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- Alwin, Jenny, 1978-, et al.
(författare)
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Societal costs of informal care of community-dwelling frail elderly people
- 2021
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 49:4, s. 433-440
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (euro1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (euro7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (euro1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.
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| 2. |
- Lundqvist, Martina, 1986-
(författare)
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Health Technology Assessment of Assistance Dogs and Dog-Assisted Interventions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dogs as an assistive aid for people with disabilities date as far back in time as the first century CE. Today, dogs are used in various settings to help and assist humans. ‘Assistance dogs’ is an umbrella term for guide dogs, hearing dogs and service dogs. They are custom trained to help and support their owners in their everyday life and thereby give them greater independence. Dogs who perform dog-assisted interventions are another type of working dog, where the dog and the owner work together as a team visiting people with various needs in different settings such as hospitals and nursing homes. These visits aim to strengthen people’s inner motivation, using the dog as an external motivator. There is a lack of evaluations of working dogs in the health technology assessment context, and in the health economic evaluation context. Hence, there is a need for structured analyses that include both the short and long-term effects and the costs of assistance dogs and dog-assisted interventions.The overall aim of this thesis is to explore and assess the use of assistance dogs and dog-assisted interventions.The research questions were investigated using a variety of methods. In paper I, inferential statistical analysis was used to analyse patient-reported outcomes measures. In paper II, a thematic content analysis was employed to explore the experiences of service and hearing dogs. To study the long-term cost-effectiveness of physical service dogs and diabetes alert dogs, a decision analytic model was used in paper III. The input data in studies I, II, and III was obtained from the Service and Hearing Dog Project. In paper III, the data was also supplemented with information from published literature and expert opinions. Paper IV investigated the effects and cost-effectiveness of dog-assisted interventions, and takes the form of a systematic review.Paper I showed that a service or hearing dog may have positive impact on its owner’s health-related quality of life, well-being and activity level. Paper II showed that owners of service or hearing dogs experienced both positive physical and psychosocial effects from their dog. Negative experiences were also identified, for example being denied access to public places and negative attitudes from other people. Paper III showed that physical service dogs and diabetes alert dogs are cost-effective in comparison with regular companion dogs, resulting in both lower costs and a gain in QALYs. The one-way sensitivity analysis did not change the results, but the probabilistic sensitivity analysis showed that the results were uncertain. Synthesizing the results from the review in paper IV showed that dog-assisted interventions for therapeutic purposes led to minor to moderate effects in psychiatric conditions. Dog-assisted interventions as an activity had minor to moderate effects on cognitive disorders, and dog-assisted interventions for support purposes were beneficial in different types of medical interventions. Studies of cost-effectiveness were lacking. To conclude, assistance dogs are valuable and may be cost-effective for use as assistive aids and dog-assisted interventions render minor to moderate effects in certain situations in healthcare settings.
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| 3. |
- Mourad, Ghassan, 1974-, et al.
(författare)
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Hälsorelaterad livskvalitet och psykisk ohälsa hos patienter med icke-kardiell bröstsmärta
- 2020
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Ingår i: BestPractice Nordic, Primärvård. ; :2
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Återkommande icke-kardiell bröstsmärta har negativ inverkan på psykiskt välmående och hälsorelaterad livskvalitet (HRQoL). Detta gäller i synnerhet patienter med tidigare hjärtsjukdom vilka visar signifikant lägre HRQoL än patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom.Många patienter som söker akut på grund av bröstsmärta blir utskrivna utan någon förklaring, annat än att akut hjärtsjukdom uteslutits, så kallad icke-kardiell bröstsmärta.1,2 Återkommande bröstsmärta kan påverka patienternas psykiska välbefinnande och hälsorelaterade livskvalitet (HRQoL) negativt.3-6 En stor andel av dessa patienter kan ha haft hjärtsjukdom sedan tidigare.7 Det råder i dag brist på studier som undersökt HRQoL bland patienter med icke-kardiell bröstsmärta samt hur tidigare erfarenhet av hjärtsjukdom påverkar sambandet mellan psykiskt välbefinnande och HRQoL hos dessa patienter. Syftet med denna studie var därför att beskriva HRQoL bland patienter med icke-kardiell bröstsmärta, med eller utan tidigare hjärtsjukdom. Vidare var syftet att undersöka sambandet mellan HRQoL och psykisk ohälsa, vilket i denna studie omfattade hjärtrelaterad ångest, depressiva symtom, rädsla för kroppsliga sensationer och somatisering. Metod Sammanlagt 552 patienter som vårdats för bröstsmärta och skrivits ut från fyra sjukhus i sydöstra Sverige med icke-kardiell bröstsmärta som diagnos (ICD 10–diagnoskoder: R07.2, R07.3, R07.4 och Z03.4) deltog i studien. Patienterna var 64 ± 17 år gamla, huvudsakligen gifta/sambo och jämnt fördelade avseende kön. Patienter med tidigare hjärtsjukdom var äldre än de utan (71 år respektive 60 år) och bestod av fler män än kvinnor (60 procent respektive 44 procent). HRQoL undersöktes med frågeformuläret EuroQol-5D-5L (EQ-5D),8 hjärtrelaterad ångest med Cardiac Anxiety Questionnaire (CAQ),9 depressiva symtom med Patient Health Questionnaire-9 (PHQ-9),10 rädsla för kroppsliga sensationer med Body Sensations Questionnaire (BSQ)11 och somatisering med Patient Health Questionnaire-15 (PHQ-15).12 Resultat Omkring hälften av patienterna rapporterade minst måttliga problem avseende smärtor/besvär och en av fyra rapporterade minst måttliga problem i HRQoL–dimensionerna rörlighet, vanliga aktiviteter och oro/nedstämdhet. Avseende personlig vård var det åtta procent som rapporterade problem. EQ-5D VAS och EQ-5D index var 0,7 ± 0,2 respektive 0,7 ± 0,3 för den totala studiepopulationen. Patienter med icke-kardiell bröstsmärta och tidigare hjärtsjukdom rapporterade signifikant lägre HRQoL (p ≤0,05) jämfört med patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom. Hjärtrelaterad ångest, depressiva symtom och somatisering hade i den totala studiepopulationen svaga signifikanta negativa samband (beta = 0,187–0,284, p <0,001) med HRQoL. Hos patienter med tidigare hjärtsjukdom var sambandet mellan depressiva symtom och HRQoL måttligt (beta = -0,339, p <0,001), jämfört med svagt samband hos patienter utan tidigare hjärtsjukdom (beta = -0,193, p <0,001). Å andra sidan var sambandet mellan hjärtrelaterad ångest och HRQoL svagt hos både patienter med tidigare hjärtsjukdom (beta = -0,156, p = 0,05) och patienter utan tidigare hjärtsjukdom (beta = -0,229, p <0,001). Slutsatser Patienter med icke-kardiell bröstsmärta, särskilt de med tidigare hjärtsjukdom, rapporterade låga nivåer av HRQoL och en stor andel uppvisade problem med smärtor/besvär och oro/nedstämdhet. Hjärtrelaterad ångest, depressiva symtom och somatisering hade negativ inverkan på HRQoL, men skiljde sig en del mellan dem som haft eller inte haft hjärtsjukdom sedan tidigare. Detta bör beaktas vid utveckling av psykologiska interventioner som syftar till att förbättra HRQoL hos patienter med icke-kardiell bröstsmärta.Referenser 1. spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. Journal of the Royal Society of Medicine. 2003;96(3):122-125. 2. Leise MD, Locke GR, 3rd, Dierkhising RA, et al. Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clinic proceedings. Mayo Clinic. 2010;85(4): 323-330. 3. Eslick GD. Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Disease-a-month : DM. 2008;54(9): 604-612. 4. Mol KA, Smoczynska A, Rahel BM, et al. Non-cardiac chest pain: prognosis and secondary healthcare utilisation. Open Heart. 2018;5(2): e000859. 5. Mourad G, Stromberg A, Johansson P, et al. Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study. The Patient. 2016;9(1): 69-77.6. Fagring AJ, Gaston-Johansson F, Kjellgren KI, et al. Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women. European journal of cardiovascular nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2007;6(4): 329-336. 7. Mourad G, Jaarsma T, Stromberg A, et al. The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter? BMC Psychiatry. 2018;18(1): 172. 8. EuroQolGroup. EQ-5D 2017. Available from: www.euroqolgroup.org, accessed 2017-11-06. 9. Eifert GH, Thompson RN, Zvolensky MJ, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behaviour Research and Therapy. 2000;38(10): 1039-1053. 10. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9): 606-613.11. Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology. 1984;52(6): 1090-1097. 12. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine. 2002;64(2): 258-266.
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| 4. |
- Nord, Magnus, 1967-, et al.
(författare)
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Cost-Effectiveness of Comprehensive Geriatric Assessment Adapted to Primary Care
- 2022
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 23:12, s. 2003-2009
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To estimate the cost-effectiveness of a pragmatic trial of comprehensive geriatric assessment adapted to primary care, compared with care as usual. Design Within-trial cost-effectiveness study of a prospective controlled multicenter trial. Setting and Participants Nineteen primary care practices in Sweden. The original trial included 1304 individuals aged ≥75 years at high risk of hospitalization selected using a prediction model. From the original trial, 369 individuals participated in the cost-effectiveness analysis, 185 in the intervention group and 184 in the control group. Mean age was 83.9 years and 57% of the participants were men. Methods We obtained health care costs from administrative registries. Community costs and health-related quality of life data were obtained from a questionnaire sent to participants. Health-related quality of life was measured using EQ-5D-3L and quality-adjusted life years were calculated. We analyzed all outcomes according to intention to treat, and adjusted them to age, gender, and risk score (risk of hospitalization in the next 12 months). The primary outcome was the incremental cost-effectiveness ratio associated with the intervention at follow-up after 24 months. Results The difference in total cost (incremental cost) between intervention and control groups was USD −11,275 (95% CI −407 to −22,142). The incremental effect in quality-adjusted life years was −0.05 (95% CI −0.17 to 0.08). In the cost-effectiveness plane that illustrates the uncertainty of the analysis, 77.9 of the observations were within the south-east quadrant, implying lower cost and greater effect in the intervention group. Conclusions and Implications The results suggests that a primary care comprehensive geriatric assessment intervention delivered to older adults at high risk of hospitalization is cost-effective at follow-up after 24 months. The use of a prediction model to select participants and an intervention with a low cost is promising but requires further study.
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| 5. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(författare)
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Costs of an Off-the-Shelve Exergame Intervention in Patients with Heart Failure
- 2023
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Ingår i: Games for Health Journal. - : MARY ANN LIEBERT, INC. - 2161-783X .- 2161-7856. ; 12:3, s. 242-248
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programs involving traditional modes of physical activity. Although no effect on exercise capacity was found for an off-the-shelf exergame, it is important to gain insights into aspects related to costs to develop such interventions further.Materials and Methods: In a randomized controlled trial, the Heart Failure Wii study (HF-Wii study), the intervention group (exergame group) received an introduction to the exergame, the exergame was installed at home and help was offered when needed for 3 months. Patients received telephone follow-ups at 2, 4, 8, and 12 weeks after the installation. The control group (motivational support group) received activity advice and telephone follow-ups at 2, 4, 8, and 12 weeks. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs, and willingness to pay.Results: No significant differences were found between the exergame group (n = 300) versus the motivational support group (n = 305) in hospital use or costs (1-year number of hospitalizations: P = 0.60, costs: P = 0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros. Of the total estimated costs for the intervention, 287 Euros, patients were willing to pay, on average, 58%.Conclusion: This study shows that the costs of an intervention using an off-the-shelve exergame are relatively low and that the patients were willing to pay for more than half of the intervention costs. The trial is registered in ClinicalTrials.gov (NCT01785121).
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