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Husberg, Magnus
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Ekerstad, N., Karlsson, B., Andersson, D., Husberg, M., Carlsson, P., Heintz, E. & Alwin, J. (2018). Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients. Journal of the American Medical Directors Association, 19(10), 871-878.e2
Open this publication in new window or tab >>Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients
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2018 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 10, p. 871-878.e2Article in journal (Refereed) Published
Abstract [en]

Objective

The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective.

Design

Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups.

Intervention

Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit.

Setting and Participants

A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female.

Measures

The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up.

Results

We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was −3226 US dollars (95% CI: −6167 to −285).

Conclusion

The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Comprehensive Geriatric Assessment (CGA), frailty, elderly patients, cost-effectiveness, emergency care
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-154797 (URN)10.1016/j.jamda.2018.04.003 (DOI)000445790500011 ()29784592 (PubMedID)2-s2.0-85047081533 (Scopus ID)
Available from: 2019-02-27 Created: 2019-02-27 Last updated: 2019-03-06Bibliographically approved
Ekdahl, A. W., Alwin, J., Eckerblad, J., Husberg, M., Jaarsma, T., Lindh Mazya, A., . . . Carlsson, P. (2016). Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months. Journal of the American Medical Directors Association, 17(3), 263-268
Open this publication in new window or tab >>Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months
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2016 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 3, p. 263-268Article in journal (Refereed) Published
Abstract [en]

Objective: To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. Design: Randomized, controlled, assessor-blinded, single-center trial. Setting: A geriatric ambulatory unit in a municipality in the southeast of Sweden. Participants: Community-dwelling individuals aged >= 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). Intervention: Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. Outcome measures: Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. Results: Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P =.026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P =.01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P =.43). Conclusions: CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGAs superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs. (c) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keywords
Comprehensive Geriatric Assessment; total costs of care; outpatient geriatric care; mortality; hospitalizations
National Category
Clinical Medicine Sociology
Identifiers
urn:nbn:se:liu:diva-126830 (URN)10.1016/j.jamda.2015.12.008 (DOI)000370950000014 ()26805750 (PubMedID)
Note

Funding Agencies|Ostergotland Regional authority in Sweden [LIO-124301]; Linkoping University in Sweden; Stahl Foundation in Sweden [LIO-194541]; Skane Regional authority in Sweden

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2019-06-27
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
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
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
Bernfort, L., Gerdle, B., Rahmqvist, M., Husberg, M. & Levin, L.-Å. (2015). Chronic pain in an elderly population in Sweden: Impact on costs and quality of life. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Chronic pain in an elderly population in Sweden: Impact on costs and quality of life
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2015 (English)Report (Other academic)
Abstract [en]

Chronic pain among elderly people has long been a well-known problem, in terms of both societal costs and the quality of life of affected individuals. To estimate the magnitude of the problems associated with chronic pain in an elderly population, data on both costs and quality of life were gathered. A postal questionnaire was sent out to a stratified sample of 10 000 inhabitants 65 years and older in Linköping and Norrköping. The survey included questions on demographics, habits, and life situation, and different kinds of questions and instruments related to well-being (e.g., quality-of-life and pain-specific questions). In the questionnaire respondents were asked whether they were receiving any help—informal care—from a relative. If they answered yes, they were asked for permission to contact the informal caregiver and to provide contact details. The amount of informal care provided by relatives to persons with chronic pain was investigated by use of a questionnaire directed to the caregiving relatives, containing questions about time spent providing informal care.

Data on costs were collected from registers of consumption of health care, drugs, and municipal services.

The results of the study showed a very clear association between existence and severity of chronic pain and societal costs. The study population was subdivided into three groups with respect to having chronic pain or not, and a pain intensity during the last week of 0–4 (mild), 5–7 (moderate), or 8–10 (severe) on a scale of 0–10. Taking all costs (health care, drugs, municipal services, and informal care) into account, persons in the severe chronic pain group consumed on average 72% more resources than persons in the moderate chronic pain group and 143% more than those in the no or mild chronic pain group. Differences were most pronounced concerning municipal services and informal care costs.

Even more alarming are the results on the quality of life of persons in the different groups. On the EQ-5D index, the average value for persons in the no or mild chronic pain group was 0.82. For those in the moderate chronic pain group the average value was 0.64, and for those in the severe chronic pain group the average value was only 0.38. EQ-VAS resulted in less pronounced but still clearly significant differences.

It is concluded that this study, reaching a rather large part of the target population, shows that existence and severity of chronic pain among people 65 years and older affects costs to society and the quality of life of affected individuals in a massive way.

Abstract [sv]

Kronisk smärta bland äldre är sedan länge ett välkänt problem, både i termer av samhälleliga kostnader och i termer av nedsatt livskvalitet hos drabbade individer. I syfte att uppskatta omfattningen av problemen med kronisk smärta i den äldre befolkningen insamlades data avseende såväl kostnader som livskvalitet. Ett frågeformulär sändes med post ut till ett stratifierat urval om 10 000 invånare 65 år och äldre i Linköpings och Norrköpings kommuner. Frågeformuläret innehöll frågor om demografi, levnadsvanor, livssituation samt olika frågor och instrument relaterade till personernas mående (t.ex. livskvalitet och smärtspecifika frågor). I frågeformuläret tillfrågades respondenterna om huruvida de mottog någon hjälp, informell vård, från någon närstående. Om så var fallet tillfrågades respondenten om tillstånd att kontakta dennes informella vårdgivare, samt kontaktuppgifter. Mängden informell vård tillhandahållen av närstående undersöktes med hjälp av ett frågeformulär innehållande frågor om tid som använts till informella vårdinsatser.

Uppgifter om kostnader inhämtades från register avseende konsumtion av sjukvård, läkemedel och kommunala insatser.

Studiens resultat visade på ett mycket tydligt samband mellan å ena sidan förekomst och grad av kronisk smärta och å andra sidan samhälleliga kostnader. Studiepopulationen delades in i tre grupper med avseende på kronisk smärta eller inte, och smärtintensitet på en 10-gradig skala under den senaste veckan (0–4 = lindrig, 5–7 = måttlig, 8–10 = svår). Med hänsyn tagen till alla kostnader (sjukvård, läkemedel, kommunal service och informell vård) konsumerade personerna med svår kronisk smärta i snitt 72% mer resurser än personerna med måttlig kronisk smärta, och 143% mer än personer med ingen eller lindrig kronisk smärta. Skillnaderna var tydligast avseende kommunala insatser och informell vård.

Ännu mer uppseendeväckande är resultaten gällande livskvalitet för personer i de olika grupperna. Genomsnittligt indexvärde utifrån EQ-5D var för personer med ingen eller lindrig kronisk smärta 0.82. För personer med måttlig kronisk smärta var motsvarande värde 0.64, och för personer med svår kronisk smärta var värdet 0.38. EQ-VAS resulterade i mindre uttalade men tydligt signifikanta skillnader.

Denna studie, som når en relativt stor andel av målpopulationen, visar att förekomst och intensitet av kronisk smärta bland personer 65 år och äldre påverkar samhälleliga kostnader och drabbade personers livskvalitet mycket tydligt.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. p. 32
Series
CMT Report, ISSN 0283-1228, E-ISSN 1653-7556 ; 2015:2
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-117729 (URN)CMT RA/1502 (ISRN)
Available from: 2015-05-07 Created: 2015-05-07 Last updated: 2018-02-19Bibliographically approved
Ekdahl, A. W., Wirehn, A.-B., Alwin, J., Jaarsma, T., Unosson, M., Husberg, M., . . . Carlsson, P. (2015). Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial. Journal of the American Medical Directors Association, 16(6), 497-503
Open this publication in new window or tab >>Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial
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2015 (English)In: Journal of the American Medical Directors Association, ISSN 1538-9375, Vol. 16, no 6, p. 497-503Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.

DESIGN: Assessor-blinded, single-center randomized controlled trial.

SETTING: AGU in an acute hospital in southeastern Sweden.

PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.

INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.

OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).

RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371£ (39,947£) and 30,490£ (31,568£; P = .432).

CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Comprehensive geriatric assessment; ambulatory geriatric care; costs; hospitalization; multimorbidity; randomized controlled trial; security
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-118967 (URN)10.1016/j.jamda.2015.01.074 (DOI)000355134100009 ()25703450 (PubMedID)
Available from: 2015-06-05 Created: 2015-06-05 Last updated: 2019-06-27
Aronsson, M., Husberg, M., Kalkan, A., Eckard, N. & Alwin, J. (2015). Differences between hypothetical and experience-based value sets for EQ-5D used in Sweden: Implications for decision makers. Scandinavian Journal of Public Health, 43(8), 848-854
Open this publication in new window or tab >>Differences between hypothetical and experience-based value sets for EQ-5D used in Sweden: Implications for decision makers
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2015 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 8, p. 848-854Article in journal (Refereed) Published
Abstract [en]

Aims: A number of value sets are available today for converting EQ-5D questionnaire responses to quality-adjusted life year-weights used in health economic evaluations. The aim of this study is to analyse the differences between the commonly used hypothetical UK value set and the newly introduced Swedish experience-based value set and to evaluate health economic implications of such differences on policy decisions. Methods: Differences between the two value sets were studied using two methods: a comparison of health states and improvements as well as an empirical comparison. In the comparison of health states and improvements, the valuations of all EQ-5D states and all pure improvements were compared. In the empirical study, a database of 23,925 individuals was used to identify patient groups that could be affected by the implementation of the Swedish experience-based value set. Results: The comparison of health states and possible improvements showed that only three health states were assigned a lower quality-adjusted life year-weight and most improvements were given smaller absolute values if the experience-based value set was used. The empirical comparison showed that severe conditions were assigned higher values when using the experience-based value set. Conclusions: The Swedish experience-based value set seems to render a higher estimated level of health-related quality of life in virtually all health conditions compared to the hypothetical UK value set. In extension, health-related quality of life enhancing interventions are likely to be given higher priority in decision-making situations where hypothetical values are used to construct quality-adjusted life year-weights. In situations where experience-based quality-adjusted life year-weights are used, life-prolonging interventions would be prioritised.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2015
Keywords
Economic evaluations; quality-adjusted life years; EQ-5D
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123133 (URN)10.1177/1403494815596910 (DOI)000364636600010 ()26271493 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland

Available from: 2015-12-07 Created: 2015-12-04 Last updated: 2017-12-01
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
Bernfort, L., Gerdle, B., Rahmqvist, M., Husberg, M. & Levin, L.-Å. (2015). Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life. Pain, 156(3), 521-527
Open this publication in new window or tab >>Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life
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2015 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 156, no 3, p. 521-527Article in journal (Refereed) Published
Abstract [en]

Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.

Place, publisher, year, edition, pages
Elsevier / Lippincott, Williams andamp; Wilkins, 2015
Keywords
Age; Costs; Elderly; Intensity; Pain; Severity
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-116965 (URN)10.1097/01.j.pain.0000460336.31600.01 (DOI)000350526300021 ()25599240 (PubMedID)
Note

Funding Agencies|Grunenthal Sweden AB

Available from: 2015-04-13 Created: 2015-04-10 Last updated: 2018-01-11
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