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Andersson, David
Publications (10 of 13) Show all publications
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
Tinghög, G. & Andersson, D. (2016). Are Individuals Luck Egalitarians?: An Experiment on the Influence of Brute and Option Luck on Social Preferences. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Are Individuals Luck Egalitarians?: An Experiment on the Influence of Brute and Option Luck on Social Preferences
2016 (English)Report (Other academic)
Abstract [en]

According to luck egalitarianism, inequalities should be deemed fair as long as they follow from individuals’ deliberate and fully informed choices, i.e. option luck – while inequalities should be deemed unfair if they follow from choices over which the individual has no control, i.e. brute luck. This study investigates if individuals’ fairness preferences correspond with the luck egalitarian fairness position. More specifically, in a laboratory experiment we test how individuals choose to redistribute gains and losses that stem from option luck compared to brute luck.

A two-stage experimental design with real incentives was employed. In total, 226 subjects were randomly assigned to either the brute luck or option luck treatment. Treatments were identical except for how monetary compensation for participation in the experiment was settled in stage one. In the option luck treatment, subjects were given the option to chose between a safe option (50 SEK) and a risky option (a 50/50 gamble between 0 SEK and 150 SEK). In the brute luck treatment no such choice was given, instead all subjects were compensated based on outcome of the risky option. In the second stage, subjects were asked to distribute additional endowments (100 SEK) in an anonymous dictator game using the strategy method, i.e. making decisions contingent on the recipient losing or wining in the gamble.

Individuals change their action associated with re-allocation depending on the underlying conception of luck. Subjects in the brute luck treatment equalized outcomes to larger extent (p=0.0069). Thus, subjects redistributed a larger amount to unlucky losers and a smaller amount to lucky winners compared to equivalent choices made in the option luck treatment.

We find strong support for people having a fairness preference not just for outcomes, but also for how those outcomes are reached. Our findings are potentially important for understanding the role citizens assign individual responsibility for life outcomes, i.e. health and wealth.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. p. 17
Series
Linköping University Working Papers in Economics ; 2016:1
Keywords
Fairness, luck egalitarianism, brute luck, option luck, dictator game, laboratory experiment
National Category
Economics
Identifiers
urn:nbn:se:liu:diva-125248 (URN)
Available from: 2016-02-17 Created: 2016-02-17 Last updated: 2016-02-19Bibliographically approved
Hagman, W., Andersson, D., Västfjäll, D. & Tinghög, G. (2015). Public Views on Policies Involving Nudges. Review of Philosophy and Psychology, 6(3), 439-453
Open this publication in new window or tab >>Public Views on Policies Involving Nudges
2015 (English)In: Review of Philosophy and Psychology, ISSN 1878-5158, E-ISSN 1878-5166, Vol. 6, no 3, p. 439-453Article in journal (Refereed) Published
Abstract [en]

When should nudging be deemed as permissible and when should it be deemed as intrusive to individuals’ freedom of choice? Should all types of nudges be judged the same? To date the debate concerning these issues has largely proceeded without much input from the general public. The main objective of this study is to elicit public views on the use of nudges in policy. In particular we investigate attitudes toward two broad categories of nudges that we label pro-self (i.e. focusing on private welfare) and pro-social (i.e. focusing on social welfare) nudges. In addition we explore how individual differences in thinking and feeling influence attitudes toward nudges. General population samples in Sweden and the United States (n=952) were presented with vignettes describing nudge-policies and rated acceptability and intrusiveness on freedom of choice. To test for individual differences, measures on cultural cognition and analytical thinking were included. Results show that the level of acceptance toward nudge-policies was generally high in both countries, but were slightly higher among Swedes than Americans. Somewhat paradoxically a majority of the respondents also perceived the presented nudge-policies as intrusive to freedom of choice. Nudge- polices classified as pro-social had a significantly lower acceptance rate compared to pro-self nudges (p<.0001). Individuals with a more individualistic worldview were less likely to perceive nudges as acceptable, while individuals more prone to analytical thinking were less likely to perceive nudges as intrusive to freedom of choice. To conclude, our findings suggest that the notion of “one-nudge- fits-all” is not tenable. Recognizing this is an important aspect both for successfully implementing nudges as well as nuancing nudge theory. 

Keywords
Nudge; Libertarian Paternalism; Acceptability; Autonomi
National Category
Economics
Identifiers
urn:nbn:se:liu:diva-119071 (URN)10.1007/s13164-015-0263-2 (DOI)
Projects
Neuroekonomi
Available from: 2015-06-08 Created: 2015-06-08 Last updated: 2019-03-26
Wiss, J., Andersson, D., Slovic, P., Västfjäll, D. & Tinghög, G. (2015). The influence of identifiability and singularity in moral decision making. Judgment and decision making, 10(5), 492-502
Open this publication in new window or tab >>The influence of identifiability and singularity in moral decision making
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2015 (English)In: Judgment and decision making, ISSN 1930-2975, E-ISSN 1930-2975, Vol. 10, no 5, p. 492-502Article in journal (Refereed) Published
Abstract [en]

There is an increased willingness to help identified individuals rather than non-identified, and the effect of identifiability is mainly present when a single individual rather than a group is presented. However, identifiability and singularity effects have thus far not been manipulated orthogonally. The present research uses a joint evaluation approach to examine the relative contribution of identifiability and singularity in moral decision-making reflecting conflicting values between deontology and consequentialism. As in trolley dilemmas subjects could either choose to stay with the default option, i.e., giving a potentially life-saving vaccine to a single child, or to actively choose to deny the single child the vaccine in favor of five other children. Identifiability of the single child and the group of children was varied between-subjects in a 2x2 factorial design. In total 1,232 subjects from Sweden and the United States participated in three separate experiments. Across all treatments, in all three experiments, 32.6% of the subjects chose to stay with the deontological default option instead of actively choosing to maximize benefits. Results show that identifiability does not always have a positive effect on decisions in allocation dilemmas. For single targets, identifiability had a negative or no effect in two out of three experiments, while for the group of targets identifiability had a more stable positive effect on subjects’ willingness to allocate vaccines. When the effect of identifiability was negative, process data showed that this effect was mediated by emotional reactance. Hence, the results show that the influence of identifiability is more complex than it has been previously portrayed in the literature on charitable giving. 

Keywords
identifiable victim effect, singularity effect, resource allocation, trolley dilemma, moral judgment, decision making, charitable giving
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-122128 (URN)000362067700009 ()
Note

Funding text: Ragnar Soderberg Foundation; U.S. National Science Foundation [SES-1227729, SES-1427414]

Available from: 2015-10-19 Created: 2015-10-19 Last updated: 2017-12-01Bibliographically approved
Ekerstad, N., Swahn, E., Janzon, M., Alfredsson, J., Löfmark, R., Lindenberger, M., . . . Carlsson, P. (2014). Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction. European Journal of Preventive Cardiology, 21(10), 1216-1224
Open this publication in new window or tab >>Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction
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2014 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 21, no 10, p. 1216-1224Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: For the large population of elderly patients with cardiovascular disease, it is crucial to identify clinically relevant measures of biological age and their contribution to risk. Frailty is denoting decreased physiological reserves and increased vulnerability. We analysed the manner in which the variable frailty is associated with 1-year outcomes for elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients. METHODS AND RESULTS: Patients aged 75 years or older, with diagnosed NSTEMI were included at three centres, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. Of 307 patients, 149 (48.5%) were considered frail. By Cox regression analyses, frailty was found to be independently associated with 1-year mortality after adjusting for cardiovascular risk and comorbid conditions (hazard ratio 4.3, 95% CI 2.4-7.8). The time to the first event was significantly shorter for frail patients than for nonfrail (34 days, 95% CI 10-58, p = 0.005). CONCLUSIONS: Frailty is strongly and independently associated with 1-year mortality. The combined use of frailty and comorbidity may constitute an important risk prediction concept in regard to cardiovascular patients with complex needs.

Place, publisher, year, edition, pages
Sage Publications, 2014
Keywords
Elderly, frailty, mortality, myocardial infarction
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-99008 (URN)10.1177/2047487313490257 (DOI)000342818000003 ()23644488 (PubMedID)
Available from: 2013-10-15 Created: 2013-10-15 Last updated: 2017-12-06
Tinghög, G., Andersson, D., Bonn, C., Böttiger, H., Josephson, C., Lundgren, G., . . . Johannesson, M. (2013). Intuition and cooperation reconsidered. Nature, 498(7452), E1-E2
Open this publication in new window or tab >>Intuition and cooperation reconsidered
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2013 (English)In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 498, no 7452, p. E1-E2Article in journal (Refereed) Published
Abstract [en]

Rand et al.1 reported increased cooperation in social dilemmas after forcing individuals to decide quickly1. Time pressure was used to induce intuitive decisions, and they concluded that intuition promotes cooperation. We test the robustness of this finding in a series of five experiments involving about 2,500 subjects in three countries. None of the experiments confirms the Rand et al.1 finding, indicating that their result was an artefact of excluding the about 50% of subjects who failed to respond on time.

Place, publisher, year, edition, pages
Nature Publishing Group, 2013
Keywords
Human Cooperation, Intuition; Time Pressure; Public Goods; Behavioral Economics
National Category
Economics
Identifiers
urn:nbn:se:liu:diva-94022 (URN)10.1038/nature12194 (DOI)000319947800001 ()23739429 (PubMedID)
Projects
Neuroekonomi
Available from: 2013-06-16 Created: 2013-06-14 Last updated: 2017-12-06Bibliographically approved
Carstensen, J., Andersson, D., André, M., Engström, S., Magnusson, H. & Borgquist, L. (2012). How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis. BMJ Open, 2, e000809
Open this publication in new window or tab >>How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis
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2012 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, p. e000809-Article in journal (Refereed) Published
Abstract [en]

Objectives To analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs.

Design Population-based cross-sectional study.

Setting The County of Östergötland, Sweden.

Patients Data on diagnoses and healthcare costs for all 266 354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions.

Main outcome measures The effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education.

Results The largest diagnosed group was back pain (11 178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11 806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses.

Conclusions A small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy General Practice
Identifiers
urn:nbn:se:liu:diva-77845 (URN)10.1136/bmjopen-2011-000809 (DOI)000315042100071 ()
Available from: 2012-05-31 Created: 2012-05-31 Last updated: 2018-01-12
Ekerstad, N., Löfmark, R., Andersson, D. & Carlsson, P. (2011). A Tentative Consensus-Based Model for Priority Setting : An Example from Elderly Patients with Myocardial Infarction and Multi-morbidity. Scandinavian Journal of Public Health, 39(4), 345-353
Open this publication in new window or tab >>A Tentative Consensus-Based Model for Priority Setting : An Example from Elderly Patients with Myocardial Infarction and Multi-morbidity
2011 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, no 4, p. 345-353Article in journal (Refereed) Published
Abstract [en]

Background: In most Western countries the growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines into focus. However, such guidelines are difficult to use when the evidence base is weak. Priority setting for frail elderly patients with heart disease illustrates this problem. We have outlined a tentative model for priority setting regarding frail elderly heart patients. The model takes cardiovascular risk, frailty, and comorbidity into account. Objective: Our aim is to validate the model’s components. We want to evaluate the inter-rater reliability of the study experts’ rankings regarding each of the model’s categories. Methods: A confidential questionnaire study consisting of 15 authentic and validated cases was conducted to assess the views of purposefully selected cardiology experts (n = 58). They were asked to rank the cases regarding the need for coronary angiography using their individual clinical experience. The response rate was 71%. Responses were analysed with frequencies and descriptive statistics. The inter-rater reliability regarding the experts’ rankings of the cases was estimated via an intra-class correlation test (ICC). Results: The cardiologists considered the clinical cases to be realistic. The intra-class correlation (two-way random, consistency, average measure) was 0.978 (95% CI 0.958–0.991), which denotes a very good inter-rater reliability on the group level. The model’s components were considered relevant regarding complex cases of non-ST elevation myocardial infarction. Comorbidity was considered to be the most relevant component, frailty the second most relevant, followed by cardiovascular risk.

Conclusions: A framework taking comorbidity, frailty, and cardiovascular risk into account could constitute a foundation for consensus-based guidelines for frail elderly heart patients. From a priority setting perspective, it is reasonable to believe that the framework is applicable to other groups of elderly patients with acute disease and complex needs.

Place, publisher, year, edition, pages
Sage, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67637 (URN)10.1177/1403494811405092 (DOI)000290757500002 ()
Available from: 2011-04-20 Created: 2011-04-20 Last updated: 2017-12-11Bibliographically approved
Andersson, D., Magnusson, H., Carstensen, J. & Borgquist, L. (2011). Co-morbidity and health care utilisation five years prior to diagnosis for depression: A register-based study in a Swedish population. BMC Public Health, 11, 552
Open this publication in new window or tab >>Co-morbidity and health care utilisation five years prior to diagnosis for depression: A register-based study in a Swedish population
2011 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. 552-Article in journal (Refereed) Published
Abstract [en]

Background

Depressive disorders have been associated with a number of co-morbidities, and we   hypothesized that patients with a depression diagnosis would be heavy users of health   care services, not only when first evaluated for depression, but also for preceding   years. The aim of this study was to investigate whether increased health care utilisation   and co-morbidity could be seen during five years prior to an initial diagnosis of   depression.

Methods

We used a longitudinal register-based study design. The setting comprised the general   population in the county of Östergötland, south-east Sweden. All 2470 patients who   were 20 years or older in 2006 and who received a new diagnosis of depression (F32   according to ICD-10) in 2006, were selected and followed back to the year 2001, five   years before their depression diagnosis. A control group was randomly selected among   those who were aged 20 years or over in 2006 and who had received no depression diagnosis   during the period 2001-2006.

Results

Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status.

Patients who received a diagnosis of depression used twice the amount of health care   (e.g. physician visits and hospital days) during the five year period prior to diagnosis   compared to the control group. A particularly strong increase in health care utilisation   was seen the last year before diagnosis. These findings were supported with a high   level of co-morbidity as for example musculoskeletal disorders during the whole five-year   period for patients with a depression diagnosis.

Conclusions

Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status. To find early signs   of depression in the clinical setting and to use a preventive strategy to handle these   patients is important.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
General Practice Psychiatry Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-77812 (URN)10.1186/1471-2458-11-552 (DOI)21749713 (Scopus ID)
Available from: 2012-05-30 Created: 2012-05-30 Last updated: 2018-01-12Bibliographically approved
Andersson, D., Brodtkorb, T.-H. & Tinghög, G. (2010). DESCRIBING AND COMPARING HEALTH-RELATED QUALITY OF LIFE DERIVED FROM EQ-5D AND SF-6D IN A SWEDISH GENERAL POPULATION in VALUE IN HEALTH, vol 13, issue 7, pp A240-A240. In: VALUE IN HEALTH (pp. A240-A240). Blackwell Publishing Ltd, 13(7)
Open this publication in new window or tab >>DESCRIBING AND COMPARING HEALTH-RELATED QUALITY OF LIFE DERIVED FROM EQ-5D AND SF-6D IN A SWEDISH GENERAL POPULATION in VALUE IN HEALTH, vol 13, issue 7, pp A240-A240
2010 (English)In: VALUE IN HEALTH, Blackwell Publishing Ltd , 2010, Vol. 13, no 7, p. A240-A240Conference paper, Published paper (Refereed)
Abstract [en]

n/a

Place, publisher, year, edition, pages
Blackwell Publishing Ltd, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-63928 (URN)000282818001008 ()
Available from: 2011-01-11 Created: 2011-01-10 Last updated: 2015-09-22
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