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| 3. |
- Forsberg, Anna, et al.
(författare)
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Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial
- 2022
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Ingår i: The Lancet Gastroenterology & Hepatology. - : ELSEVIER INC. - 2468-1253. ; 7:6, s. 513-521
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Tidskriftsartikel (refereegranskat)abstract
- Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
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| 4. |
- Grip, Lars, 1952, et al.
(författare)
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From European to National guidelines on heart disease
- 2011
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 45:1, s. 3-13
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Forskningsöversikt (refereegranskat)abstract
- Background/aims. Guidelines from the European Society of Cardiology are important tools for defining and establishing current standards of care for various heart diseases. The aim of the present paper is to describe the process of how these international guidelines may be transformed and implemented at a national level in Sweden. Methods/results. The structure and process behind the national guidelines for heart diseases in Sweden and their relationship to the underlying European guidelines are described and differences between the national and European levels highlighted. We also give examples of how the scientific values of health care measures are weighted against health economic perspectives and integrated in a prioritization process. Compared to the European guidelines, the Swedish national guidelines have a broader economic perspective and aim to ensure that health care is cost effective and provided to all Swedish citizens on equal terms. Discussion. When certain health care measures are implemented, the national process can result in other priorities than could be expected from the European guidelines alone. On the other hand, a forceful implementation may be facilitated by the societal context in which these national guidelines are produced.
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| 5. |
- Levin, Lars-Åke, et al.
(författare)
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Health-Related Quality of Life of Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes-Results from the PLATO Trial
- 2013
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Ingår i: Value in Health. - : Wiley-Blackwell: No OnlineOpen / Elsevier. - 1098-3015 .- 1524-4733. ; 16:4, s. 574-580
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to compare the effects of ticagrelor versus clopidogrel on health-related quality of life in the PLATelet inhibition and patient Outcomes (PLATO) trial. Background: The PLATO trial showed that ticagrelor was superior to clopidogrel for the prevention of cardiovascular death, myocardial infarction, or stroke in a broad population of patients with acute coronary syndromes. Methods: HRQOL in the PLATO study was measured at hospital discharge, 6-month visit, and end of treatment (anticipated at 12 months) by using the EuroQol five-dimensional (EQ-5D) questionnaire. All patients who had an EQ-5D questionnaire assessment at discharge from the index hospitalization (n = 15,212) were included in the study. Patients who died prior to the end-of-treatment visit were assigned an EQ-5D questionnaire value of 0. Results: The EQ-5D questionnaire value at discharge among 7631 patients assigned to ticagrelor was 0.847 and among 7581 patients assigned to clopidogrel was 0.846 (P = 0.71). At 12 months, the mean EQ-5D questionnaire value was 0.840 for ticagrelor and 0.832 for clopidogrel (P = 0.046). Excluding patients who died resulted in mean EQ-5D questionnaire values of 0.864 among ticagrelor patients and 0.863 among clopidogrel patients (P = 0.69). Conclusions: In patients hospitalized with acute coronary syndromes with or without ST-segment elevation, treatment with ticagrelor was associated with a lower mortality but otherwise no difference in quality of life relative to treatment with clopidogrel. The improved survival and reduction in cardiovascular events with ticagrelor are therefore obtained with no loss in quality of life.
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| 6. |
- Philipson, Anna, 1978-
(författare)
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Health economic aspects of emotional problems and pain symptoms in childhood and adolescence : Long-term outcomes, efficacy and cost-effectiveness of interventions
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Emotional problems and pain symptoms among children and adolescents are a global public health challenge that imposes a great burden on the individuals affected and on society. Because resources are limited, allocation and prioritization are needed. Health economic analysis can constitute a foundation for such decisions.The overall aim of this thesis is to estimate long-term outcomes associated with adolescent depression and to evaluate interventions for emotional problems and pain symptoms in childhood and adolescence from a health economic perspective. The thesis is based on four papers: paper I is a longitudinal cohort study of 539 participants, showing that adolescent depression is associated with reduced earnings in adulthood, papers II, III, and IV are based on two randomized controlled trials of interventions. In paper II, a dance intervention for 112 adolescent females with internalizing symptoms were evaluated. A cost–utility analysis was performed, indicating that the intervention was costeffective given a willingness-to-pay threshold of USD 50,000 with an incremental cost-effectiveness ratio of USD 3830/quality-adjusted life year. Papers III and IV evaluated a dance and yoga intervention for 121 girls, 9–13 years old, with functional abdominal pain disorders. Paper III showed that the intervention group decreased their abdominal pain more than did the control group. In paper IV, the cost–utility analysis of the trial indicated a negative incremental cost-effectiveness ratio, investigated from a societal perspective, over both one and ten years.In conclusion, this thesis identifies a need for preventive as well as treatment interventions for emotional problems in adolescence, to decrease the prevalence of emotional problems and mitigate negative outcomes. Dance or dance and yoga combined can be effective and cost-effective early treatment interventions for emotional problems and pain symptoms among females in childhood and adolescence. These findings may assist decision-makers in resource allocation within this area
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| 7. |
- Wallentin, Lars, 1943-, et al.
(författare)
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Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II) : 15 year follow-up of a prospective, randomised, multicentre study
- 2016
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Ingår i: The Lancet. - : ELSEVIER SCIENCE INC. - 0140-6736 .- 1474-547X. ; 388:10054, s. 1903-1911
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Tidskriftsartikel (refereegranskat)abstract
- Background The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up. Methods The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. Findings At a minimum of 15 years' follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p= 0.0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; p(interaction) = 0.0182), patients with elevated troponin T (778 days, 357-1165; p (interaction) = 0.0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; p (interaction) = 0.0210). The difference was mainly driven by postponement of new myocardial infarction, whereas the early difference in mortality alone was not sustained over time. The invasive strategy led to a mean of 1128 days (95% CI 830-1366) postponement of death or next readmission to hospital for ischaemic heart disease, which was consistent in all subgroups (p< 0.0001). Interpretation During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.
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| 10. |
- Aasa, Mikael, et al.
(författare)
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Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.
- 2010
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Ingår i: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 160:2, s. 322-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS: Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS: Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION: In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
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| 11. |
- Aronsson, Mattias, 1989-
(författare)
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Health Economic Evaluations of Screening Programs - Applications and Method Improvements
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening.The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making.This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations.As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design.In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.
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| 12. |
- Berglund, Eva Caroline, et al.
(författare)
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A Study Protocol for Validation and Implementation of Whole-Genome and -Transcriptome Sequencing as a Comprehensive Precision Diagnostic Test in Acute Leukemias
- 2022
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Ingår i: Frontiers in Medicine. - Lausanne, Switzerland : Frontiers Media SA. - 2296-858X. ; 9, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whole-genome sequencing (WGS) and whole-transcriptome sequencing (WTS), with the ability to provide comprehensive genomic information, have become the focal point of research interest as novel techniques that can support precision diagnostics in routine clinical care of patients with various cancer types, including hematological malignancies. This national multi-center study, led by Genomic Medicine Sweden, aims to evaluate whether combined application of WGS and WTS (WGTS) is technically feasible and can be implemented as an efficient diagnostic tool in patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). In addition to clinical impact assessment, a health-economic evaluation of such strategy will be performed. Methods and Analysis: The study comprises four phases (i.e., retrospective, prospective, real-time validation, and follow-up) including approximately 700 adult and pediatric Swedish AML and ALL patients. Results of WGS for tumor (90×) and normal/germline (30×) samples as well as WTS for tumors only will be compared to current standard of care diagnostics. Primary study endpoints are diagnostic efficiency and improved diagnostic yield. Secondary endpoints are technical and clinical feasibility for routine implementation, clinical utility, and health-economic impact. Discussion: Data from this national multi-center study will be used to evaluate clinical performance of the integrated WGTS diagnostic workflow compared with standard of care. The study will also elucidate clinical and health-economic impacts of a combined WGTS strategy when implemented in routine clinical care. Clinical Trial Registration: [https://doi.org/10.1186/ISRCTN66987142], identifier [ISRCTN66987142].
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| 13. |
- Bernfort, Lars, et al.
(författare)
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Bakgrund till QALY som effektmått
- 2012
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Ingår i: QALY som effektmått inom vården. - Linköping : Linköping University Electronic Press. ; , s. 3-14
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 14. |
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| 15. |
- Bernfort, Lars, et al.
(författare)
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Chronic pain in an elderly population in Sweden : Impact on costs and quality of life
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain among elderly people has long been a well-known problem, in terms of both societal costs and the quality of life of affected individuals. To estimate the magnitude of the problems associated with chronic pain in an elderly population, data on both costs and quality of life were gathered. A postal questionnaire was sent out to a stratified sample of 10 000 inhabitants 65 years and older in Linköping and Norrköping. The survey included questions on demographics, habits, and life situation, and different kinds of questions and instruments related to well-being (e.g., quality-of-life and pain-specific questions). In the questionnaire respondents were asked whether they were receiving any help—informal care—from a relative. If they answered yes, they were asked for permission to contact the informal caregiver and to provide contact details. The amount of informal care provided by relatives to persons with chronic pain was investigated by use of a questionnaire directed to the caregiving relatives, containing questions about time spent providing informal care.Data on costs were collected from registers of consumption of health care, drugs, and municipal services.The results of the study showed a very clear association between existence and severity of chronic pain and societal costs. The study population was subdivided into three groups with respect to having chronic pain or not, and a pain intensity during the last week of 0–4 (mild), 5–7 (moderate), or 8–10 (severe) on a scale of 0–10. Taking all costs (health care, drugs, municipal services, and informal care) into account, persons in the severe chronic pain group consumed on average 72% more resources than persons in the moderate chronic pain group and 143% more than those in the no or mild chronic pain group. Differences were most pronounced concerning municipal services and informal care costs.Even more alarming are the results on the quality of life of persons in the different groups. On the EQ-5D index, the average value for persons in the no or mild chronic pain group was 0.82. For those in the moderate chronic pain group the average value was 0.64, and for those in the severe chronic pain group the average value was only 0.38. EQ-VAS resulted in less pronounced but still clearly significant differences.It is concluded that this study, reaching a rather large part of the target population, shows that existence and severity of chronic pain among people 65 years and older affects costs to society and the quality of life of affected individuals in a massive way.
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| 16. |
- Bernfort, Lars, et al.
(författare)
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Disease Burden and Healthcare Costs for T2D Patients With and Without Established Cardiovascular Disease in Sweden: A Retrospective Cohort Study
- 2020
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Ingår i: Diabetes Therapy. - : SPRINGER HEIDELBERG. - 1869-6953 .- 1869-6961. ; 11:7, s. 1537-1549
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionType 2 diabetes (T2D) is a complex chronic disease with an increasing prevalence worldwide. It is commonly associated with complications, such as cardiovascular disease (CVD). Patients with both T2D and established CVD are exposed to increased risk of further cardiovascular events, which means increased healthcare costs and impairments to quality of life and survival. To determine the added burden of CVD for T2D patients, we have analyzed the consumption and costs of healthcare and mortality in two T2D patient cohorts, with and without established CVD, respectively, during a 5-year follow-up in a Swedish region.MethodsPatients with T2D on 1 January 2012 were identified using the administrative database of Region ostergotland and the Swedish National Diabetes Register. Established CVD was defined as the presence of a CVD-related healthcare visit in the period 2002-2011. Identified T2D patients were then followed retrospectively for 5 years (2012-2016) and data collected on utilization of healthcare resources, healthcare costs, and survival. Data pertinent to the study were retrieved from regional databases and national registries.ResultsOn the index date (1 January 2012) there were 19,731 patients with T2D (prevalence 4.5%) in Region ostergotland, of whom 5490 had established CVD. Those patients with established CVD were older, more often men, and had longer diabetes duration and worse kidney function than those without. Compared to T2D patients without CVD, those with CVD had a significantly higher healthcare consumption, experienced higher costs, and had lower survival during the follow-up.ConclusionThis study confirms that established CVD is common among patients with T2D (approximately 30%). Established CVD has negative effects on the utilization of healthcare resources, healthcare costs, and mortality. It is therefore very important to improve the treatment strategy of this patient group.
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| 17. |
- Bernfort, Lars, et al.
(författare)
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Implementation of Empagliflozin in Patients with Diabetes Mellitus Type 2 and Established Cardiovascular Disease : Estimation of 5-Year Survival and Costs in Sweden
- 2020
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Ingår i: Diabetes Therapy. - : Springer Berlin/Heidelberg. - 1869-6953 .- 1869-6961. ; 11, s. 2921-2930
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionCardiovascular disease (CVD) affects approximately 30% of patients with diabetes mellitus type 2 (T2D) and leads to increased morbidity, decreased survival and increased healthcare utilization. The aim of this study was to estimate the impact of treating these patients with the sodium–glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on survival and healthcare utilization.MethodsActual survival and healthcare utilization data from a 5-year retrospective cohort study on patients with T2D and CVD in the Region of Östergötland, Sweden were used as a starting point. Actual data were adjusted in accordance with risk reductions for mortality and CV events related to empagliflozin treatment as reported in the EMPA-REG OUTCOME study.ResultsApplying the risk reductions related to empagliflozin treatment on the cohort of patients with T2D and CVD in Östergötland resulted in an increase in 5-year survival of 96 days per patient and reduced costs for healthcare and drugs other than empagliflozin. Including the cost of empagliflozin, treatment led to an increased net cost per patient of approximately SEK 18,000 over 5 years.ConclusionEmpagliflozin treatment would reduce mortality and healthcare utilization in the patient group. The treatment strategy should be considered cost-effective, supporting a broad implementation of empagliflozin for patients with T2D and established CVD, in line with current national and international guidelines.
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| 18. |
- Bernfort, Lars, 1967-, et al.
(författare)
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Kostnadseffektivitet av allergen immunterapi : analys och genomgång av kunskapsläget
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Allergier orsakar mycket besvär för drabbade individer och stora kostnader för hälso- och sjukvården och samhället. Tidigare forskning tyder på att allergen immunterapi (AIT) kan vara ett framgångsrikt sätt att behandla personer med allergisk rinit/rinokonjunktivit. Tidigare genomförda hälsoekonomiska studier tyder också på en acceptabel kostnadseffektivitet för AIT jämfört med enbart symtomatisk behandling.Syftet med denna studie var att kartlägga evidensläget för att undersöka möjligheterna att uttala sig om för vilka patienter som AIT är lämpligt, samt när förskrivning kan bedömas som kostnadseffektiv. Grundtanken var att försöka dela in patienter i subgrupper med olika egenskaper, behandlingseffekt och kostnadseffektivitet. Indelningen i subgrupper var i första hand tänkt att baseras på ålder, typ av allergen, symtomens svårighetsgrad och symtomens varaktighet.Tidigt beslutades att evidensläget inte tillåter analys av subkutan (SCIT) och sublingual (SLIT) immunterapi separat, utan dessa behandlas i klump med det förenklade antagandet om en jämn fördelning mellan SCIT och SLIT. Denna analys genomfördes som en modellanalys med antagandet att personer startar AIT-behandling vid 25 års ålder. Det generella resultatet av analysen var att med ett samhällsperspektiv är AIT dominant, dvs. att behandlingen både sparar kostnader och genererar hälsovinster jämfört med enbart symtomatisk behandling. Med ett hälso- och sjukvårdsperspektiv blev kostnadseffektivitetskvoten av AIT jämfört med enbart symtomatisk behandling cirka 245 000 kronor per kvalitetsjusterat levnadsår (QALY).Tillgänglig evidens tillåter tyvärr inte subgruppsanalyser på det sätt som var tänkt. Detta beroende på att behandlingseffekt specificerat på allergentyp, allergins svårighetsgrad och symtomens varaktighet inte analyserats och rapporterats i tidigare publicerade studier. Den enda uppdelningen som befanns vara någorlunda meningsfull var den baserad på ålder. Inte heller avseende denna variabel har skillnader i behandlingseffekt studerats. Däremot antogs olika indirekta kostnader (produktionsförluster) för barn, ungdomar och vuxna. Dessa kostnader saknar betydelse i en analys med hälso- och sjukvårdsperspektiv varför detta resultat inte påverkas. Med ett samhällsperspektiv däremot befanns AIT mest kostnadseffektiv riktad till vuxna (dominant), följt av barn (179 000 kronor/QALY) och ungdomar (245 000 kronor/QALY). För att kunna genomföra en mer komplett kostnadseffektanalys behövs en del information som i dagsläget saknas. Exempel på kunskapsluckor som identifierats är:En meningsfull uppdelning i tillstånd baserat på svårighetsgrad (lindrig/måttlig/svår), utifrån biomarkörer och/eller symtom.Effektiviteten av AIT och dess inverkan på övergångar mellan tillstånd.Livskvalitet och kostnader förknippade med olika tillstånd.Skillnader i behandlingseffektivitet för olika subgrupper (ålder, svårighet och varaktighet av symtom, olika allergener).Evidens som möjliggör jämförelse mellan SCIT och SLIT, när är den ena respektive den andra mest effektiv/kostnadseffektiv?Långtidseffekt av vissa AIT-terapier.
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| 19. |
- Bernfort, Lars, 1967-, et al.
(författare)
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Obstecares AFL-metod för mätning av laktatkoncentration vid avstannat värkarbete : en kostnadsanalys
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Ett vanligt problem i samband med förlossningar, inte minst bland förstagångsföderskor, är att värkarbetet avstannar och förlossningen riskerar att dra ut på tiden. Värksvaghet ökar risken för födsel genom instrumentell förlossning eller med akut kejsarsnitt vilket i sin tur ökar risken för komplikationer (t.ex. blödningar).Den vedertagna behandlingen av en värksvaghet är ett användande av Oxytocin, som dock riskerar att överstimulera livmodermuskeln och istället förlänga förlossningstiden. Obstecare har tagit framen smidig, pålitlig och icke-invasiv metod för mätning av laktatnivåer i fostervatten. Med ledning av dessa mätningar kan välgrundade beslut fattas om huruvida oxytocin ska sättas in eller inte vid värksvaghet. Att undvika insättning av oxytocin vid redan höga laktatnivåer skulle leda till färre onödigt långa förlossningar och färre akuta kejsarsnitt och instrumentella förlossningar.För att undersöka huruvida kostnaden för användning av Obstecares AFL-metod uppvägs av inbesparade kostnader till följd av förändringar i förlossningsutfall genomfördes en hälsoekonomisk (kostnads)analys av att använda denna metod på förstföderskor jämfört med att inte göra det. Analysen är begränsad till den vårdepisod då förlossningen sker och till kostnader.De mest framträdande resultaten av analysen var att antalet akuta kejsarsnitt beräknades minska med cirka 30% och instrumentella förlossningar med cirka 12%. Hälso- och sjukvårdens kostnader beräknades minska med 1 662 kronor (-4%) per förlossning med avstannat värkarbete (inräknat kostnad för laktatmätning).Resultatet av denna analys tyder på att mätning av laktatnivåer vid värksvaghet hos förstföderskor är kostnadsbesparande. Tillgänglig evidens tyder på att strategin borde införas i svensk hälso- och sjukvård.
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| 20. |
- Bernfort, Lars, 1967-, et al.
(författare)
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Patienter med diabetes typ 2 och etablerad hjärt-kärlsjukdom i Östergötland : 5-års sjukvårdskonsumtion, kostnad och överlevnad med eller utan behandling med empagliflozin
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Diabetes mellitus typ 2 är en kronisk sjukdom med en prevalens på cirka 4% i Sverige. T2D behandlas genom omläggning av matvanor och viktnedgång, eller om detta inte är tillräckligt med antingen blodsockerreglerande läkemedel eller insulin. Sjukdomen är förknippad med ökad risk för följdsjukdomar, bland annat hjärt-kärlsjuklighet som är i fokus i denna rapport. I EMPA REG Outcome studien analyserades effekterna av att som tillägg till standardbehandling ge den glukossänkande SGLT-2-hämmaren empagliflozin till patienter med T2D och etablerad hjärt-kärlsjukdom. I studien konstaterades att empagliflozin minskade risken för hjärt-kärlhändelser samt gav förbättrad överlevnad. Syftet med denna studie var tudelat. I den första delen gjordes en kartläggning och beräkning av sjukvårdskonsumtion och kostnader för patienter med T2D, med och utan etablerad hjärtkärlsjukdom, i Östergötland under en femårsperiod (2012–2016). I den andra delen beräknades hur kostnader och mortalitet relaterade till hjärt-kärlhändelser skulle påverkas av att behandla patienter med T2D och etablerad hjärt-kärlsjukdom i Östergötland med empagliflozin.Sjukvårdskonsumtion, kostnader och mortalitet i Östergötland kartlades och beräknades med hjälp av nationella och regionala register. Resultaten från EMPA REG Outcome studien tillämpades på kohorten av patienter med T2D och etablerad hjärt-kärlsjukdom i Östergötland för att på så sätt estimera effekterna av behandling med empagliflozin med avseende på sjukvårdskostnader och mortalitet.Kartläggningen visade att i Östergötland fanns 1 januari 2012 18 586 patienter med T2D, varav 5 490 (30%) även hade etablerad hjärt-kärlsjukdom. Patienter med T2D och etablerad hjärt-kärlsjukdom (CVD-kohorten) var jämfört med övriga patienter med T2D i genomsnitt äldre, i större utsträckning män, samt hade längre diabetesduration och sämre njurfunktion. CVD-kohorten hade under uppföljningsperioden signifikant högre sjukvårdskostnader och sämre överlevnad.Förskrivning av empagliflozin till patienter med T2D och etablerad hjärt-kärlsjukdom i Östergötland beräknades resultera i minskade genomsnittliga sjukvårdskostnader per patient motsvarande cirka 4 100 kronor över fem år, varav cirka 2 300 kronor kunde relateras till minskade kostnader på grund av hjärtsvikt. Mot detta ska ställas ökade läkemedelskostnader. Totalt ger behandling med empagliflozin ökade kostnader på cirka 18 000 kronor per patient över fem år. Den stora vinsten av empagliflozin till patienter med T2D och etablerad hjärt-kärlsjukdom utgörs av tydligt minskad mortalitet. I genomsnitt lever en patient behandlad med empagliflozin 96 dagar längre än om empagliflozin inte förskrivs, sett över en femårsperiod.Förskrivning av empagliflozin minskar behovet av andra glukossänkande läkemedel vilket visades av en upptitrering av glukossänkande läkemedel i placebogruppen i EMPA-REG Outcome studien. Obeaktat minskad förskrivning av övriga glukossänkare och insulin leder resultaten till att empagliflozin (jämfört med standardbehandling) beräknas generera hälsovinster till en kostnad av cirka 69 000 kronor per levnadsår, eller 85 000 kronor per kvalitetsjusterat levnadsår, vilket Socialstyrelsen i sina riktlinjer bedömer som en låg kostnad.Slutsatsen är att behandling med empagliflozin i den tämligen utsatta patientgrupp som har T2D och etablerad hjärt-kärlsjukdom är såväl medicinskt effektivt som kostnadseffektivt.
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| 21. |
- Bernfort, Lars, et al.
(författare)
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People in states worse than dead according to the EQ-5D UK value set: would they rather be dead?
- 2018
-
Ingår i: Quality of Life Research. - : SPRINGER. - 0962-9343 .- 1573-2649. ; 27:7, s. 1827-1833
-
Tidskriftsartikel (refereegranskat)abstract
- Quality-adjusted life years (QALYs) measure health by combining length and quality of life. QALYs constitute the effect side of incremental cost-effectiveness ratios, describing the results of health economic evaluations. The objectives of this study were to (1) investigate the prevalence of states worse than dead (SWD) when using the EuroQol-5D UK value set, and (2) to study to what extent SWDs are reasonable with a starting point in experience-based valuations of health states. Data from a Swedish cross-sectional population survey were used. The survey was directed to 10,000 persons 65 years and older and its primary aim was to investigate the prevalence and consequences of chronic pain. The survey included questions reflecting life situation and well-being. Some of these were used in order to characterise people in SWD. SWD were found in 1.8% of the 6611 respondents. The prevalence of SWD increased with advancing age and was more common among women than men. The control questions used indicated that most of the persons being in SWD according to the EQ-5D UK value set most probably would not judge themselves to be in a SWD. Though negative QALY-weights are not very common, they constitute a non-negligible part of health states in a Swedish population 65 years and older. Prevalence of SWD is higher among women than men and increases with age. From responses to other questions on well-being and life situation, there is reason to doubt the reasonableness of experience-based negative QALY-weights in many cases.
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| 22. |
- Bernfort, Lars, 1967-
(författare)
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Setting priorities in health care : Studies on equity and efficiency
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The inevitable gap between needs and resources in health care, together with the problems associated with a market solution, necessitates priority setting. The aims of this thesis are associated with the process of priority setting in health care, and are divided into three issues:1.) To analyse the potential conflict between the two basic principles for priority setting: efficiency and equity. 2.) To analyse the significance of choice of method for measuring health-related status when determining who has the greatest need for health care. 3.) To analyse the possibilities to create an equation for translating results from a psychometricinstrument (the SF-36) into health utilities.The analyses are performed by use of literature studies, applications of methods for the measurement of health-related status, and comparative statistics.The equity principle is in this thesis interpreted to mean equality in the distribution of health. It is exemplified by Rawls' theory of justice, in turri taken to prescribe need as allocation principle. The efficiency principle is taken to mean cost-effectiveness according to welfare economics, i.e. in terms of utility maximisation. A preliminary result found is that the utility of health is declining on the margin. Vagueness concerning basic concepts thus might imply that the potential conflict between equity and efficiency is sometimes exaggerated. Further, methods used on the medical practice level and a general level respectively for the measurements of health-related status correspond more or less poorlywith one another. This might lead to contradicting decisions on resource allocation, and finding methods that correspond fairly might help linking the different levels together. Results from the SF-36 correlate only moderately with health utility equivalents on an individual level. However, equations for translating the SF-36 into health utilities on a group level, i.e. that discriminate correctly between groups, is probabiy feasible.
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| 23. |
- Bernfort, Lars, et al.
(författare)
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Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life
- 2015
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Ingår i: Pain. - : Elsevier / Lippincott, Williams andamp; Wilkins. - 0304-3959 .- 1872-6623. ; 156:3, s. 521-527
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.
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| 24. |
- Carlsson, Per, 1951-, et al.
(författare)
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Prioritering av läkemedel för behandling av patienter med sällsynta sjukdomar
- 2014
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Ingår i: Läkemedel för djur, maskinell dos och sällsynta tillstånd. - Stockholm : Fritzes. - 9789138242070 ; , s. 639-699
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- I vilken utsträckning kan särskilda hänsyn tas vid prioritering av särläkemedel och läkemedel för behandling av sällsynta tillstånd? Bör man i vissa speciella situationer kunna acceptera sämre kostnadseffektivitet och lägre krav på vetenskapligt underlag? Om så, vad är det för villkor/kriterier som då bör vara uppfyllda? Hur stämmer ett sådant undantag med den etiska plattformen för prioriteringar? Finns det andra argument som talar för eller mot en särbehandling av sällsynta tillstånd? Detta är frågor som vi diskuterar i denna rapport som tagits fram på uppdrag av Läkemedels- och apoteksutredningen.I rapporten konstaterar vi att särläkemedel är en relativt heterogen grupp av läkemedel och att det finns andra läkemedel med motsvarande egenskaper som inte ansökt eller kunnat ansöka om status som särläkemedel. Ur prioriteringssynpunkt är det därför mer relevant att fokusera på alla typer av läkemedel, som används för sällsynta tillstånd, när vi diskuterar vilka principer för prioriteringar som bör gälla.Utifrån litteratur och erfarenheter i andra länder, som formulerat kriterier för en särskild hantering av läkemedel vid sällsynta sjukdomar, drar vi den preliminära slutsatsen att samhället bör kunna betala mer per hälsovinst (kostnad per kvalitetsjusterat levnadsår (QALY)) och acceptera lägre krav på vetenskapligt underlag vid prioritering av läkemedel för behandling av sällsynta sjukdomar om samtliga följande villkor är uppfyllda:att behandlingen har en hög kostnad per hälsovinst som en konsekvens av att den omfattar endast få patienter,att det rör sig om ett tillstånd med mycket stor svårighetsgrad,att det behandlingsalternativ som övervägs på goda grunder ska antas ha en väsentlig effekt,att det inte finns någon alternativ behandling med en väsentlig effekt som förväntas förebygga, bota, fördröja försämring eller lindra det aktuella tillståndet.Om dessa kriterier anses uppfyllda kan läkemedlet bedömas i relation till ett förhöjt tröskelvärde för kostnadseffektivitet. Hur högt detta värde kan vara för att anses rimligt tar vi inte ställning till i rapporten, men en viktig ståndpunkt är att det måste finnas en övre gräns för hur hög kostnad per QALY samhället kan acceptera. Detta bör gälla även om ovanstående kriterier är uppfyllda, annars riskerar det uppstå oacceptabla undanträngningseffekter av andra prioriterade åtgärder. Även lägre krav på vetenskapligt underlag skakunna accepteras....
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| 25. |
- Carlsson, Per, et al.
(författare)
-
Prioritering och finansiering av läkemedel för behandling av patienter med sällsynta sjukdomar
- 2012
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Den pågående Läkemedels- och apoteksutredningen har i ett tilläggsdirektiv fått i uppdrag att analysera behovet av särskilda lösningar vid beslut om subventionering för särläkemedel. Ett särläkemedel är ett läkemedel som uppfyller vissa villkor och därmed omfattas av ett särskilda stimulansåtgärder innan godkännande av läkemedelsmyndighet samt möjlighet, men inte rätt, till ensamrätt på marknaden under 10 år. Till villkoren hör bl.a. att läkemedlet är avsett för att diagnostisera, förebygga eller behandla livshotande tillstånd eller tillstånd med kronisk funktionsnedsättning och som högst 5 av 10 000 personer i gemenskapen lider av vid ansökningstillfället.
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