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  • 1.
    Bernfort, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Reichard, Olle
    Infektionskliniken Karolinska Universitetssjukhuset.
    Sennfält, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden2005Ingår i: Health Technology Assessment International,2005, 2005Konferensbidrag (Övrigt vetenskapligt)
  • 2.
    Bernfort, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Reichard, Olle
    Karolinska sjukhuset.
    Sennfält, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Kostnadseffektiviteten av peginterferon alfa-2b (PegIntron) jämfört med interferon alfa-2b (Intron A) vid kombinationsbehandling av kronisk hepatit C i Sverige2004Ingår i: Svenska Läkaresällskapets riksstämma,2004, 2004Konferensbidrag (Refereegranskat)
  • 3.
    Bernfort, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Sennfält, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Reichard, Olle
    Dept of Infectious Diseases Karolinska Institutet.
    Cost-effectiveness of peginterferon alfa-2b in combination with ribavirin as initial treatment for chronic hepatitis C in Sweden2006Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 38, s. 497-505Artikel i tidskrift (Refereegranskat)
  • 4. Bistoletti, P.
    et al.
    Sennfält, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering.
    Dillner, J.
    Department of Medical Microbiology, Lund University, MAS University Hospital, Malmö, Sweden, Department of Medical Microbiology, Lund University, MAS University Hospital, SE-20502 Malmö, Sweden.
    Cost-effectiveness of primary cytology and HPV DNA cervical screening2008Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 122, nr 2, s. 372-376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 5.
    Bistoletti, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Sennfält, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    En hälsoekonomisk modellstudie av primärscreening mot livmoderhalscancer med cellprov- och HPV DNA-test2008Rapport (Övrigt vetenskapligt)
    Abstract [sv]

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

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

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

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

    Linköping september 2007

    Per Carlsson, professor

  • 6.
    Levin, Lars-Åke
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Sennfält, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Janzon, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Henriksson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Andersson, Agneta
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Socialmedicin och folkhälsovetenskap.
    Bernfort, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    En introduktion i hälsoekonomi2004Bok (Övrig (populärvetenskap, debatt, mm))
  • 7. Sandblom, G
    et al.
    Carlsson, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Sennfält, Karin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Varenhorst, Eberhard
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för kirurgi. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Urologiska kliniken i Östergötland.
    A population-based study of pain and quality of life during the year before death in men with prostate cancer2004Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 90, nr 6, s. 1163-1168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 8.
    Sennfält, Karin
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Economic studies of health technology changes in prostate cancer care2005Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

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

    Delarbeten
    1. Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002
    Öppna denna publikation i ny flik eller fönster >>Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-2002
    2006 (Engelska)Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 49, nr 6, s. 1028-1034Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

       Objective

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

    Methods

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

    Results

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

    Conclusions

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

    Nationell ämneskategori
    Samhällsvetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-36907 (URN)10.1016/j.eururo.2005.12.018 (DOI)33009 (Lokalt ID)33009 (Arkivnummer)33009 (OAI)
    Tillgänglig från: 2009-10-10 Skapad: 2009-10-10 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Technological changes in the management of prostate cancer result in increased healthcare costs: a retrospective study in a defined Swedish population
    Öppna denna publikation i ny flik eller fönster >>Technological changes in the management of prostate cancer result in increased healthcare costs: a retrospective study in a defined Swedish population
    Visa övriga...
    2003 (Engelska)Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 37, nr 3, s. 226-231Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE:

    In two previous studies we calculated direct costs for men with prostate cancer who died in 1984-85 and 1992-93, respectively. We have now performed a third cost analysis to enable a longitudinal cost comparison. The aim was to calculate direct costs for the management of prostate cancer, describe the economic consequences of technological changes over time and estimate total direct costs for prostate cancer in Sweden.

    MATERIAL AND METHODS:

    A total of 204 men in a defined population with a diagnosis of prostate cancer and who died in 1997-98 were included. Data on utilization of health services were extracted from clinical records from time of diagnosis to death from a university hospital and from one county hospital in the county of Ostergötland.

    RESULTS:

    The average direct cost per patient has been nearly stable over time (1984-85: 143 000 SEK; 1992-93: 150 000 SEK; 1997-98: 146 000 SEK). The share of costs for drugs increased from 7% in 1992-93 to 17% in 1997-98. The total direct costs for prostate cancer in Sweden have increased over time (1994-85: 610 MSEK; 1992-93: 860 MSEK; 1997-98: 970 MSEK).

    CONCLUSIONS:

    Two-thirds of the total cost is incurred by inpatient care. The share of the total costs for drugs is increasing due to increased use of gonadotrophin-releasing hormone analogues. Small changes in average direct costs per patient despite greater use of technology are explained by the fact that more prostate cancers are detected at the early stages.

    Nyckelord
    Costs, Prostate cancer, Technological changes
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-46551 (URN)10.1080/00365590310008109 (DOI)
    Tillgänglig från: 2009-10-11 Skapad: 2009-10-11 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial
    Öppna denna publikation i ny flik eller fönster >>Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial
    2004 (Engelska)Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 38, nr 4, s. 291-298Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE:

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

    MATERIAL AND METHODS:

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

    RESULTS:

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

    CONCLUSION:

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

    Nyckelord
    Costs, Prostate cancer, Screening
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-45606 (URN)10.1080/00365590410028890 (DOI)
    Tillgänglig från: 2009-10-11 Skapad: 2009-10-11 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    4. Costs and effect of biennial prostate cancer screening in Sweden: results from a randomized trial in a defined population
    Öppna denna publikation i ny flik eller fönster >>Costs and effect of biennial prostate cancer screening in Sweden: results from a randomized trial in a defined population
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: The aim was to estimate the lifetime cost in relation to the extra number of detected localized and potentially curable cancers, and to estimate the economic impact on health care of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-64 years.

    Material and Methods: From the total male population in the city of Gothenburg born between 1930-1944 (n=32,298), 10,000 men were randornized to prostate cancer screening beginning in January 1995, and 10,000 men were randomized to serve as a control group. PSA tests were offered every 2nd year until the age of 70. All health care costs for administration of the screening programme, screening tests, diagnostic procedures, and treatments were included. Data on detected cancers were collected from the prospective programme and from patient records. A Markov model was developed to calculate the cost-effectiveness and the total extra cost of the screening programme.

    Results: For the period from the start of the screening programme until death, the estimates were 17.7 extra localized cancers per 1,000 men and 7.3 extra cases of curative aimed treatments per 1,000 men. The incremental cost per extra detected localized cancer was calculated at 98,000 SEK, and per cancer with curative aimed treatment the figure was 236,000 SEK. Introducing this screening programme for prostate cancer in Sweden would yield 92 million SEK annually in additional costs for screening and management compared to a non-screening strategy.

    Conclusion: Introduction of prostate cancer screening with PSA would increase the total economic burden of prostate cancer for society by approximately 30 percent. Due to the lack of scientific data concerning possible survival benefits from prostate cancer screening, we must wait several years before the true cost-effectiveness of the programme can be calculated.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-84229 (URN)
    Tillgänglig från: 2012-10-02 Skapad: 2012-10-02 Senast uppdaterad: 2012-10-02Bibliografiskt granskad
    5. The estimated economic value of the welfare loss due to prostate cancer pain in a defined population
    Öppna denna publikation i ny flik eller fönster >>The estimated economic value of the welfare loss due to prostate cancer pain in a defined population
    2004 (Engelska)Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 43, nr 3, s. 290-296Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The aim of the study reported here was to estimate the economic value of the welfare loss due to prostate cancer pain by estimating the extent to which pain affects health-related quality of life among patients with prostate cancer. The material consisted of a point estimate of health status among men with prostate cancer in a well-defined population of 200 000 males. Clinical data concerning the disease at diagnosis (extracted from patients’ records and the Regional Prostate Cancer Registry), and health utility ratings (using EuroQol) were obtained from 1 156 males with prostate cancer. A descriptive model showed that optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life years (QALY) to every man with prostate cancer. Based on an estimate of the willingness to pay for a QALY the economic value of this welfare loss due to prostate cancer pain is in the magnitude of €86 600 000 per year (€19 800 000 per million men in Sweden).

    Nationell ämneskategori
    Samhällsvetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-23961 (URN)10.1080/02841860410028411 (DOI)3511 (Lokalt ID)3511 (Arkivnummer)3511 (OAI)
    Tillgänglig från: 2009-10-07 Skapad: 2009-10-07 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
  • 9.
    Sennfält, Karin
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Axelsson, Hanna
    Department of Urology, Sahlgrenska Hospital, Gothenburg, Sweden.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Hugosson, Jonas
    Department of Urology, Sahlgrenska Hospital, Gothenburg, Sweden.
    Costs and effect of biennial prostate cancer screening in Sweden: results from a randomized trial in a defined populationManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: The aim was to estimate the lifetime cost in relation to the extra number of detected localized and potentially curable cancers, and to estimate the economic impact on health care of repeated screening for prostate cancer in Sweden in a cohort of men aged 50-64 years.

    Material and Methods: From the total male population in the city of Gothenburg born between 1930-1944 (n=32,298), 10,000 men were randornized to prostate cancer screening beginning in January 1995, and 10,000 men were randomized to serve as a control group. PSA tests were offered every 2nd year until the age of 70. All health care costs for administration of the screening programme, screening tests, diagnostic procedures, and treatments were included. Data on detected cancers were collected from the prospective programme and from patient records. A Markov model was developed to calculate the cost-effectiveness and the total extra cost of the screening programme.

    Results: For the period from the start of the screening programme until death, the estimates were 17.7 extra localized cancers per 1,000 men and 7.3 extra cases of curative aimed treatments per 1,000 men. The incremental cost per extra detected localized cancer was calculated at 98,000 SEK, and per cancer with curative aimed treatment the figure was 236,000 SEK. Introducing this screening programme for prostate cancer in Sweden would yield 92 million SEK annually in additional costs for screening and management compared to a non-screening strategy.

    Conclusion: Introduction of prostate cancer screening with PSA would increase the total economic burden of prostate cancer for society by approximately 30 percent. Due to the lack of scientific data concerning possible survival benefits from prostate cancer screening, we must wait several years before the true cost-effectiveness of the programme can be calculated.

  • 10.
    Sennfält, Karin
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Sandblom, Gabriel
    Department of Surgery, Uppsala Academic Hospital, Sweden.
    Varenhorst, Eberhard
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    The estimated economic value of the welfare loss due to prostate cancer pain in a defined population2004Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 43, nr 3, s. 290-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study reported here was to estimate the economic value of the welfare loss due to prostate cancer pain by estimating the extent to which pain affects health-related quality of life among patients with prostate cancer. The material consisted of a point estimate of health status among men with prostate cancer in a well-defined population of 200 000 males. Clinical data concerning the disease at diagnosis (extracted from patients’ records and the Regional Prostate Cancer Registry), and health utility ratings (using EuroQol) were obtained from 1 156 males with prostate cancer. A descriptive model showed that optimal treatment that would reduce pain to zero during the whole episode of disease would add on average 0.85 quality-adjusted life years (QALY) to every man with prostate cancer. Based on an estimate of the willingness to pay for a QALY the economic value of this welfare loss due to prostate cancer pain is in the magnitude of €86 600 000 per year (€19 800 000 per million men in Sweden).

  • 11.
    Sennfält, Karin
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Thorfinn, Johan
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    Frisk, Jessica
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    Henriksson, Martin
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Varenhorst, Eberhard
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet.
    Technological changes in the management of prostate cancer result in increased healthcare costs: a retrospective study in a defined Swedish population2003Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 37, nr 3, s. 226-231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    In two previous studies we calculated direct costs for men with prostate cancer who died in 1984-85 and 1992-93, respectively. We have now performed a third cost analysis to enable a longitudinal cost comparison. The aim was to calculate direct costs for the management of prostate cancer, describe the economic consequences of technological changes over time and estimate total direct costs for prostate cancer in Sweden.

    MATERIAL AND METHODS:

    A total of 204 men in a defined population with a diagnosis of prostate cancer and who died in 1997-98 were included. Data on utilization of health services were extracted from clinical records from time of diagnosis to death from a university hospital and from one county hospital in the county of Ostergötland.

    RESULTS:

    The average direct cost per patient has been nearly stable over time (1984-85: 143 000 SEK; 1992-93: 150 000 SEK; 1997-98: 146 000 SEK). The share of costs for drugs increased from 7% in 1992-93 to 17% in 1997-98. The total direct costs for prostate cancer in Sweden have increased over time (1994-85: 610 MSEK; 1992-93: 860 MSEK; 1997-98: 970 MSEK).

    CONCLUSIONS:

    Two-thirds of the total cost is incurred by inpatient care. The share of the total costs for drugs is increasing due to increased use of gonadotrophin-releasing hormone analogues. Small changes in average direct costs per patient despite greater use of technology are explained by the fact that more prostate cancers are detected at the early stages.

  • 12.
    Sennfält, Karin
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Varenhorst, Eberhard
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Urologi. Linköpings universitet, Hälsouniversitetet.
    Diffusion and Economic Consequences of Health Technologies in Prostate Cancer Care in Sweden, 1991-20022006Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 49, nr 6, s. 1028-1034Artikel i tidskrift (Refereegranskat)
    Abstract [en]

       Objective

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

    Methods

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

    Results

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

    Conclusions

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

  • 13.
    Sennfält, Karin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle.
    Magnusson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Internmedicin. Östergötlands Läns Landsting, Medicincentrum, Njurmedicinska kliniken US.
    Carlsson, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle.
    Comparison of hemodialysis and peritoneal dialysis - A cost-utility analysis2002Ingår i: Peritoneal Dialysis International, ISSN 0896-8608, E-ISSN 1718-4304, Vol. 22, nr 1, s. 39-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ? Objective: Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. ? Design: Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. ? Setting: All dialysis departments in the southeastern health-care region of Sweden. ? Patients: 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study, 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. ? Main Outcome Measures: Cost per life year and cost per quality-adjusted life year. ? Results: The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 - 40 years, a 31% difference in the age group 41 - 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. ? Conclusion: The cost-utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

  • 14.
    Sennfält, Karin
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Sandblom, G.
    Department of Surgery, Uppsala Academic Hospital, Uppsala, Sweden.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Varenhorst, Eberhard
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Urologi. Linköpings universitet, Hälsouniversitetet.
    Costs and effects of prostate cancer screening in Sweden: a 15-year follow-up of a randomized trial2004Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 38, nr 4, s. 291-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

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

    MATERIAL AND METHODS:

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

    RESULTS:

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

    CONCLUSION:

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

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