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Hallert, Eva
Publications (10 of 31) Show all publications
Hallert, E., Husberg, M., Kalkan, A. & Bernfort, L. (2016). Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996-98 and 2006-09. Scandinavian Journal of Rheumatology, 45(5), 371-378
Open this publication in new window or tab >>Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996-98 and 2006-09
2016 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 45, no 5, p. 371-378Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

To calculate total costs during the first year after diagnosis in 463 patients with early rheumatoid arthritis (RA) included during 2006-09 (T2) and compare the results with a similar cohort included in 1996-98 (T1).

METHOD:

Clinical and laboratory data were collected regularly in both cohorts, and patients completed biannual questionnaires reporting health care utilization and number of days lost from work.

RESULTS:

Disease activity was similar in both cohorts T1 and T2 at inclusion. Significant improvements were seen during the first year in both cohorts but were more pronounced in T2. Outpatient care increased and hospitalization decreased in T2 compared with T1. Almost 3% of patients had surgery in both cohorts, but in T2, only women had surgery. Drug costs were higher in T2 than in T1 (EUR 689 vs. EUR 435). In T2, 12% of drug costs were direct costs and 4% were total costs. The corresponding values for T1 were 9% and 3%. In T1, 50% were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion, compared to T2, where prescription was > 90%. Direct costs were EUR 5716 in T2 and EUR 4674 in T1. Costs for sick leave were lower in T2 than in T1 (EUR 5490 vs. EUR 9055) but disability pensions were higher (EUR 4152 vs. EUR 2139), resulting in unchanged total costs. In T1, direct costs comprised 29% and indirect costs 71% of the total costs. The corresponding values for T2 were 37% and 63%.

CONCLUSIONS:

The earlier and more aggressive treatment of RA with traditional DMARDs in T2 resulted in better outcomes compared to T1. Direct costs were higher in T2, partly offset by decreased sick leave, but total costs remained unchanged.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016
National Category
Rheumatology and Autoimmunity Dermatology and Venereal Diseases Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-126395 (URN)10.3109/03009742.2015.1126344 (DOI)000383010700005 ()26854719 (PubMedID)
Note

Funding agencies: Medical Research County Council of South-East Sweden (FORSS); County Council in Ostergotland

Available from: 2016-03-23 Created: 2016-03-23 Last updated: 2017-05-03
Hallert, E., Husberg, M., Kalkan, A., Rahmqvist, M., Skogh, T. & Bernfort, L. (2015). Changes in sociodemographic characteristics at baseline in two Swedish cohorts of patients with early rheumatoid arthritis diagnosed 1996-98 and 2006-09. Scandinavian Journal of Rheumatology, 44(2), 100-105
Open this publication in new window or tab >>Changes in sociodemographic characteristics at baseline in two Swedish cohorts of patients with early rheumatoid arthritis diagnosed 1996-98 and 2006-09
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, p. 100-105Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare baseline sociodemographic characteristics in two rheumatoid arthritis (RA) cohorts enrolled 10 years apart, and to examine differences with respect to the general population. Method: Clinical and sociodemographic data were collected in 320 early RA patients during 1996-98 (TIRA-1) and 467 patients in 2006-09 (TIRA-2). Multivariate logistic regression tests were performed and intercohort comparisons were related to general population data, obtained from official databases. Results: TIRA-2 patients were older than TIRA-1 (58 vs. 56 years). Women (both cohorts, 67%) were younger than men in TIRA-1 (55 vs. 59 years) and in TIRA-2 (57 vs. 61 years). Disease activity was similar but TIRA-2 women scored worse pain and worse on the HAQ. Approximately 73% were cohabiting, in both cohorts and in the general population. Education was higher in TIRA-2 than in TIRA-2 but still lower than in the general population. Women had consistently higher education than men. Education was associated with age, younger patients having higher education. In both cohorts, lower education was associated with increased disability pension and increased sick leave. Sick leave was lower in TIRA-2 than in TIRA-1 (37% vs. 50%) but disability pension was higher (16% vs. 10%). In TIRA-1, 9% of women had disability pension compared with 17% in TIRA-2. A similar decrease in sick leave and an increase in disability pension were also seen in the general population. Older age and a higher HAQ score were associated with increased sick leave and being in the TIRA-2 cohort was associated with decreased sick leave. Conclusions: TIRA-2 patients were slightly older, better educated, had lower sick leave and higher disability pension than those in TIRA-1. Similar changes were seen simultaneously in the general population. Belonging to the TIRA-2 cohort was associated with decreased sick leave, indicating that societal changes are of importance.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-117271 (URN)10.3109/03009742.2014.930926 (DOI)000351182100003 ()25352338 (PubMedID)
Note

Funding Agencies|Norrbacka-Eugenia Foundation; Medical Research County Council of South-East Sweden (FORSS); County Council in Ostergotland; Swedish Rheumatism Association

Available from: 2015-04-22 Created: 2015-04-21 Last updated: 2018-01-11
Kalkan, A., Hallert, E., Carlsson, P., Roback, K. & Sjöwall, C. (2015). Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis. Scandinavian Journal of Rheumatology, 44(4), 265-270
Open this publication in new window or tab >>Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, p. 265-270Article in journal (Refereed) Published
Abstract [en]

Objective: In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs, despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objective was to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices.

Methods: Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (YES/NO) and to explain their decisions.

Results: The response rate was 26/105; 25%. Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the ten hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decision to prescribe biologics, as well as not to prescribe, were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or social function of the patient.

Conclusion: The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practising at the same clinic. Treatment choices were primarily motivated by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113301 (URN)10.3109/03009742.2014.997286 (DOI)000359960100002 ()
Note

DOI does not work: 10.3109/03009742.2014.997286

Available from: 2015-01-15 Created: 2015-01-15 Last updated: 2018-12-13Bibliographically approved
Kalkan, A., Husberg, M., Hallert, E., Roback, K., Thyberg, I., Skogh, T. & Carlsson, P. (2015). Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden. Arthritis care & research, 67(12), 1679-1685
Open this publication in new window or tab >>Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden
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2015 (English)In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 67, no 12, p. 1679-1685Article in journal (Refereed) Published
Abstract [en]

Objective. The prescription of biologic drugs for rheumatoid arthritis (RA) patients has varied considerably across different regions. Previous studies have shown physician preferences to be an important determinant in the decision to select biologic disease-modifying antirheumatic drugs (bDMARDs) rather than nonbiologic, synthetic DMARDs (sDMARDs) alone. The aim of this study was to test the hypothesis that physician preferences are an important determinant for prescribing bDMARDs for RA patients in Sweden. Methods. Using data from the Swedish Rheumatology Quality Register, we identified 4,010 RA patients who were not prescribed bDMARDs during the period 2008-2012, but who, on at least 1 occasion, had an sDMARD prescription and changed treatment for the first time to either a new sDMARD or a bDMARD. Physician preference for the use of bDMARDs was calculated using data on each physicians prescriptions during the study period. The relationship between prescription of a bDMARD and physician preference, controlling for patient characteristics, disease activity, and the physicians local context was evaluated using multivariate logistic regression. Results. When adjusting for patient characteristics, disease activity, and the physicians local context, physician preference was an important predictor for prescription of bDMARDs. Compared with patients of a physician in the lowest preference tertile, patients of physicians in the highest and middle tertiles had an odds ratio for receiving bDMARDs of 2.8 (95% confidence interval [95% CI] 2.13-3.68) and 1.28 (95% CI 1.05-1.57), respectively. Conclusion. Physician preference is an important determinant for prescribing bDMARDs.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-124498 (URN)10.1002/acr.22640 (DOI)000367681900008 ()26097219 (PubMedID)
Note

Funding Agencies|Norrbacka-Eugenia Foundation; Swedish Rheumatism Association

Available from: 2016-02-02 Created: 2016-02-01 Last updated: 2017-11-30
Kalkan, A., Hallert, E., Bernfort, L., Husberg, M. & Carlsson, P. (2014). Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden. Rheumatology, 53(1), 153-160
Open this publication in new window or tab >>Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden
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2014 (English)In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 53, no 1, p. 153-160Article in journal (Refereed) Published
Abstract [en]

Objectives. The objectives of this study were to analyse the total socio-economic impact of RA in Sweden during the period 1990–2010 and to analyse possible changes in costs during this period. The period was deliberately chosen to cover 10 years before and 10 years after the introduction of biologic drugs.

Methods. A prevalence-based cost-of-illness study was conducted based on data from national and regional registries.

Results. There was a decrease in the utilization of RA-related inpatient care as well as sick leave and disability pension during 1990–2010 in Sweden. Total costs for RA are presented in current prices as well as inflation-adjusted with the consumer price index (CPI) and a healthcare price index. The total fixed cost of RA was €454 million in 1990, adjusted to the price level of 2010 with the CPI. This cost increased to €600 million in 2010 and the increase was mainly due to the substantially increasing costs for pharmaceuticals. Of the total costs, drug costs increased from 3% to 33% between 1990 and 2010. Consequently the portion of total costs accounting for indirect costs for RA is lowered from 75% in 1990 to 58% in 2010.

Conclusion. By inflation adjusting with the CPI, which is reasonable from a societal perspective, there was a 32% increase in the total fixed cost of RA between 1990 and 2010. This suggests that decreased hospitalization and indirect costs have not fallen enough to offset the increasing cost of drug treatment.

Place, publisher, year, edition, pages
Oxford University Press, 2014
National Category
Medical and Health Sciences Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-100004 (URN)10.1093/rheumatology/ket290 (DOI)000329041900022 ()24136064 (PubMedID)
Available from: 2013-10-24 Created: 2013-10-24 Last updated: 2017-12-06Bibliographically approved
Hallert, E., Husberg, M., Kalkan, A., Skogh, T. & Bernfort, L. (2014). Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project. Scandinavian Journal of Rheumatology, 43(3), 177-183
Open this publication in new window or tab >>Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project
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2014 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 43, no 3, p. 177-183Article in journal (Refereed) Published
Abstract [en]

Objectives: To calculate total costs over 6 years after diagnosis of early rheumatoid arthritis (RA).

Method: In the longitudinal prospective multicentre TIRA study, 239 patients from seven units, diagnosed in 1996–98, reported regularly on health-care utilization and the number of days lost from work. Costs were obtained from official databases and calculated using unit costs (Swedish kronor, SEK) from 2001. Indirect costs were calculated using the human capital approach (HCA). Costs were inflation adjusted to Euro June 2012, using the Swedish Consumer Price Index and the exchange rate of June 2012. Statistical analyses were based on linear mixed models (LMMs) for changes over time.

Results: The mean total cost per patient was EUR 14 768 in year 1, increasing to EUR 18 438 in year 6. Outpatient visits and hospitalization decreased but costs for surgery increased from EUR 92/patient in year 1 to EUR 444/patient in year 6. Drug costs increased from EUR 429/patient to EUR 2214/patient, mainly because of the introduction of biologics. In year 1, drugs made up for 10% of direct costs, and increased to 49% in year 6. Sick leave decreased during the first years but disability pensions increased, resulting in unchanged indirect costs. Over the following years, disability pensions increased further and indirect costs increased from EUR 10 284 in year 1 to EUR 13 874 in year 6. LMM analyses showed that indirect costs were unchanged whereas direct costs, after an initial fall, increased over the following years, leading to increasing total costs.

Conclusions: In the 6 years after diagnosis of early RA, drug costs were partially offset by decreasing outpatient visits but indirect costs remained unchanged and total costs increased.

 

Place, publisher, year, edition, pages
Informa Healthcare, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105634 (URN)10.3109/03009742.2013.835442 (DOI)000335512300001 ()24354438 (PubMedID)
Available from: 2014-03-31 Created: 2014-03-31 Last updated: 2017-12-05
Kalkan, A., Roback, K., Hallert, E. & Carlsson, P. (2014). Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study. Implementation Science, 9(153)
Open this publication in new window or tab >>Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study
2014 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 9, no 153Article in journal (Refereed) Published
Abstract [en]

Background: The introduction of biological drugs involved a fundamental change in the treatment of rheumatoid arthritis (RA). The extent to which biological drugs are prescribed to RA patients in different regions in Sweden varies greatly. Previous research has indicated that differences in health care practice at the regional level might obscure differences at the individual level. The objective of this study is to explore what influences individual rheumatologists decisions when prescribing biological drugs. Method: Semi-structured interviews, utilizing closed-and open-ended questions, were conducted with senior rheumatologists, selected through a mix of random and purposive sampling. The interview questions consisted of two parts, with a "parallel mixed method" approach. In the first and main part, open-ended exploratory questions were posed about factors influencing prescription. In the second part, the rheumatologists were asked to rate predefined factors that might influence their prescription decisions. The Consolidated Framework for Implementation Research (CFIR) was used as a conceptual framework for data collection and analysis. Results: Twenty-six rheumatologists were interviewed. A constellation of various factors and their interaction influenced rheumatologists prescribing decisions, including the individual rheumatologists experiences and perceptions of the evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participation in clinical trials. The patient as an actor emerged as an important factor. Hence, factors both at organizational and individual levels influenced the prescribing of biological drugs. The factors should not be seen as individual influences but were described as influencing prescription in an interactive, nonlinear way. Conclusions: Potential factors explaining differences in prescription practice are experience and perception of the evidence on the individual level and the structure of the department and participation in clinical trials on the organizational level. The influence of patient attitudes and preferences and interpretation of scientific evidence seemed to be somewhat contradictory in the qualitative responses as compared to the quantitative rating, and this needs further exploration. An implication of the present study is that in addition to scientific knowledge, attempts to influence prescription behavior need to be multifactorial and account for interactions of factors between different actors.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Prescription; Rheumatoid arthritis; Biological drugs; Implementation; Physicians; Clinical decision-making; Practice variations; Qualitative; CFIR
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113028 (URN)10.1186/s13012-014-0153-5 (DOI)000345438200001 ()25304517 (PubMedID)
Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2017-12-05
Hallert, E., Husberg, M. & Bernfort, L. (2013). Hälsoekonomiska bedömningar i samband med behandling av RA. BestPractice Reumatologi (14), 6-9
Open this publication in new window or tab >>Hälsoekonomiska bedömningar i samband med behandling av RA
2013 (Swedish)In: BestPractice Reumatologi, ISSN 1903-6590, no 14, p. 6-9Article in journal (Other academic) Published
Abstract [sv]

Slutsats Sjukvårdens andel av BNP ligger väsentligen oförändrad samtidigt som dyrare behandlingsmöjligheter introduceras på marknaden. Detta skapar ett behov av att fasa ut ineffektiva tekniker samt att motivera om nya metoder är kostnadseffektiva och om de ska subventioneras av samhället. Hälsoekonomiska studier får således en allt större betydelse och det är oerhört viktigt att kunna tolka dessa analyser utifrån hur data använts och på vilket sätt data har analyserats. Det är också alldeles nödvändigt att relatera effekter och nytta av en specifik intervention/teknik till förändringar i samhället. Exempelvis kan sjukskrivning och sjukersättning/förtidspension vara ett effektmått på nyttan av en specifik insats, men kan i lika hög grad spegla effekter av konjunkturläge, arbetslöshet och förändringar i sjukförsäkringssystemet. Detta bör således alltid tas med i beräkningen, eftersom dessa variabler samvearierar i mycket hög grad.

Place, publisher, year, edition, pages
Ballerup, Danmark: BestPractice ApS., 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-90391 (URN)
Available from: 2013-03-25 Created: 2013-03-25 Last updated: 2013-10-14
Hallert, E., Husberg, M., Kalkan, A., Rahmqvist, M., Skogh, T. & Bernfort, L. (2013). Socioeconomic and demographic characteristics among two cohorts of patients with early rheumatoid arthritis in Sweden, enrolled 1996-98 and 2006-09.. In: : . Paper presented at Annual European Congress of Rheumatology (EULAR), Barcelona 2013.
Open this publication in new window or tab >>Socioeconomic and demographic characteristics among two cohorts of patients with early rheumatoid arthritis in Sweden, enrolled 1996-98 and 2006-09.
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2013 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-98256 (URN)
Conference
Annual European Congress of Rheumatology (EULAR), Barcelona 2013
Available from: 2013-10-04 Created: 2013-10-04 Last updated: 2013-10-14
Pohl, P., Dizdar (Dizdar Segrell), N. & Hallert, E. (2013). The Ronnie Gardiner Rhythm and Music Method – a feasibility study in Parkinson’s disease. Disability and Rehabilitation, 35(26), 2197-2204
Open this publication in new window or tab >>The Ronnie Gardiner Rhythm and Music Method – a feasibility study in Parkinson’s disease
2013 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 35, no 26, p. 2197-2204Article in journal (Refereed) Published
Abstract [en]

Purpose: To assess the feasibility of the novel intervention, Ronnie Gardiner Rhythm and Music (RGRM™) Method compared to a control group for patients with Parkinson’s disease (PD).

Method: Eighteen patients, mean age 68, participating in a disability study within a neurological rehabilitation centre, were randomly allocated to intervention group (n = 12) or control group (n = 6). Feasibility was assessed by comparing effects of the intervention on clinical outcome measures (primary outcome: mobility as assessed by two-dimensional motion analysis, secondary outcomes: mobility, cognition, quality of life, adherence, adverse events and eligibility).

Results: Univariable analyses showed no significant differences between groups following intervention. However, analyses suggested that patients in the intervention group improved more on mobility (p = 0.006), cognition and quality of life than patients in the control group. There were no adverse events and a high level of adherence to therapy was observed.

Conclusions: In this disability study, the use of the RGRM™ Method showed promising results in the intervention group and the adherence level was high. Our results suggest that most assessments chosen are eligible to use in a larger randomized controlled study for patients with PD.

Implications for Rehabilitation

  • The RGRM™ Method appeared to be a useful and safe method that showed promising results in both motor and cognitive functions as well as quality of life in patients with moderate PD.

  • The RGRM™ Method can be used by physiotherapists, occupational, speech and music therapists in neurological rehabilitation.

  • Most measurements were feasible except for Timed-Up-and-Go.

 

 

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Music therapy, neurological disorders, Parkinson’s disease, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-98249 (URN)10.3109/09638288.2013.774060 (DOI)000328282400003 ()23480646 (PubMedID)
Note

 

 

Available from: 2013-10-04 Created: 2013-10-04 Last updated: 2018-01-12
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