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Sennfält, Karin
Publications (10 of 14) Show all publications
Bistoletti, P., Sennfält, K. & Dillner, J. (2008). Cost-effectiveness of primary cytology and HPV DNA cervical screening. International Journal of Cancer, 122(2), 372-376
Open this publication in new window or tab >>Cost-effectiveness of primary cytology and HPV DNA cervical screening
2008 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 122, no 2, p. 372-376Article in journal (Refereed) Published
Abstract [en]

Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3-5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. © 2007 Wiley-Liss, Inc.

Keywords
Cervical cancer, Health economics, Markov model, Organized screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47155 (URN)10.1002/ijc.23124 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Bistoletti, P. & Sennfält, K. (2008). En hälsoekonomisk modellstudie av primärscreening mot livmoderhalscancer med cellprov- och HPV DNA-test. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>En hälsoekonomisk modellstudie av primärscreening mot livmoderhalscancer med cellprov- och HPV DNA-test
2008 (Swedish)Report (Other academic)
Abstract [sv]

Livmoderhalscancer är en ovanlig cancersjukdom i Sverige. Sjukdomen är ändå ett allvarligt hälsoproblem då den ofta drabbar relativt unga kvinnor och kan leda till döden. Inte minst tack vare införande av regelbundna hälsokontroller med tidigare upptäckt av sjukdomen som följd så har dödligheten minskat en lång period. Betydelsen av organiserad screening har dock ifrågasatts då programmet aldrig blev föremål för någon adekvat utvärdering innan det startade.

Nu står vi inför nya medicinska och sjukvårdpolitiska frågeställningar rörande åtgärder för att förebygga livmoderhalscancer. Det vetenskapligt fastställda sambandet mellan förekomst av HPV (Humant Papillomavirus) och livmoderhalscancer har bland annat inneburit framtagning av ett vaccin mot vissa typer av HPV med en livlig debatt rörande utformning av det nationella vaccinationsprogrammet. Vidare finns det nya tester för att upptäcka förekomst av HPV hos kvinnor som kan kombineras med och eventuellt ersätta nuvarande cellprov. Det är komplicerat att bestämma vilken strategi som är bäst då det i praktiken är empiriskt omöjligt att utvärdera alla tänkbara alternativ i traditionella kliniska studier. Förutsättningarna förändras också hela tiden när nya teknologier aktualiseras. Detta ställer krav på analyser som samlar bästa tillgängliga information på ett systematiskt sätt för att belysa olika konsekvenser med de data som finns idag.

Denna rapport presenterar en modellanalys som gjorts av docent Peter Bistoletti och fil dr Karin Sennfält. De har genomfört analysen tillsammans med flera av Sveriges ledande experter inom detta område. Vid tidpunkten för studien var Peter och Karin verksamma vid Centrum för utvärdering av medicinsk teknologi (CMT), Institutionen för hälsa och samhälle (IHS), Linköpings Universitet.

Arbetet har finansierats av Landstinget i Östergötland, Cancerfonden, och från EU.

Linköping september 2007

Per Carlsson, professor

Abstract [en]

Title: A modelling study of the cost-effectiveness of primary cytology and HPV DNA cervical cancer screening (En hälsoekonomisk modellstudie av primärscreening mot livmoderhalscancer med cellprov och HPV DNA-test)

Organisation: Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping university, S- 581 83 Linköping, Sweden.

Contact person: Peter Bistoletti, peterbistoletti@yahoo.com.

Language: Swedish

Publication type: Health Technology Assessment report

Technology type: Screening

Objectives: The general objective of this report was to assess the costeffectiveness of different cervical cytology screening strategies with and without HPV DNA-testing in primary cervical cancer screening. Four strategies were compared: 1) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, 2) same strategy with addition of testing for HPV DNA persistence at age 32, 3) screening with combined cytology and HPV DNA-testing at age 32, 41 and 50, 4) no screening

Methods: Input data were derived from a population-based HPV screening trial, from population-based screening registries and health service costs. A probabilistic Markov model was used to estimate life expectancy and health-care costs per woman during the remaining lifetime.

Results: Cytology screening between 32-60 years of age in 3-5 year intervals increased life expectancy and life time costs were reduced from 533 to 248 US Dollars per women compared with no screening. Addition of HPV DNA-testing at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy.

Recommendations: Population-based, organized cervical cytology screening between age 32 to 60 in this setting is an effective health care policy which both prevents cervical cancer and can produce overall health care cost savings. If screening intervals are increased to nine years, combined cytology and HPV DNA screening appeared to be at least equally effective and less costly.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. p. 29
Series
CMT Report, ISSN 0283-1228, E-ISSN 1653-7556 ; 2008:1
Keywords
Massundersökningar medicin, livmoderhalscancer
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53975 (URN)LIU CMT RA/0801 (ISRN)
Available from: 2008-03-18 Created: 2010-02-17 Last updated: 2018-02-09Bibliographically approved
Bernfort, L., Sennfält, K. & Reichard, O. (2006). Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden. Scandinavian Journal of Infectious Diseases, 38, 497-505
Open this publication in new window or tab >>Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden
2006 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 38, p. 497-505Article in journal (Refereed) Published
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-37632 (URN)10.1080/00365540500532803 (DOI)36885 (Local ID)36885 (Archive number)36885 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Sennfält, K., Carlsson, P. & Varenhorst, E. (2006). Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002. European Urology, 49(6), 1028-1034
Open this publication in new window or tab >>Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002
2006 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 49, no 6, p. 1028-1034Article in journal (Refereed) Published
Abstract [en]

   Objective

To describe the diffusion of six main health technologies used for management of prostate cancer, to estimate the economic consequences of technological changes, and to explore factors behind the diffusion.

Methods

Data describing the diffusion 1991–2002 were obtained from population-based databases. Costs were obtained from Linköping University Hospital and Apoteket AB. Factors affecting the diffusion of the technologies were explored.

Results

Utilization of technologies with a curative and/or palliative aim has increased over time, except for surgical castration. PSA-tests are used increasingly. The total cost of the study technologies has increased from 20 million euros in 1991 to 65 million euros in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA-tests revealed a profile associated with a rapid/extensive diffusion.

Conclusions

Several technological changes in the management of prostate cancer have occurred without proven benefits and have contributed to increased costs. There are other factors, besides scientific evidence, that have an impact on the diffusion. Consequently, activities aimed at facilitating an appropriate diffusion of new technologies are needed. The analytical framework used here may be helpful in identifying technologies that are likely to experience inappropriate diffusion and therefore need particular attention.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-36907 (URN)10.1016/j.eururo.2005.12.018 (DOI)33009 (Local ID)33009 (Archive number)33009 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Bernfort, L., Reichard, O. & Sennfält, K. (2005). Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden. In: Health Technology Assessment International,2005.
Open this publication in new window or tab >>Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden
2005 (English)In: Health Technology Assessment International,2005, 2005Conference paper, Published paper (Other academic)
Keywords
Hepatit C, läkemedelsbehandling, kostnadseffektivitet, Markov-modell
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-31506 (URN)17302 (Local ID)17302 (Archive number)17302 (OAI)
Available from: 2009-10-09 Created: 2009-10-09
Sennfält, K. (2005). Economic studies of health technology changes in prostate cancer care. (Doctoral dissertation). Linköping: Linköpings universitet
Open this publication in new window or tab >>Economic studies of health technology changes in prostate cancer care
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: New health technologies are one of the major drivers of increasing health care costs, although not all technologies have been shown to be effective. Initiation of activities for ensuring an appropriate diffusion of new health technologies is therefore an important task for a society. To ensure a choice of relevant policy actions, it is necessary to have knowledge about what factors affect the rate and extent of diffusion and what consequences can be expected from adopting a new health technology.

Aim: The aim of this thesis is to estimate economic consequences and cost-effectiveness of health technology changes and to explore factors affecting the diffusion of health technologies. To elucidate these issues, prostate cancer was used as the subject of study.

Material and Methods: The diffusion of six selected technologies for prostate cancer care was analysed and the economic consequences of these technological changes estimated. Data describing the diffusion and costs were obtained from relevant databases. Economic consequences of technological changes in prostate cancer care were also estimated with a cohort approach using 204 men with a diagnosis of prostate cancer who died in 1997-98. Data on health service utilization were extracted from clinical records and the results were compared with those of corresponding cohorts of men who died in 1984-85 or in 1992-93. The cost-effectiveness and expected economic consequences of introduction of prostate cancer screening in Sweden were estimated based on randomized studies in the city of Norrköping (n=9,171) and in the city of Gothenburg (n=20,000). The potential value of a technological change in the treatment of prostate cancer pain was estimated based on data from 1,156 men with a diagnosis of prostate cancer.

Results: The utilization of all selected technologies has increased over time with the exception of orchiectomy, which shows a decreasing use. The total cost of these technologies has increased from 200 MSEK in 1991 to 600 MSEK in 2002. Classification of radical prostatectomy revealed a profile associated with a slow/limited diffusion, while classification of PSA tests revealed a profile associated with a rapid/extensive diffusion. The total health care costs for prostate cancer in Sweden have increased from 610 MSEK in 1984-85 to 970 MSEK in 1997-98, but the average cost per patient has been nearly stable over time. The incremental cost per extra detected localized cancer in a prostate cancer screening programme was estimated at 168,000 SEK and 98,000 SEK, respectively, and per curative aimed treated cancer at 356,000 SEK and 236,000 SEK. Introducing a screening programme for prostate cancer in Sweden would yield 244 MSEK and 92 MSEK, respectively, in additional costs per year for screening and treatment compared to a non-screening strategy. An optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life-years for every man with prostate cancer. A rough estimate for Sweden is a total expected loss of 4,421 QALYs per year at a monetary value of 840 MSEK.

Conclusions: Many technological changes occur in prostate cancer care and result in cost increases with minor or uncertain health improvements. A number of factors in addition to cost-effectiveness of the technology influence the diffusion. To ensure an appropriate diffusion of health technologies in society, one necessary condition is a system for early identification and assessment of cost-effectiveness and economic consequences. Another is an appropriate use of decision models populated with data from early clinical trials, epidemiology and costs. The combination of assessment of the costs and effects and identification of the diffusion profile of the technology may facilitate the design of relevant policy actions to promote an effective utilization of health technologies.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2005. p. 110
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 889
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-29365 (URN)14689 (Local ID)91-7373-868-9 (ISBN)14689 (Archive number)14689 (OAI)
Public defence
2005-04-29, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-02Bibliographically approved
Sandblom, G., Carlsson, P., Sennfält, K. & Varenhorst, E. (2004). A population-based study of pain and quality of life during the year before death in men with prostate cancer. British Journal of Cancer, 90(6), 1163-1168
Open this publication in new window or tab >>A population-based study of pain and quality of life during the year before death in men with prostate cancer
2004 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 90, no 6, p. 1163-1168Article in journal (Refereed) Published
Abstract [en]

In order to explore how health-related quality of life changes towards the end of life, a questionnaire including the EuroQOI form and the Brief Pain Inventory form was sent to all men with prostate cancer in the county of Östergötland, Sweden, in September 1999. Responders who had died prior to 1 January 2001 were later identified retrospectively. Of the 1442 men who received the questionnaire, 1243 responded (86.2%). In the group of responders, 167 had died within the study period, 66 of prostate cancer. In multivariate analysis, pain as well as death within the period of study were found to predict decreased quality of life significantly. Of those who died of prostate cancer, 29.0% had rated their worst pain the previous week as severe. The same figure for those still alive was 10.5%. On a visual analogue scale (range 0-100), the mean rating of quality of life for those who subsequently died of prostate cancer was 54.0 (95% confidence interval ±5.2) and those still alive was 70.0 (±1.2). In conclusion, hearth-related quality of life gradually declines during the last year of life in men with prostate cancer. This decline may partly be avoided by an optimised pain management. © 2004 Cancer Research UK.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24262 (URN)10.1038/sj.bjc.6601654 (DOI)3866 (Local ID)3866 (Archive number)3866 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
Sennfält, K., Sandblom, G., Carlsson, P. & Varenhorst, E. (2004). Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial. Scandinavian Journal of Urology and Nephrology, 38(4), 291-298
Open this publication in new window or tab >>Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial
2004 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 38, no 4, p. 291-298Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To estimate the lifetime cost per detected potentially curable cancer and the economic impact on healthcare of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-69 years.

MATERIAL AND METHODS:

All 9171 men in a geographically defined population were included: 1492 were randomized to screening in four rounds every third year and 7679 constituted a control group. Digital rectal examination and prostate-specific antigen screening in different combinations were used as diagnostic measures. Costs associated with administration of the screening programme, loss of patient time, diagnostic measures and management strategies were included. A decision model was developed to calculate the total cost of the programme.

RESULTS:

The incremental cost per extra detected localized cancer was 168,000 SEK and per potentially curable cancer 356,000 SEK. Introducing this screening programme for prostate cancer in Sweden would incur 244 million SEK annually in additional costs for screening and treatment compared to a non-screening strategy.

CONCLUSION:

There is still no scientific evidence that patients will benefit from screening programmes. Prostate cancer screening would probably be perceived as cost-effective if potentially curable patients gained on average at least 1 year of survival.

Keywords
Costs, Prostate cancer, Screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45606 (URN)10.1080/00365590410028890 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
Levin, L.-Å., Sennfält, K., Janzon, M., Henriksson, M., Andersson, A. & Bernfort, L. (2004). En introduktion i hälsoekonomi. Södertälje: AstraZeneca Sverige AB
Open this publication in new window or tab >>En introduktion i hälsoekonomi
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2004 (Swedish)Book (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Södertälje: AstraZeneca Sverige AB, 2004
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-24126 (URN)3707 (Local ID)91-86058-95-5 (ISBN)3707 (Archive number)3707 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-09-11
Bernfort, L., Reichard, O. & Sennfält, K. (2004). Kostnadseffektiviteten av peginterferon alfa-2b (PegIntron) jämfört med interferon alfa-2b (Intron A) vid kombinationsbehandling av kronisk hepatit C i Sverige. In: Svenska Läkaresällskapets riksstämma,2004.
Open this publication in new window or tab >>Kostnadseffektiviteten av peginterferon alfa-2b (PegIntron) jämfört med interferon alfa-2b (Intron A) vid kombinationsbehandling av kronisk hepatit C i Sverige
2004 (Swedish)In: Svenska Läkaresällskapets riksstämma,2004, 2004Conference paper, Published paper (Refereed)
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-24121 (URN)3698 (Local ID)3698 (Archive number)3698 (OAI)
Available from: 2009-10-07 Created: 2009-10-07
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