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Henriksson, Martin
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Siverskog, J. & Henriksson, M. (2019). Estimating the marginal cost of a life year in Sweden's public healthcare sector. European Journal of Health Economics
Open this publication in new window or tab >>Estimating the marginal cost of a life year in Sweden's public healthcare sector
2019 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601Article in journal (Refereed) Epub ahead of print
Abstract [en]

Although cost-effectiveness analysis has a long tradition of supporting healthcare decision-making in Sweden, there are no clear criteria for when an intervention is considered too expensive. In particular, the opportunity cost of healthcare resource use in terms of health forgone has not been investigated empirically. In this work, we therefore seek to estimate the marginal cost of a life year in Sweden's public healthcare sector using time series and panel data at the national and regional levels, respectively. We find that estimation using time series is unfeasible due to reversed causality. However, through panel instrumental variable estimation we are able to derive a marginal cost per life year of about SEK 370,000 (EUR 39,000). Although this estimate is in line with emerging evidence from other healthcare systems, it is associated with uncertainty, primarily due to the inherent difficulties of causal inference using aggregate observational data. The implications of these difficulties and related methodological issues are discussed.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Cost-effectiveness analysis, Healthcare expenditure, Life expectancy, Mortality, Opportunity cost, Threshold
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Economics
Identifiers
urn:nbn:se:liu:diva-155512 (URN)10.1007/s10198-019-01039-0 (DOI)30796552 (PubMedID)2-s2.0-85062020116 (Scopus ID)
Available from: 2019-03-20 Created: 2019-03-20 Last updated: 2019-03-27Bibliographically approved
Henriksson, M., Siverskog, J., Johannesen, K. & Eriksson, T. (2018). Tröskelvärden och kostnadseffektivitet: innebörd och implikationer för ekonomiska utvärderingar och beslutsfattande i hälso- och sjukvården. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Tröskelvärden och kostnadseffektivitet: innebörd och implikationer för ekonomiska utvärderingar och beslutsfattande i hälso- och sjukvården
2018 (Swedish)Report (Other academic)
Abstract [sv]

Resultaten från hälsoekonomiska utvärderingar redovisas oftast som en inkrementell kostnadseffektivitetskvot (ICER efter engelskans incremental cost-efectiveness ratio) vilken anger kostnaden per uppnådd effektenhet för den åtgärd som utvärderas. En åtgärd kan vara ett preventionsprogram, en diagnostisk metod eller en behandling i form av ett kirurgiskt ingrepp eller ett läkemedel (vi använder fortsättningsvis begreppet interventioner som ett samlingsnamn för alla dessa åtgärder). Vanligtvis används ett hälsorelaterat mått såsom kvalitetsjusterade levnadsår (QALYs) som effektmått. För att en ICER på ett meningsfullt sätt skall kunna tolkas och tillämpas i beslutsfattande krävs att vi har en uppfattning om vad resultaten representerar och vad de kan jämföras med. Inte sällan anges ett gräns-värde för när en intervention kan anses vara kostnadseffektiv i litteraturen, ett så kallat tröskelvärde för kostnadseffektivitet. Ambitiösa försök att skatta detta värde har nyligen presenterats och bidrar med ny kunskap på området. I ljuset av denna forskning är det också tydligt att det finns olika tolkningar av tröskelvärdet, vilket kan bidra till otydlighet i både beslutsfattande och diskussioner om vad som kan anses vara en rimlig gräns för kostnadseffektivitet. Syftet med föreliggande rapport är att beskriva olika tolkningar av tröskelvärdet, sammanfatta vilken empirisk kunskap vi har om detta värde idag och slutligen diskutera vidare forskning i en svensk kontext.

I rapporten illustreras de två huvudsakliga definitionerna av tröskelvärde som återfinns i litteraturen.

Konsumtionsvärdet av hälsa kan tänkas representera vad individer på marginalen är villiga att ge upp i konsumtion för att erhålla ytterligare en QALY. I den internationella litteraturen har detta värde kommit att benämnas v.

Marginalproduktiviteten i hälso- och sjukvårdssektorn kan tänkas representera kostnaden för att generera ytterligare en QALY på marginalen i hälso- och sjukvårdssektorn. Tröskelvärdet med denna tolkning bör utgöra kostnaden per QALY för den minst kostnadseffektiva interventionen som återfinns inom hälso- och sjukvårdssektorn. I den internationella litteraturen benämns detta värde k.

I rapporten diskuteras implikationerna av att använda de olika definitionerna i beslutsfattande samt hur de hänger ihop med alternativkostnader i olika delar av samhället. När en intervention tar resurser i anspråk som annars skulle ha använts till sjukvård är alternativkostnaden förlorad hälsa. Denna alternativkostnad kan representeras av marginalproduktiviteten i hälso- och sjukvårdssektorn, k. När en intervention tar resurser i anspråk som annars skulle ha använts för privat konsumtion är alternativ-kostnaden istället förlorad konsumtion, vilken kan representeras av konsumtionsvärdet av hälsa, v. Vilket perspektiv som anses relevant samt i vilken sektor konsekvenserna av olika interventioner upp-står bör därmed vara avgörande för vilken eller vilka definitioner av tröskelvärdet som kan behöva beaktas.

Empiriska studier har i större utsträckning försökt skatta konsumtionsvärdet av hälsa (v) jämfört med marginalproduktiviteten i hälso- och sjukvårdssektorn (k). Kunskapen om båda storheterna är begränsad ur ett svenskt perspektiv. En större studie från England utgör det första och mest ambitiösa försöket att explicit skatta tröskelvärdet ur ett marginalproduktivitetsperspektiv med hjälp av större data-material. I den studien skattades tröskelvärdet till en kostnad per QALY motsvarande ungefär 150 000 kronor. I ett försök att översätta dessa skattningar till tröskelvärden i andra länder redovisas en kostnad per QALY i intervallet 170 000 till 210 000 kronor för Sverige. Skattningarna får anses vara behäftade med en hög grad av osäkerhet. Nyligen publicerade studier från Australien och Spanien redovisar skattningar motsvarande 185 00 och 250 000 kronor per QALY. I studier som undersökt konsumtions-värdet av hälsa redovisas skattningar på 30 000 till flera miljoner kronor per QALY.

En stor del av variationen i resultaten kan troligtvis hänföras till metodologiska aspekter. Studierna varierar i flera dimensioner; praktisk undersökningsmetod (online, intervjuer eller pappersenkäter), utformning av svarsalternativ, statistiska metoder för att analysera data, typ av hälsoförändring som värderats (enbart livskvalitet, enbart livslängd eller en kombination), om värderade hälsoförändringar uppnås med säkerhet eller med en viss sannolikhet samt om hälsoförändringen som värderas tillfaller respondenten själv eller någon annan. Få studier med data från svenska individer där generella hälso-förändringar värderats av ett urval från allmänheten har identifierats. Den enda studien som vi identifierat i referentgranskade tidskrifter redovisar skattningarna för Sverige i intervallet 150 000 till 350 000 kronor. I en relativt ny svensk rapport som finns tillgänglig på Institutet för Hälso- och Sjukvårds-ekonomis (IHE) hemsida redovisas skattningar på 2,4 miljoner kronor per QALY.

En slutsats i vår rapport är att det behöver tydliggöras hur valet av perspektiv faktiskt påverkar vilken eller vilka definitioner av tröskelvärdet som bör vara relevanta när hälsoekonomiska utvärderingar används som underlag vid beslutsfattande inom hälso- och sjukvården. Om ett bredare samhällsperspektiv anses relevant kan både konsumtionsvärdet av hälsa (v) och marginalproduktiviteten i hälso- och sjukvården (k) behöva beaktas.

En annan slutsats är att oavsett vilken definition av tröskelvärde som anses relevant så har vi mycket begränsad kunskap om både marginalproduktiviteten i hälso- och sjukvårdssektorn och konsumtions-värdet av hälsa i en svensk kontext. Statistisk modellering av befintliga datakällor kan vara en fram-komlig väg för att skatta marginalproduktiviteten medan välgjorda experiment eller metoder för att studera individers värderingar av hälsa via faktiska beslut och ageranden i icke-experimentella situationer kan vara en framkomlig väg för att studera konsumtionsvärdet av hälsa.

Abstract [en]

The results of health economic evaluations are often reported as an incremental cost-effectiveness ratio (ICER) indicating the additional cost in relation to the additional benefit of providing the health care technology under evaluation compared with a relevant alternative. The health care technology may be a prevention program, a diagnostic method, a surgical procedure or a pharmaceutical treatment (henceforth we refer to interventions as a general term for all health care technologies). Commonly, benefits are measured in health-related outcomes such as the quality-adjusted life year (QALY). To interpret and operationalize ICERs in health care decision making, they have to be compared with some benchmark value. This value of a QALY when an intervention can be interpreted as being cost-effective is often referred to as the cost-effectiveness threshold in the literature. Ambitious attempts to estimate this threshold value have recently been reported, contributing with new knowledge in the field. In light of this research it is also evident that there are different interpretations of the threshold and different views regarding what the threshold should represent. Different interpretations may lead to different policy conclusions as well as diverging interpretations of cost-effectiveness. The aim of this report is to describe different interpretations of the cost-effectiveness threshold, summarize the empirical evidence, and discuss the threshold and further research in a Swedish context. In the report, the two main definitions of cost-effectiveness thresholds appearing in the literature are covered. One definition of the threshold is the consumption value of health, or the willingness to pay for health, and may represent what individuals on the margin are willing to forego in consumption in order to obtain an additional QALY. This definition is sometimes referred to as a demand side threshold, and has been dubbed v in the literature. Another definition of the threshold is based on the productivity of the health care sector and is some-times referred to as the supply side threshold, dubbed k in the literature. With this approach, estimates of the marginal productivity of the health care sector can indicate if a new intervention generates more health than is expected to be forgone when displacing other health care (to fund the new intervention). In principle, the cost-effectiveness threshold with this definition should be the cost per QALY gained of the least cost-effective intervention still funded within the health care system. The implications of a wider societal perspective (including non-health care sectors) for the two definitions of the cost-effectiveness threshold are discussed in the report. It is argued that the marginal productivity of the health care sector always has to be considered if some opportunity costs of a new intervention fall on the health care sector. When opportunity costs of a new intervention in the health care sector fall on private consumption, the consumption value of health may also have to be considered. The answer to the question of which definition of the cost-effectiveness threshold is more appropriate or relevant is therefore that it depends on the perspective deemed relevant as well as where the opportunity costs are expected to fall. Empirical studies have to a larger extent focussed on estimating the consumption value of health (v) compared with the marginal productivity of the health care sector (k). Regarding estimates of both v and k, the empirical evidence regarding a Swedish context is limited. An English study is, as far as we are aware, the first attempt to explicitly estimate k based on large scale data. In this study, the cost-effectiveness threshold was estimated at a cost per QALY of £13,000. In an attempt to translate this estimate to a Swedish setting, a cost per QALY in the interval $21,000 to $27,000 has been presented. Studies attempting to estimate v report estimates of 30,000 to several million Swedish kronor.

Much of the variation in results appears to be explained by methodological differences in the studies including: study design (online, interviews or surveys), response alternatives, statistical methods for analysing data, type of health evaluated (length of life, quality of life or both), certainty in evaluated health change, and whether the evaluated health change will be obtained by the respondent or someone else. Estimates of v in a Swedish setting are scarce when a general health change has been valued by a sample of the general public. The only identified study in the peer-reviewed literature with respondents from Sweden reports estimates in the interval 150,000 to 350,000 Swedish kronor. In a recent report available from the Swedish Institute for Health Economics (IHE) an estimated cost per QALY of 2.4 million is reported. It is concluded in the report that it is not possible to determine which definition of the cost-effective-ness threshold is most relevant or appropriate for health care decision making unless the purpose of the health care sector, and the relevant perspective are defined first. It is further concluded that regardless of the definition of the threshold, the empirical knowledge of marginal productivity of the health care sector (k) as well as the consumption value of health (v) is limited in a Swedish context. Further empirical studies are needed on both. Statistical modelling of available statistical resources may be a feasible approach for estimating the marginal productivity, while well conducted experiments, or methods to study revealed preferences by observing behaviour of individuals in real-life decision making may be feasible approaches for estimating the consumption value of health.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 37
Series
CMT Report, ISSN 0283-1228, E-ISSN 1653-7556 ; 2018:3
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-153141 (URN)
Available from: 2018-11-30 Created: 2018-11-30 Last updated: 2018-11-30
Johannesen, K. & Henriksson, M. (2017). Getting value today and incentivising for the future: Pharmaceutical development and healthcare policies. Nordic Journal of Health Economics, 5(1), 77-96
Open this publication in new window or tab >>Getting value today and incentivising for the future: Pharmaceutical development and healthcare policies
2017 (English)In: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 5, no 1, p. 77-96Article, review/survey (Refereed) Published
Abstract [en]

To manage the challenge of limited healthcare resources and unlimited demand for healthcare, decision makers utilise a variety of demand side policies, such as health technology appraisals and international reference pricing to regulate price and utilisation. By controlling price and utilisation demand side policies determine the earnings potential, and hence the incentives to invest in research and development (R&D) of new technologies. However, the impact of demand side policies on R&D incentives is seldom formally assessed. Based on the key assumption that intellectual property rights, i.e. patents, and expected rent are key drivers of pharmaceutical R&D, this work outlines a framework illustrating the link between demand side policies and pharmaceutical R&D incentives. By analysing how policies impact expected rent and consumer surplus, the framework is used to understand how commonly used demand side policies (including timing and length of reimbursement process, international reference pricing, parallel trade, and sequential adoption into clinical practice) may influence R&D incentives. The analysis demonstrates that delayed reimbursement decisions as well as sequential adoption into clinical practise may in fact reduce both expected rent and consumer surplus. It is also demonstrated how international reference pricing is likely to increase consumer surplus at the expense of lower rent and thus lower R&D incentives. Although this work illustrates the importance of considering how demand side policies may impact long-term R&D incentives, it is important to note that the purpose has not been to prescribe which demand side policies should be utilised or how. Rather, the main contribution is to illustrate the need for a structured approach to the analysis of the complex, and at times highly politicised question of how demand side policies ultimately influence population health, both in the short and in the long term.

Place, publisher, year, edition, pages
University of Oslo, 2017
Keywords
pharmaceutical market, pharmaceutical regulation, R&D incentives, intellectual property rights
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-154061 (URN)10.5617/njhe.888 (DOI)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-07
Henriksson, M., Jindal, R., Sternhufvud, C., Bergenheim, K., Sorstadius, E. & Willis, M. (2016). A Systematic Review of Cost-Effectiveness Models in Type 1 Diabetes Mellitus. PharmacoEconomics (Auckland), 34(6), 569-585
Open this publication in new window or tab >>A Systematic Review of Cost-Effectiveness Models in Type 1 Diabetes Mellitus
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2016 (English)In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 34, no 6, p. 569-585Article, review/survey (Refereed) Published
Abstract [en]

Critiques of cost-effectiveness modelling in type 1 diabetes mellitus (T1DM) are scarce and are often undertaken in combination with type 2 diabetes mellitus (T2DM) models. However, T1DM is a separate disease, and it is therefore important to appraise modelling methods in T1DM. This review identified published economic models in T1DM and provided an overview of the characteristics and capabilities of available models, thus enabling a discussion of best-practice modelling approaches in T1DM. A systematic review of Embase(A (R)), MEDLINEA (R), MEDLINEA (R) In-Process, and NHS EED was conducted to identify available models in T1DM. Key conferences and health technology assessment (HTA) websites were also reviewed. The characteristics of each model (e.g. model structure, simulation method, handling of uncertainty, incorporation of treatment effect, data for risk equations, and validation procedures, based on information in the primary publication) were extracted, with a focus on model capabilities. We identified 13 unique models. Overall, the included studies varied greatly in scope as well as in the quality and quantity of information reported, but six of the models (Archimedes, CDM [Core Diabetes Model], CRC DES [Cardiff Research Consortium Discrete Event Simulation], DCCT [Diabetes Control and Complications Trial], Sheffield, and EAGLE [Economic Assessment of Glycaemic control and Long-term Effects of diabetes]) were the most rigorous and thoroughly reported. Most models were Markov based, and cohort and microsimulation methods were equally common. All of the more comprehensive models employed microsimulation methods. Model structure varied widely, with the more holistic models providing a comprehensive approach to microvascular and macrovascular events, as well as including adverse events. The majority of studies reported a lifetime horizon, used a payer perspective, and had the capability for sensitivity analysis. Several models have been developed that provide useful insight into T1DM modelling. Based on a review of the models identified in this study, we identified a set of best in class methods for the different technical aspects of T1DM modelling.

Place, publisher, year, edition, pages
ADIS INT LTD, 2016
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:liu:diva-129148 (URN)10.1007/s40273-015-0374-8 (DOI)000376104800004 ()26792792 (PubMedID)
Note

Funding Agencies|AstraZeneca

Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2018-01-10
Geale, K., Henriksson, M. & Schmitt-Egenolf, M. (2016). Evaluating equality in psoriasis healthcare: a cohort study of the impact of age on prescription of biologics. British Journal of Dermatology, 174(3), 579-587
Open this publication in new window or tab >>Evaluating equality in psoriasis healthcare: a cohort study of the impact of age on prescription of biologics
2016 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 174, no 3, p. 579-587Article in journal (Refereed) Published
Abstract [en]

Background Inequality in healthcare has been identified in many contexts. To the best of our knowledge, this is the first study investigating age inequality in the form of prescription patterns of biologics in psoriasis care. Objectives To determine whether patients with psoriasis have equal opportunities to receive biological medications as they age. If patients did not receive equal treatment, a subsequent objective was to determine the magnitude of the disparity. Methods A cohort of biologic-naive patients with psoriasis was analysed using Cox proportional hazards models to measure the impact of each additional year of life on the likelihood of initiating biological treatment, after controlling for sex, body mass index, comorbidities, disease activity and educational level. A supporting analysis used a nonparametric graphical method to study the proportion of patients initiating biological treatment as age increased, after controlling for the same covariates. Results The Cox proportional hazards model resulted in hazard ratios of a 1-year increase in age of 0.96-0.97 depending on calendar-year stratification, which implies that an increase in age of 30 years corresponds to a reduced likelihood of initiating biological treatment by 61.3-67.6%. The estimated proportion of patients initiating biological medication always decreased as age increased, at a statistically significant level. Conclusions Patients with psoriasis have fewer opportunities to access biological medications as they age. This result was shown to be applicable at all stages in a patients life course and was not only restricted to the elderly, although it implies greater disparities as the age difference between patients increases. These results show that inequality in access to biological treatments due to age is prevalent in clinical practice today. Further research is needed to investigate the extent to which this result is influenced by patient preferences.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127277 (URN)10.1111/bjd.14331 (DOI)000372805100027 ()26616003 (PubMedID)
Note

Funding Agencies|Swedish Board of Health and Welfare; Swedish Association of Local Authorities and Regions; Vasterbotten County Council

Available from: 2016-04-20 Created: 2016-04-19 Last updated: 2017-11-30
Janzon, M., Henriksson, M., Hasvold, P., Hjelm, H., Thuresson, M. & Jernberg, T. (2016). Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting - results from a contemporary nationwide registry study. European Heart Journal - Quality of Care and Clinical Outcomes, 2, 291-298
Open this publication in new window or tab >>Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting - results from a contemporary nationwide registry study
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2016 (English)In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, Vol. 2, p. 291-298Article in journal (Refereed) Published
Abstract [en]

Aims Long-term contemporary nationwide data on resource use and healthcare costs after myocardial infarction (MI) in a clinical practice setting are not widely studied, and the aim of this study was to investigate resource use patterns and healthcare costs in patients with MI in a nationwide clinical practice setting.

Methods and results This retrospective cohort study included all patients identified in the compulsory Swedish nationwide patient register with a diagnosis of MI between 1 July 2006 and 30 June 2011. Cardiovascular hospitalization and outpatient visits data from the patient register were combined with data from the cause of death register and the drug utilization register. For a subset of patients, data were also available from a primary care register. Healthcare resource use patterns and annual costs [reported in 2014 euros (€) converted from Swedish kronor (SEK) using the exchange rate €1 = SEK 9.33)] were estimated for the year prior to the occurrence of MI as well as for a maximum follow-up period of 6 years post-MI. The study included 97 252 patients with a diagnosis of MI with a total number of 285 351 observation years. The majority of healthcare consumption occurred within the first year of MI where patients were on average hospitalized 1.55 times, made 1.08 outpatient care visits, and 3.80 primary care visits. In the long term, for the majority of resource use categories, average consumption was higher in the years after MI compared with the year prior to MI. Healthcare costs at 6 years of follow-up were approximately €20 000 of which €12 460 occurred in the first year, and the major part was attributed to hospitalizations.

Conclusion For patients with 6 years of follow-up after MI, healthcare costs were approximately €20 000. The major part of costs occurred in the first year after MI and was driven by hospitalizations

Place, publisher, year, edition, pages
European Society of Cardiology, 2016
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:liu:diva-130049 (URN)10.1093/ehjqcco/qcw019 (DOI)
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2017-03-01
Henriksson, M. (Ed.). (2016). Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson
2016 (Swedish)Collection (editor) (Other academic)
Abstract [sv]

Under alla år som jag arbetat med hälsoekonomi har Per Carlsson funnits närvarande. Mest intensivt som handledare under mina år som doktorand. När jag lärde känna Per år 2000 kom jag som nybakad nationalekonom till dåvarande CMT med en ganska snävt definierad nyttofunktion där fotboll var ett av de absolut dominerande attributen. Det har egentligen inte ändrats radikalt, men definitivt nyanserats en del under åren och det är delvis tack vare Per. Idol kan låta lite drastiskt, jag sprang inte omkring och bad om autografer eller att få fotas tillsammans med Per, men det är helt klart så att Per blev den första personen i min yrkeskarriär som jag med stor beundran såg upp till på ungefär samma sätt som man tidigare enbart gjort med sina idoler på fotbollsplanen. Med klokskap, sunt förnuft och en otrolig förmåga att hela tiden se de lite bredare sammanhangen blev han inte bara ett ovärderligt stöd i mitt eget arbete utan också en stor förebild mer generellt.

När det nu är dags för Per att trappa ner efter en lång och framgångsrik yrkeskarriär i akademins och hälso- och sjukvårdspolicyns tjänst kändes det både självklart och naturligt att försöka bidra med en bestående hyllning. Glädjande nog var vi många som delade den tanken och resultatet blev den antologi med samlade reflektioner som du nu håller i din hand. Bidragen spänner över ett brett fält från teorier om livskvalitet till praktiskt prioriteringsarbete och är talande för den bredd som genomsyrat Pers karriär. Vidare kan man säga att bidragen också kronologiskt inkluderar hela Pers era inom området då vi inleder med Bengt Jönsson som var handledare till Per och avslutar med Johanna Wiss som snart disputerar med Per som handledare.

Jag vill självklart också rikta ett stort tack till alla författare som bidragit till skriften. Den ger förhoppningsvis Per en möjlighet att reflektera över en livslång gärning inom akademi och hälso- och sjukvårdspolicy när det blir lite tid över i hängmattan framöver. Skriften ger också en bred populärvetenskaplig introduktion till aspekter som berör prioriteringar, utvärderingar, implementering och hälsoekonomi och det är min förhoppning att den kan uppskattas av alla som har intresse av dessa frågor.

Martin Henriksson

Maj 2016

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. p. 105
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-129521 (URN)9789176857441 (ISBN)
Note

Med bidrag från: Malin Andre, Eva Arvidsson, Lars Borgquist, Karin Bäckman, Niklas Ekerstad, Peter Garpenby, Martin Henriksson, Bengt Jönsson, Almina Kalkan, Barbro Krevers, Lars-Åke Levin, Lennart Nordenfelt, Kerstin Roback, Lars Sandman, Gustav Tinghög, Johanna Wiss

Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-01-10Bibliographically approved
Jernberg, T., Hasvold, P., Henriksson, M., Hjelm, H., Thuresson, M. & Janzon, M. (2015). Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.. European Heart Journal, 36(19), 1163-1170
Open this publication in new window or tab >>Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.
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2015 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 19, p. 1163-1170Article in journal (Refereed) Published
Abstract [en]

AIMS: Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.

METHODS AND RESULTS: This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.

CONCLUSIONS: Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-119668 (URN)10.1093/eurheartj/ehu505 (DOI)000356185300014 ()25586123 (PubMedID)
Available from: 2015-06-24 Created: 2015-06-24 Last updated: 2017-12-04
Janzon, M., James, S., Cannon, C. P., Storey, R. F., Mellström, C., Nicolau, J. C., . . . Henriksson, M. (2015). Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy. Heart, 101(2), 119-25
Open this publication in new window or tab >>Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy
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2015 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 101, no 2, p. 119-25Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management.

METHODS: A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems.

RESULTS: Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability.

CONCLUSIONS: Treatment of patients with ACS scheduled for 12 months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel.

TRIAL REGISTRATION NUMBER: NCT000391872.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113396 (URN)10.1136/heartjnl-2014-305864 (DOI)000347459800008 ()25227704 (PubMedID)
Available from: 2015-01-17 Created: 2015-01-17 Last updated: 2017-12-05
Sabale, U., Bodegard, J., Sundstrom, J., Östgren, C. j., Nilsson, P., Johansson, G., . . . Henriksson, M. (2015). Healthcare utilization and costs following newly diagnosed type-2 diabetes in Sweden: A follow-up of 38,956 patients in a clinical practice setting. Primary Care Diabetes, 9(5), 330-337
Open this publication in new window or tab >>Healthcare utilization and costs following newly diagnosed type-2 diabetes in Sweden: A follow-up of 38,956 patients in a clinical practice setting
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2015 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 9, no 5, p. 330-337Article in journal (Refereed) Published
Abstract [en]

Aims: To describe healthcare resource use patterns and estimate healthcare costs of newly diagnosed Type 2 diabetes mellitus (T2DM) patients in Sweden. Methods: Patients with a newly diagnosed T2DM between 1999 and 2009 were identified from 84 Swedish primary care centres. Healthcare resource use data, excluding pharmaceuticals, were extracted from electronic patient records and a national patient register, and reported as per patient mean number of primary care contacts, laboratory tests and hospitalizations. Per patient mean healthcare costs are reported as annual and cumulative costs. Results: During a median (maximum) of 4.6 (9.0) years follow-up; 38,956 patients (183,513 patient years) on average made 81 primary care contacts, was hospitalized 2.14 times, and took 31 laboratory tests. Mean per patient annual healthcare costs were (sic)4128 (95% CI, 4054-4199) the first year after diagnosis, (sic)2708 (95% CI, 2641-2776) the second year, and (sic)3030 (95% CI, 2854-3204) in year 9 (2012 values). Mean per patient cumulative healthcare costs were (sic)26,503 (95% CI, 26,025-26,970) at 9 years of follow-up. Hospitalizations accounted for the majority of healthcare costs. Conclusions: Although newly diagnosed T2DM patients require a substantial amount of healthcare services in primary care, hospitalizations account for the majority of healthcare costs. (C) 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2015
Keywords
Type 2 diabetes mellitus; Healthcare utilization; Healthcare costs; Retrospective observational study
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-122105 (URN)10.1016/j.pcd.2015.01.001 (DOI)000361868100002 ()25631469 (PubMedID)
Note

Funding Agencies|AstraZeneca

Available from: 2015-10-19 Created: 2015-10-19 Last updated: 2017-12-01
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