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  • 1.
    Aronsson, Mattias
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Health Economic Evaluations of Screening Programs - Applications and Method Improvements2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Screening to detect diseases early is attractive as it can improve the prognosis and decrease costs, but it is often a problematic concept and there are several pitfalls. Many healthy individuals have to be investigated to avoid a disease in a few, which results in a dilemma because to save a few, many are exposed to a procedure that could potentially harm them. Other examples of problems associated with screening are latent diseases and over-treating. The question of optimal design of a screening program is another source of uncertainty for decision-makers, as a screening program may potentially be implemented in very different ways. This highlights the need for structured analyses that weigh benefits against the harms and costs that occur as consequences of the screening.

    The aim of this thesis is, therefore, to explore, develop and implement methods for health economic evaluations of screening programs. This is done to identify problems and suggest solutions to improve future evaluations and in extension policy making.

    This aim was analysed using decision analytic cost-effectiveness analyses constructed as Markov models. These are well-suited for this task given the sequential management approach where all relevant data are unlikely to come from a single source of evidence. The input data were in this thesis obtained from the published literature and were complemented with data from Swedish registries and the included case studies. The case studies were two different types of screening programs; a program of screening for unknown atrial fibrillation and a program to detect colorectal cancer early. Further, the implementation of treatment with thrombectomy and novel oral anticoagulants were used to illustrate how factors outside the screening program itself have an impact on the evaluations.

    As shown by the result of the performed analyses, the major contribution of this thesis was that it provided a simple and systematic approach for the economic evaluation of multiple screening designs to identify an optimal design.

    In both the included case studies, the screening was considered costeffective in detecting the disease; unknown atrial fibrillation and colorectal cancer, respectively. Further, the optimal way to implement these screening programs is dependent on the threshold value for cost-effectiveness in the health care sector and the characteristics of the investigated cohort. This is because it is possible to gain increasingly more health benefits by changing the design of the screening program, but that the change in design also results in higher marginal costs. Additionally, changes in the screening setting were shown to be important as they affect the cost-effectiveness of the screening. This implies that flexible modelling with continuously updated models are necessary for an optimal resource allocation.

    List of papers
    1. Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer
    Open this publication in new window or tab >>Cost-effectiveness of high-sensitivity faecal immunochemical test and colonoscopy screening for colorectal cancer
    Show others...
    2017 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, no 8, p. 1078-1086Article in journal (Refereed) Published
    Abstract [en]

    Background: Colorectal cancer screening can decrease morbidity and mortality. However, there are widespread differences in the implementation of programmes and choice of strategy. The primary objective of this study was to estimate lifelong costs and health outcomes of two of the currently most preferred methods of screening for colorectal cancer: colonoscopy and sensitive faecal immunochemical test (FIT). Methods: A cost-effectiveness analysis of colorectal cancer screening in a Swedish population was performed using a decision analysis model, based on the design of the Screening of Swedish Colons (SCREESCO) study, and data from the published literature and registries. Lifelong cost and effects of colonoscopy once, colonoscopy every 10 years, FIT twice, FIT biennially and no screening were estimated using simulations. Results: For 1000 individuals invited to screening, it was estimated that screening once with colonoscopy yielded 49 more quality-adjusted life-years (QALYs) and a cost saving of (sic)64 800 compared with no screening. Similarly, screening twice with FIT gave 26 more QALYs and a cost saving of (sic)17 600. When the colonoscopic screening was repeated every tenth year, 7 additional QALYs were gained at a cost of (sic)189 400 compared with a single colonoscopy. The additional gain with biennial FIT screening was 25 QALYs at a cost of (sic)154 300 compared with two FITs. Conclusion: All screening strategies were cost-effective compared with no screening. Repeated and single screening strategies with colonoscopy were more cost-effective than FIT when lifelong effects and costs were considered. However, other factors such as patient acceptability of the test and availability of human resources also have to be taken into account.

    Place, publisher, year, edition, pages
    WILEY, 2017
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-139394 (URN)10.1002/bjs.10536 (DOI)000403158800015 ()28561259 (PubMedID)
    Note

    Funding Agencies|SCREESCO; Regionala Cancer-centrum i samverkan; Swedish Cancer Foundation; Karolinska Institute

    Available from: 2017-08-24 Created: 2017-08-24 Last updated: 2018-04-16
    2. Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording
    Open this publication in new window or tab >>Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording
    Show others...
    2015 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 7, p. 1023-1029Article in journal (Refereed) Published
    Abstract [en]

    Aims The aim of this study was to estimate the cost-effectiveness of 2 weeks of intermittent screening for asymptomatic atrial fibrillation (AF) in 75/76-year-old individuals. Methods and results The cost-effectiveness analysis of screening in 75-year-old individuals was based on a lifelong decision analytic Markov model. In this model, 1000 hypothetical individuals, who matched the population of the STROKESTOP study, were simulated. The population was analysed for different parameters such as prevalence, AF status, treatment with oral anticoagulation, stroke risk, utility, and costs. In the base-case scenario, screening of 1000 individuals resulted in 263 fewer patient-years with undetected AF. This implies eight fewer strokes, 11 more life-years, and 12 more quality-adjusted life years (QALYs) per 1000 screened individuals. The screening implies an incremental cost of (sic)50 012, resulting in a cost of (sic)4313 per gained QALY and (sic)6583 per avoided stroke. Conclusions With the use of a decision analytic simulation model, it has been shown that screening for asymptomatic AF in 75/76-year-old individuals is cost-effective.

    Place, publisher, year, edition, pages
    Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY, 2015
    Keywords
    Atrial fibrillation; Screening; Hand-held ECG; Quality-adjusted life year ( QALY); Cost-effectiveness
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-120879 (URN)10.1093/europace/euv083 (DOI)000359153000006 ()25868469 (PubMedID)
    Note

    Funding Agencies|Swedish Heart and Lung Foundation; Board of Benevolence of the Swedish Order of Freemasons; Tornspiran

    Available from: 2015-08-28 Created: 2015-08-28 Last updated: 2017-12-04
    3. Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke
    Open this publication in new window or tab >>Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke
    Show others...
    2016 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 86, no 11, p. 1053-1059Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.

    METHODS: The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.

    RESULTS: The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.

    CONCLUSIONS: Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.

    Place, publisher, year, edition, pages
    Lippincott Williams & Wilkins, 2016
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-126429 (URN)10.1212/WNL.0000000000002439 (DOI)000371887200012 ()26873954 (PubMedID)
    Note

    Funding agencies: Dental and Pharmaceutical Benefits Agency

    Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2017-11-30
    4. Designing an optimal screening program for unknown atrial fibrillation: a cost-effectiveness analysis.
    Open this publication in new window or tab >>Designing an optimal screening program for unknown atrial fibrillation: a cost-effectiveness analysis.
    Show others...
    2017 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 10, p. 1650-1656Article in journal (Refereed) Published
    Abstract [en]

    Aims: The primary objective of this study was to use computer simulations to suggest an optimal age for initiation of screening for unknown atrial fibrillation and to evaluate if repeated screening will add value.

    Methods and results: In the absence of relevant clinical studies, this analysis was based on a simulation model. More than two billion different designs of screening programs for unknown atrial fibrillation were simulated and analysed. Data from the published scientific literature and registries were used to construct the model and estimate lifelong effects and costs. Costs and effects generated by 2 147 483 648 different screening designs were calculated and compared. Program designs that implied worse clinical outcome and were less cost-effective compared to other programs were excluded from the analysis. Seven program designs were identified, and considered to be cost effective depending on what the health-care decision makers are ready to pay for gaining a quality-adjusted life-year (QALY). Screening at the age of 75 implied the lowest cost per gained QALY (€4 800/QALY).

    Conclusion: In conclusion, examining the results of more than two billion simulated screening program designs for unknown atrial fibrillation, seven designs were deemed cost-effective depending on how much we are prepared to pay for gaining QALYs. Our results showed that repeated screening for atrial fibrillation implied additional health benefits to a reasonable cost compared to one-off screening.

    Place, publisher, year, edition, pages
    Oxford: Oxford University Press, 2017
    Keywords
    Atrial fibrillation, Cost-utility analysis, Optimization analysis, Screening
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-141557 (URN)10.1093/europace/eux002 (DOI)000412840300006 ()28340009 (PubMedID)
    Note

    Funding agencies: Dental and Pharmaceutical Benefits Agency

    Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2017-10-31
  • 2.
    Aronsson, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    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.
    Hälsoekonomisk förstudie av digital patologi: Var finns de potentiella vinsterna?2015Report (Other academic)
    Abstract [en]

    Background

    There is an ongoing development in pathology laboratories towards increased digital storage and analysis of images from tissue samples through computer screens instead of conventional microscopes. The digital storage of information has a number of potential advantages. The information can be used by several individuals simultaneously, even remotely, which facilitates the use of expert knowledge and provide opportunities for increased capacity utilization.

    An expected increase in costs resulting from the implementation of digital pathology combined with uncertainty about the positive effects makes health economic analyses requested. Lack of data regarding the effects of digitalization has not yet allowed any adequate evaluations of the health economic aspects. Despite the practical difficulties that exist today, there are reasons to start thinking about what we want to investigate, how to do it and the possibility to fill current knowledge gaps.

    Purpose

    The purpose of this study is to investigate how a health economic evaluation of digital pathology can be designed, the possibility to make such an evaluation based on available data and identify the need for additional research.

    Method

    Digitalization of a pathology laboratory includes and affects many of the current activities at the unit in a complex manner. Therefore, the total economic effect of time savings, increased costs due to added operations, storage, and new equipment need to be studied.

    To make an early attempt to identify the costs and benefits of digital pathology in the present analysis we used three models with different perspectives. Shortterm and long-term potential effects of a full-scale implementation were analyzed with the use of the three analytical models.

    Results

    Important information is missing regarding the situation today, but above all,about the effects of a digitalization. This means that it is currently impossible tomake calculations or well-informed conclusions regarding the health economicimpact of a digitalization. However, using the three models we could make someconclusions. We have speculated on the potential benefits of a full-scale digitalization in two of the three models. Model 1 can be used to analyze an improved work flow within the pathology unit, above all, it is interesting to try to measure the average processing time per slide for the pathologist. Model 2 can be used to study how a reduction in waiting times for PAD-results affects the patient in terms of reduced anxiety. Based on Model 3, we conclude that it is unlikely that any shortened waiting times as a result of a digitalization means measurable medical benefit. However, it is important to point out that we only studied one example where a medical benefit could be expected.

    Conclusions

    • No scientific evaluation of the effects and costs regarding the diglization ofpathology laboratories in a Swedish setting were identified.
    • In the current situation it is not possible to make exact calculations or wellinformedconclusions regarding the health economic impact of a digitalizationas basic performance data and reliable cost data are not available.
    • With the help of the three models developed in this analysis it is possible todraw some conclusions about what types of data that are relevant to study.Model 1 can be used to analyze an improved work flow within the pathologyunit. Model 2 can be used to study how a reduction in waiting times for PADresultsaffect the patient in terms of reduced anxiety. Model 3 can be used as abasis for identification and analyze of situations in the health care where ashorter response time can influence clinical decisions.

    Studies of patient´s quality of life while waiting for test results is an exampleof data that need to be investigated for future health economic analyses. Suchanalyses would also benefit from an improved reporting of cost data. A thirdarea concerns studies of unnecessary or inaccurate health care due to false testresults.

  • 3.
    Aronsson, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Kalkan, Almina
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Eckard, Nathalie
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Differences between hypothetical and experience-based value sets for EQ-5D used in Sweden: Implications for decision makers2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 8, p. 848-854Article in journal (Refereed)
    Abstract [en]

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

  • 4.
    Aronsson, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Persson, Josefine
    Sahlgrenska Academy, University of Gothenburg.
    Blomstrand, Christian
    Sahlgrenska Academy, University of Gothenburg.
    Wester, Per
    University of Umeå, Sweden; Danderyd Hospital Karolinska Institutet, Sweden, Sweden.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke2016In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 86, no 11, p. 1053-1059Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.

    METHODS: The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.

    RESULTS: The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.

    CONCLUSIONS: Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.

  • 5.
    Aronsson, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Svennberg, Emma
    Danderyd Hospital, Sweden.
    Rosenqvist, Marten
    Danderyd Hospital, Sweden.
    Engdahl, Johan
    Halland Hospital, Sweden.
    Al-Khalili, Faris
    Danderyd Hospital, Sweden; Stockholm Heart Centre, Sweden.
    Friberg, Leif
    Danderyd Hospital, Sweden.
    Frykman-Kull, Viveka
    Danderyd Hospital, Sweden.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 7, p. 1023-1029Article in journal (Refereed)
    Abstract [en]

    Aims The aim of this study was to estimate the cost-effectiveness of 2 weeks of intermittent screening for asymptomatic atrial fibrillation (AF) in 75/76-year-old individuals. Methods and results The cost-effectiveness analysis of screening in 75-year-old individuals was based on a lifelong decision analytic Markov model. In this model, 1000 hypothetical individuals, who matched the population of the STROKESTOP study, were simulated. The population was analysed for different parameters such as prevalence, AF status, treatment with oral anticoagulation, stroke risk, utility, and costs. In the base-case scenario, screening of 1000 individuals resulted in 263 fewer patient-years with undetected AF. This implies eight fewer strokes, 11 more life-years, and 12 more quality-adjusted life years (QALYs) per 1000 screened individuals. The screening implies an incremental cost of (sic)50 012, resulting in a cost of (sic)4313 per gained QALY and (sic)6583 per avoided stroke. Conclusions With the use of a decision analytic simulation model, it has been shown that screening for asymptomatic AF in 75/76-year-old individuals is cost-effective.

  • 6.
    Aronsson, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Svennberg, Emma
    Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden..
    Rosenqvist, Mårten
    Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden..
    Engdahl, Johan
    Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden..
    Al-Khalili, Faris
    Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden..
    Friberg, Leif
    Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden..
    Frykman, Viveka
    Karolinska Institutet, Department of Clinical Science, Cardiology Unit, Danderyd University Hospital, Stockholm, Sweden..
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Designing an optimal screening program for unknown atrial fibrillation: a cost-effectiveness analysis.2017In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 19, no 10, p. 1650-1656Article in journal (Refereed)
    Abstract [en]

    Aims: The primary objective of this study was to use computer simulations to suggest an optimal age for initiation of screening for unknown atrial fibrillation and to evaluate if repeated screening will add value.

    Methods and results: In the absence of relevant clinical studies, this analysis was based on a simulation model. More than two billion different designs of screening programs for unknown atrial fibrillation were simulated and analysed. Data from the published scientific literature and registries were used to construct the model and estimate lifelong effects and costs. Costs and effects generated by 2 147 483 648 different screening designs were calculated and compared. Program designs that implied worse clinical outcome and were less cost-effective compared to other programs were excluded from the analysis. Seven program designs were identified, and considered to be cost effective depending on what the health-care decision makers are ready to pay for gaining a quality-adjusted life-year (QALY). Screening at the age of 75 implied the lowest cost per gained QALY (€4 800/QALY).

    Conclusion: In conclusion, examining the results of more than two billion simulated screening program designs for unknown atrial fibrillation, seven designs were deemed cost-effective depending on how much we are prepared to pay for gaining QALYs. Our results showed that repeated screening for atrial fibrillation implied additional health benefits to a reasonable cost compared to one-off screening.

  • 7.
    Aronsson, Mattias
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Walfridsson, Håkan
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nielsen, Jens Cosedis
    Aarhus University Hospital, Denmark.
    Hansen, Peter Steen
    Aarhus University Hospital, Denmark.
    Johannessen, Arne
    Gentofte University Hospital, Denmark.
    Raatikainen, Pekka
    Tampere University Hospital, Finland.
    Hindricks, Gerhard
    Leipzig University Hospital, Germany.
    Kongstad, Ole
    Lund University Hospital, Sweden.
    Pehrson, Steen
    Rigshospitalet, Denmark.
    Englund, Anders
    University Hospital, Örebro, Sweden.
    Hartikainen, Juha
    Kuopio University Hospital, Finland.
    Mortensen, Leif Spange
    Danish Information Technology Centre for Education and Research, Aarhus, Denmark.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy.2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment.

    METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients.

    CONCLUSION: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).

  • 8.
    Walfridsson, Håkan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Walfridsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cosedis Nielsen, J.
    Aarhus University Hospital, Denmark.
    Johannessen, A.
    Gentofte University Hospital, Denmark.
    Raatikainen, P.
    Tampere University Hospital, Finland.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Aronsson, Mattias
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Hindricks, G.
    Leipzig University Hospital, Germany.
    Kongstad, O.
    University of Lund Hospital, Sweden.
    Pehrson, S.
    Rigshosp, Denmark.
    Englund, A.
    University Hospital, Örebro, Sweden.
    Hartikainen, J.
    Kuopio University Hospital, Finland.
    Mortensen, L. S.
    12UNI-C, Danish Information Technology Centre for Education and Research, Denmark.
    Hansen, P. S.
    Aarhus University Hospital, Denmark.
    Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 215-221Article in journal (Refereed)
    Abstract [en]

    Aims The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial assessed the long-term efficacy of an initial strategy of radiofrequency ablation (RFA) vs. antiarrhythmic drug therapy (AAD) as first-line treatment for patients with PAF. In this substudy, we evaluated the effect of these treatment modalities on the Health-Related Quality of Life (HRQoL) and symptom burden of patients at 12 and 24 months. Methods and results During the study period, 294 patients were enrolled in the MANTRA-PAF trial and randomized to receive AAD (N = 148) or RFA (N = 146). Two generic questionnaires were used to assess the HRQoL [Short Form-36 (SF-36) and EuroQol-five dimensions (EQ-5D)], and the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) was used to evaluate the symptoms appearing during the trial. All comparisons were made on an intention-to-treat basis. Both randomization groups showed significant improvements in assessments with both SF-36 and EQ-5D, at 24 months. Patients randomized to RFA showed significantly greater improvement in four physically related scales of the SF-36. The three most frequently reported symptoms were breathlessness during activity, pronounced tiredness, and worry/anxiety. In both groups, there was a significant reduction in ASTA symptom index and in the severity of seven of the eight symptoms over time. Conclusion Both AAD and RFA as first-line treatment resulted in substantial improvement of HRQoL and symptom burden in patients with PAF. Patients randomized to RFA showed greater improvement in physical scales (SF-36) and the EQ-visual analogue scale.

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