Jenny, et al.
(author)
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Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data
- 2023
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In: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 26:5, s. 639-648
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Journal article (peer-reviewed)abstract
- Objectives: There is a lack of consensus around the definition of delivery by cesarean section (CS) on maternal request, and clinical practice varies across and within countries. Previous economic evaluations have focused on specific populations and selected complications. Our aim was to evaluate the cost-effectiveness of CS on maternal request compared with planned vaginal birth in a Swedish context, based on a systematic review of benefits and drawbacks and national registry data on costs.Methods: We used the results from a systematic literature review of somatic risks for long-and short-term complications for mother and child, in which certainty was rated low, moderate, or high using the Grading of Recommendations Assessment, Development and Evaluation. Swedish national registry data were used for healthcare costs of delivery and complications. Utilities for long-term complications were based on a focused literature review. We constructed a decision tree and conducted separate analyses for primi-and multiparous women. Costs and effects were discounted by 3% and the time horizon was varied between 1 and 20 years.Results: Planned vaginal birth leads to lower healthcare costs and somatic health gains compared with elective CS without medical indication over up to 20 years. Although there is uncertainty around, for example, quality-of-life effects, results remain stable across sensitivity analyses.Conclusions: CS on maternal request leads to increased hospitalization costs in a Swedish setting, taking into account short -and long-term consequences for both mother and child. Future research needs to study the psychological consequences related to different delivery methods, costs in outpatient care, and productivity losses.
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- Coaquira, Castro J., et al.
(author)
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INTERNAL, EXTERNAL, AND CROSS-VALIDATION OF THE DEDUCE MODEL, A COST-UTILITY TOOL USING PATIENT-LEVEL MICROSIMULATION TO EVALUATE SENSOR-BASED GLUCOSE MONITORING SYSTEMS IN TYPE 1 AND TYPE 2 DIABETES
- 2022
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In: Value in Health. - : ELSEVIER SCIENCE INC. - 1098-3015 .- 1524-4733. ; 25:12 Suppl., s. S11-S11
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Journal article (other academic/artistic)abstract
- Objectives: For health care decision-makers, the use of computer simulation modelsr equires transparency, precision and accuracy. Systematic comparisons of diabetes models, per Mount Hood Challenges, have shown significant variability in results between models. We developed and validated a new cost-effectiveness model (the DEtermination of Diabetes Utilities, Costs, and Effects [DEDUCE] model) in both type 1 and 2 diabetes mellitus (T1DM, T2DM) to evaluate sensor-based glucose monitoring.Methods: This Excel-based patient-level microsimulation model used a cost-utility approach to compare sensor-based glucose monitoring systems to self-monitoring of blood glucose (SMBG) testing over a specified time horizon (1 to 100 years) with yearly cycles. The model used the Sheffield risk engine for T1DM and the Risk Equations for Complications Of type 2 Diabetes (RECODe) risk engine for T2DM to predict macro- and microvascular events. Inputs, model architecture, and subse-quent validation analyses were reviewed and informed by an advisory board of health economists, endocrinologists and diabetologists.Results: Internal validation (comparing model predictions to observed outcomes from studies from which the risk equations were derived) and external validation (predictions compared to external datasets) demonstrated high precision (R2 $ 0.98) and reasonable accuracy (mean absolute percentage error [MAPE] ranging from 7.64-68%) with regards to macrovascular outcomes for T1DM, and high precision (R2 = 0.94) and high accuracy (MAPE = 19.8%) with regards to all-cause mortality in T2DM. Cross validation (comparing model outcomes between DEDUCE and published results from models participating in previous Mount Hood Challenges) indicated that DEDUCE had the best accuracy (MAPE = 36%) and non-inferior precision (R2 = 0.16) relative to other T1DM models, and second-to-best accuracy (MAPE = 25.03%) and high precision (R2 = 0.95) relative to other T2DM models.Conclusions: In both T1DM & T2DM, DEDUCE suitably predicted key outcomes and performed favorably compared with existing models that participated in the Mount Hood Challenges, including the Core Diabetes Model.
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- Colson, Abigail R., et al.
(author)
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Antimicrobial Resistance : Is Health Technology Assessment Part of the Solution or Part of the Problem?
- 2021
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In: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 24:12, s. 1828-1834
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Journal article (peer-reviewed)abstract
- Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.
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- Holmes, G. R., et al.
(author)
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Cost-Effectiveness Modeling of Surgery Plus Adjuvant Endocrine Therapy Versus Primary Endocrine Therapy Alone in UK Women Aged 70 and Over With Early Breast Cancer
- 2021
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In: Value in Health. - : Elsevier BV. - 1098-3015. ; 24:6, s. 770-779
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Journal article (peer-reviewed)abstract
- Objectives: Approximately 20% of UK women aged 70+ with early breast cancer receive primary endocrine therapy (PET) instead of surgery. PET reduces surgical morbidity but with some survival decrement. To complement and utilize a treatment dependent prognostic model, we investigated the cost-effectiveness of surgery plus adjuvant therapies versus PET for women with varying health and fitness, identifying subgroups for which each treatment is cost-effective. Methods: Survival outcomes from a statistical model, and published data on recurrence, were combined with data from a large, multicenter, prospective cohort study of over 3400 UK women aged 70+ with early breast cancer and median 52-month follow-up, to populate a probabilistic economic model. This model evaluated the cost-effectiveness of surgery plus adjuvant therapies relative to PET for 24 illustrative subgroups: Age {70, 80, 90} × Nodal status {FALSE (F), TRUE (T)} × Comorbidity score {0, 1, 2, 3+}. Results: For a 70-year-old with no lymph node involvement and no comorbidities (70, F, 0), surgery plus adjuvant therapies was cheaper and more effective than PET. For other subgroups, surgery plus adjuvant therapies was more effective but more expensive. Surgery plus adjuvant therapies was not cost-effective for 4 of the 24 subgroups: (90, F, 2), (90, F, 3), (90, T, 2), (90, T, 3). Conclusion: From a UK perspective, surgery plus adjuvant therapies is clinically effective and cost-effective for most women aged 70+ with early breast cancer. Cost-effectiveness reduces with age and comorbidities, and for women over 90 with multiple comorbidities, there is little cost benefit and a negative impact on quality of life. © 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research
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- Huls, Samare P. I., et al.
(author)
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Preference Variation : Where Does Health Risk Attitude Come Into the Equation?
- 2022
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In: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 25:12, s. 2044-2052
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Journal article (peer-reviewed)abstract
- ObjectivesDecisions about health often involve risk, and different decision makers interpret and value risk information differently. Furthermore, an individual’s attitude toward health-specific risks can contribute to variation in health preferences and behavior. This study aimed to determine whether and how health-risk attitude and heterogeneity of health preferences are related.MethodsTo study the association between health-risk attitude and preference heterogeneity, we selected 3 discrete choice experiment case studies in the health domain that included risk attributes and accounted for preference heterogeneity. Health-risk attitude was measured using the 13-item Health-Risk Attitude Scale (HRAS-13). We analyzed 2 types of heterogeneity via panel latent class analyses, namely, how health-risk attitude relates to (1) stochastic class allocation and (2) systematic preference heterogeneity.ResultsOur study did not find evidence that health-risk attitude as measured by the HRAS-13 distinguishes people between classes. Nevertheless, we did find evidence that the HRAS-13 can distinguish people’s preferences for risk attributes within classes. This phenomenon was more pronounced in the patient samples than in the general population sample. Moreover, we found that numeracy and health literacy did distinguish people between classes.ConclusionsModeling health-risk attitude as an individual characteristic underlying preference heterogeneity has the potential to improve model fit and model interpretations. Nevertheless, the results of this study highlight the need for further research into the association between health-risk attitude and preference heterogeneity beyond class membership, a different measure of health-risk attitude, and the communication of risks.
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- Isheden, G., et al.
(author)
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SWEDISH NATIONWIDE REGISTER DATA AS A LOW-COST RESOURCE TO DETECT DRUG-REPURPOSING SIGNALS : A STUDY ON DE NOVO METASTATIC BREAST CANCER PATIENTS
- 2022
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In: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 25:12 Suppl., s. S375-S375
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Journal article (other academic/artistic)abstract
- Objectives: Electronic health records have recently been highlighted as a low-cost resource to accelerate cancer therapeutics by drug repurposing discovery (Wu et al., JCO Clinical Cancer Informatics 2019:3, 1-9). The aim of this study was to test this approach on Swedish nationwide register data focusing on breast cancer cases with distant metastasis at initial diagnosis (de novo mBC). To demonstrate the feasibility of this methodology we i) evaluated the nine drug candidates identified by Wu et al. on our dataset, ii) generated drug repurposing hypotheses based on prescription drugs given to patients during metastatic breast cancer diagnosis/treatment.Methods: Patients diagnosed with de novo mBC between 2010 and 2020 were identified in the Swedish Cancer Register. Data on prescription drug use was collected from the National Prescribed Drug Register and survival data was collected from the National Cause of Death Register. Based on a 6-month window from diagnosis, drug repurposing candidates were evaluated using Cox proportional hazards models.Results: A total of 2,106 de novo mBC patients were included. The nine drug candidates found by Wu et al. (Rosuvastatin, Simvastatin, Amlodipine, Tamsulosin, Metformin, Omeprazole, Warfarin, Lisinoprol and Metroprolol) were not found significant in our data. However, a total of seven other drug repurposing hy-potheses were generated, with a plausible biological rationale for at least five of them (Calcium + Vitamin D, Morphine, Furosemide, Salbutamol and Ipratropium bromide, and Fentanyl). The other two were vaginal gel and Fluoride mouthwash.Conclusions: This study shows that the Swedish National Health Data Registers may be leveraged as a low-cost data source to detect drug repurposing signals. While results need to be interpreted with caution to not confuse causal relationships, the hypotheses generated in our study show a model for discovering noncancer drug effects on overall survival.
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- Kjellander, Christian, et al.
(author)
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Costs of Hospital Care and Productivity Loss Due to Sickle Cell Disease in Sweden: A Retrospective Study
- 2022
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In: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 25:1, s. S248-S248
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Journal article (peer-reviewed)abstract
- Objectives: Sickle cell disease (SCD) is an inherited disorder of hemoglobin, associated with significant morbidity and mortality. Although the disease is most prevalent in Africa, it has been increasingly common in Western countries due to migration. The number of SCD patients in Sweden is unknown and the comprehensive national registries in Sweden provide a unique opportunity to address the objective to assess the burden of SCD.Methods: Using Sweden’s national patient registry, the 1-year prevalence of SCD with crisis (at least one registration of ICD-10 code D57.0 during the identification period, 2001-2018) was estimated during a 13-year follow-up period (2006-2018). Costs for hospital care of SCD (any ICD-10 D57) were estimated through hospital remuneration amounts based on diagnosis-related group. Productivity losses due to sick leave or disability for SCD, from the Swedish Social Insurance Agency, were assessed for working-age patients (18-65 years) and costed with Swedish mean salary, plus social security contributions.Results: The 1-year prevalence of SCD with crisis increased during the follow-up period from 139 patients in year 2006 to 260 in 2018. A total of 2,427 inpatients stays were recorded with SCD (ICD-10 D57) as main reason for stay (observed in 2,632 SCD patient years) over the study period. In addition, 7,213 outpatient visits due to SCD were recorded. These stays and visits were estimated to cost 76.4 million (M) Swedish Krona (SEK) and 31.0 M SEK, respectively. Productivity losses due to sick leaves and disability pension amounted to 14.8 M SEK and 68.3 M SEK, respectively.Conclusions: This study demonstrates that SCD with crisis is associated with economic burden to society, health care and patients in Sweden and increasing prevalence and costs over the years of follow up. In total, for the years 2006-2018, the cost of hospital care and productivity losses for SCD amounted to 190.6 M SEK.
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- Kwon, J. Y., et al.
(author)
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The Use of Generic Patient-Reported Outcome Measures in Emergency Department Surveys: Discriminant Validity Evidence for the Veterans RAND 12-Item Health Survey and the EQ-5D
- 2022
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In: Value in Health. - : Elsevier BV. - 1098-3015. ; 25:12, s. 1939-1946
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Journal article (peer-reviewed)abstract
- Objectives: This study aimed to compare discriminant validity evidence of 2 generic patient-reported outcome measures (PROMs), the Veterans RAND 12-Item Health Survey (VR-12) and level 5 of EQ-5D (EQ-5D-5L), for use in emergency departments (EDs).Methods: Data were obtained via a cross-sectional survey of 5876 patients in British Columbia (Canada) who completed a questionnaire after visiting an ED in 2018. We compared the extent to which the VR-12 and the EQ-5D-5L distinguished among groups of ED patients with different levels of comorbidity burden and self-reported physical and mental or emotional health status. Multivariable logistic regression was used to evaluate the ability of the 2 PROMs to identify patients presenting with a mental health (MH) condition.Results: All the measures produced small effect sizes (ESs) for discriminating comorbidity levels (R2 range: 0.00 [VR-12 mental component summary {MCS}] to 0.10 [VR-12 physical component summary score]). The EQ-5D visual analog scale offered the largest ES for discriminating self-reported physical health (R2 = 0.48), whereas the MCS, the VR-12 MH domain, and the EQ-5D-5L anxiety/depression dimension had the largest ESs for discriminating self-reported mental or emotional health (R2 = 0.42, 0.40, and 0.38, respectively). The MCS produced a medium ES (R2 = 0.42) along with the VR-12 utility score (R2 = 0.27) compared with the EQ-5D-5L index (R2 = 0.19). Having a MH condition was predominantly identified by the MCS (Pratt index = 0.56).Conclusions: The VR-12 PROM provides a more comprehensive measurement of MH than the EQ-5D-5L, which is important to inform healthcare service needs for patients who present in EDs with MH challenges.
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- Le, Ha N. D., et al.
(författare)
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Health-Related Quality of Life in Children With Low Language or Congenital Hearing Loss, as Measured by the PedsQL and Health Utility Index Mark 3
- 2020
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Ingår i: Value in Health. - : Elsevier. - 1098-3015 .- 1524-4733. ; 23:2, s. 164-170
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine health-related quality of life (HRQoL) in young children with low language or congenital hearing loss and to explore the value of assessing HRQoL by concurrently administering 2 HRQoL instruments in populations of children.Methods: Data were from 2 Australian community-based studies: Language for Learning (children with typical and low language at age 4 years, n = 1012) and the Statewide Comparison of Outcomes study (children with hearing loss, n = 108). HRQoL was measured using the parent-reported Health Utilities Index Mark 3 (HUI3) and the Pediatrics Quality of Life Inventory 4.0 (PedsQL) generic core scale. Agreement between the HRQoL instruments was assessed using intraclass correlation and Bland-Altman plots.Results: Children with low language and with hearing loss had lower HRQoL than children with normal language; the worst HRQoL was experienced by children with both. The lower HRQoL was mainly due to impaired school functioning (PedsQL) and speech and cognition (HUI3). Children with hearing loss also had impaired physical and social functioning (PedsQL), vision, hearing, dexterity, and ambulation (HUI3). Correlations between instruments were poor to moderate, with low agreement.Conclusions: Children with low language and congenital hearing loss might benefit from interventions targeting overall health and well-being, not just their impairments. The HUI3 and PedsQL each seemed to provide unique information and thus may supplement each other in assessing HRQoL of young children, including those with low language or congenital hearing loss.
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- Mitchell, Eileen, et al.
(författare)
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The Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: : A Systematic Review of Economic Evaluations
- 2022
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015. ; 25:10, s. 1778-1790
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Forskningsöversikt (refereegranskat)abstract
- Objectives: Acquired brain injury (ABI) has long-lasting effects, and patients and their families require continued care andsupport, often for the rest of their lives. For many individuals living with an ABI disorder, nonpharmacologicalrehabilitation treatment care has become increasingly important care component and relevant for informed healthcaredecision making. Our study aimed to appraise economic evidence on the cost-effectiveness of nonpharmacologicalinterventions for individuals living with an ABI.Methods: This systematic review was registered in PROSPERO (CRD42020187469), and a protocol article was subject to peerreview. Searches were conducted across several databases for articles published from inception to 2021. Study quality wasassessed according the Consolidated Health Economic Evaluation Reporting Standards checklist and Population, Intervention,Control, and Outcomes criteria.Results: Of the 3772 articles reviewed 41 publications met the inclusion criteria. There was a considerable heterogeneityin methodological approaches, target populations, study time frames, and perspectives and comparators used. Keepingthese issues in mind, we find that 4 multidisciplinary interventions studies concluded that fast-track specialized serviceswere cheaper and more cost-effective than usual care, with cost savings ranging from £253 to £6063. In 3neuropsychological studies, findings suggested that meditated therapy was more effective and saved money thanusual care. In 4 early supported discharge studies, interventions were dominant over usual care, with cost savingsranging from £142 to £1760.Conclusions: The cost-effectiveness evidence of different nonpharmacological rehabilitation treatments is scant. More robustevidence is needed to determine the value of these and other interventions across the ABI care pathway.
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