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Davidson, Thomas
Publications (10 of 43) Show all publications
Hedin, C., Sjödahl, R., Aldman, Å., Davidson, T., Kammerlind, A.-S., Nodbrant, P., . . . Theodorsson, E. (2018). Intraoperativ strålbehandling vid primar operation for bröstcancer: TARGIT-A-studien ej konklusiv. Läkartidningen, 115, Article ID EWFF.
Open this publication in new window or tab >>Intraoperativ strålbehandling vid primar operation for bröstcancer: TARGIT-A-studien ej konklusiv
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2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EWFFArticle, review/survey (Refereed) Published
Abstract [sv]

The TARGIT-A (TARGeted Intraoperative radioTherapy) multicentre study of early breast cancer compared intraoperative radiotherapy with external radiotherapy. While the intraoperative radiotherapy was standardised, the external postoperative comparison treatment followed established routines in the participating treatment centres resulting in substantial variations in dosages and treatment durations. The uncertainties in the interpretation of the study results created by the design of the TARGIT-A study constitute substantial obstacles to the possible introduction of intraoperative radiotherapy for early breast cancer.

Place, publisher, year, edition, pages
Stockholm, Sweden: Läkartidningen Förlag AB, 2018
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-154595 (URN)29381183 (PubMedID)
Available from: 2019-02-21 Created: 2019-02-21 Last updated: 2019-04-18Bibliographically approved
Heintz, E., Gerber-Grote, A., Ghabri, S., Hamers, F. F., Prevolnik Rupel, V., Slabe-Erker, R. & Davidson, T. (2016). Is There a European View on Health Economic Evaluations? Results from a Synopsis of Methodological Guidelines Used in the EUnetHTA Partner Countries. PharmacoEconomics (Auckland), 34(1), 59-76
Open this publication in new window or tab >>Is There a European View on Health Economic Evaluations? Results from a Synopsis of Methodological Guidelines Used in the EUnetHTA Partner Countries
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2016 (English)In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 34, no 1, p. 59-76Article in journal (Refereed) Published
Abstract [en]

The objectives of this study were to review current methodological guidelines for economic evaluations of all types of technologies in the 33 countries with organizations involved in the European Network for Health Technology Assessment (EUnetHTA), and to provide a general framework for economic evaluation at a European level. Methodological guidelines for health economic evaluations used by EUnetHTA partners were collected through a survey. Information from each guideline was extracted using a pre-tested extraction template. On the basis of the extracted information, a summary describing the methods used by the EUnetHTA countries was written for each methodological item. General recommendations were formulated for methodological issues where the guidelines of the EUnetHTA partners were in agreement or where the usefulness of economic evaluations may be increased by presenting the results in a specific way. At least one contact person from all 33 EUnetHTA countries (100 %) responded to the survey. In total, the review included 51 guidelines, representing 25 countries (eight countries had no methodological guideline for health economic evaluations). On the basis of the results of the extracted information from all 51 guidelines, EUnetHTA issued ten main recommendations for health economic evaluations. The presented review of methodological guidelines for health economic evaluations and the consequent recommendations will hopefully improve the comparability, transferability and overall usefulness of economic evaluations performed within EUnetHTA. Nevertheless, there are still methodological issues that need to be investigated further.

Place, publisher, year, edition, pages
ADIS INT LTD, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-124639 (URN)10.1007/s40273-015-0328-1 (DOI)000368163000007 ()26446858 (PubMedID)
Available from: 2016-02-09 Created: 2016-02-08 Last updated: 2017-11-30
Levin, L.-Å., Husberg, M., Sobocinski, P. D., Kull, V. F., Friberg, L., Rosenqvist, M. & Davidson, T. (2015). A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.. Europace, 17(2), 207-14
Open this publication in new window or tab >>A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.
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2015 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 207-14Article in journal (Refereed) Published
Abstract [en]

AIMS: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.

METHODS AND RESULTS: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.

CONCLUSION: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keywords
Atrial fibrillation; Cost-effectiveness; Ischaemic stroke; QALY; Screening; Secondary prevention
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-115381 (URN)10.1093/europace/euu213 (DOI)000351601600008 ()25349228 (PubMedID)
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2017-12-04
Lundqvist, M., Davidson, T., Ordell, S., Sjöstrom, O., Zimmerman, M. & Sjogren, P. (2015). Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden. Community Dental Health, 32(1), 39-43
Open this publication in new window or tab >>Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden
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2015 (English)In: Community Dental Health, ISSN 0265-539X, Vol. 32, no 1, p. 39-43Article in journal (Refereed) Published
Abstract [en]

Objectives: Dental care for elderly nursing home residents is traditionally provided at fixed dental clinics, but domiciliary dental care is an emerging alternative. Longer life expectancy accompanied with increased morbidity, and hospitalisation or dependence on the care of others will contribute to a risk for rapid deterioration of oral health so alternative methods for delivering oral health care to vulnerable individuals for whom access to fixed dental clinics is an obstacle should be considered. The aim was to analyse health economic consequences of domiciliary dental care for elderly nursing home residents in Sweden, compared to dentistry at a fixed clinic. Methods: A review of relevant literature was undertaken complemented by interviews with nursing home staff, officials at county councils, and academic experts in geriatric dentistry. Domiciliary dental care and fixed clinic care were compared in cost analyses and cost-effectiveness analyses. Results: The mean societal cost of domiciliary dental care for elderly nursing home residents was lower than dental care at a fixed clinic, and it was also considered cost-effective. Lower cost of dental care at a fixed dental clinic was only achieved in a scenario where dental care could not be completed in a domiciliary setting. Conclusions: Domiciliary dental care for elderly nursing home residents has a lower societal cost and is cost-effective compared to dental care at fixed clinics. To meet current and predicted need for oral health care in the ageing population alternative methods to deliver dental care should be available.

Place, publisher, year, edition, pages
Dennis Barber, 2015
Keywords
aged; dentistry; domiciliary care; geriatric dentistry; health care economics and organizations; home care services; nursing homes; Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-117382 (URN)10.1922/CDH_3407Lundqvist05 (DOI)000351993500008 ()
Note

Funding Agencies|CMT at Linkoping University; Oral Care AB; CMT

Available from: 2015-04-24 Created: 2015-04-24 Last updated: 2017-12-04
Davidson, T., Lindelof, A., Wallen, T., Lindahl, T. & Hallert, C. (2015). Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study. Journal of Telemedicine and Telecare, 21(5), 298-301
Open this publication in new window or tab >>Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study
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2015 (English)In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 21, no 5, p. 298-301Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2015
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-120279 (URN)10.1177/1357633X15574963 (DOI)000357495500007 ()25766854 (PubMedID)
Note

Funding Agencies|FORSS; Ostergotland County Council

Available from: 2015-07-24 Created: 2015-07-24 Last updated: 2018-01-11
Davidson, T., Rohlin, M., Hultin, M., Jemt, T., Nilner, K., Sunnegardh-Gronberg, K., . . . Nilsson, M. (2015). Reimbursement systems influence prosthodontic treatment of adult patients. Acta Odontologica Scandinavica, 73(6), 414-420
Open this publication in new window or tab >>Reimbursement systems influence prosthodontic treatment of adult patients
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2015 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 6, p. 414-420Article in journal (Refereed) Published
Abstract [en]

Objective. To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. Materials and methods. Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patients age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. Results. Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. Conclusions. Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
Keywords
insurance; financial incentives; prosthodontics
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-118971 (URN)10.3109/00016357.2014.976260 (DOI)000354608200003 ()25643867 (PubMedID)
Available from: 2015-06-08 Created: 2015-06-05 Last updated: 2017-12-04
Pirhonen, L. & Davidson, T. (2014). Experiences of including costs of added life years in health economic evaluations in Sweden. Farmeconomia. Health Economics and Therapeutic Pathways, 15(2), 45-53
Open this publication in new window or tab >>Experiences of including costs of added life years in health economic evaluations in Sweden
2014 (English)In: Farmeconomia. Health Economics and Therapeutic Pathways, ISSN 1721-6915, Vol. 15, no 2, p. 45-53Article in journal (Refereed) Published
Abstract [en]

It is of importance to include the appropriate costs and outcomes when evaluating a health intervention. Sweden is the only country where the national guidelines of decisions on reimbursement explicitly state that costs of added life years should be accounted for when presenting health economic evaluations. The aim of this article is to, from a theoretical and empirical point of view, critically analyze the Swedish recommendations used by the Dental and Pharmaceutical Benefits Agency (TLV), when it comes to the use of costs of added life years in economic evaluations of health care. The aim is furthermore to analyze the numbers used in Sweden and discuss their impact on the incremental cost‑effectiveness ratios of assessed technologies. If following a societal perspective, based on welfare economics, there is strong support for the inclusion of costs of added life years in health economic evaluations. These costs have a large impact on the results. However this fact may be in conflict with ethical concerns of allocation of health care resources, such as favoring the younger part of the population over the older. It is important that the estimates of production and consumption reflect the true societal values, which is not the case with the values used in Sweden.

Place, publisher, year, edition, pages
SEEd Medical Publishers, 2014
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-115787 (URN)10.7175/fe.v15i2.925 (DOI)
Available from: 2015-03-19 Created: 2015-03-19 Last updated: 2017-03-24Bibliographically approved
Heintz, E., Arnberg, K., Levin, L.-Å., Liliemark, J. & Davidson, T. (2014). The impact of health economic evaluations in Sweden.. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 108(7), 375-82
Open this publication in new window or tab >>The impact of health economic evaluations in Sweden.
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2014 (English)In: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, ISSN 2212-0289, Vol. 108, no 7, p. 375-82Article in journal (Refereed) Published
Abstract [en]

The responsibility for healthcare in Sweden is shared by the central government, county councils and municipalities. The counties and municipalities are free to make their own prioritizations within the framework of the state healthcare laws. To guide prioritization of healthcare resources in Sweden, there is consensus that cost-effectiveness constitutes one of the three principles. The objective of this paper is to describe how cost-effectiveness, and hence health economic evaluations (HEE), have a role in pricing decisions, reimbursement of pharmaceuticals as well as the overall prioritization and allocation of resources in the Swedish healthcare system. There are various organizations involved in the processes of implementing health technologies in the Swedish healthcare system, several of which consider or produce HEEs when assessing different technologies: the Dental and Pharmaceutical Benefits Agency (TLV), the county councils' group on new drug therapies (NLT), the National Board of Health and Welfare, the Swedish Council on Health Technology Assessment (SBU), regional HTA agencies and the Public Health Agency of Sweden. The only governmental agency that has official and mandatory guidelines for how to perform HEE is TLV (LFNAR 2003:2). Even though HEEs may seem to have a clear and explicit role in the decision-making processes in the Swedish healthcare system, there are various obstacles and challenges in the use and dissemination of the results.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Reimbursement; health economic evaluation; pricing; Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-115380 (URN)10.1016/j.zefq.2014.09.006 (DOI)25444295 (PubMedID)2-s2.0-84908346413 (Scopus ID)
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2015-04-09
Ågren, S., Evangelista, L. S., Davidson, T. & Strömberg, A. (2013). Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners. Journal of Clinical Nursing, 22(15-16), 2347-2353
Open this publication in new window or tab >>Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners
2013 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 15-16, p. 2347-2353Article in journal (Refereed) Published
Abstract [en]

Aims and objectives.  This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners.

Background.  There are few studies evaluating cost-effectiveness of interventions among HF patient–partner dyads.

Methods.  Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D.

Results.  A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners.

Conclusion.  The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved.

Relevance to clinical practice.  The study shows trends of a cost-effective education and psychosocial care of HF patient–partner dyads.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2013
Keywords
dyads, health-related quality of life, heart failure, nursing, QALY
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96415 (URN)10.1111/j.1365-2702.2012.04246.x (DOI)000321332100027 ()
Note

Funding Agencies|Linkoping University||Swedish Institute for Health Sciences||Swedish Research Council||Heart and Lung Foundation||Vardal Foundation||National Heart, Lung, and Blood Institute|1R01HL093466-01|University of California, Los Angeles, Resource Centers for Minority Aging Research/Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under National Institute in Aging|P30-AG02-1684|

Available from: 2013-08-20 Created: 2013-08-19 Last updated: 2017-12-06
Davidson, T., Husberg, M., Janzon, M., Oldgren, J. & Levin, L.-Å. (2013). Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden. European Heart Journal, 34(3), 177-183
Open this publication in new window or tab >>Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden
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2013 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 3, p. 177-183Article in journal (Refereed) Published
Abstract [en]

Patients with atrial fibrillation have a significantly increased risk of thromboembolic events such as ischaemic stroke, and patients are therefore recommended to be treated with anticoagulation treatment. The most commonly used anticoagulant consists of vitamin K antagonist such as warfarin. A new oral anticoagulation treatment, dabigatran, has recently been approved for stroke prevention among patients with atrial fibrillation. The purpose of this study was to estimate the cost-effectiveness of dabigatran as preventive treatment of stroke and thromboembolic events compared with warfarin in 65-year-old patients with atrial fibrillation in Sweden. less thanbrgreater than less thanbrgreater thanA decision analytic simulation model was used to estimate the long-term (20-year) costs and effects of the different treatments. The outcome measures are the number of strokes prevented, life years gained, and quality-adjusted life years (QALYs) gained. Costs and effect data are adjusted to a Swedish setting. Patients below 80 years of age are assumed to start with dabigatran 150 mg twice a day and switch to 110 mg twice a day at the age of 80 years due to higher bleeding risk. The price of dabigatran in Sweden is Euro2.82 (Swedish kronor 25.39) per day for both doses. The cost per QALY gained for dabigatran compared with warfarin is estimated at Euro7742, increasing to Euro12 449 if dabigatran is compared with only well-controlled warfarin treatment. less thanbrgreater than less thanbrgreater thanDabigatran is a cost-effective treatment in Sweden, as its incremental cost-effectiveness ratio is below the normally accepted willingness to pay limit.

Place, publisher, year, edition, pages
Oxford University Press (OUP): Policy B, 2013
Keywords
Cost-effectiveness, Atrial fibrillation, Anticoagulants, Stroke
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-89523 (URN)10.1093/eurheartj/ehs157 (DOI)000313831000008 ()
Note

Funding Agencies|Boehringer Ingelheim||County council of Ostergotland, Sweden||Bayer||Bristol-Myers Squibb||Pfizer||

Available from: 2013-02-26 Created: 2013-02-26 Last updated: 2017-12-06
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