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  • 1.
    Aasa, Mikael
    et al.
    Karolinska Institute.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Dellborg, Mikael
    Gothenburg University.
    Grip, Lars
    Gothenburg University.
    Herlitz, Johan
    Gothenburg University.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Svensson, Leif
    Stockholm Prehospital Centre.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial2010Inngår i: AMERICAN HEART JOURNAL, ISSN 0002-8703, Vol. 160, nr 2, s. 322-328Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be andlt;$0, $50,000, and $100,000 respectively. Conclusion In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.

  • 2.
    Andersson, Swen-Olof
    et al.
    Orebro University Hospital.
    Andren, Ove
    Orebro University Hospital.
    Lyth, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Stark, Jennifer R
    Brigham and Womens Hospital.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Adami, Hans-Olov
    Harvard University.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Johansson, Jan-Erik
    Orebro University Hospital.
    Managing localized prostate cancer by radical prostatectomy or watchful waiting: Cost analysis of a randomized trial (SPCG-4)2011Inngår i: SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY, ISSN 0036-5599, Vol. 45, nr 3, s. 177-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. The cost of radical prostatectomy (RP) compared to watchful waiting (WW) has never been estimated in a randomized trial. The goal of this study was to estimate long-term total costs per patient associated with RP and WW arising from inpatient and outpatient hospital care. Material and methods. This investigation used the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) trial, comparing RP to WW, and included data from 212 participants living in two counties in Sweden from 1989 to 1999 (105 randomized to WW and 107 to RP). All costs were included from randomization date until death or end of follow-up in July 2007. Resource use arising from inpatient and outpatient hospital costs was measured in physical units and multiplied by a unit cost to come up with a total cost per patient. Results. During a median follow-up of 12 years, the overall cost in the RP group was 34% higher (p andlt; 0.01) than in the WW group, corresponding to euroa,not sign6123 in Sweden. The difference was driven almost exclusively by the cost of the surgical procedure. The cost difference between RP and WW was two times higher among men with low (2--6) than among those with high (7--10) Gleason score. Conclusion. In this economic evaluation of RP versus WW of localized prostate cancer in a randomized study, RP was associated with 34% higher costs. This difference, attributed exclusively to the cost of the RP procedure, was not overcome during extended follow-up.

  • 3.
    Askling, Helena
    et al.
    Karolinska Institute, Sweden.
    Shedrawy, Jad
    Karolinska Institute, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Allmän TBE-vaccination ger hälsovinst till rimlig kostnad [Subsidized TBE vaccination appears cost-effective in a life-time perspective]2019Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Given the setting of Stockholm County, a recently published health-economic analysis shows that the cost per Quality-adjusted life year (QALY) of a free TBE vaccinations program is below generally acceptable cost-effectiveness thresholds in Sweden. A report from the Public Health Agency (PHA), based on similar input data, shows that it is not cost effective to subsidize TBE vaccination in the Stockholm county. The main difference in the two analyses is the time horizon for the analyses; a life-time perspective versus 10-year perspective. Health economics of vaccination strategies should be based on a long time perspective and especially when the disease is more severe in older adults, i.e. TBE. Health-care decision-makers should be aware of the importance of the time horizon for the results when considering these evaluations in prioritization decisions. With a life-time perspective a TBE-vaccination program appears cost-effective.

  • 4.
    Barra, Mathias
    et al.
    Akershus Univ Hosp, Norway.
    Broqvist, Mari
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Gustavsson, Erik
    Linköpings universitet, Institutionen för kultur och samhälle, Avdelningen för filosofi, historia, konst och religion. Linköpings universitet, Filosofiska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Juth, Niklas
    Karolinska Inst, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Solberg, Carl Tollef
    Akershus Univ Hosp, Norway; Univ Bergen, Norway.
    Severity as a Priority Setting Criterion: Setting a Challenging Research Agenda2020Inngår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 28, nr 1, s. 25-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Priority setting in health care is ubiquitous and health authorities are increasingly recognising the need for priority setting guidelines to ensure efficient, fair, and equitable resource allocation. While cost-effectiveness concerns seem to dominate many policies, the tension between utilitarian and deontological concerns is salient to many, and various severity criteria appear to fill this gap. Severity, then, must be subjected to rigorous ethical and philosophical analysis. Here we first give a brief history of the path to todays severity criteria in Norway and Sweden. The Scandinavian perspective on severity might be conducive to the international discussion, given its long-standing use as a priority setting criterion, despite having reached rather different conclusions so far. We then argue that severity can be viewed as a multidimensional concept, drawing on accounts of need, urgency, fairness, duty to save lives, and human dignity. Such concerns will often be relative to local mores, and the weighting placed on the various dimensions cannot be expected to be fixed. Thirdly, we present what we think are the most pertinent questions to answer about severity in order to facilitate decision making in the coming years of increased scarcity, and to further the understanding of underlying assumptions and values that go into these decisions. We conclude that severity is poorly understood, and that the topic needs substantial further inquiry; thus we hope this article may set a challenging and important research agenda.

    Fulltekst (pdf)
    fulltext
  • 5.
    Brodtkorb, Thor-Henrik
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Filosofiska fakulteten.
    Johannesen-Munk, Kasper
    Thidell, Fredrik
    Cost-effectiveness of C-Leg compared to non microprocessor controlled knees: a modeling approach2008Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 89, nr 1, s. 24-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To estimate the costs and health outcomes of C-Leg and non–microprocessor-controlled (NMC) knees using a decision-analytic model.

    Design: Data on costs, rates and duration of problems, knee survival, and health-related quality of life were obtained from interviews with patients and prosthetists with experience of both C-Leg and NMC knees. Interview data were assessed in a decision-analytic Markov model to estimate cost-effectiveness from a health care perspective.

    Setting: Outpatient.

    Participants: A population sample of 20 patients currently using the C-Leg and prior experience of nonmicroprocessor knees, and 5 prosthetists.

    Interventions: Not applicable.

    Main Outcome Measure: Incremental cost per quality-adjusted life year (QALY).

    Results: The mean incremental cost (in 2006 Euros) and QALYs for the C-Leg was €7657 and 2.38, respectively, yielding a cost per QALY gained of €3218.

    Conclusions: It is important to provide decision-makers with relevant information on costs and health outcomes of different treatment strategies on actual decision problems despite limited evidence. The results of the study, taking into account both costs and a broadly defined health outcome in terms of QALY, show that given existing albeit limited evidence the C-Leg appears to yield positive health outcomes at an acceptable cost.

    Fulltekst (pdf)
    FULLTEXT01
  • 6.
    Brodtkorb, Thor-Henrik
    et al.
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering.
    Henriksson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Johannesen-Munk, Kasper
    Dept of rehabilitation School of Health Sciences, Jönköping.
    Thidell, Fredrik
    Dept of rehabilitation School of Health Sciences, Jönköping.
    Cost-effectiveness of C-Leg compared to non microprocessor controlled knees: a modelling approach (oral presentation)2007Konferansepaper (Annet vitenskapelig)
  • 7.
    Burstrom, Kristina
    et al.
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Teni, Fitsum Sebsibe
    Karolinska Inst, Sweden.
    Gerdtham, Ulf-G.
    Lund Univ, Sweden.
    Leidl, Reiner
    German Res Ctr Environm Hlth, Germany; Ludwig Maximilians Univ Munchen, Germany.
    Helgesson, Gert
    Karolinska Inst, Sweden.
    Rolfson, Ola
    Karolinska Inst, Sweden; Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden; Ctr Registers Vastra Gotaland, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States2020Inngår i: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Objective Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. Methods In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondents current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). Results A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Conclusions Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based time trade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.

    Fulltekst (pdf)
    fulltext
  • 8.
    Eckard, Nathalie
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Henriksson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Davidson, Thomas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Walfridsson, Håkan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Levin, Lars-Åke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Cost-effectiveness of catheter ablation versus antiarrhytmic drugs for patients with symptomatic atrial fibrillation (oral presentation)2008Inngår i: SMDM Europe,2008, 2008Konferansepaper (Annet vitenskapelig)
  • 9.
    Geale, K.
    et al.
    Umeå University, Sweden; PAREXEL Int, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Schmitt-Egenolf, M.
    Umeå University, Sweden.
    Evaluating equality in psoriasis healthcare: a cohort study of the impact of age on prescription of biologics2016Inngår i: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 174, nr 3, s. 579-587Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Inequality in healthcare has been identified in many contexts. To the best of our knowledge, this is the first study investigating age inequality in the form of prescription patterns of biologics in psoriasis care. Objectives To determine whether patients with psoriasis have equal opportunities to receive biological medications as they age. If patients did not receive equal treatment, a subsequent objective was to determine the magnitude of the disparity. Methods A cohort of biologic-naive patients with psoriasis was analysed using Cox proportional hazards models to measure the impact of each additional year of life on the likelihood of initiating biological treatment, after controlling for sex, body mass index, comorbidities, disease activity and educational level. A supporting analysis used a nonparametric graphical method to study the proportion of patients initiating biological treatment as age increased, after controlling for the same covariates. Results The Cox proportional hazards model resulted in hazard ratios of a 1-year increase in age of 0.96-0.97 depending on calendar-year stratification, which implies that an increase in age of 30 years corresponds to a reduced likelihood of initiating biological treatment by 61.3-67.6%. The estimated proportion of patients initiating biological medication always decreased as age increased, at a statistically significant level. Conclusions Patients with psoriasis have fewer opportunities to access biological medications as they age. This result was shown to be applicable at all stages in a patients life course and was not only restricted to the elderly, although it implies greater disparities as the age difference between patients increases. These results show that inequality in access to biological treatments due to age is prevalent in clinical practice today. Further research is needed to investigate the extent to which this result is influenced by patient preferences.

  • 10.
    Geale, Kirk
    et al.
    Umeå University, Sweden; PAREXEL Int, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Schmitt-Egenolf, Marcus
    Umeå University, Sweden.
    How is disease severity associated with quality of life in psoriasis patients? Evidence from a longitudinal population-based study in Sweden2017Inngår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 15, artikkel-id 151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Assessing the impact of disease severity on generic quality of life (QOL) is a critical step in outcomes research and in the development of decision-analytic models structured around health states defined by clinical measures. While data from routine clinical practice found in healthcare registers are increasingly used for research, more attention should be paid to understanding the relationship between clinical measures of disease severity and QOL. The purpose of this work was therefore to investigate this relationship in psoriasis using a population-based dataset. Methods: Severity was measured by the Psoriasis Area and Severity Index (PASI), which combines severity of erythema, induration, and desquamation into a single value ranging from 0 to 72. The generic EQ-5D-3L utility instrument, under the UK tariff, was used to measure QOL. The association between PASI and EQ-5D-3L was estimated using a population-based dataset of 2674 patients with moderate to severe psoriasis enrolled over ten years in the Swedish psoriasis register (PsoReg). Given the repeated measurement of patients in the register data, a longitudinal fixed-effects model was employed to control for unobserved patient-level heterogeneity. Results: Marginal changes in PASI are associated with a non-linear response in EQ-5D-3L: Moving from PASI 10 to 9 (1 to 0) is associated with an increase of 0.0135 (0.0174) in EQ-5D-3L. Furthermore, unobserved patient-level heterogeneity appears to be an important source of confounding when estimating the relationship between QOL and PASI. Conclusions: Using register data to estimate the impact of disease severity on QOL while controlling for unobserved patient-level heterogeneity shows that PASI appears to have a larger impact on QOL than previously estimated. Routine collection of generic QOL data in registers should be encouraged to enable similar applications in other disease areas.

    Fulltekst (pdf)
    fulltext
  • 11.
    Geale, Kirk
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Saridogan, Ertan
    Womens Health Division, University College London Hospital, London, UK.
    Lehmann, Matthieu
    PregLem SA, Geneva, Switzerland.
    Arriagada, Pablo
    PregLem SA, Geneva, Switzerland.
    Hultberg, Marcus
    PAREXEL International, Stockholm, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Repeated intermittent ulipristal acetate in the treatment of uterine fibroids: a cost-effectiveness analysis2017Inngår i: ClinicoEconomics and Outcomes Research, ISSN 1178-6981, E-ISSN 1178-6981, Vol. 9, s. 669-676Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There are limited treatment options available for women with moderate to severe symptoms of uterine fibroids (UFs) who wish to avoid surgery. For these women, treatment with standard pharmaceuticals such as contraceptives is often insufficient to relieve symptoms, and patients may require surgery despite their wish to avoid it. Clinical trials demonstrate that ulipristal acetate 5 mg (UPA) is an effective treatment for this patient group, but its cost-effectiveness has not been assessed in this population. A decision-analytic model was developed to simulate a cohort of patients in this population under treatment with UPA followed by surgery as needed compared to treatment with iron and non-steroidal anti-inflammatory drug (NSAID) followed by surgery as needed (best supportive care, BSC). The analysis took the perspective of the National Health Service (NHS) in England, UK, and was based on the published UPA clinical trials. Results were calculated for the long-term costs and quality-adjusted life years (QALYs) for each treatment arm and combined into an incremental cost-effectiveness ratio (ICER) as the primary outcome. The impact of parameter uncertainty on the results was assessed using scenario, deterministic, and probabilistic sensitivity analyses. The results show that treating patients with the UPA strategy, instead of the BSC strategy, results in an additional cost of £1,115 and a gain of 0.087 QALYs, resulting in an ICER of £12,850. Given commonly accepted cost-effectiveness thresholds in England, the use of UPA as a repeated, intermittent treatment for women with moderate to severe symptoms of UF wishing to avoid surgery is likely to be a cost-effective intervention when compared to BSC.

    Fulltekst (pdf)
    fulltext
  • 12.
    Hager, Jakob
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Changing Conditions - the same Conclusion: Cost-effective to Screen for Abdominal Aortic Aneurysm among 65-year-old Men, based on Data from an Implemented Screening Programme2014Manuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related as well as allcause mortality. However, results from running screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men on a general basis is cost-effective under current clinical practice.

    Methods: A decision-analytic model, previously used to show the cost-effectiveness of an AAA-screening programme before decision to introduce screening in practice, was updated using results from implemented screening-programmes as well as data from contemporary published data and the Swedvasc registry.

    Results: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were 3252 € and 4231 €, respectively. The probability of screening being cost-effective was high.

    Conclusion: Despite profound changes in disease pattern and AAA-management, the current results are similar to those reported almost 10 years ago, and thus screening 65-year-old men for AAA still appears to be cost-effective.

  • 13.
    Hager, Jakob
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken ViN.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Medicinska fakulteten.
    Lundgren, Fredrik
    Department of Surgery, Kalmar County Hospital, Kalmar, Sweden.
    Revisiting the cost-effectiveness of screening 65-year-old men for abdominal aortic aneurysm based on data from an implemented screening programme.2017Inngår i: International Journal of Angiology, ISSN 0392-9590, E-ISSN 1827-1839, Vol. 36, nr 6, s. 517-525Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme.

    METHODS: A decision-analytic model, previously used to analyse the cost-effectiveness of an AAA screening programme prior to implementation in clinical practice, was updated using data collected from an implemented screening programme as well as data from contemporary published data and the Swedish register for vascular surgery (Swedvasc).

    RESULTS: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were €4832 and €6325, respectively. Based on conventional threshold values of cost-effectiveness, the probability of screening being cost-effective was high.

    CONCLUSION: Despite the reduction of AAA-prevalence and changes in AAA-management over time, screening 65-year-old men for AAA still appears to yield health outcomes at a cost below conventional thresholds of cost-effectiveness.

  • 14.
    Hemingway, H
    et al.
    Department of Epidemiology and Public Health, University College London, UK.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Chen, R.
    Department of Epidemiology and Public Health, University College London, UK.
    Damant, J.
    Department of Epidemiology and Public Health, University College London, UK.
    Fitzpatrick, N.
    Department of Epidemiology and Public Health, University College London, UK.
    Abrams, K.
    Department of Health Sciences, University of Leicester, UK.
    Hingorani, A.
    Department of Epidemiology and Public Health, University College London, UK.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Shipley, M.
    Department of Epidemiology and Public Health, University College London, UK.
    Feder, G.
    Department of Primary Health Care, University of Bristol, UK.
    Keogh, B.
    Department of Health, London, UK.
    Stenestrand, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    McAllister, K.
    1Department of Epidemiology and Public Health, University College London, UK.
    Kaski, J-C
    Cardiovascular Biology Research Centre, St George’s, University of London, UK.
    Timmis, A.
    Barts and the London NHS Trust, London, UK.
    Palmer, S.
    Centre for Health Economics, University of York, UK.
    Sculpher, M.
    Centre for Health Economics, University of York, UK.
    The effectiveness and cost-effectiveness of biomarkers for the prioritisation of patients awaiting coronary revascularisation: a systematic review and decision model.2010Inngår i: Health Technology Assessment, ISSN 1366-5278, Vol. 14, nr 9, s. 1-178Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To determine the effectiveness and cost-effectiveness of a range of strategies based on conventional clinical information and novel circulating biomarkers for prioritising patients with stable angina awaiting coronary artery bypass grafting (CABG).

    DATA SOURCES: MEDLINE and EMBASE were searched from 1966 until 30 November 2008.

    REVIEW METHODS: We carried out systematic reviews and meta-analyses of literature-based estimates of the prognostic effects of circulating biomarkers in stable coronary disease. We assessed five routinely measured biomarkers and the eight emerging (i.e. not currently routinely measured) biomarkers recommended by the European Society of Cardiology Angina guidelines. The cost-effectiveness of prioritising patients on the waiting list for CABG using circulating biomarkers was compared against a range of alternative formal approaches to prioritisation as well as no formal prioritisation. A decision-analytic model was developed to synthesise data on a range of effectiveness, resource use and value parameters necessary to determine cost-effectiveness. A total of seven strategies was evaluated in the final model.

    RESULTS: We included 390 reports of biomarker effects in our review. The quality of individual study reports was variable, with evidence of small study (publication) bias and incomplete adjustment for simple clinical information such as age, sex, smoking, diabetes and obesity. The risk of cardiovascular events while on the waiting list for CABG was 3 per 10,000 patients per day within the first 90 days (184 events in 9935 patients with a mean of 59 days at risk). Risk factors associated with an increased risk, and included in the basic risk equation, were age, diabetes, heart failure, previous myocardial infarction and involvement of the left main coronary artery or three-vessel disease. The optimal strategy in terms of cost-effectiveness considerations was a prioritisation strategy employing biomarker information. Evaluating shorter maximum waiting times did not alter the conclusion that a prioritisation strategy with a risk score using estimated glomerular filtration rate (eGFR) was cost-effective. These results were robust to most alternative scenarios investigating other sources of uncertainty. However, the cost-effectiveness of the strategy using a risk score with both eGFR and C-reactive protein (CRP) was potentially sensitive to the cost of the CRP test itself (assumed to be 6 pounds in the base-case scenario).

    CONCLUSIONS: Formally employing more information in the prioritisation of patients awaiting CABG appears to be a cost-effective approach and may result in improved health outcomes. The most robust results relate to a strategy employing a risk score using conventional clinical information together with a single biomarker (eGFR). The additional prognostic information conferred by collecting the more costly novel circulating biomarker CRP, singly or in combination with other biomarkers, in terms of waiting list prioritisation is unlikely to be cost-effective.

  • 15. Hemingway, Harry
    et al.
    Chen, Ruoling
    Damant, Jacqueline
    Fitzpatrick, Natalie
    Hingorani, Aroon
    Keogh, Bruce
    McAllister, Kate
    Henriksson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Abrams, Keith
    Janzon, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Stenestrand, Ulf
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Kaski, Juan-Carlos
    Timmis, Adam
    Palmer, Stephen
    Sculpher, Mark
    Cost-effectiveness of circulating biomarkers in managing stable coronary disease.2008Inngår i: SMDM,2008, 2008Konferansepaper (Fagfellevurdert)
  • 16. Bestill onlineKjøp publikasjonen >>
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Cost-effectiveness and Value of Further Research of Treatment Strategies for Cardiovascular Disease2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Economic evaluations provide a tool to estimate costs and health consequences of competing medical technologies, ultimately to aid decision makers when deciding which medical technologies should be funded from available resources. Such decisions inevitably need to be taken under uncertainty and it is not clear how to approach them in health care decision-making. Recent work in economic evaluation has proposed an analytic framework where two related, but conceptually different decisions need to be considered: (1) should a medical technology be adopted given existing evidence; and (2) whether more evidence should be acquired to support the adoption decision in the future. The proposed analytic framework requires a decision-analytic model appropriately representing the clinical decision problem under consideration, a probabilistic analysis of this model in order to determine cost-effectiveness and characterise current decision uncertainty, and estimating the value of additional information from research to reduce decision uncertainty. The main aim of this thesis is to apply the analytic framework on three case studies concerning treatment strategies for cardiovascular disease in order to establish whether the treatment strategies should be adopted given current available information and if more information should be acquired to support the adoption decisions in the future. The implications for policy and methodology of utilising the analytic framework employed in the case studies are also discussed in this thesis.

    The results of the case studies show that a screening programme for abdominal aortic aneurysm in 65-year-old men is likely to be cost-effective in a Swedish setting and there appears to be little value in performing further research regarding this decision problem; an early interventional strategy in non-ST-elevation acute coronary syndrome is cost-effective for patients at intermediate to high risk of further cardiac events in a UK setting; endarterectomy in patients with an asymptomatic carotid artery stenosis is cost-effective for men around 73 years of age or younger in a Swedish setting and conducting further research regarding this decision problem is potentially worthwhile.

    Comparing the results of the present analyses with current clinical practice shows a need for changing clinical practice in Sweden regarding screening for abdominal aortic aneurysm and endarterectomy in patients with asymptomatic carotid artery stenosis. Furthermore, employing the analytic framework applied in the case studies can improve treatment guidelines and recommendations for further research. In particular, treatment guidelines ought to consider in which particular subgroups of patients an intervention is cost-effective.

    The case studies indicate that it is feasible to apply the analytic framework for economic evaluation of health care. Methodological development can improve the accuracy with which cost-effectiveness and value of information is estimated, but may also lead to comprehensive and complex evaluations. The nature of the decision problem should determine the level of comprehensiveness required for a particular evaluation.

    Delarbeid
    1. Decision-anaytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneursm in 65-year-old men
    Åpne denne publikasjonen i ny fane eller vindu >>Decision-anaytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneursm in 65-year-old men
    2005 (engelsk)Inngår i: British Journal of Surgery, ISSN 0007-1323, Vol. 92, nr 8, s. 976-983Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Abdominal aortic aneurysm (AAA) causes about 2 per cent of all deaths in men over the age of 65 years. A major improvement in operative mortality would have little impact on total mortality, so screening for AAA has been recommended as a solution. The cost-effectiveness of a programme that invited 65-year-old men for ultrasonographic screening was compared with current clinical practice in a decision-analytical model.

    Methods: In a probabilistic Markov model, costs and health outcomes of a screening programme and current clinical practice were simulated over a lifetime perspective. To populate the model with the best available evidence, data from published papers, vascular databases and primary research were used.

    Results: The results of the base-case analysis showed that the incremental cost per gained life-year for a screening programme compared with current practice was €7760, and that for a quality-adjusted life-year was €9700. The probability of screening being cost-effective was high.

    Conclusion: A financially and practically feasible screening programme for AAA, in which men are invited for ultrasonography in the year in which they turn 65, appears to yield positive health outcomes at a reasonable cost.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14658 (URN)10.1002/bjs.5122 (DOI)
    Tilgjengelig fra: 2007-09-24 Laget: 2007-09-24 Sist oppdatert: 2009-05-18
    2. Informing the efficient use of health care and health care research resources: the case of screening for abdominal aortic aneurysm in Sweden
    Åpne denne publikasjonen i ny fane eller vindu >>Informing the efficient use of health care and health care research resources: the case of screening for abdominal aortic aneurysm in Sweden
    2006 (engelsk)Inngår i: Health Economics, ISSN 1057-9230, Vol. 15, nr 12, s. 1311-1322Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: An analytical framework using Bayesian decision theory and value-of-information analysis has recently been advocated for the economic evaluation of health technologies. The purpose of this study was to apply this framework to screening for abdominal aortic aneurysm (AAA) in Sweden and to compare the conclusions from this study with the conclusions presented in an assessment performed by the Swedish Council of Technology Assessment (SBU).

    Methods: A probabilistic decision-analytical model was developed to establish the cost-effectiveness of a screening programme for AAA relative to current clinical practice and to calculate the value-of-information.

    Results: The cost per quality-adjusted life-year for screening was €9700. The expected value of perfect information for the assessment of overall cost-effectiveness was low, suggesting little benefit in conducting further research. Expected value of perfect partial information indicated that rupture probabilities were associated with the highest uncertainty. By contrast, the SBU report concluded there was limited evidence of cost-effectiveness and proposed further research.

    Conclusion: The investigated screening programme for AAA is likely to be cost-effective and conducting another clinical trial is unlikely to add much valuable information to this decision problem. These recommendations contrast with the vaguer recommendations from SBU that more evidence is required of costs-effectiveness.

    Emneord
    cost-effectiveness, decision making, prioritising research, abdominal aortic aneurysm
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14659 (URN)10.1002/hec.1130 (DOI)
    Tilgjengelig fra: 2007-09-24 Laget: 2007-09-24
    3. The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial
    Åpne denne publikasjonen i ny fane eller vindu >>The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial
    Vise andre…
    2008 (engelsk)Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 94, s. 717-723Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.

    Objective: The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective.

    Design: Decision-analytic model based on randomised clinical trial data.

    Main outcome measures: Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.

    Methods: Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients’ lifetimes within the decision-analytic model.

    Results: The mean incremental cost per QALY gained for an early interventional strategy was approximately £55 000, £22 000 and £12 000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of £20 000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.

    Conclusion: An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk.

    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14660 (URN)10.1136/hrt.2007.127340 (DOI)
    Tilgjengelig fra: 2007-09-24 Laget: 2007-09-24 Sist oppdatert: 2017-12-13
    4. Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden
    Åpne denne publikasjonen i ny fane eller vindu >>Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden
    2008 (engelsk)Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, nr 6, s. 714-720Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background: Long-term health outcomes and costs are important when deciding whether a strategy of carotid endarterectomy in addition to best medical management should be recommended for patients with asymptomatic carotid artery stenosis. This study investigated the cost-effectiveness of such a strategy compared with a strategy of best medical management alone.

    Methods: Based on data from the randomized Asymptomatic Carotid Surgery Trial (ACST), a national vascular database and other published sources, expected costs and health outcomes in terms of quality-adjusted life years (QALYs) of both treatment strategies were estimated using decision-analytical modelling. Cost-effectiveness was established for a Swedish setting from a societal perspective.

    Results: Base-case analysis showed that the incremental cost per QALY of a strategy with carotid endarterectomy for 65- and 75-year-old men (women) was 34 557 (311 133) and 58 930 (779 776) respectively. Sensitivity analyses indicated that the duration of the treatment effect after 5 years of follow-up in the ACST was important for the cost-effectiveness results.

    Conclusion: Carotid endarterectomy in addition to best medical management can be considered cost-effective in men aged 73 years or less but is less likely to be cost-effective in older men or in women.

    sted, utgiver, år, opplag, sider
    Chichester, West Sussex, United Kingdom: John Wiley & Sons, 2008
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14661 (URN)10.1002/bjs.6157 (DOI)000258391500009 ()
    Tilgjengelig fra: 2007-09-24 Laget: 2007-09-24 Sist oppdatert: 2017-12-13bibliografisk kontrollert
    5. The value of further research into the cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden
    Åpne denne publikasjonen i ny fane eller vindu >>The value of further research into the cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden
    2007 (engelsk)Artikkel i tidsskrift (Fagfellevurdert) Submitted
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-14662 (URN)
    Tilgjengelig fra: 2007-09-24 Laget: 2007-09-24
    Fulltekst (pdf)
    FULLTEXT01
    Download (pdf)
    COVER01
    Download (pdf)
    POPULARSUMMARY01
  • 17.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Hälsoekonomiska utvärderingar och beslutsfattande2016Inngår i: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson / [ed] Martin Henriksson, Linköping: Linköping University Electronic Press, 2016, s. 38-50Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 18.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson2016Collection/Antologi (Annet vitenskapelig)
    Abstract [sv]

    Under alla år som jag arbetat med hälsoekonomi har Per Carlsson funnits närvarande. Mest intensivt som handledare under mina år som doktorand. När jag lärde känna Per år 2000 kom jag som nybakad nationalekonom till dåvarande CMT med en ganska snävt definierad nyttofunktion där fotboll var ett av de absolut dominerande attributen. Det har egentligen inte ändrats radikalt, men definitivt nyanserats en del under åren och det är delvis tack vare Per. Idol kan låta lite drastiskt, jag sprang inte omkring och bad om autografer eller att få fotas tillsammans med Per, men det är helt klart så att Per blev den första personen i min yrkeskarriär som jag med stor beundran såg upp till på ungefär samma sätt som man tidigare enbart gjort med sina idoler på fotbollsplanen. Med klokskap, sunt förnuft och en otrolig förmåga att hela tiden se de lite bredare sammanhangen blev han inte bara ett ovärderligt stöd i mitt eget arbete utan också en stor förebild mer generellt.

    När det nu är dags för Per att trappa ner efter en lång och framgångsrik yrkeskarriär i akademins och hälso- och sjukvårdspolicyns tjänst kändes det både självklart och naturligt att försöka bidra med en bestående hyllning. Glädjande nog var vi många som delade den tanken och resultatet blev den antologi med samlade reflektioner som du nu håller i din hand. Bidragen spänner över ett brett fält från teorier om livskvalitet till praktiskt prioriteringsarbete och är talande för den bredd som genomsyrat Pers karriär. Vidare kan man säga att bidragen också kronologiskt inkluderar hela Pers era inom området då vi inleder med Bengt Jönsson som var handledare till Per och avslutar med Johanna Wiss som snart disputerar med Per som handledare.

    Jag vill självklart också rikta ett stort tack till alla författare som bidragit till skriften. Den ger förhoppningsvis Per en möjlighet att reflektera över en livslång gärning inom akademi och hälso- och sjukvårdspolicy när det blir lite tid över i hängmattan framöver. Skriften ger också en bred populärvetenskaplig introduktion till aspekter som berör prioriteringar, utvärderingar, implementering och hälsoekonomi och det är min förhoppning att den kan uppskattas av alla som har intresse av dessa frågor.

    Martin Henriksson

    Maj 2016

    Fulltekst (pdf)
    Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson
    Download (jpg)
    presentationsbild
  • 19.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Eilard, M. Sternby
    Univ Gothenburg, Sweden.
    Lindell, G.
    Lund Univ, Sweden.
    Strömberg, C.
    Karolinska Univ Hosp, Sweden.
    Hemmingsson, O.
    Umea Univ, Sweden.
    Isaksson, B.
    Uppsala Univ, Sweden.
    Rizell, M.
    Univ Gothenburg, Sweden.
    Sandström, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Treatment patterns and survival in patients with hepatocellular carcinoma in the Swedish national registry SweLiv2020Inngår i: BJS OPEN, ISSN 2474-9842, Vol. 4, nr 1, s. 109-117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Consistent data on clinical features, treatment modalities and long-term survival in patients with hepatocellular carcinoma (HCC) using nationwide quality registers are lacking. This study aimed to describe treatment patterns and survival outcomes in patients diagnosed with HCC using a national maintained database. Methods Characteristics and treatment patterns in patients diagnosed with HCC and registered in the national register of liver and bile duct tumours (SweLiv) between 2009 and 2016 were reviewed. Overall survival (OS) was estimated using Kaplan-Meier analysis and the log rank test to compare subgroups for clinical features, treatment modalities and outcomes according to the year of treatment. Results A total of 3376 patients with HCC were registered over 8 years, 246 (7 center dot 3 per cent) of whom underwent transplantation. Some 501 (14 center dot 8 per cent) and 390 patients (11 center dot 6 per cent) had resection and ablation as primary treatment. Transarterial chemoembolization and systemic sorafenib treatment were intended in 476 (14 center dot 1 per cent) and 426 patients (12 center dot 6 per cent) respectively; the remaining 1337 (39 center dot 6 per cent) were registered but referred for best supportive care (BSC). The 5-year survival rate was approximately 75 per cent in the transplantation group. Median OS was 4 center dot 6 (i.q.r. 2 center dot 0 to not reached) years after resection and 3 center dot 1 (2 center dot 3-6 center dot 7) years following ablation. In patients referred for palliative treatment, median survival was 1 center dot 4 (0 center dot 8-2 center dot 9), 0 center dot 5 (0 center dot 3-1 center dot 2) and 0 center dot 3 (0 center dot 1-1 center dot 0) years for the TACE, sorafenib and BSC groups respectively (P amp;lt; 0 center dot 001). Median survival was 0 center dot 9 years for the total HCC cohort in 2009-2012, before publication of the Swedish national treatment programme, increasing to 1 center dot 4 years in 2013-2016 (P amp;lt; 0 center dot 001). Conclusion The survival outcomes reported were in line with previous results from smaller cohorts. The introduction of national guidelines may have contributed to improved survival among patients with HCC in Sweden.

    Fulltekst (pdf)
    fulltext
  • 20.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Burström, Kristina
    Inst för folkhälsovetenskap Karolinska institutet.
    Kvalitetsjusterade levnadsår och EQ-5D. En introduktion2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, nr 21-22, s. 1734-1739Artikkel i tidsskrift (Fagfellevurdert)
  • 21.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Damant, Jacqueline
    UCL.
    K Fitzpatrick, Natalie
    UCL.
    Abrams, Keith
    University of Leicester.
    Hingorani, Aroon D
    UCL.
    Stenestrand, Ulf
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Feder, Gene
    University of Bristol.
    Keogh, Bruce
    UCL.
    Shipley, Martin J
    UCL.
    Kaski, Juan-Carlos
    University of London.
    Timmis, Adam
    Barts and London Medical School.
    Sculpher, Mark
    University of York.
    Hemingway, Harry
    UCL.
    Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery2010Inngår i: BRITISH MEDICAL JOURNAL, ISSN 0959-535X, Vol. 340Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Design Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Data sources Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers. Results The observed risk of cardiovascular events while on the waiting list for coronary artery bypass grafting was 3 per 10 000 patients per day within the first 90 days (184 events in 9935 patients). Using a cost effectiveness threshold of 20 pound 000-30 pound 000 ((sic)22 000-(sic)33 000; $32 000-$48 000) per additional QALY, a prioritisation strategy using a risk score with estimated glomerular filtration rate was the most cost effective strategy (cost per additional QALY was andlt;410 pound compared with the Ontario urgency score). The impact on population health of implementing this strategy was 800 QALYs per 100 000 patients at an additional cost of 245 pound 000 to the National Health Service. The prioritisation strategy using a risk score with C reactive protein was associated with lower QALYs and higher costs compared with a risk score using estimated glomerular filtration rate. Conclusion Evaluating the cost effectiveness of prognostic biomarkers is important even when effects at an individual level are small. Formal prioritisation of patients awaiting coronary artery bypass grafting using a routinely assessed biomarker (estimated glomerular filtration rate) along with simple, routinely collected clinical information was cost effective. Prioritisation strategies based on the prognostic information conferred by C reactive protein, which is not currently measured in this context, or a combination of C reactive protein and estimated glomerular filtration rate, is unlikely to be cost effective. The widespread practice of using only implicit or informal means of clinically ordering the waiting list may be harmful and should be replaced with formal prioritisation approaches.

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  • 22.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    Epstein, David
    Centre for Health Economics, University of York, UK .
    Palmer, Stephen
    Centre for Health Economics, University of York, UK .
    Sculpher, Mark
    Centre for Health Economics, University of York, UK .
    Clayton, Tim
    Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK .
    Pocock, Stuart
    Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, UK .
    Henderson, Robert
    Nottingham City Hospital NHS Trust, Nottingham UK.
    Buxton, Martin
    Health Economics Research Group, Brunel University, Uxbridge, UK.
    Fox, Keith A. A.
    Centre for Cardiovascular Science, Department of Medical and Radiological Sciences, University of Edinburgh, UK .
    The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial2008Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 94, s. 717-723Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.

    Objective: The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective.

    Design: Decision-analytic model based on randomised clinical trial data.

    Main outcome measures: Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.

    Methods: Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients’ lifetimes within the decision-analytic model.

    Results: The mean incremental cost per QALY gained for an early interventional strategy was approximately £55 000, £22 000 and £12 000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of £20 000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.

    Conclusion: An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk.

  • 23.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Epstein, David
    University of York.
    Palmer, Steve
    University of York.
    Sculpher, Mark
    University of York.
    The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome2006Inngår i: Society for Medical Decision Making SMDM,2006, 2006Konferansepaper (Fagfellevurdert)
    Abstract [en]

       

  • 24.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Eptein, David
    York University.
    Palmer, Stephen
    York University.
    Sculpher, Mark
    York Univesity.
    Pros and cons of event based modelling in economic evaluation (oral presentation)2007Inngår i: IHEA,2007, 2007Konferansepaper (Annet vitenskapelig)
  • 25.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Janzon, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Aasa, M.
    Lundborg (Nikolic), Elisabet
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Svensson, L.
    Herlitz, J.
    Grip, L.
    Levin, Lars-Åke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Cost-effectiveness of very early treatment strategies for acute ST-elevation myocardial infarction based on the Swedish early decision (SWEDES) reperfusion trial (oral presentation)2008Inngår i: SMDM Europe,2008, 2008Konferansepaper (Annet vitenskapelig)
    Abstract [en]

       

  • 26.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. PAREXEL Int, Sweden.
    Jindal, Ramandeep
    PAREXEL Int, India.
    Sternhufvud, Catarina
    AstraZeneca, Sweden.
    Bergenheim, Klas
    AstraZeneca, Sweden.
    Sorstadius, Elisabeth
    AstraZeneca, Sweden.
    Willis, Michael
    Swedish Institute Health Econ, Sweden.
    A Systematic Review of Cost-Effectiveness Models in Type 1 Diabetes Mellitus2016Inngår i: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 34, nr 6, s. 569-585Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Critiques of cost-effectiveness modelling in type 1 diabetes mellitus (T1DM) are scarce and are often undertaken in combination with type 2 diabetes mellitus (T2DM) models. However, T1DM is a separate disease, and it is therefore important to appraise modelling methods in T1DM. This review identified published economic models in T1DM and provided an overview of the characteristics and capabilities of available models, thus enabling a discussion of best-practice modelling approaches in T1DM. A systematic review of Embase(A (R)), MEDLINEA (R), MEDLINEA (R) In-Process, and NHS EED was conducted to identify available models in T1DM. Key conferences and health technology assessment (HTA) websites were also reviewed. The characteristics of each model (e.g. model structure, simulation method, handling of uncertainty, incorporation of treatment effect, data for risk equations, and validation procedures, based on information in the primary publication) were extracted, with a focus on model capabilities. We identified 13 unique models. Overall, the included studies varied greatly in scope as well as in the quality and quantity of information reported, but six of the models (Archimedes, CDM [Core Diabetes Model], CRC DES [Cardiff Research Consortium Discrete Event Simulation], DCCT [Diabetes Control and Complications Trial], Sheffield, and EAGLE [Economic Assessment of Glycaemic control and Long-term Effects of diabetes]) were the most rigorous and thoroughly reported. Most models were Markov based, and cohort and microsimulation methods were equally common. All of the more comprehensive models employed microsimulation methods. Model structure varied widely, with the more holistic models providing a comprehensive approach to microvascular and macrovascular events, as well as including adverse events. The majority of studies reported a lifetime horizon, used a payer perspective, and had the capability for sensitivity analysis. Several models have been developed that provide useful insight into T1DM modelling. Based on a review of the models identified in this study, we identified a set of best in class methods for the different technical aspects of T1DM modelling.

  • 27.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Lundgren, Fredrik
    Kärlkirurgen Universitetssjukhuset i Linköpings.
    Cost-effectiveness of screening 65 year old males for abdominal aortic aneurysm2004Inngår i: Health Technology Assessment International HTAi,2004, 2004Konferansepaper (Fagfellevurdert)
  • 28.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Decision-anaytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneursm in 65-year-old men2005Inngår i: British Journal of Surgery, ISSN 0007-1323, Vol. 92, nr 8, s. 976-983Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Abdominal aortic aneurysm (AAA) causes about 2 per cent of all deaths in men over the age of 65 years. A major improvement in operative mortality would have little impact on total mortality, so screening for AAA has been recommended as a solution. The cost-effectiveness of a programme that invited 65-year-old men for ultrasonographic screening was compared with current clinical practice in a decision-analytical model.

    Methods: In a probabilistic Markov model, costs and health outcomes of a screening programme and current clinical practice were simulated over a lifetime perspective. To populate the model with the best available evidence, data from published papers, vascular databases and primary research were used.

    Results: The results of the base-case analysis showed that the incremental cost per gained life-year for a screening programme compared with current practice was €7760, and that for a quality-adjusted life-year was €9700. The probability of screening being cost-effective was high.

    Conclusion: A financially and practically feasible screening programme for AAA, in which men are invited for ultrasonography in the year in which they turn 65, appears to yield positive health outcomes at a reasonable cost.

  • 29.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Lundgren, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kärlkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    Modelling the cost-effectiveness of screening for abdominal aortic aneurysm and assessing the value of further research2005Inngår i: IHEA,2005, 2005Konferansepaper (Fagfellevurdert)
  • 30.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Lundgren, Fredrik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kärlkirurgi. Östergötlands Läns Landsting, Hjärtcentrum, Thorax-kärlkliniken.
    One-time Screening of Abdominal Aortic Aneurysm in 65-year-old Men2005Rapport (Annet vitenskapelig)
  • 31.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Lundgren, Fredrik
    Kärlkirurgen Universitetssjukhuset i Linköpings.
    Screening för pulsåderbråck i buken - en hälsoekonomisk utvärdering2004Rapport (Annet vitenskapelig)
  • 32.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    Cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden2008Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 95, nr 6, s. 714-720Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Long-term health outcomes and costs are important when deciding whether a strategy of carotid endarterectomy in addition to best medical management should be recommended for patients with asymptomatic carotid artery stenosis. This study investigated the cost-effectiveness of such a strategy compared with a strategy of best medical management alone.

    Methods: Based on data from the randomized Asymptomatic Carotid Surgery Trial (ACST), a national vascular database and other published sources, expected costs and health outcomes in terms of quality-adjusted life years (QALYs) of both treatment strategies were estimated using decision-analytical modelling. Cost-effectiveness was established for a Swedish setting from a societal perspective.

    Results: Base-case analysis showed that the incremental cost per QALY of a strategy with carotid endarterectomy for 65- and 75-year-old men (women) was 34 557 (311 133) and 58 930 (779 776) respectively. Sensitivity analyses indicated that the duration of the treatment effect after 5 years of follow-up in the ACST was important for the cost-effectiveness results.

    Conclusion: Carotid endarterectomy in addition to best medical management can be considered cost-effective in men aged 73 years or less but is less likely to be cost-effective in older men or in women.

  • 33.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Informing the efficient use of health care and health care research resources: the case of screening for abdominal aortic aneurysm in Sweden2006Inngår i: Health Economics, ISSN 1057-9230, Vol. 15, nr 12, s. 1311-1322Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: An analytical framework using Bayesian decision theory and value-of-information analysis has recently been advocated for the economic evaluation of health technologies. The purpose of this study was to apply this framework to screening for abdominal aortic aneurysm (AAA) in Sweden and to compare the conclusions from this study with the conclusions presented in an assessment performed by the Swedish Council of Technology Assessment (SBU).

    Methods: A probabilistic decision-analytical model was developed to establish the cost-effectiveness of a screening programme for AAA relative to current clinical practice and to calculate the value-of-information.

    Results: The cost per quality-adjusted life-year for screening was €9700. The expected value of perfect information for the assessment of overall cost-effectiveness was low, suggesting little benefit in conducting further research. Expected value of perfect partial information indicated that rupture probabilities were associated with the highest uncertainty. By contrast, the SBU report concluded there was limited evidence of cost-effectiveness and proposed further research.

    Conclusion: The investigated screening programme for AAA is likely to be cost-effective and conducting another clinical trial is unlikely to add much valuable information to this decision problem. These recommendations contrast with the vaguer recommendations from SBU that more evidence is required of costs-effectiveness.

  • 34.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    Lundgren, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Medicinsk teknologiutvärdering. Linköpings universitet, Hälsouniversitetet.
    The value of further research into the cost-effectiveness of endarterectomy in patients with asymptomatic carotid artery stenosis in Sweden2007Artikkel i tidsskrift (Fagfellevurdert)
  • 35.
    Henriksson, Martin
    et al.
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Astra Zeneca Nordic-Baltic, Södertälje, Sweden.
    Nikolic, Elisabet
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Ohna, Audun
    Astra Zeneca Nordic-Baltic, Södertälje, Sweden.
    Wallentin, Lars
    Uppsala University, Sweden.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Ticagrelor treatment in patients with acute coronary syndrome is cost-effective in Sweden and Denmark2014Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, nr 3, s. 138-147Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. To evaluate the cost-effectiveness of treating patients with acute coronary syndromes (ACS) for 12 months with ticagrelor compared with generic clopidogrel in Sweden and Denmark. Design. Decision-analytic model to estimate lifetime costs, life-expectancy, and quality-adjusted life years (QALYs) with ticagrelor and clopidogrel. Event rates, healthcare resource use, and health-related quality of life during 12 months of therapy were estimated from the PLATelet inhibition and patient Outcomes (PLATO) trial. Beyond 12 months, quality-adjusted survival and costs were estimated conditional on events occurring during the 12 months of therapy. When available, country-specific data were employed in the analysis. Incremental cost-effectiveness ratios are presented from a healthcare perspective and a broader societal perspective including costs falling outside the healthcare sector in 2010 local currency. Results. The cost per QALY with ticagrelor compared with generic clopidogrel was SEK 25 022 and DKK 26 892 for Sweden and Denmark, respectively, from a healthcare perspective. The cost per QALY from a broader societal perspective was SEK 24 290 and DKK 25 051 for Sweden and Denmark, respectively. Conclusion. The cost per QALY of treating ACS-patients with ticagrelor compared with generic clopidogrel is below the conventional thresholds of cost-effectiveness in Sweden and Denmark.

  • 36.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle.
    Nordlund, Anders
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Rikscentrum arbetslivsinriktad rehabilitering IHS.
    Janzon, Magnus
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Swahn, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    A comparison of EQ-5D and SF-6D utilities2003Inngår i: iHEA 2003, San Francisco. Muntlig posterpresentation,2003, 2003Konferansepaper (Fagfellevurdert)
  • 37.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Palmer, S.
    York University.
    Sculpher, Mark
    York University.
    Abrams, K.
    Hemingway, H.
    Cost-Effectiveness of circulating biomarkers in managing stable coronary artery disease2008Inngår i: SMDM,2008, 2008Konferansepaper (Annet vitenskapelig)
  • 38.
    Henriksson, Martin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Ramsberg, Joakim
    Läkemedelsförmånsnämnden.
    Cost-effectiveness of Strategies for Testing out Triptan Treatment on Migraine Patients2005Inngår i: Health Technology Assessment International,2005, 2005Konferansepaper (Fagfellevurdert)
  • 39.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Siverskog, Jonathan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Johannesen, Kasper
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Eriksson, Thérèse
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Tröskelvärden och kostnadseffektivitet: innebörd och implikationer för ekonomiska utvärderingar och beslutsfattande i hälso- och sjukvården2018Rapport (Annet vitenskapelig)
    Abstract [sv]

    Resultaten från hälsoekonomiska utvärderingar redovisas oftast som en inkrementell kostnadseffektivitetskvot (ICER efter engelskans incremental cost-efectiveness ratio) vilken anger kostnaden per uppnådd effektenhet för den åtgärd som utvärderas. En åtgärd kan vara ett preventionsprogram, en diagnostisk metod eller en behandling i form av ett kirurgiskt ingrepp eller ett läkemedel (vi använder fortsättningsvis begreppet interventioner som ett samlingsnamn för alla dessa åtgärder). Vanligtvis används ett hälsorelaterat mått såsom kvalitetsjusterade levnadsår (QALYs) som effektmått. För att en ICER på ett meningsfullt sätt skall kunna tolkas och tillämpas i beslutsfattande krävs att vi har en uppfattning om vad resultaten representerar och vad de kan jämföras med. Inte sällan anges ett gräns-värde för när en intervention kan anses vara kostnadseffektiv i litteraturen, ett så kallat tröskelvärde för kostnadseffektivitet. Ambitiösa försök att skatta detta värde har nyligen presenterats och bidrar med ny kunskap på området. I ljuset av denna forskning är det också tydligt att det finns olika tolkningar av tröskelvärdet, vilket kan bidra till otydlighet i både beslutsfattande och diskussioner om vad som kan anses vara en rimlig gräns för kostnadseffektivitet. Syftet med föreliggande rapport är att beskriva olika tolkningar av tröskelvärdet, sammanfatta vilken empirisk kunskap vi har om detta värde idag och slutligen diskutera vidare forskning i en svensk kontext.

    I rapporten illustreras de två huvudsakliga definitionerna av tröskelvärde som återfinns i litteraturen.

    Konsumtionsvärdet av hälsa kan tänkas representera vad individer på marginalen är villiga att ge upp i konsumtion för att erhålla ytterligare en QALY. I den internationella litteraturen har detta värde kommit att benämnas v.

    Marginalproduktiviteten i hälso- och sjukvårdssektorn kan tänkas representera kostnaden för att generera ytterligare en QALY på marginalen i hälso- och sjukvårdssektorn. Tröskelvärdet med denna tolkning bör utgöra kostnaden per QALY för den minst kostnadseffektiva interventionen som återfinns inom hälso- och sjukvårdssektorn. I den internationella litteraturen benämns detta värde k.

    I rapporten diskuteras implikationerna av att använda de olika definitionerna i beslutsfattande samt hur de hänger ihop med alternativkostnader i olika delar av samhället. När en intervention tar resurser i anspråk som annars skulle ha använts till sjukvård är alternativkostnaden förlorad hälsa. Denna alternativkostnad kan representeras av marginalproduktiviteten i hälso- och sjukvårdssektorn, k. När en intervention tar resurser i anspråk som annars skulle ha använts för privat konsumtion är alternativ-kostnaden istället förlorad konsumtion, vilken kan representeras av konsumtionsvärdet av hälsa, v. Vilket perspektiv som anses relevant samt i vilken sektor konsekvenserna av olika interventioner upp-står bör därmed vara avgörande för vilken eller vilka definitioner av tröskelvärdet som kan behöva beaktas.

    Empiriska studier har i större utsträckning försökt skatta konsumtionsvärdet av hälsa (v) jämfört med marginalproduktiviteten i hälso- och sjukvårdssektorn (k). Kunskapen om båda storheterna är begränsad ur ett svenskt perspektiv. En större studie från England utgör det första och mest ambitiösa försöket att explicit skatta tröskelvärdet ur ett marginalproduktivitetsperspektiv med hjälp av större data-material. I den studien skattades tröskelvärdet till en kostnad per QALY motsvarande ungefär 150 000 kronor. I ett försök att översätta dessa skattningar till tröskelvärden i andra länder redovisas en kostnad per QALY i intervallet 170 000 till 210 000 kronor för Sverige. Skattningarna får anses vara behäftade med en hög grad av osäkerhet. Nyligen publicerade studier från Australien och Spanien redovisar skattningar motsvarande 185 00 och 250 000 kronor per QALY. I studier som undersökt konsumtions-värdet av hälsa redovisas skattningar på 30 000 till flera miljoner kronor per QALY.

    En stor del av variationen i resultaten kan troligtvis hänföras till metodologiska aspekter. Studierna varierar i flera dimensioner; praktisk undersökningsmetod (online, intervjuer eller pappersenkäter), utformning av svarsalternativ, statistiska metoder för att analysera data, typ av hälsoförändring som värderats (enbart livskvalitet, enbart livslängd eller en kombination), om värderade hälsoförändringar uppnås med säkerhet eller med en viss sannolikhet samt om hälsoförändringen som värderas tillfaller respondenten själv eller någon annan. Få studier med data från svenska individer där generella hälso-förändringar värderats av ett urval från allmänheten har identifierats. Den enda studien som vi identifierat i referentgranskade tidskrifter redovisar skattningarna för Sverige i intervallet 150 000 till 350 000 kronor. I en relativt ny svensk rapport som finns tillgänglig på Institutet för Hälso- och Sjukvårds-ekonomis (IHE) hemsida redovisas skattningar på 2,4 miljoner kronor per QALY.

    En slutsats i vår rapport är att det behöver tydliggöras hur valet av perspektiv faktiskt påverkar vilken eller vilka definitioner av tröskelvärdet som bör vara relevanta när hälsoekonomiska utvärderingar används som underlag vid beslutsfattande inom hälso- och sjukvården. Om ett bredare samhällsperspektiv anses relevant kan både konsumtionsvärdet av hälsa (v) och marginalproduktiviteten i hälso- och sjukvården (k) behöva beaktas.

    En annan slutsats är att oavsett vilken definition av tröskelvärde som anses relevant så har vi mycket begränsad kunskap om både marginalproduktiviteten i hälso- och sjukvårdssektorn och konsumtions-värdet av hälsa i en svensk kontext. Statistisk modellering av befintliga datakällor kan vara en fram-komlig väg för att skatta marginalproduktiviteten medan välgjorda experiment eller metoder för att studera individers värderingar av hälsa via faktiska beslut och ageranden i icke-experimentella situationer kan vara en framkomlig väg för att studera konsumtionsvärdet av hälsa.

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    Tröskelvärden och kostnadseffektivitet: innebörd och implikationer för ekonomiska utvärderingar och beslutsfattande i hälso- och sjukvården
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  • 40.
    Janson, Martin
    et al.
    Karolinska Institutet Huddinge universitetssjukhus.
    Björholt, Ingela
    Göteborgs universitet.
    Carlsson, Per
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Haglind, Eva
    Göteborgs universitet.
    Henriksson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Lindholm, Elisabeth
    Göteborgs universitet.
    Anderberg, Bo
    Huddinge universitetssjukhus.
    Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer2004Inngår i: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 91, nr 4, s. 409-417Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There has been no randomized clinical trial of the costs of laparoscopic colonie resection (LCR) compared with those of open colonic resection (OCR) in the treatment of colonic cancer. Methods: A subset of Swedish patients included in the Colon Cancer Open Or Laparoscopic Resection (COLOR) trial was included in a prospective cost analysis, costs were calculated up to 12 weeks after surgery. All relevant costs to society were included. No effects of the procedures, such as quality of life or survival, were taken into account. Results: Two hundred and ten patients were included in the primary analysis, 98 of whom had LCR and 112 OCR. Total costs to society did not differ significantly between groups (difference in means for LCR versus OCR €1846, P = 0.104). The cost of operation was significantly higher for LCR than for OCR (difference in means €1171, P < 0.001), as was the cost of the first admission (difference in means €1556, P = 0.015) and the total cost to the healthcare system (difference in means €2244, P = 0.018). Conclusion: Within 12 weeks of surgery for colonic cancer, there was no difference in total costs to society incurred by LCR and OCR. The LCR procedure, however, was more costly to the healthcare system.

  • 41.
    Janzon, Magnus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Hasvold, Pål
    AstraZeneca Nordic-Baltic, Södertälje, Sweden.
    Hjelm, Hans
    Nyköping Hospital, Nyköping, Sweden.
    Thuresson, Marcus
    Statisticon AB, Uppsala, Sweden.
    Jernberg, Tomas
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm, Sweden.
    Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting - results from a contemporary nationwide registry study2016Inngår i: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, Vol. 2, s. 291-298Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims Long-term contemporary nationwide data on resource use and healthcare costs after myocardial infarction (MI) in a clinical practice setting are not widely studied, and the aim of this study was to investigate resource use patterns and healthcare costs in patients with MI in a nationwide clinical practice setting.

    Methods and results This retrospective cohort study included all patients identified in the compulsory Swedish nationwide patient register with a diagnosis of MI between 1 July 2006 and 30 June 2011. Cardiovascular hospitalization and outpatient visits data from the patient register were combined with data from the cause of death register and the drug utilization register. For a subset of patients, data were also available from a primary care register. Healthcare resource use patterns and annual costs [reported in 2014 euros (€) converted from Swedish kronor (SEK) using the exchange rate €1 = SEK 9.33)] were estimated for the year prior to the occurrence of MI as well as for a maximum follow-up period of 6 years post-MI. The study included 97 252 patients with a diagnosis of MI with a total number of 285 351 observation years. The majority of healthcare consumption occurred within the first year of MI where patients were on average hospitalized 1.55 times, made 1.08 outpatient care visits, and 3.80 primary care visits. In the long term, for the majority of resource use categories, average consumption was higher in the years after MI compared with the year prior to MI. Healthcare costs at 6 years of follow-up were approximately €20 000 of which €12 460 occurred in the first year, and the major part was attributed to hospitalizations.

    Conclusion For patients with 6 years of follow-up after MI, healthcare costs were approximately €20 000. The major part of costs occurred in the first year after MI and was driven by hospitalizations

  • 42.
    Janzon, Magnus
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Henriksson, Martin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Levin, Lars-Åke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Swahn, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Quality of life in unstable angina - Individual and public preferences differ in levels but are similar when measuring changes over time2002Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, s. 730-730Konferansepaper (Annet vitenskapelig)
  • 43.
    Janzon, Magnus
    et al.
    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.
    Levin, Lars-Åke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle.
    Swahn, Eva
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Quality of life in unstable angina. Individual and public preferences differ in levels but are similar when measuring changes over time2002Inngår i: ISTAHC-konferens, Berlin, juni 2002,2002, 2002Konferansepaper (Fagfellevurdert)
  • 44.
    Janzon, Magnus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    James, S
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden.
    Cannon, C P
    ] Brigham & Womens Hosp, Thrombolysis Myocardial Infarct TIMI Study Grp, Boston, MA 02115 USA Harvard Univ, Sch Med, Boston, MA USA .
    Storey, R F
    Univ Sheffield, Dept Cardiovasc Sci, Sheffield, S Yorkshire, England.
    Mellström, C
    AstraZeneca R&D, Molndal, Sweden.
    Nicolau, J C
    Univ Sao Paulo Med Sch, Heart Inst InCor, Sao Paulo, Brazil.
    Wallentin, L
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. AstraZeneca Nord Balt, Sodertalje, Sweden.
    Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy2015Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 101, nr 2, s. 119-25Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management.

    METHODS: A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems.

    RESULTS: Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability.

    CONCLUSIONS: Treatment of patients with ACS scheduled for 12 months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel.

    TRIAL REGISTRATION NUMBER: NCT000391872.

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  • 45.
    Jernberg, Tomas
    et al.
    Karolinska Univ Hosp, Dept Cardiol, Karolinska Inst, Dept Med, S-14186 Stockholm, Sweden.
    Hasvold, Pål
    AstraZeneca NordicBalt, Sodertalje, Sweden.
    Henriksson, Martin
    AstraZeneca NordicBalt, Sodertalje, Sweden.
    Hjelm, Hans
    Nykoping Hosp, Nykoping, Sweden.
    Thuresson, Marcus
    Statisticon AB, S-75322 Uppsala, Sweden.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.2015Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, nr 19, s. 1163-1170Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.

    METHODS AND RESULTS: This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.

    CONCLUSIONS: Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.

  • 46.
    Johannesen, Kasper
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Department of Health Economics, AstraZeneca Nordic, Södertälje, Sweden .
    Henriksson, Martin
    Department of Health Economics, AstraZeneca Nordic, Södertälje, Sweden.
    Getting value today and incentivising for the future: Pharmaceutical development and healthcare policies2017Inngår i: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 5, nr 1, s. 77-96Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    To manage the challenge of limited healthcare resources and unlimited demand for healthcare, decision makers utilise a variety of demand side policies, such as health technology appraisals and international reference pricing to regulate price and utilisation. By controlling price and utilisation demand side policies determine the earnings potential, and hence the incentives to invest in research and development (R&D) of new technologies. However, the impact of demand side policies on R&D incentives is seldom formally assessed. Based on the key assumption that intellectual property rights, i.e. patents, and expected rent are key drivers of pharmaceutical R&D, this work outlines a framework illustrating the link between demand side policies and pharmaceutical R&D incentives. By analysing how policies impact expected rent and consumer surplus, the framework is used to understand how commonly used demand side policies (including timing and length of reimbursement process, international reference pricing, parallel trade, and sequential adoption into clinical practice) may influence R&D incentives. The analysis demonstrates that delayed reimbursement decisions as well as sequential adoption into clinical practise may in fact reduce both expected rent and consumer surplus. It is also demonstrated how international reference pricing is likely to increase consumer surplus at the expense of lower rent and thus lower R&D incentives. Although this work illustrates the importance of considering how demand side policies may impact long-term R&D incentives, it is important to note that the purpose has not been to prescribe which demand side policies should be utilised or how. Rather, the main contribution is to illustrate the need for a structured approach to the analysis of the complex, and at times highly politicised question of how demand side policies ultimately influence population health, both in the short and in the long term.

    Fulltekst (pdf)
    fulltext
  • 47.
    Johannesen, Kasper
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Janzon, Magnus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jernberg, Tomas
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives2020Inngår i: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, artikkel-id 0272989X20907353Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (22,300) pound per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

  • 48.
    Kip, Michelle M. A.
    et al.
    Univ Twente, Netherlands.
    IJzerman, Maarten J.
    Univ Twente, Netherlands.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Merlin, Tracy
    Univ Adelaide, Australia.
    Weinstein, Milton C.
    Harvard TH Chan Sch Publ Hlth, MA USA.
    Phelps, Charles E.
    Univ Rochester, NY USA.
    Kusters, Ron
    Univ Twente, Netherlands; Jeroen Bosch Ziekenhuis, Netherlands.
    Koffijberg, Hendrik
    Univ Twente, Netherlands.
    Toward Alignment in the Reporting of Economic Evaluations of Diagnostic Tests and Biomarkers: The AGREEDT Checklist2018Inngår i: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 38, nr 7, s. 778-788Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. General frameworks for conducting and reporting health economic evaluations are available but not specific enough to cover the intricacies of the evaluation of diagnostic tests and biomarkers. Such evaluations are typically complex and model-based because tests primarily affect health outcomes indirectly and real-world data on health outcomes are often lacking. Moreover, not all aspects relevant to the evaluation of a diagnostic test may be known and explicitly considered for inclusion in the evaluation, leading to a loss of transparency and replicability. To address this challenge, this study aims to develop a comprehensive reporting checklist. Methods. This study consisted of 3 main steps: 1) the development of an initial checklist based on a scoping review, 2) review and critical appraisal of the initial checklist by 4 independent experts, and 3) development of a final checklist. Each item from the checklist is illustrated using an example from previous research. Results. The scoping review followed by critical review by the 4 experts resulted in a checklist containing 44 items, which ideally should be considered for inclusion in a model-based health economic evaluation. The extent to which these items were included or discussed in the studies identified in the scoping review varied substantially, with 14 items not being mentioned in 47 (75%) of the included studies. Conclusions. The reporting checklist developed in this study may contribute to improved transparency and completeness of model-based health economic evaluations of diagnostic tests and biomarkers. Use of this checklist is therefore encouraged to enhance the interpretation, comparability, andindirectlythe validity of the results of such evaluations.

    Fulltekst (pdf)
    fulltext
  • 49.
    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 (Annet (populærvitenskap, debatt, mm))
  • 50.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ekdahl, Anne W.
    Karolinska Inst, Sweden; Lund Univ, Sweden.
    Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial2018Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, artikkel-id 32Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Older people with multi-morbidity are increasingly challenging for todays healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people amp;gt;= 75 years with multi-morbidity. Method: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros. Results: Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer. Conclusion: CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population.

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