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  • 1.
    Akcan, Derya
    et al.
    Swedish Council Health Technology Assessment SBU, Sweden .
    Axelsson, Susanna
    Swedish Council Health Technology Assessment SBU, Sweden .
    Bergh, Christina
    Gothenburg University, Sweden Sahlgrens University Hospital, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Rosen, Mans
    Swedish Council Health Technology Assessment SBU, Sweden Karolinska Institute, Sweden .
    Methodological quality in clinical trials and bibliometric indicators: no evidence of correlations2013In: Scientometrics, ISSN 0138-9130, E-ISSN 1588-2861, Vol. 96, no 1, p. 297-303Article in journal (Refereed)
    Abstract [en]

    Citation frequencies and journal impact factors (JIFs) are being used more and more to assess the quality of research and allocate research resources. If these bibliometric indicators are not an adequate predictor of research quality, there could be severe negative consequences for research. To analyse to which extent citation frequencies and journal impact factors correlate with the methodological quality of clinical research articles included in an SBU systematic review of antibiotic prophylaxis in surgery. All 212 eligible original articles were extracted from the SBU systematic review "Antibiotic Prophylaxis in Surgery" and categorized according to their methodological rigourness as high, moderate or low quality articles. Median of citation frequencies and JIFs were compared between the methodological quality groups using Kruskal-Wallis non-parametric test. An in-depth study of low-quality studies with higher citation frequencies/JIFs was also conducted. No significant differences were found in median citation frequencies (p = 0.453) or JIFs (p = 0.185) between the three quality groups. Studies that had high citation frequencies/JIFs but were assessed as low-quality lacked control groups, had high dropout rates or low internal validity. This study of antibiotic prophylaxis in surgery does not support the hypothesis that bibliometric indicators are a valid instrument for assessing methodological quality in clinical trials. This is a worrying observation, since bibliometric indicators have a major influence on research funding. However, further studies in other areas are needed.

  • 2.
    Bartha, Erzsebet
    et al.
    Karolinska Institute, CLINTEC, Div of Anaesthesiology.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Brodtkorb, Thor-Henrik
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Kalman, Sigridur
    Karolinska Institute, CLINTEC, Div of Anasthesiology.
    Optimization of circulation by fluid treatment of elderly patients with hip fracture (oral presentation): Cost-effectiveness and value of information analysis2011Conference paper (Refereed)
  • 3.
    Bartha, Erzsebet
    et al.
    Karolinska University Hospital, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Brodtkorb, Thor-Henrik
    RTI Health Solut, Sweden.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Kalman, Sigridur
    Karolinska University Hospital, Sweden.
    Value of information: interim analysis of a randomized, controlled trial of goal-directed hemodynamic treatment for aged patients2013In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 14Article in journal (Refereed)
    Abstract [en]

    Background

    A randomized, controlled trial, intended to include 460 patients, is currently studying peroperative goal-directed hemodynamic treatment (GDHT) of aged hip-fracture patients. Interim efficacy analysis performed on the first 100 patients was statistically uncertain; thus, the trial is continuing in accordance with the trial protocol. This raised the present investigation’s main question: Is it reasonable to continue to fund the trial to decrease uncertainty? To answer this question, a previously developed probabilistic cost-effectiveness model was used. That model depicts (1) a choice between routine fluid treatment and GDHT, given uncertainty of current evidence and (2) the monetary value of further data collection to decrease uncertainty. This monetary value, that is, the expected value of perfect information (EVPI), could be used to compare future research costs. Thus, the primary aim of the present investigation was to analyze EVPI of an ongoing trial with interim efficacy observed.

    Methods

    A previously developed probabilistic decision analytic cost-effectiveness model was employed to compare the routine fluid treatment to GDHT. Results from the interim analysis, published trials, the meta-analysis, and the registry data were used as model inputs. EVPI was predicted using (1) combined uncertainty of model inputs; (2) threshold value of society’s willingness to pay for one, quality-adjusted life-year; and (3) estimated number of future patients exposed to choice between GDHT and routine fluid treatment during the expected lifetime of GDHT.

    Results

    If a decision to use GDHT were based on cost-effectiveness, then the decision would have a substantial degree of uncertainty. Assuming a 5-year lifetime of GDHT in clinical practice, the number of patients who would be subject to future decisions was 30,400. EVPI per patient would be €204 at a €20,000 threshold value of society’s willingness to pay for one quality-adjusted life-year. Given a future population of 30,400 individuals, total EVPI would be €6.19 million.

    Conclusions

    If future trial costs are below EVPI, further data collection is potentially cost-effective. When applying a cost-effectiveness model, statements such as ‘further research is needed’ are replaced with ‘further research is cost-effective and ‘further funding of a trial is justified’.

  • 4.
    Bartha, Erzsebet
    et al.
    Karolinska Institute, CLINTEC, Div of Anesthesiology.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hommel, Ami
    Lund University, Dept of Health Sciences.
    Thorngren, Karl-Göran
    Lund University Hospital, Dept of Orthopedics.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Kalman, Sigridur
    Karolinska Institute, CLINTEC, Div of Anestesiology.
    Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients: Before Clinical Research Starts2012In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 117, no 3, p. 519-530Article in journal (Refereed)
    Abstract [en]

    Background: Health economic evaluations are increasingly used to make the decision to adopt new medical interventions. Before such decisions, various stakeholders have invested in clinical research. But health economic factors are seldom considered in research funding decisions. Cost-effectiveness analysis could be informative before the launch of clinical research projects, particularly when a targeted intervention is resource-intensive, total cost for the trial is very high, and expected gain of health benefits is uncertain. This study analyzed cost-effectiveness using a decision analytic model before initiating a large clinical research project on goal-directed hemodynamic treatment of elderly patients with hip fracture.

    Methods: A probabilistic decision analytic cost-effectiveness model was developed; the model contains a decision tree for the postoperative short-term outcome and a Markov structure for long-term outcome. Clinical effect estimates, costs, health-related quality-of-life measures, and long-term survival constituted model input that was extracted from clinical trials, national databases, and surveys. Model output consisted of estimated medical care costs related to quality-adjusted life-years.

    Results: In the base care analysis, goal-directed hemodynamic treatment reduced average medical care costs by €1,882 and gained 0.344 qualilty-adjusted life-years. In 96.5% of the simulations, goal-directed hemodynamic treatment is less costly and provides more quality-adjusted life-years. The results are sensitive to clinical effect size variations, although goal-directed hemodynamic treatment seems to be cost-effective even with moderate clinical effect.

    Conclusion: This study demonstrates that cost-effectiveness analysis is feasible, meaningful, and recommendable before launch of costly clinical research projects.

  • 5.
    Bergenholtz, Gunnar
    et al.
    Varsaparken Gothenburg.
    Axelsson, Susanna
    Varsaparken, Gothenburg.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Statens beredning för medicinsk utvärdering, Stockholm.
    Frisk, Fredrik
    Varsaparken, Gothenburg.
    Hakeberg, Magnus
    Varsaparken, Gothenburg.
    Kvist, Thomas
    Varsaparken, Gothenburg.
    Norlund, Anders
    Varsaparken, Gothenburg.
    Petersson, Arne
    Varsaparken, Gothenburg.
    Portenier, Isabelle
    Varsaparken, Gothenburg.
    Sandberg, Hans
    Varsaparken, Gothenburg.
    Tranæus, Sofia
    Varsaparken, Gothenburg.
    Mejare, Ingegerd
    Varsaparken, Gothenburg.
    Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.2013In: Singapore dental journal, ISSN 0377-5291, Vol. 34, no 1, p. 1-12Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.

    STUDY DESIGN: An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.

    RESULTS: No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.

    CONCLUSIONS: Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.

  • 6.
    Boman, Kurt
    et al.
    Umeå University, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Gustavsson, Mats
    Primary Health Care Unit, Sweden .
    Olofsson, Mona
    Umeå University, Sweden .
    Renstrom, Gun-Britt
    Skelleftea County Hospital, Sweden .
    Johansson, Lars
    Umeå University, Sweden .
    Telemedicine improves the monitoring process in anticoagulant treatment2012In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, no 6, p. 312-316Article in journal (Refereed)
    Abstract [en]

    We compared the INR (International Normalized Ratio) monitoring process using a telemedicine device with the conventional approach in which blood samples were sent to the hospital for analysis. We conducted a randomized controlled trial. We enrolled 40 patients on chronic warfarin therapy from two primary healthcare centres (PHCs). Half were monitored using the telemedicine device and half were monitored conventionally. Each patient received three INR measurements. The total processing time was measured from blood sampling until warfarin dosing was performed in the anticoagulant clinic. The median total processing time was significantly shorter with telemedicine than usual care (34 vs. 260 min, P andlt; 0.001). This was mainly because sample transport was avoided using the point-of-care device and automatic data transmission. Telemedicine reduced the total processing time for INR monitoring and has the potential to improve the management of patients undergoing anticoagulant treatment at PHCs.

  • 7.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    How to include relatives and productivity loss in a cost‐effectiveness analysis2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Health economic evaluations are today commonly used in the decision‐making process in health care. Within the field of cost‐effectiveness analysis (CEA), there are several methodological and empirical issues that cause debate about what is included in the analysis. This thesis covers two such issues; costs and effects for relatives, and the valuation of individuals’ productivity loss due to morbidity. The objective of the thesis is to provide further knowledge about what should be included in CEAs which take a societal approach. The papers that the thesis is based on, four in total, examine the theoretical aspects of the studied issues and test these aspects empirically. Three different data materials were used. The CEA and the estimation of costs and effects are central in all the papers. The outcome measure used is quality‐adjusted life years (QALYs).

    The relatives of an individual with a disease or disability often provide informal care, and there may also be concomitant effect on their own well‐being. Nevertheless, the costs and effects for the relatives are generally excluded from CEAs, and there are few guidelines for how to include relatives’ effects. This thesis suggests the use of a new measure, R‐QALYs, which can be used both to visualise relatives’ effects and to include them in the analysis. We found that while the EQ‐5D instrument can be used to capture some of the relatives’ effects, it most likely misses a number of important attributes, for example altruistic preferences. Methods of eliciting R‐QALY weights include direct valuation methods and indirect methods, using existing relativerelated instruments. However, none of these methods are without difficulties, and there is a need for more studies on estimating valid relatives’ effects. Another possible approach with high potential is to use monetary measurements for both the costs and effects relevant to relatives.

    The results also show that income affects the QALY weights if the individuals include the utility generated by consumption within their QALY weights. The empirical tests showed that a majority of individuals do not consider their own income when they value health states. An explicit instruction to take income into account seemed to affect the valuation of those health states that were assumed to have consequences on the ability to perform daily activities. These findings give support for including the productivity costs caused by morbidity in the analysis; as these costs are not, or are only to a minor extent, implicitly incorporated in individuals’ QALY weights. The loss of leisure time, however, is captured in the QALY weight, and care must be taken to avoid double counting this loss in the analysis.

    The results of CEAs will only be partial if relatives’ costs and effects and the costs of individuals’ productivity loss are excluded for health interventions where they are assumed to be of significant importance.

    List of papers
    1. Is the societal approach wide enough to include relatives?: incorporating relatives' costs and effects in a cost-effectiveness analysis.
    Open this publication in new window or tab >>Is the societal approach wide enough to include relatives?: incorporating relatives' costs and effects in a cost-effectiveness analysis.
    2010 (English)In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 8, no 1, p. 25-35Article in journal (Refereed) Published
    Abstract [en]

    It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives' costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives' costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives' effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives' QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient's QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives' costs and effects. Because cost-effectiveness analyses are used for decision making, and this is often achieved by comparing different cost-effectiveness ratios, we argue that it is important to find ways of incorporating all relatives' costs and effects into the analysis. This may not be necessary for every analysis of every intervention, but for treatments where relatives' costs and effects are substantial there may be some associated influence on the cost-effectiveness ratio.

    Place, publisher, year, edition, pages
    Springer, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-53069 (URN)10.2165/11313910-000000000-00000 (DOI)20038191 (PubMedID)
    Note

    The previous status of this article was Manuscript.

    Available from: 2010-01-15 Created: 2010-01-15 Last updated: 2017-12-12Bibliographically approved
    2. In pursuit of QALY weights for relatives: Empirical estimates in relatives caring for older people
    Open this publication in new window or tab >>In pursuit of QALY weights for relatives: Empirical estimates in relatives caring for older people
    2008 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 9, no 3, p. 285-292Article in journal (Refereed) Published
    Abstract [en]

    This study estimates quality-adjusted life-year (QALY) weights for relatives caring for an older person. The data used are from the Swedish part of the EUROFAMCARE study. A new measure is introduced called the R-QALY weight, defined as the effect on a relative’s QALY weight due to being a relative of a disabled or sick individual. R-QALY weights were created by comparing relatives’ QALY weights with population-based QALY weights. They were also created by comparing with QALY weights reassessed for a hypothetical situation in which the older person needed no care. The results indicate that R-QALY weights are small when compared with population-based weights, but large when compared with QALY weights reassessed for the hypothetical situation. Moreover, R-QALY weights were affected by relatives’ age, sex, and subjective perception of positive and negative aspects of the caregiving situation. These aspects should therefore be taken into account in health economics evaluations using a societal approach.

    Place, publisher, year, edition, pages
    SpringerLink, 2008
    Keywords
    Economics, Relatives, Caregivers, QALY weight
    National Category
    Economics and Business
    Identifiers
    urn:nbn:se:liu:diva-16948 (URN)10.1007/s10198-007-0076-z (DOI)
    Available from: 2009-03-02 Created: 2009-02-26 Last updated: 2017-12-13Bibliographically approved
    3. Direct valuation of health state among patients with chest pain: Does income level matter
    Open this publication in new window or tab >>Direct valuation of health state among patients with chest pain: Does income level matter
    (English)Manuscript (preprint) (Other (popular science, discussion, etc.))
    Abstract [en]

    There is still uncertainty over where to include the production loss caused by morbidity in cost-effectiveness analyses. This loss could be included as a cost; but if individuals take their own income into consideration when valuing health states, this would lead to double counting. The purpose of this study was to find out whether individuals’ incomes can explain their valuations of their own current health states.

    The sample consisted of 156 patients (312 observations) admitted to hospital with chest pain (the FRISC II trial). These patients valued their own current health states by using the time trade-off method (TTO) and a visual analogue scale (VAS). They also answered the EQ-5D instrument and stated their monthly income. Income level was additionally controlled via their taxed income at the tax agency, together with their income generated from capital. Generalised estimation equations were used to test whether the EQ- 5D dimensions and monthly gross income could explain the variation in the valuations of the health states.

    The results indicate that neither self-stated nor taxed income could explain the variation in the valuations made by TTO. However, self-stated income (but not taxed income) was a significant variable in explaining variation in the VAS valuations.

    These findings support the inclusion of the production loss caused by morbidity in the analysis, as these costs are not, or at least not to any great extent, implicitly incorporated in the individuals’ QALY weights when TTO is used to value the health states. Using a VAS, some income effects may be included.

    Keywords
    Outcome research, QALY, income, cost-effectiveness analysis
    National Category
    Economics and Business
    Identifiers
    urn:nbn:se:liu:diva-16952 (URN)
    Note

    This paper will not be published.

    Available from: 2009-02-26 Created: 2009-02-26 Last updated: 2017-01-11Bibliographically approved
    4. Do individuals consider expected income when valuing health states?
    Open this publication in new window or tab >>Do individuals consider expected income when valuing health states?
    2008 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 24, no 4, p. 488-494Article in journal (Refereed) Published
    Abstract [en]

    Objectives: The purpose of this study was to empirically explore whether individuals take their expected income into consideration when directly valuing predefined health states. This was intended to help determine how to handle productivity costs due to morbidity in a cost-effectiveness analysis.

    Methods: Two hundred students each valued four hypothetical health states by using time trade-off (TTO) and a visual analogue scale (VAS). The students were randomly assigned to two groups. One group was simply asked, without mentioning income, to value the different health states (the non-income group). The other group was explicitly asked to consider their expected income in relation to the health states in their valuations (the income group).

    Results: For health states that are usually assumed to have a large effect on income, the valuations made by the income group seemed to be lower than the valuations made by the non-income group. Among the students in the non-income group, 96 percent stated that they had not thought about their expected income when they valued the health states. In the income group, 40 percent believed that their expected income had affected their valuations of the health states.

    Conclusion: The results show that, as long as income is not mentioned, most individuals do not seem to consider their expected income when they value health states. This indicates that productivity costs due to morbidity are not captured within individuals’ health state valuations. These findings, therefore, suggest that productivity costs due to morbidity should be included as a cost in cost-effectiveness analyses.

    Keywords
    Cost-effectiveness analysis, Valuation, Health state utility, Expected income
    National Category
    Economics and Business
    Identifiers
    urn:nbn:se:liu:diva-16949 (URN)10.1017/S0266462308080641 (DOI)
    Available from: 2009-03-02 Created: 2009-02-26 Last updated: 2017-12-13Bibliographically approved
  • 8.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Ekermo, Bengt
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Gaines, Hans
    Lesko, Birgitta
    Akerlind, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    The cost-effectiveness of introducing nucleic acid testing to test for hepatitis B, hepatitis C, and human immunodeficiency virus among blood donors in Sweden2011In: TRANSFUSION, ISSN 0041-1132, Vol. 51, no 2, p. 421-429Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The purpose of this study was to estimate the cost-effectiveness of using individual-donor nucleic acid testing (ID-NAT) in addition to serologic tests compared with the sole use of serologic tests for the identification of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among blood donors in Sweden. STUDY DESIGN AND METHODS: The two strategies analyzed were serologic tests and ID-NAT plus serologic tests. A health-economic model was used to estimate the lifetime costs and effects. The effects were measured as infections avoided and quality-adjusted life-years (QALYs) gained. A societal perspective was used. RESULTS: The largest number of viral transmissions occurred with serologic testing only. However, the risks for viral transmissions were very low with both strategies. The total cost was mainly influenced by the cost of the test carried out. The cost of using ID-NAT plus serologic tests compared to serologic tests alone was estimated at Swedish Krona (SEK) 101 million (USD 12.7 million) per avoided viral transmission. The cost per QALY gained was SEK 22 million (USD 2.7 million). CONCLUSION: Using ID-NAT for testing against HBV, HCV, and HIV among blood donors leads to cost-effectiveness ratios that are far beyond what is usually considered cost-effective. The main reason for this is that with current methods, the risks for virus transmission are very low in Sweden.

  • 9.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    CMT rapport: kostnader och kostnadseffektivitet av ett införande av dabigatran hos patienter med förmaksflimmer2011Report (Other academic)
    Abstract [sv]

    Förmaksflimmer är den vanligaste arytmin i Sverige och orsakar stora kostnader inom hälso- och sjukvården. Förutom att patienterna vanligen drabbas av försämrad livskvalitet går det också åt stora resurser för komplikationer i form av tromboembolier och stroke. De flesta behandlingar inom förmaksflimmer kombineras med antikoagulationsbehandling för att förebygga eller förhindra uppkomst av tromboembolier och ischemisk stroke. Vid denna behandling krävs noggrann dosering för att sänka risken för stroke utan att kraftigt höja risken för blödningar. Warfarin har under lång tid varit det mest effektivaantikoagulationsläkemedlet för skydd mot tromboembolier vid  förmaksflimmer. Ett annat behandlingsalternativ är acetylsalicylsyra (ASA). Ett nytt antikoagulationsläkemedel som heter dabigatran (Pradaxa®) har nyligen godkänts som förebyggande behandling av stroke och systemisk embolism hos patienter med förmaksflimmer. Dabigatran har i en stor studie, (RE-LY), visat sig reducera risken för stroke jämfört med warfarin.

    Det övergripande syftet med denna rapport är att beräkna hälsoekonomiska konsekvenser i form av kostnader och kostnadseffektivitet av ett införande av dabigatran (Pradaxa®) som förebyggande behandling av stroke och systemisk embolism hos patienter med förmaksflimmer. I grundanalysen analyseras dabigatran 150 mg två gånger per dag för personer som är under 80 år och dabigatran 110 mg två gånger per dag för personer 80 år eller äldre. Jämförelser görs med warfarin och ASA, och warfarinbehandlingen delas dessutom in i tre subgrupper; välinställda, dåligt inställda samt warfarin-naïva patienter.

    En simuleringsmodell har skapats för att beräkna långsiktiga kostnader och effekter för de olika behandlingsalternativen. Effekterna mäts i antal förhindrade stroke, antal vunna levnadsår samt antal vunna kvalitetsjusterade levnadsår (QALYs). Priset för de båda dagliga doserna av dabigatran (150 mg gånger två och 110 mg gånger två) är 25,39 kronor per dag.

    Analyserna i den här rapporten visar att kostnaden för förmaksflimmer i Sverige beräknas till drygt 4,1 miljarder kronor år 2010. Denna kostnad förväntas sjunka vid införande av dabigatran, till följd av besparingar inom vården av stroke och ett sänkt produktionsbortfall. Kostnaden per vunnet QALY för dabigatran 150 mg / 110 mg jämfört med warfarin, hos patienter som är 65 år gamla och följs upp i 20 år, har beräknats till 74 216 kronor. Vid jämförelse med välinställd warfarinbehandling höjs kostnaden per vunnet QALY till 107 186 kronor. Om dabigatran 110 mg två gånger dagligen jämförs med ASA leder det till lägre kostnader och bättre effekter, vilket innebär att dabigatran 110 mg två gånger dagligen är en dominant behandling för patienter som inte är lämpliga för warfarinbehandling.

    Ett införande av dabigatran leder till kostnadsförskjutningar inom flera olika områden. En ökad kostnad uppkommer för läkemedel, medan  sänkta kostnader uppkommer till följd av färre stroke. För patienten innebär dabigatran lägre risk för stroke och färre besök i sjukvården.

  • 10.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    The cost of atrial fibrillation in Sweden (Poster)2010In: Value in Health, Malden: Wiley Periodicals, Inc , 2010, p. 350-350Conference paper (Refereed)
  • 11.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    The Cost of Thromboembolic Events and their Prevention among Patients with Atrial Fibrillation2011In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 2, no 4, p. 00-00Article in journal (Refereed)
    Abstract [en]

    Aim: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. People with AF have a significantly increased risk of thromboembolic events, including stroke, and the main treatment is therefore aimed at preventing thromboembolic events via anticoagulation with warfarin or acetylsalicylic acid. However, the development of new anticoagulation treatments has prompted a need to know the current cost of AF-related thromboembolic events, for future cost-effectiveness comparisons with the existing treatments. In this study, we estimated the cost of thromboembolic events and their prevention among Swedish AF patients in 2010.

    Methods: The relevant costs were identified, quantified, and valued. The complications included were ischaemic and haemorrhagic stroke, gastrointestinal bleeding, and other types of major bleeding caused by AF. Treatments intended to lower the risk of ischaemic stroke were also included. A societal perspective was used, including productivity loss due to morbidity. Patients with a CHADS2 score of 1 or higher were included.

    Results: Among the 9 340 682 inhabitants of Sweden, there are 118 000 patients with AF and at least one more risk factor for stroke, comprising 1.26% of the population. Of these patients, 43.3% are treated with warfarin, 28.3% use acetylsalicylic acid, and 28.3% are assumed to have no anticoagulation treatment. The cost of AF-related complications and its prevention in Sweden was estimated at €437 million for 2010, corresponding to €3 712 per AF patient per year. The highest cost was caused by stroke, and the second highest by the cost of monitoring the warfarin treatment. As the prevalence of AF is expected to increase in the future, AF-related costs are also expected to rise.

    Conclusion: Thromboembolic events cause high costs. New, easily-administered treatments that could reduce the risk of stroke have the potential to be cost-effective.

     

  • 12.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Oldgren, Jonas
    Uppsala University, Sweden .
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 3, p. 177-183Article in journal (Refereed)
    Abstract [en]

    Patients with atrial fibrillation have a significantly increased risk of thromboembolic events such as ischaemic stroke, and patients are therefore recommended to be treated with anticoagulation treatment. The most commonly used anticoagulant consists of vitamin K antagonist such as warfarin. A new oral anticoagulation treatment, dabigatran, has recently been approved for stroke prevention among patients with atrial fibrillation. The purpose of this study was to estimate the cost-effectiveness of dabigatran as preventive treatment of stroke and thromboembolic events compared with warfarin in 65-year-old patients with atrial fibrillation in Sweden. less thanbrgreater than less thanbrgreater thanA decision analytic simulation model was used to estimate the long-term (20-year) costs and effects of the different treatments. The outcome measures are the number of strokes prevented, life years gained, and quality-adjusted life years (QALYs) gained. Costs and effect data are adjusted to a Swedish setting. Patients below 80 years of age are assumed to start with dabigatran 150 mg twice a day and switch to 110 mg twice a day at the age of 80 years due to higher bleeding risk. The price of dabigatran in Sweden is Euro2.82 (Swedish kronor 25.39) per day for both doses. The cost per QALY gained for dabigatran compared with warfarin is estimated at Euro7742, increasing to Euro12 449 if dabigatran is compared with only well-controlled warfarin treatment. less thanbrgreater than less thanbrgreater thanDabigatran is a cost-effective treatment in Sweden, as its incremental cost-effectiveness ratio is below the normally accepted willingness to pay limit.

  • 13.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Krevers , Barbro
    Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    In pursuit of QALY weights for relatives: Empirical estimates in relatives caring for older people2008In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 9, no 3, p. 285-292Article in journal (Refereed)
    Abstract [en]

    This study estimates quality-adjusted life-year (QALY) weights for relatives caring for an older person. The data used are from the Swedish part of the EUROFAMCARE study. A new measure is introduced called the R-QALY weight, defined as the effect on a relative’s QALY weight due to being a relative of a disabled or sick individual. R-QALY weights were created by comparing relatives’ QALY weights with population-based QALY weights. They were also created by comparing with QALY weights reassessed for a hypothetical situation in which the older person needed no care. The results indicate that R-QALY weights are small when compared with population-based weights, but large when compared with QALY weights reassessed for the hypothetical situation. Moreover, R-QALY weights were affected by relatives’ age, sex, and subjective perception of positive and negative aspects of the caregiving situation. These aspects should therefore be taken into account in health economics evaluations using a societal approach.

  • 14.
    Davidson, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Krevers, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Physiotherapy.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Identification and Estimation of Relatives' QALY Weights for Use in Health Economic Evaluations2006In: ECHE, 6th European Conference in Health Economics,2006, 2006Conference paper (Other academic)
  • 15.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Ake
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Is the societal approach wide enough to include relatives?: incorporating relatives' costs and effects in a cost-effectiveness analysis.2010In: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 8, no 1, p. 25-35Article in journal (Refereed)
    Abstract [en]

    It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives' costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives' costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives' effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives' QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient's QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives' costs and effects. Because cost-effectiveness analyses are used for decision making, and this is often achieved by comparing different cost-effectiveness ratios, we argue that it is important to find ways of incorporating all relatives' costs and effects into the analysis. This may not be necessary for every analysis of every intervention, but for treatments where relatives' costs and effects are substantial there may be some associated influence on the cost-effectiveness ratio.

  • 16.
    Davidson, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Do individuals consider expected income when valueing health states?2007In: iHEA, the 6th world congress on health economics,2007, 2007Conference paper (Refereed)
    Abstract [en]

       

  • 17.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Do individuals consider expected income when valuing health states?2008In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 24, no 4, p. 488-494Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study was to empirically explore whether individuals take their expected income into consideration when directly valuing predefined health states. This was intended to help determine how to handle productivity costs due to morbidity in a cost-effectiveness analysis.

    Methods: Two hundred students each valued four hypothetical health states by using time trade-off (TTO) and a visual analogue scale (VAS). The students were randomly assigned to two groups. One group was simply asked, without mentioning income, to value the different health states (the non-income group). The other group was explicitly asked to consider their expected income in relation to the health states in their valuations (the income group).

    Results: For health states that are usually assumed to have a large effect on income, the valuations made by the income group seemed to be lower than the valuations made by the non-income group. Among the students in the non-income group, 96 percent stated that they had not thought about their expected income when they valued the health states. In the income group, 40 percent believed that their expected income had affected their valuations of the health states.

    Conclusion: The results show that, as long as income is not mentioned, most individuals do not seem to consider their expected income when they value health states. This indicates that productivity costs due to morbidity are not captured within individuals’ health state valuations. These findings, therefore, suggest that productivity costs due to morbidity should be included as a cost in cost-effectiveness analyses.

  • 18.
    Davidson, Thomas
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Kostnaden för förmaksflimmer i Östergötland2006Report (Other academic)
    Abstract [en]

    Atrial  fibrillation  (AF)  is  the  most  common  arrhythmic  disease  in  Sweden. Persons  with  AF  have  a  significant  increased  risk  of  stroke  and  the  main treatment  is  therefore  intended  to  prevent  stroke  by  anticoagulation  with warfarin. There is no existing calculation of the cost of AF in Sweden today and since new treatments soon may become available there is a need to know the societal cost of AF. The aim of this report was therefore to calculate the cost of AF in the Östergötland County in Sweden. This was done by identifying all relevant  costs  and  by  quantifying  and  valuing  them.  The  cost  of  AF  was calculated by using a model, which was also used to forecast the cost of the coming years. The focus in the calculation has been on the side effects caused by AF and treatments intended to lower the risks for these events. The treatment of AF is often not aimed at curing the disease but rather to prevent the negative events connected to it.

    Three  possible  treatments  for  a  person  with  AF  have  been  included  in  the calculation; treatment with warfarin, treatment with ASA or no treatment. Only patients with moderate or high risk for stroke were included in the calculation. Only about 50 per cent of the patients receive treatment with warfarin although the recommendation is that most persons with AF should receive Warfarin, and this low use of warfarin may cause extra costs for the society.

    The total cost of AF in Östergötland has been calculated to SEK 137 million in year 2006 and the prognosis for 2008 is SEK 155 million and SEK 177 million in year 2010, which is an increase of almost 30 per cent within these four years. If only direct costs were included, the result for 2006 is SEK 115 millions. The cost for stroke is the main cost and counts for 84 per cent of the total cost for AF when also the indirect costs are included.

    Because the prevalence of AF is increasing for persons above 60 years and is very high among persons over 80 years, the expected number of persons with AF is increasing as the number of elderly persons in the society is increasing. This generates large and increasing costs for the society. Due to potential new treatments of either curing the disease or by lowering the risks for stroke, it is possible that the societal costs may be less in the long run compared to the calculation in this report.

  • 19.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Närståendes konsekvenser: Hur kan de inkluderas i den hälsoekonomiska analysen?2008Report (Other academic)
    Abstract [en]

    There is a need for cost-effectiveness analyses to include relatives’ consequences in order to fulfil the recommendation of having a societal perspective. Being a relative to a patient with a disease or a disablement can cause consequences, and these consequences may be separated between costs and effects. The costs are mainly caused by the need of providing informal care. The effects are caused by relatives’ affected quality of life. The cost for informal care is sometimes included in cost-effectiveness analyses, but relatives’ effects are, as far as we have seen, never included.

    In this report we discuss relatives’ consequences, how they can be measured and valued, and also how they could be incorporated in the cost-effectiveness analysis. The recommended approach to calculate the cost of informal care is to value lost paid production as the salary including employment fees, and lost unpaid production to be valued as the relative’s own valuation of this leisure time. It is more difficult to give recommendations about how to measure and value relatives’ affected quality of life (and more studies about this are needed). One possible solution is to use instruments that measures relative-related quality of life. Another potential method is to study relatives’ willingness to pay for an improvement of the patient’s health.

    It is important to avoid double counting in a cost-effectiveness analysis. This must therefore be acknowledged when relatives’ consequences are included. Cost of informal care may incorporate some of the effects on relatives’ quality of life. Furthermore there is a risk for double counting when both the patient’s and the relatives’ effects are included in the analysis. It is therefore of importance that these risks are considered in the choice of methods to measure and value relatives’ consequences.

    An outcome measure that is often used to measure the effects of a treatment is quality-adjusted life years (QALY). One potential method to incorporate relatives’ effects in the cost-effectiveness ratio, which is discussed in this report, is to measure relatives’ effects in the new outcome R-QALY weights. These weights are defined as the change in relatives’ QALY weights caused by being a relative to a patient with a disease or disablement. When these weights are used to create QALYs, they can be summed with the patient’s QALYs and placed together in the denominator of the cost-effectiveness ratio. This method is however controversial as the denominator normally only includes the patient’s effects. An alternative of combining the patient’s QALY weight with relatives’ R-QALY weights could be to find a monetary value of the R-QALY weight and include this value together with the other costs in the analysis. Because of the difficulties of including relatives’ consequences we recommend to present the results both with and without relatives’ consequences. This would furthermore enable the analysis to be compared with other analyses.

    As cost-effectiveness analyses often are used for decision making, we argue that it is of importance to find methods which enable the incorporation of all consequences of the relatives in the analysis. This field is evolving and more research is needed before further recommendations can be made.

  • 20.
    Davidson, Thomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Using the costs of added life-years in a cost-effectiveness analysis2005In: HTAi, 2nd Annual HTAi Meeting - Bringing HTA into practice,2005, 2005Conference paper (Other academic)
  • 21.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Bergström, Anders
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    En pilotstudie av självtestning vid behandling med oral antikoagulantia: Hälsoekonomiska aspekter2013Report (Other academic)
    Abstract [en]

    To avoid the occurrence of thromboembolic events and ischemic stroke in the diagnoses that lead to increased risk of blood clotting, anticoagulant treatment, primarily in the form of warfarin (Waran®), is used. Warfarin requires regular testing to ensure efficient treatment. This testing is normally done at clinics but can also be performed by patients themselves by self-testing.

    This pilot study studies patients who self-test their warfarin therapy in the county of Östergötland, with a focus on costs and cost effectiveness.

    The study has a pre-post design for 12 months where the patients are their own controls. Twenty patients with warfarin therapy were included. The primary outcome measure is the time within therapeutic range before and after the selftesting. Patients answered at three times the instruments EQ-5D and SF-36 as well as questions regarding how much they would hypothetically be willing to pay to use self-testing equipment.

    Mean age was 56 years and 67 percent were male. Percentage of treatment within the therapeutic range was between 57 and 100 percent, with an average of 86 percent. Minor bleeding occurred in 3 patients but no thrombosis occurred. The study is too small to ensure no clinical differences. In total, self-testing cost SEK 180 per session, which was lower than the cost at the clinic (SEK 370). Patients' quality of life (measured in QALY weights) indicated a tendency to rise during the studied 12 months. The willingness-to-pay decreased from SEK 11,526 at baseline to SEK 6,490 after 12 months. As costs have been spared and the effects are expected to be equivalent, self-testing can be considered costeffective. Moreover, since it has been shown that there is a societal willingness to pay for the equipment this strengthens the result that self-testing is costeffective.

    The study’s findings suggest that self-testing leads to lower costs and a trend toward improved quality of life for patients. No clinical differences have been demonstrated. This makes self-testing considered a cost-effective measure of the studied patient population. However, this is a small pilot study and its results need to be verified in larger studies.

  • 22.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Lindelof, Ann
    Region Östergötland, Local Health Care Services in East Östergötland.
    Wallen, Torbjorn
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping. Vastervik Hospital, Sweden.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Hallert, Claes
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study2015In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 21, no 5, p. 298-301Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.

  • 23.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Lyth, Johan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Direct valuation of health state among patients with chest pain: Does income level matterManuscript (preprint) (Other (popular science, discussion, etc.))
    Abstract [en]

    There is still uncertainty over where to include the production loss caused by morbidity in cost-effectiveness analyses. This loss could be included as a cost; but if individuals take their own income into consideration when valuing health states, this would lead to double counting. The purpose of this study was to find out whether individuals’ incomes can explain their valuations of their own current health states.

    The sample consisted of 156 patients (312 observations) admitted to hospital with chest pain (the FRISC II trial). These patients valued their own current health states by using the time trade-off method (TTO) and a visual analogue scale (VAS). They also answered the EQ-5D instrument and stated their monthly income. Income level was additionally controlled via their taxed income at the tax agency, together with their income generated from capital. Generalised estimation equations were used to test whether the EQ- 5D dimensions and monthly gross income could explain the variation in the valuations of the health states.

    The results indicate that neither self-stated nor taxed income could explain the variation in the valuations made by TTO. However, self-stated income (but not taxed income) was a significant variable in explaining variation in the VAS valuations.

    These findings support the inclusion of the production loss caused by morbidity in the analysis, as these costs are not, or at least not to any great extent, implicitly incorporated in the individuals’ QALY weights when TTO is used to value the health states. Using a VAS, some income effects may be included.

  • 24.
    Davidson, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Swedish Council Health Technology Assessment, Sweden.
    Rohlin, Madeleine
    Malmö University, Sweden.
    Hultin, Margareta
    Karolinska Institute, Sweden.
    Jemt, Torsten
    University of Gothenburg, Sweden; Branemark Clin, Sweden.
    Nilner, Krister
    Malmö University, Sweden.
    Sunnegardh-Gronberg, Karin
    Umeå University, Sweden.
    Tranaeus, Sofia
    Swedish Council Health Technology Assessment, Sweden; Malmö University, Sweden; Karolinska Institute, Sweden.
    Nilsson, Mats
    County Hospital Ryhov, Sweden.
    Reimbursement systems influence prosthodontic treatment of adult patients2015In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, no 6, p. 414-420Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. Materials and methods. Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patients age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. Results. Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. Conclusions. Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

  • 25.
    Eckard, Nathalie
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Walfridsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Cost-Effectiveness of Catheter Ablation Treatment for Patients with Symptomatic Atrial Fibrillation2009In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 1, no 8, p. 461-470Article in journal (Refereed)
    Abstract [en]

    Background:  Atrial Fibrillation is the most common cardiac arrhythmia.  It increases the risk of thromboembolic events and many atrial fibrillation patients suffer quality of life impairment due to disturbed heart rhythm.  Pulmonary vein isolation using radiofrequency catheter ablation treatment is aimed at maintaining sinus rhythm ultimately improving quality of life.  Randomized clinical trial have shown that catheter ablation is more effective than antiarrhythmic drugs for the treatment of atrial fibrillation, but its impact on quality of life and cost-effectiveness has not been widely studied.  Aims:  To assess the cost-effectiveness of radiofrequency ablation (RFA) vs. antiarrhythmic drug (AAD) treatment, among symptomatic atrial fibrillation patients not previously responding to AAD.  Methods:  A decision-analytic Markov model was developed to assess costs and health outcomes in terms of quality adjusted life years (QALYs) of RFA and AAD over a lifetime time horizon.  We conducted a literature search and used data from several sources as input variables of the model.  One-year rates of atrial fibrillation with RFA and AAD, respectively, were available from published randomized clinical trials.  Other data sources were published papers and register data.  Results:  The RFA treatment strategy was associated with reduced costs and an incremental gain in QALYs compared to the AAD treatment strategy.  The results were sensitive to whether long-term quality of life improvement is maintained for the RFA treatment strategy and the risk of stroke in the different atrial fibrillation health states.  Conclusion:  This study shows that the short-term improvement in atrial fibrillation associated with RFA is likely to lead to long-term quality of life improvement and lower costs indicating that RFA is cost-effective compared to AAD. 

  • 26.
    Eckard, Nathalie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Henriksson, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Davidson, Thomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Cost-effectiveness of catheter ablation versus antiarrhytmic drugs for patients with symptomatic atrial fibrillation (oral presentation)2008In: SMDM Europe,2008, 2008Conference paper (Other academic)
  • 27.
    Frisk, Fredrik
    et al.
    nstitute for Postgraduate Dental Education, Jönköping, Sweden.
    Kvist, Thomas
    University of Gothenburg, Sweden .
    Axelsson, Susanna
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Bergenholtz, Gunnar
    University of Gothenburg, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Mejare, Ingegerd
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Norlund, Anders
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Petersson, Arne
    Malmö University, Sweden .
    Sandberg, Hans
    Karolinska Institutet, Stockholm, Sweden.
    Tranaeus, Sofia
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Hakeberg, Magnus
    University of Gothenburg, Sweden .
    Pulp exposures in adults - choice of treatment among Swedish dentists2013In: Swedish Dental Journal, ISSN 0347-9994, Vol. 37, no 3, p. 153-161Article in journal (Refereed)
    Abstract [en]

    This study comprises a survey of Swedish dentists treatment preferences in cases of carious exposure of the dental pulp in adults. The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines. Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included. The final study sample comprised 412 participants. The dentists were presented with two case scenarios. In Case a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14. The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.

  • 28.
    Hedin, Christina
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sjödahl, Rune
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Aldman, Åke
    Västerviks sjukhus, Västervik, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Kammerlind, Ann-Sofie
    Region Jönköpings län, Jönköping, Sweden.
    Nodbrant, Per
    Onkologiska kliniken, Länssjukhuset Ryhov, Jönköping, Sweden.
    Agrup, Måns
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology. Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Intraoperativ strålbehandling vid primar operation for bröstcancer: TARGIT-A-studien ej konklusiv2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EWFFArticle, review/survey (Refereed)
    Abstract [sv]

    The TARGIT-A (TARGeted Intraoperative radioTherapy) multicentre study of early breast cancer compared intraoperative radiotherapy with external radiotherapy. While the intraoperative radiotherapy was standardised, the external postoperative comparison treatment followed established routines in the participating treatment centres resulting in substantial variations in dosages and treatment durations. The uncertainties in the interpretation of the study results created by the design of the TARGIT-A study constitute substantial obstacles to the possible introduction of intraoperative radiotherapy for early breast cancer.

  • 29.
    Heibert Arnlind, Marianne
    et al.
    Statens beredning för medicinsk utvärdering.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hälsoekonomi i relation till kvalitets- och förbättringsarbete i vården2012In: Kvalitetsarbete för bättre och säkrare vård / [ed] Gun Nordström och Bodil Wilde-Larsson, Lund: Studentlitteratur, 2012, 1, p. 219-238Chapter in book (Other academic)
  • 30.
    Heintz, Emelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Swedish Council on Health Technology Assessment (SBU), Stockholm.
    Arnberg, Karl
    The Dental and Pharmaceutical Benefits Agency (TLV) Stockholm.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Liliemark, Jan
    Swedish Council on Health Technology Assessment (SBU), Stockholm and The county councils' group on new drug therapies (NLT), The Swedish Association of Local Authorities and Regions (SALAR), Stockholm.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Swedish Council on Health Technology Assessment (SBU), Stockholm.
    The impact of health economic evaluations in Sweden.2014In: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, ISSN 2212-0289, Vol. 108, no 7, p. 375-82Article in journal (Refereed)
    Abstract [en]

    The responsibility for healthcare in Sweden is shared by the central government, county councils and municipalities. The counties and municipalities are free to make their own prioritizations within the framework of the state healthcare laws. To guide prioritization of healthcare resources in Sweden, there is consensus that cost-effectiveness constitutes one of the three principles. The objective of this paper is to describe how cost-effectiveness, and hence health economic evaluations (HEE), have a role in pricing decisions, reimbursement of pharmaceuticals as well as the overall prioritization and allocation of resources in the Swedish healthcare system. There are various organizations involved in the processes of implementing health technologies in the Swedish healthcare system, several of which consider or produce HEEs when assessing different technologies: the Dental and Pharmaceutical Benefits Agency (TLV), the county councils' group on new drug therapies (NLT), the National Board of Health and Welfare, the Swedish Council on Health Technology Assessment (SBU), regional HTA agencies and the Public Health Agency of Sweden. The only governmental agency that has official and mandatory guidelines for how to perform HEE is TLV (LFNAR 2003:2). Even though HEEs may seem to have a clear and explicit role in the decision-making processes in the Swedish healthcare system, there are various obstacles and challenges in the use and dissemination of the results.

  • 31.
    Heintz, Emelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Gerber-Grote, Andreas
    Institut für Qualität und Wirtschaftlichkeit Gesundheitswes, Germany.
    Ghabri, Salah
    Department of Economic and Public Health Evaluation, Haute Autorite Sante, France.
    Hamers, Francoise F.
    Department of Economic and Public Health Evaluation, Haute Autorite de Sante, France.
    Prevolnik Rupel, Valentina
    Institute for Economic Research, Slovenia.
    Slabe-Erker, Renata
    Institute for Econ Research, Slovenia.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Is There a European View on Health Economic Evaluations? Results from a Synopsis of Methodological Guidelines Used in the EUnetHTA Partner Countries2016In: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 34, no 1, p. 59-76Article in journal (Refereed)
    Abstract [en]

    The objectives of this study were to review current methodological guidelines for economic evaluations of all types of technologies in the 33 countries with organizations involved in the European Network for Health Technology Assessment (EUnetHTA), and to provide a general framework for economic evaluation at a European level. Methodological guidelines for health economic evaluations used by EUnetHTA partners were collected through a survey. Information from each guideline was extracted using a pre-tested extraction template. On the basis of the extracted information, a summary describing the methods used by the EUnetHTA countries was written for each methodological item. General recommendations were formulated for methodological issues where the guidelines of the EUnetHTA partners were in agreement or where the usefulness of economic evaluations may be increased by presenting the results in a specific way. At least one contact person from all 33 EUnetHTA countries (100 %) responded to the survey. In total, the review included 51 guidelines, representing 25 countries (eight countries had no methodological guideline for health economic evaluations). On the basis of the results of the extracted information from all 51 guidelines, EUnetHTA issued ten main recommendations for health economic evaluations. The presented review of methodological guidelines for health economic evaluations and the consequent recommendations will hopefully improve the comparability, transferability and overall usefulness of economic evaluations performed within EUnetHTA. Nevertheless, there are still methodological issues that need to be investigated further.

  • 32.
    Hultin, Margareta
    et al.
    Karolinska Institute, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Gynther, Goran
    Karolinska Institute, Sweden Visby Hospital, Sweden .
    Helgesson, Gert
    Karolinska Institute, Sweden .
    Jemt, Torsten
    University of Gothenburg, Sweden Public Dent Health Serv, Sweden .
    Lekholm, Ulf
    Public Dent Health Serv, Sweden .
    Nilner, Krister
    Malmö University, Sweden .
    Nordenram, Gunilla
    Karolinska Institute, Sweden .
    Norlund, Anders
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Rohlin, Madeleine
    Malmö University, Sweden .
    Sunnegardh-Gronberg, Karin
    Umeå University, Sweden .
    Tranaeus, Sofia
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Oral Rehabilitation of Tooth Loss: A Systematic Review of Quantitative Studies of OHRQoL2012In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 25, no 6, p. 543-552Article, review/survey (Refereed)
    Abstract [en]

    Purpose: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health-related quality of life (OHRQoL). Materials and Methods: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. Results: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. Conclusions: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied.

  • 33.
    Levin, Lars-Åke
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Sobocinski, Piotr Doliwa
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Kull, Viveka Frykman
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Leif
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 207-14Article in journal (Refereed)
    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.

  • 34.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Hälsoekonomisk analys av hemtandvård jämfört med tandvård på stationära kliniker för äldre vid särskilda boenden2013Report (Other academic)
    Abstract [en]

    Background: The number and age of the elderly population in Sweden is increasing, and the cost of dental care is expected to increase  substantially during the next decades. Improved dental status among elderly, has led to a majority of elderly with most of their own teeth relatively intact, often in combination with dental restorations, or prosthetics (e.g. crowns, bridges, dental implants). Ageing leads to increased morbidity, and hospitalization or dependence on the care of others lead to a risk for severe deterioration of oral health. The county councils subsidize dental care for elderly nursing home residents in Sweden. Elderly nursing home residents are entitled to limited dental care, for the same fixed patient fee as in outpatient health care. The patient is free to choose provider of dental care. Dental care is usually offered at stationary dental clinics, but domiciliary dental care is an alternative.

    Purpose: The aim was to analyze economic consequences of domiciliary dental care, compared to dentistry at a stationary clinic, for elderly nursing home residents in Sweden.

    Methods: Nursing home staff, officials at county councils, and academic experts in geriatric dentistry, were interviewed. Cost analyses and costeffectiveness analyses were done. The market of dental care was analyzed from a societal perspective, to identify aspects of importance for the choice of stationary clinic or domiciliary dental care for elderly nursing home residents. Risks of asymmetric information between the involved participants (i.e. county council, dental care providers, municipalities, nursing homes, and patients) were analyzed, together with respective incentives to gain benefits.

    Results: For elderly nursing home residents the mean societal cost of domiciliary dental care was lower compared to dental care at stationary dental clinic. Domiciliary dental care was expected to increase the quality of life, and was cost effective compared to dental care at a stationary clinic.

    Conclusions: Domiciliary dental care has lower societal cost, is expected to improve the quality of life, and is cost-effective compared to dental care at stationary clinics, for elderly nursing home residents in Sweden. Since the prerequisites for seeking dental care among the elderly differ, it is important that dental care can be provided at different settings. Increased collaboration between the involved participants is needed in order to improve the efficiency and cost-effectiveness of dental care for elderly nursing home residents.

  • 35.
    Lundqvist, Martina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Ordell, Sven
    Region Östergötland, Public Dental Health Care.
    Sjöstrom, O.
    Oral Care AB, Sweden.
    Zimmerman, M.
    Oral Care AB, Sweden.
    Sjogren, P.
    Oral Care AB, Sweden.
    Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden2015In: Community Dental Health, ISSN 0265-539X, Vol. 32, no 1, p. 39-43Article in journal (Refereed)
    Abstract [en]

    Objectives: Dental care for elderly nursing home residents is traditionally provided at fixed dental clinics, but domiciliary dental care is an emerging alternative. Longer life expectancy accompanied with increased morbidity, and hospitalisation or dependence on the care of others will contribute to a risk for rapid deterioration of oral health so alternative methods for delivering oral health care to vulnerable individuals for whom access to fixed dental clinics is an obstacle should be considered. The aim was to analyse health economic consequences of domiciliary dental care for elderly nursing home residents in Sweden, compared to dentistry at a fixed clinic. Methods: A review of relevant literature was undertaken complemented by interviews with nursing home staff, officials at county councils, and academic experts in geriatric dentistry. Domiciliary dental care and fixed clinic care were compared in cost analyses and cost-effectiveness analyses. Results: The mean societal cost of domiciliary dental care for elderly nursing home residents was lower than dental care at a fixed clinic, and it was also considered cost-effective. Lower cost of dental care at a fixed dental clinic was only achieved in a scenario where dental care could not be completed in a domiciliary setting. Conclusions: Domiciliary dental care for elderly nursing home residents has a lower societal cost and is cost-effective compared to dental care at fixed clinics. To meet current and predicted need for oral health care in the ageing population alternative methods to deliver dental care should be available.

  • 36.
    Mejare, I A
    et al.
    Malmö University, Sweden Swedish Council Health Technology Assessment, Sweden .
    Axelsson, S
    Swedish Council Health Technology Assessment, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Frisk, F
    Institute Postgrad Dent Educ, Sweden University of Gothenburg, Sweden .
    Hakeberg, M
    University of Gothenburg, Sweden .
    Kvist, T
    University of Gothenburg, Sweden .
    Norlund, A
    Swedish Council Health Technology Assessment, Sweden .
    Petersson, A
    Malmö University, Sweden .
    Portenier, I
    University of Geneva, Switzerland .
    Sandberg, H
    Karolinska Institute, Sweden .
    Tranaeus, S
    Swedish Council Health Technology Assessment, Sweden .
    Bergenholtz, G
    University of Gothenburg, Sweden .
    Diagnosis of the condition of the dental pulp: a systematic review2012In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 45, no 7, p. 597-613Article, review/survey (Refereed)
    Abstract [en]

    Mejare IA, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tran ae us S, Bergenholtz G. Diagnosis of the condition of the dental pulp: a systematic review. International Endodontic Journal, 45, 597613, 2012. Abstract The aim of this systematic review was to appraise the diagnostic accuracy of signs/symptoms and tests used to determine the condition of the pulp in teeth affected by deep caries, trauma or other types of injury. Radiographic methods were not included. The electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to June 2011. The complete search strategy is given in an Appendix S1 (available online as Supporting Information). In addition, hand searches were made. Two reviewers independently assessed abstracts and full-text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 155 articles were read in full text. Of these, 18 studies fulfilled pre-specified inclusion criteria. The quality of included articles was assessed using the QUADAS tool. Based on studies of high or moderate quality, the quality of evidence of each diagnostic method/test was rated in four levels according to GRADE. No study reached high quality; two were of moderate quality. The overall evidence was insufficient to assess the value of toothache or abnormal reaction to heat/cold stimulation for determining the pulp condition. The same applies to methods for establishing pulp status, including electric or thermal pulp testing, or methods for measuring pulpal blood circulation. In general, there are major shortcomings in the design, conduct and reporting of studies in this domain of dental research.

  • 37.
    Nordenram, Gunilla
    et al.
    Karolinska Institutet, Department of Dental Medicine, Sweden.
    Davidson, Thomas
    The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Gynther, Göran
    Karolinska Institutet, Department of Dental Medicine, Sweden; Oral and Maxillofacial Centre, Visby Hospital, Sweden.
    Helgesson, Gert
    Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Sweden.
    Hultin, Margareta
    Karolinska Institutet, Department of Dental Medicine, Sweden.
    Jemt, Torsten
    Department of Prosthetic Dentistry/Dental Material Science, The Sahlgrenska Academy, Göteborg University, Sweden; Brånemark Clinic, Public Dental health Care Service, Region of Västra Götaland, Sweden.
    Lekholm, Ulf
    Clinic of Odontology, Public Dental health Service, West Region of Sweden, Sweden; Sahlgrenska Academy at University of Göteborg, Sweden.
    Nilner, Krister
    Faculty of Odontology, Malmö University, Sweden.
    Norlund, Anders
    The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Rohlin, Madeleine
    Faculty of Odontology, Malmö University, Sweden.
    Sunnegårdh-Grönberg, Karin
    Department of Odontology, Umeå University, Sweden.
    Tranæus, Sofia
    Karolinska Institutet, Department of Dental Medicine, Sweden; The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: a systematic review with meta-synthesis.2013In: Acta odontologica Scandinavica, ISSN 1502-3850, Vol. 71, no 3-4, p. 937-51Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To conduct a systematic review and meta-synthesis of qualitative studies addressing patients' perceptions of loss of teeth, edentulism and oral rehabilitation.

    BACKGROUND: Qualitative studies can complement quantitative studies by achieving deep understanding of patients' subjective experiences of losing teeth and coping with edentulism. They can also explore the perception that the benefits of prosthetic rehabilitation extend far beyond primary clinical treatment goals of restoration of oral function.

    MATERIALS AND METHODS: The major data bases were searched extensively for relevant qualitative and quantitative studies, followed by manual searching of the reference lists of included publications. Two authors independently read all abstracts. Relevant papers were retrieved in full-text and included or excluded according to a specially designed protocol. The included articles were then appraised and rated for quality: high, moderate or low. Articles of low quality were excluded.

    RESULTS: The database search yielded 36 abstracts of qualitative studies; manual search disclosed one further article. All were read in full-text by two independent authors: 28 were excluded. Of the remaining nine, two (assessed as of low quality) were excluded for further analysis. Meta-synthesis, based on seven studies, disclosed two major themes: loss of quality-of-life associated with losing teeth and restored quality-of-life after oral rehabilitation.

    CONCLUSIONS: In this relatively new field of research, there are few published papers. Nevertheless, the studies to date show that loss of teeth is associated not only with compromised oral function, but also loss of social status and diminished self-esteem. Oral rehabilitation has broad positive implications, restoring quality of life and self-worth.

  • 38.
    Petersson, A.
    et al.
    Malmö University, Sweden .
    Axelsson, S.
    Malmö University, Sweden SBU Swedish Council Health Technology Assessment, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Frisk, F.
    Institute Postgrad Dent Educ, Sweden University of Gothenburg, Sweden .
    Hakeberg, M.
    University of Gothenburg, Sweden .
    Kvist, T.
    University of Gothenburg, Sweden .
    Norlund, A.
    SBU Swedish Council Health Technology Assessment, Sweden Karolinska Institute, Sweden .
    Mejare, I.
    SBU Swedish Council Health Technology Assessment, Sweden Malmö University, Sweden .
    Portenier, I.
    University of Geneva, Switzerland .
    Sandberg, H.
    SBU Swedish Council Health Technology Assessment, Sweden Karolinska Institute, Sweden .
    Tranaeus, S.
    SBU Swedish Council Health Technology Assessment, Sweden .
    Bergenholtz, G.
    University of Gothenburg, Sweden .
    Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review2012In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 45, no 9, p. 783-801Article, review/survey (Refereed)
    Abstract [en]

    Petersson A, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Mejare I, Portenier I, Sandberg H, Tranaeus S, Bergenholtz G. Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review. International Endodontic Journal, 45, 783801, 2012. Abstract This systematic review evaluates the diagnostic accuracy of radiographic methods employed to indicate presence/absence and changes over time of periapical bone lesions. Also investigated were the leads radiographic images may give about the nature of the process and the condition of the pulp in nonendodontically treated teeth. Electronic literature search included the databases PubMed, Embase and CENTRAL from January 1950 to June 2011. All languages were accepted provided there was an abstract in English. The MeSH terms were Cone beam computed tomography (CBCT), Radiography, panoramic, Periapical diseases, Dental pulp diseases, Sensitivity and specificity, receiver operating characteristics (ROC) curve, Cadaver, Endodontics and Radiography dental. Two reviewers independently assessed abstracts and full text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 181 articles were read in full text. The GRADE approach was used to assess the quality of evidence of each radiographic method based on studies of high or moderate quality. Twenty-six studies fulfilled criteria set for inclusion. None was of high quality; 11 were of moderate quality. There is insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to CBCT. No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.

  • 39.
    Pirhonen, Laura
    et al.
    Centrum för hälsoekonomi, Göteborgs universitet, Sverige.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. SBU – Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Experiences of including costs of added life years in health economic evaluations in Sweden2014In: Farmeconomia. Health Economics and Therapeutic Pathways, ISSN 1721-6915, Vol. 15, no 2, p. 45-53Article in journal (Refereed)
    Abstract [en]

    It is of importance to include the appropriate costs and outcomes when evaluating a health intervention. Sweden is the only country where the national guidelines of decisions on reimbursement explicitly state that costs of added life years should be accounted for when presenting health economic evaluations. The aim of this article is to, from a theoretical and empirical point of view, critically analyze the Swedish recommendations used by the Dental and Pharmaceutical Benefits Agency (TLV), when it comes to the use of costs of added life years in economic evaluations of health care. The aim is furthermore to analyze the numbers used in Sweden and discuss their impact on the incremental cost‑effectiveness ratios of assessed technologies. If following a societal perspective, based on welfare economics, there is strong support for the inclusion of costs of added life years in health economic evaluations. These costs have a large impact on the results. However this fact may be in conflict with ethical concerns of allocation of health care resources, such as favoring the younger part of the population over the older. It is important that the estimates of production and consumption reflect the true societal values, which is not the case with the values used in Sweden.

  • 40.
    Rohlin, Madeleine
    et al.
    Malmö University, Sweden .
    Nilner, Krister
    Malmö University, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Gynther, Goran
    Karolinska Institute, Sweden Visby Hospital, Sweden .
    Hultin, Margareta
    Karolinska Institute, Sweden .
    Jemt, Torsten
    University of Gothenburg, Sweden Public Dent Health Serv, Sweden .
    Lekholm, Ulf
    University of Gothenburg, Sweden Public Dent Health Serv, Sweden .
    Nordenram, Gunilla
    Karolinska Institute, Sweden .
    Norlund, Anders
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Sunnegardh-Gronberg, Karin
    Umeå University, Sweden .
    Tranaeus, Sofia
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Treatment of Adult Patients with Edentulous Arches: A Systematic Review2012In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 25, no 6, p. 553-567Article, review/survey (Refereed)
    Abstract [en]

    Purpose: This study aimed to evaluate the outcomes of treatment methods used to rehabilitate adult patients with maxillary and/or mandibular edentulism after at least 5 years of follow-up. The risks, adverse effects, and cost effectiveness of these methods were also evaluated. Materials and Methods: Three databases as well as the reference lists of included publications were searched using specified indexing terms. Publications that met the inclusion criteria were read and interpreted using pre-established protocols. Quality of evidence was classified according to the GRADE system (high, moderate, low, or very low). Results: The search yielded 2,130 titles and abstracts. Of these, the full-text versions of 488 publications were obtained. After data extraction and interpretation, 10 studies with moderate study quality of evidence and 1 study with low quality of evidence regarding outcomes, risks, and adverse effects remained. Three studies on the economic aspects of treatment were also included (1 with moderate quality and 2 with low quality). Low-quality evidence showed that the survival rate of implant-supported fixed prostheses is 95% after 5 years in patients with maxillary edentulism and 97% after 10 years in patients with mandibular edentulism. The survival rate of implant-supported overdentures is 93% after 5 years (low-quality evidence). In implant-supported fixed prostheses, 70 of every 1,000 implants are at risk of failing in the maxilla after 5 years and 17 of every 1,000 implants in the mandible are at risk after 10 years. Regarding economic aspects, the evidence was insufficient to provide reliable results. Conclusions: Due to the low quality of evidence found in the included studies, further research with a higher quality of evidence is recommended to better understand the outcomes of treatment for patients with maxillary and/or mandibular edentulism.

  • 41.
    Sunnegardh-Gronberg, Karin
    et al.
    Umeå University, Sweden .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Gynther, Goran
    Karolinska Institute, Sweden Visby Hospital, Sweden .
    Jemt, Torsten
    University of Gothenburg, Sweden Public Dent Health Serv, Sweden .
    Lekholm, Ulf
    University of Gothenburg, Sweden Public Dent Health Serv, Sweden .
    Nilner, Krister
    Malmö University, Sweden .
    Nordenram, Gunilla
    Karolinska Institute, Sweden .
    Norlund, Anders
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Rohlin, Madeleine
    Malmö University, Sweden .
    Tranaeus, Sofia
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Hultin, Margareta
    Karolinska Institute, Sweden .
    Treatment of Adult Patients with Partial Edentulism: A Systematic Review2012In: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 25, no 6, p. 568-581Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The purpose of this systematic review was to identify and critically appraise published studies of treatment methods used in general practice to rehabilitate adult patients with single tooth loss or partial edentulism, with special emphasis on outcomes reported after at least 5 years of follow-up. Materials and Methods: Three databases were searched using specified indexing terms. Publications were included if the study design, research questions, and sample size satisfied pre-established criteria. Reference lists of relevant publications and systematic reviews were also searched. The quality of evidence was classified according to the GRADE system as high, moderate, low, or very low. Results: The search yielded 7,675 titles, of which 1,130 were read in full text. A final total of 15 publications were deemed eligible for inclusion: 5 of moderate quality and 10 of low quality. The five studies of moderate quality were all related to implant-based treatment. The 5-year survival rates for implant-supported single crowns and prostheses were 91% and 94.7%, respectively (implant survival rates: 98.5% and 94.9%, respectively). The underlying scientific evidence was low in quality. No relevant publications were identified regarding the economic aspects of treatment. Conclusion: Due to the low scientific evidence of the included studies, it was not possible to compare various treatment methods used for rehabilitation of single tooth loss or partial edentulism.

  • 42.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Evangelista, Lorraine
    School of Nursing University of California Los Angeles USA.
    Davidson, Thomas
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    The influence of chronic heart failure in patient-partner dyads: a comparative study addressing issues of health-related quality of life2011In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 26, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background: Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving the patients’ HRQOL, but the awareness of partners’ and families’ role and situation is increasing. Therefore further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF.

    Objectives: To describe and compare HRQOL, quality-adjusted life year (QALY) weights, symptoms of depression, perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and gender-matched group.

    Methods: Data was collected from 135 patient-partner dyads at two Swedish hospitals. Data on the reference group was collected from the same region.

    Results: Patients had lower HRQOL in all dimensions (p < 0.001) except in the mental health domain and lower QALY weights compared to their partners (p < 0.001). Mental health scores were lower in partners compared to the age and gender-matched references (p < 0.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than their partners (p < 0.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners.

    Conclusion: Being a partner to a patient with chronic HF markedly affects the mental aspect of HRQOL. Interventions focusing on education and psychosocial support may potentially promote effective coping in partners and enhance their ability to support the patient.

  • 43.
    Ågren, Susanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Evangelista, Lorraine S.
    UC Irvine Program Nursing Science, CA USA .
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners2013In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 22, no 15-16, p. 2347-2353Article in journal (Refereed)
    Abstract [en]

    Aims and objectives.  This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners.

    Background.  There are few studies evaluating cost-effectiveness of interventions among HF patient–partner dyads.

    Methods.  Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D.

    Results.  A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners.

    Conclusion.  The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient–partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved.

    Relevance to clinical practice.  The study shows trends of a cost-effective education and psychosocial care of HF patient–partner dyads.

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