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Levin, Lars-Åke, Professor
Publications (10 of 128) Show all publications
Berglund, E., Barbany, G., Orsmark-Pietras, C., Fogelstrand, L., Abrahamsson, J., Golovleva, I., . . . Rosenquist, R. (2022). A Study Protocol for Validation and Implementation of Whole-Genome and -Transcriptome Sequencing as a Comprehensive Precision Diagnostic Test in Acute Leukemias. Frontiers in Medicine, 9, Article ID 842507.
Open this publication in new window or tab >>A Study Protocol for Validation and Implementation of Whole-Genome and -Transcriptome Sequencing as a Comprehensive Precision Diagnostic Test in Acute Leukemias
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2022 (English)In: Frontiers in Medicine, E-ISSN 2296-858X, Vol. 9, article id 842507Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Lausanne, Switzerland: Frontiers Media S.A., 2022
Keywords
acute lymphoblastic leukemia; acute myeloid leukemia; whole-genome sequencing; whole-transcriptome sequencing; technical feasibility; clinical utility; health-economic evaluation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-185421 (URN)10.3389/fmed.2022.842507 (DOI)000789699000001 ()35402448 (PubMedID)2-s2.0-85130851065 (Scopus ID)
Note

On behalf of the Clinical Genomics Platform at SciLifeLab and Genomic Medicine Sweden.

Funding: This work was supported by Vinnova, the Swedish Innovation Agency, the Swedish Childhood Cancer Fund, the Swedish Cancer Society, the Swedish Research Council, regional ALF funding from Region Skåne, Region Västra Götaland, Karolinska Institutet, and Karolinska University Hospital. The sequencing of the retrospective cohort was funded by the SciLifeLab National Projects (NP00043).

Available from: 2022-06-03 Created: 2022-06-03 Last updated: 2022-06-22Bibliographically approved
Ghazal, F., Aronsson, M., Al-Khalili, F., Rosenqvist, M. & Levin, L.-Å. (2022). Cost-effectiveness of screening for atrial fibrillation in a single primary care center at a 3-year follow-up. Scandinavian Cardiovascular Journal, 56(1), 35-41
Open this publication in new window or tab >>Cost-effectiveness of screening for atrial fibrillation in a single primary care center at a 3-year follow-up
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2022 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 56, no 1, p. 35-41Article in journal (Refereed) Published
Abstract [en]

Objectives

The aim of this study was to estimate the cost-effectiveness of intermittent electrocardiogram (ECG) screening for atrial fibrillation (AF) among 70-74-year old individuals in primary care. We also aimed to assess adherence to anticoagulants, severe bleeding, stroke and mortality among screening-detected AF cases at three-year follow-up.

Methods

A post hoc analysis based on a cross-sectional screening study for AF among 70-74-year old patients, who were registered at a single primary care center, was followed for three years for mortality. Data about adherence to anticoagulants, incidence of stroke and severe bleeding among screening-detected AF cases, were collected from patients records. Markov model and Monte Carlo simulation were used to assess the cost-effectiveness of the screening program.

Results

The mortality rate among screening-detected AF cases (n = 16) did not differ compared to the 274 individuals with no AF (hazard ratio 0.86, CI 0.12-6.44). Adherence to anticoagulants was 92%. There was no stroke or severe bleeding. The incremental cost-effectiveness ratio of screening versus no screening was EUR 2389/quality-adjusted life year (QALY) gained. The screening showed a 99% probability of being cost-effective compared to no screening at a willingness-to-pay threshold of EUR 20,000 per QALY.

Conclusion

Screening for AF among 70-74-year olds in primary care using intermittent ECG appears to be cost-effective at 3-year follow-up with high anticoagulants adherence and no increased mortality.

Place, publisher, year, edition, pages
Abingdon, Oxfordshire, United Kingdom: Taylor & Francis, 2022
Keywords
Atrial fibrillation; screening; cost-effectiveness; quality-adjusted life year (QALY); anticoagulants
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-184378 (URN)10.1080/14017431.2022.2060523 (DOI)000779160100001 ()35389311 (PubMedID)2-s2.0-85128247727 (Scopus ID)
Note

Funding: M. R. has received research grants, lecture and consulting honoraria from the following sources. Abbott, Carl Bennett AB, Bristol Myers Squibb, Medtronic, MSD, Pfizer, Roche, Sanofi, and Zenicor. L. L. has received economic support for lecturing, advisory boards and research from AstraZeneca, Bayer, Boehringer Ingelheim and Pfizer. F. A. has received lecture fees from Bristol-Myers-Squibb, Pfizer, Boehringer-Ingelheim, and Bayer. M. A. employed by AstraZeneca. 

Available from: 2022-04-20 Created: 2022-04-20 Last updated: 2023-05-03Bibliographically approved
Guenther, L., Takhar, A., Megna, M., Sebastian, M., Nyholm, N., Thoning, H. & Levin, L.-Å. (2022). Impact of fixed-dose combination Cal/BD foam on the work productivity of patients with psoriasis: results from the 52-week randomized, double-blind, PSO-LONG trial. Journal of the European Academy of Dermatology and Venereology, 36(7), 1054-1063
Open this publication in new window or tab >>Impact of fixed-dose combination Cal/BD foam on the work productivity of patients with psoriasis: results from the 52-week randomized, double-blind, PSO-LONG trial
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2022 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 36, no 7, p. 1054-1063Article in journal (Refereed) Published
Abstract [en]

Background Psoriasis contributes to unemployment, work impairment, missed workdays and substantial indirect costs due to lost productivity. Combination Cal/BD foam is the only topical that is approved for long-term maintenance treatment of plaque psoriasis for 52 weeks. This is the first known investigation of the effect of topical psoriasis therapy on productivity. Objective To examine the change in work productivity and activity impairment after 4 weeks of treatment with fixed-dose combination calcipotriol 50 mu g/g/betamethasone dipropionate 0.5 mg/g (Cal/BD) foam and observe long-term changes after 52 weeks of long-term management (proactive or reactive treatment). Methods This is a post-hoc analysis of the PSO-LONG trial - a phase 3, randomized, double-blind, vehicle-controlled, parallel group, international multi-centre trial of treatment with combination Cal/BD foam. Work and activity impairment due to psoriasis were assessed by the Dermatology Life Quality Index (DLQI) and the Work Productivity and Activity Impairment Psoriasis (WPAI:PSO) questionnaire at baseline, week 4, week 28 and week 56. The improvement in hours of work productivity was translated into monthly and annual indirect cost savings estimates for patients in Italy, Sweden, United Kingdom, Canada and Germany. Results Using fixed-dose combination Cal/BD foam for four weeks significantly reduced psoriasis-related work presenteeism, total work productivity impairment (TWPI) and total activity impairment (TAI) over 56 weeks, with significant improvements observed as early as 4 weeks after the baseline visit. The proportion of patients reporting impact on work productivity (as measured by presenteeism and TWPI) and activity impairment (as measured by both DLQI-Q7b and TAI) also decreased. Conclusion Fixed-dose combination Cal/BD foam used for long-term management of psoriasis significantly reduces psoriasis-related work productivity and activity impairment which may result in substantial indirect cost savings.

Place, publisher, year, edition, pages
WILEY, 2022
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-184095 (URN)10.1111/jdv.18053 (DOI)000773460900001 ()35297108 (PubMedID)
Available from: 2022-04-07 Created: 2022-04-07 Last updated: 2023-03-14Bibliographically approved
Cuppen, E., Elemento, O., Rosenquist, R., Nikic, S., IJzerman, M., Zaleski, I. D., . . . Jobanputra, V. (2022). Implementation of Whole-Genome and Transcriptome Sequencing Into Clinical Cancer Care. JCO Precision Oncology, 6, Article ID e2200245.
Open this publication in new window or tab >>Implementation of Whole-Genome and Transcriptome Sequencing Into Clinical Cancer Care
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2022 (English)In: JCO Precision Oncology, E-ISSN 2473-4284, Vol. 6, article id e2200245Article in journal (Refereed) Published
Abstract [en]

PURPOSE The combination of whole-genome and transcriptome sequencing (WGTS) is expected to transformdiagnosis and treatment for patients with cancer. WGTS is a comprehensive precision diagnostic test that isstarting to replace the standard of care for oncology molecular testing in health care systems around the world;however, the implementation and widescale adoption of this best-in-class testing is lacking.

METHODS Here, we address the barriers in integrating WGTS for cancer diagnostics and treatment selection andanswer questions regarding utility in different cancer types, cost-effectiveness and affordability, and otherpractical considerations for WGTS implementation.

RESULTS We review the current studies implementing WGTS in health care systems and provide a synopsis of theclinical evidence and insights into practical considerations for WGTS implementation. We reflect on regulatory,costs, reimbursement, and incidental findings aspects of this test.

CONCLUSION WGTS is an appropriate comprehensive clinical test for many tumor types and can replacemultiple, cascade testing approaches currently performed. Decreasing sequencing cost, increasing number ofclinically relevant aberrations and discovery of more complex biomarkers of treatment response, should pave theway for health care systems and laboratories in implementing WGTS into clinical practice, to transform diagnosisand treatment for patients with cancer.

Place, publisher, year, edition, pages
American Society of Clinical Oncology, 2022
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-193342 (URN)10.1200/po.22.00245 (DOI)000975488400088 ()36480778 (PubMedID)
Note

Funding agencies: Hartwig Medical Foundation (Hans van Snellenberg, Edwin Cuppen)receives funding from Hartwig Foundation, the Dutch Cancer Foundation(KWF), ZonMW and Illumina Inc. R.R. received funding from the SwedishCancer Society, the Swedish Research Council, the Knut and AliceWallenberg Foundation, Karolinska Institutet, Karolinska UniversityHospital, and Radiumhemmets Forskningsfonder, Stockholm. Universityof Twente, Enschede, The Netherlands (M.I.) receives funding fromIllumina Inc. C.G.M. is supported by NCI CA 197695. S.F. receivedsupport from the National Center for Tumor Diseases and the German Cancer Consortium. C.C. is supported by funding from CRUK (grantnumbers A17197, A27657 and A29580) and a European ResearchCouncil Advanced Award (grant number 694620). T.J.P. holds theCanada Research Chair in Translational Genomics and is supported by aSenior Investigator Award from the Ontario Institute for Cancer Researchand the Gattuso-Slaight Personalized Cancer Medicine Fund.

Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2023-08-21
Egeberg, A., Freilich, J., Stelmaszuk, M. N., Kongerslev, R., Apol, E., Hansen, J. B. & Levin, L.-Å. (2022). Real-world dose adjustments of biologic treatments in psoriasis and their economic impact: a Swedish national population study. Clincal and Experimental Dermatology, 47(11), 1968-1975
Open this publication in new window or tab >>Real-world dose adjustments of biologic treatments in psoriasis and their economic impact: a Swedish national population study
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2022 (English)In: Clincal and Experimental Dermatology, ISSN 0307-6938, E-ISSN 1365-2230, Vol. 47, no 11, p. 1968-1975Article in journal (Refereed) Published
Abstract [en]

Background To date, evidence on the dose adjustments of biologics in the real-world treatment of psoriasis is limited. However, dose adjustments may have important clinical and economic implications. Aims To study the dose adjustments of individual biologics over time in real-world practice in Sweden. Methods A retrospective observational study of adults with moderate to severe psoriasis was conducted based on Swedish national registry data from 2010 to 2018. Treatment episodes were identified for individual patients from the date of drug dispensation to the end of the supply of the drug. Dosing data were expressed as the proportion of treatment episodes with accumulated syringes/vials equal to, above or below the recommended guidelines. Real-world costs were calculated and compared with costs predicted from dosing guidelines. Results The mean dose was above recommended levels for all biologics investigated. Weighted mean dose adjustments for adalimumab, etanercept, secukinumab and ustekinumab were 13%, 23%, 8% and 3%, respectively, over the entire treatment period. Higher doses translate to higher costs, including notable increases over time vs. expected costs for secukinumab. Conclusions Dose adjustments of biologics are frequent in clinical practice but differ for the various biologics. The mean observed increases in dose above guideline recommendations might indicate perceptions of suboptimal efficacy for biologics, with implications for the cost and cost-effectiveness of these treatments. Further research is warranted to understand the reasons for dose adjustments in clinical practice.

Place, publisher, year, edition, pages
Wiley, 2022
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-188602 (URN)10.1111/ced.15288 (DOI)000850488500001 ()35670046 (PubMedID)
Note

Funding Agencies|LEO Pharma A/S

Available from: 2022-09-20 Created: 2022-09-20 Last updated: 2023-03-07Bibliographically approved
Stenzinger, A., Edsjö, A., Ploeger, C., Friedman, M., Fröhling, S., Wirta, V., . . . Rosenquist, R. (2022). Trailblazing precision medicine in Europe: A joint view by Genomic Medicine Sweden and the Centers for Personalized Medicine, ZPM, in Germany. Seminars in Cancer Biology, 84, 242-254
Open this publication in new window or tab >>Trailblazing precision medicine in Europe: A joint view by Genomic Medicine Sweden and the Centers for Personalized Medicine, ZPM, in Germany
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2022 (English)In: Seminars in Cancer Biology, ISSN 1044-579X, E-ISSN 1096-3650, Vol. 84, p. 242-254Article in journal (Refereed) Published
Abstract [en]

Over the last decades, rapid technological and scientific advances have led to a merge of molecular sciences and clinical medicine, resulting in a better understanding of disease mechanisms and the development of novel therapies that exploit specific molecular lesions or profiles driving disease. Precision oncology is here used as an example, illustrating the potential of precision/personalized medicine that also holds great promise in other medical fields. Real-world implementation can only be achieved by dedicated healthcare connected centers which amass and build up interdisciplinary expertise reflecting the complexity of precision medicine. Networks of such centers are ideally suited for a nation-wide outreach offering access to precision medicine to patients independent of their place of residence. Two of these multicentric initiatives, Genomic Medicine Sweden (GMS) and the Centers for Personalized Medicine (ZPM) initiative in Germany have teamed up to present and share their views on core concepts, potentials, challenges, and future developments in precision medicine. Together with other initiatives worldwide, GMS and ZPM aim at providing a robust and sustainable framework, covering all components from technology development to clinical trials, ethical and legal aspects as well as involvement of all relevant stakeholders, including patients and policymakers in the field.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Cancer; Clinical trials; Molecular profiling; Personalized medicine; Precision medicine
National Category
Clinical Laboratory Medicine
Identifiers
urn:nbn:se:liu:diva-192710 (URN)10.1016/j.semcancer.2021.05.026 (DOI)000830066100004 ()34033893 (PubMedID)2-s2.0-85111382323 (Scopus ID)
Funder
Vinnova
Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2023-04-04Bibliographically approved
Eriksson, T., Levin, L.-Å. & Nedlund, A.-C. (2021). Centrality and compatibility of institutional logics when introducing value-based reimbursement. Journal of Health Organization & Management, 35(9), 298-314
Open this publication in new window or tab >>Centrality and compatibility of institutional logics when introducing value-based reimbursement
2021 (English)In: Journal of Health Organization & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 35, no 9, p. 298-314Article in journal (Refereed) Published
Abstract [en]

Purpose: Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands.

Design/methodology/approach: 41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory.

Findings: After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride.

Originality/value: Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2021
Keywords
Health Policy, Business, Management and Accounting (miscellaneous)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-180828 (URN)10.1108/jhom-01-2021-0010 (DOI)000697172500001 ()34535988 (PubMedID)2-s2.0-85114992992 (Scopus ID)
Available from: 2021-11-03 Created: 2021-11-03 Last updated: 2022-05-06Bibliographically approved
Bernfort, L. & Levin, L.-Å. (2020). Obstecares AFL-metod för mätning av laktatkoncentration vid avstannat värkarbete: en kostnadsanalys. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Obstecares AFL-metod för mätning av laktatkoncentration vid avstannat värkarbete: en kostnadsanalys
2020 (Swedish)Report (Other academic)
Abstract [sv]

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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. p. 12
Series
CMT Report, ISSN 0283-1228, E-ISSN 1653-7556 ; 2020:1
Keywords
mätning; laktasnivåer; fostervatten; värksvaghet; Obstecares AFL-metod; ekonomi; kostnad; hälsoekonomi
National Category
Gynaecology, Obstetrics and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-171778 (URN)
Available from: 2020-12-04 Created: 2020-12-04 Last updated: 2025-02-11Bibliographically approved
Ennab Vogel, N. & Levin, L.-Å. (2020). Sms-livräddare vid akut omhändertagande av patient med hjärtstopp utanför sjukhus - en kostnadseffektivitetsanalys. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Sms-livräddare vid akut omhändertagande av patient med hjärtstopp utanför sjukhus - en kostnadseffektivitetsanalys
2020 (Swedish)Report (Other academic)
Abstract [sv]

Sms-livräddare är ett system som utvecklats för att stödja och komplettera befintlig ambulanssjukvård med potentiellt livräddande frivilliginsatser av civila insatspersoner i det akuta omhändertagande av patient vid misstanke om hjärtstopp utanför sjukhus. Systemet koordinerar frivilligt anslutna insatspersoner, så kallade Sms-livräddare, via en särskilt utvecklad mobilapplikation. Rapporten är producerad i syfte att bemöta efterfrågan på hälsoekonomiska utvärderingar av Sms-livräddare som komplement till regionernas befintliga ambulansdirigering vid larm om misstänkt hjärtstopp utanför sjukhus, och på uppdrag av SOS Alarm Sverige AB. Mot bakgrund av tillgängliga data från Hjärtstoppscentrum vid Karolinska Institutet (KI), Heartrunner Sweden AB och Svenska Hjärt-lungräddningsregistret har en förenklad kostnadseffektivitetsanalys av Sms-livräddare som tilläggsintervention till prehospitalt, akut omhändertagande av patient vid misstanke om hjärtstopp utanför sjukhus kunnat genomföras. En kortfattad epidemiologisk översikt av hjärtstopp utanför sjukhus, i riket och på regionnivå ges tillsammans med beskrivning av data på tilldelade uppdrag i Sms-livräddare som tjänat underlag för estimering av hälsoeffektmått och de kostnader som införts analysen. Efterföljande metodbeskrivning redogör för de underliggande antaganden och avgränsningar som påförts modellerna i den förenklade kostnadseffektivitetsanalysen. Rapporten presenterar resultatberäkningar av den förenklade kostnadseffektivitetsanalysen på regionnivå och avslutas med en allmän diskussion av resultatens relevans och begränsningar i estimering av Sms-livräddares kostnadseffektivitet som tilläggsintervention till befintlig ambulansdirigering på regionnivå. Resultaten indikerar att Sms-livräddare är en kostnadseffektiv tilläggsintervention till prehospitalt akut omhändertagandet av hjärtstoppatient utanför sjukhus, och visar att systematiserade och tydligt avgränsade räddningsinsatser av frivilligpersoner i prehospitalt omhändertagande av patient med ett livshotande tillstånd kan ha livsavgörande betydelse för den hjälpsökande i väntan på avancerad akutsjukvård.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. p. 24
Series
CARER Report ; 2020:31
Keywords
Sms-livräddare; frivilliginsatser; civila insatspersoner; hälsoekonomiska utvärderingar; resultatberäkningar
National Category
Peace and Conflict Studies Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-175137 (URN)9789179296506 (ISBN)
Funder
Swedish Civil Contingencies Agency
Available from: 2021-04-20 Created: 2021-04-20 Last updated: 2025-02-20Bibliographically approved
Bernfort, L. & Levin, L.-Å. (2019). Kostnadseffektivitet av allergen immunterapi: analys och genomgång av kunskapsläget. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Kostnadseffektivitet av allergen immunterapi: analys och genomgång av kunskapsläget
2019 (Swedish)Report (Other academic)
Abstract [sv]

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.
Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 64
Series
CMT Report, ISSN 0283-1228, E-ISSN 1653-7556 ; 2019:2
Keywords
Immunterapi
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-162590 (URN)LIU CMT RA/1902 (Local ID)LIU CMT RA/1902 (Archive number)LIU CMT RA/1902 (OAI)
Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2019-12-10Bibliographically approved
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