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  • 1.
    Akcan, Derya
    et al.
    Swedish Council Health Technology Assessment SBU, Sweden .
    Axelsson, Susanna
    Swedish Council Health Technology Assessment SBU, Sweden .
    Bergh, Christina
    Gothenburg University, Sweden Sahlgrens University Hospital, Sweden .
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Rosen, Mans
    Swedish Council Health Technology Assessment SBU, Sweden Karolinska Institute, Sweden .
    Methodological quality in clinical trials and bibliometric indicators: no evidence of correlations2013Ingår i: Scientometrics, ISSN 0138-9130, E-ISSN 1588-2861, Vol. 96, nr 1, s. 297-303Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 2.
    Anderson, Maria
    et al.
    Karolinska Inst, Sweden; Publ Dent Hlth Serv, Sweden; Ctr Pediat Oral Hlth, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Dahllof, Goran
    Karolinska Inst, Sweden; Ctr Pediat Oral Hlth, Sweden.
    Grindefjord, Margaret
    Karolinska Inst, Sweden; Publ Dent Hlth Serv, Sweden; Ctr Pediat Oral Hlth, Sweden.
    Economic evaluation of an expanded caries-preventive program targeting toddlers in high-risk areas in Sweden2019Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, nr 4, s. 303-309Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program. Material and methods: Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented. Results: Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high. Conclusions: The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended. Trial registration: (ISRCTN35086887).

  • 3.
    Astvaldsdottir, Alfheidur
    et al.
    Karolinska Inst, Sweden.
    Bostrom, Anne-Marie
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden; Western Norway Univ Appl Sci, Norway.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Malmo Univ, Sweden.
    Gabre, Pia
    Uppsala Cty Council, Sweden; Univ Gothenburg, Sweden.
    Gahnberg, Lars
    Reg Vastra Gotaland, Sweden; Univ Gothenburg, Sweden.
    Englund, Gunilla Sandborgh
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Skott, Pia
    Karolinska Inst, Sweden.
    Stahlnacke, Katri
    Reg Orebro Cty, Sweden; Orebro Univ, Sweden.
    Tranaeus, Sofia
    Karolinska Inst, Sweden; Malmo Univ, Sweden.
    Wilhelmsson, Hanna
    Malmo Univ, Sweden.
    Wardh, Inger
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Ostlund, Pernilla
    Malmo Univ, Sweden.
    Nilsson, Mikael
    Malmo Univ, Sweden.
    Oral health and dental care of older persons-A systematic map of systematic reviews2018Ingår i: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 35, nr 4, s. 290-304Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives: To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. Background: Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a persons physical, psychological and social wellbeing. Methods: A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. Results: We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. Conclusions: There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.

  • 4.
    Astvaldsdottir, Alfheiour
    et al.
    Karolinska Institute, Sweden.
    Naimi-Akbar, Aron
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Brolund, Agneta
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Lintamo, Laura
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Attergren Granath, Anna
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Tranaeus, Sofia
    Karolinska Institute, Sweden; Swedish Agency Health Technology Assessment and Assessment, Sweden; Malmt University, Sweden.
    Ostlund, Pernilla
    Swedish Agency Health Technology Assessment and Assessment, Sweden; Malmt University, Sweden.
    Arginine and Caries Prevention: A Systematic Review2016Ingår i: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 50, nr 4, s. 383-393Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate the available evidence that the use of arginine-containing dental care products prevents the development of new caries lesions and the progression of existing lesions. Search Methods: We performed a systematic literature search of databases including PubMed, the Cochrane Library and EMBASE. Selection Criteria: We selected randomized controlled trials of treatment with arginine in fluoride-containing dental products measuring dental caries incidence or progression in children, adults and elderly subjects. Data Collection and Analysis: Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE classification. Main Results: Due to conflicts of interest and weak transferability to Swedish conditions, no conclusions can be drawn from studies on the effects of arginine-fluoride toothpaste in children. Arginine-containing toothpaste costs about 40% more than basic fluoride toothpaste; to determine whether it is more cost-effective, the higher cost must be considered in relation to any additional caries-preventive effect. The literature review also disclosed some questionable research ethics: in several of the studies, the children in the control group used non-fluoride toothpaste. Toothpaste without fluoride is not as effective against dental caries as the standard treatment - fluoride toothpaste - which has a well -documented effect. This contravenes the fundamental principles of research ethics. Conclusion: At present there is insufficient evidence in support of a caries-preventive effect for the inclusion of arginine in toothpastes. More rigorous studies, and studies which are less dependent on commercial interests, are required. (C) 2016 S. Karger AG, Basel

  • 5.
    Bartha, Erzsebet
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Berg, Hans E.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Kalman, Sigridur
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    A 1-year perspective on goal-directed therapy in elderly with hip fracture: Secondary outcomes2019Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 63, nr 5, s. 610-614Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background We have previously reported inconclusive results from a randomized controlled trial in elderly with hip-fracture comparing intra-operative goal-directed therapy with routine fluid treatment. Now we aimed to describe and compare secondary outcomes at 4 months and 1 year follow-up and to analyze the cost-effectiveness. Methods Patients with hip fracture (age amp;gt;= 70) were randomized for GDT or routine fluid treatment (RFT). The secondary outcomes were long-term survival, complications, number of hospital readmissions, and quality of life (EQ-5D) changes. Additionally, cost effectiveness was analyzed by an analytic tool which combines the clinical effectiveness, quality of life changes and costs. Results Patient data (GDT n = 74; RFT n = 75) were analyzed on an intention to treat basis. Statistically significant differences (GDT vs RFT) were not found considering survival (RR 0.76, 95%CI 0.45-1.28) and complications (RR 0.68, 95% CI 0.4-1.10) at 12 months. No statistically significant difference was found between hospital readmissions and quality of life changes. Conclusion The statistical uncertainty of risk reduction of negative outcomes and the large variability of the collected data indicate the need of further research in large sample sizes. To enable future health economic evaluation for decision support surrounding implementation of GDT, we suggest adding patient-oriented outcomes in future trials.

  • 6.
    Bartha, Erzsebet
    et al.
    Karolinska Institute, CLINTEC, Div of Anaesthesiology.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Brodtkorb, Thor-Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Kalman, Sigridur
    Karolinska Institute, CLINTEC, Div of Anasthesiology.
    Optimization of circulation by fluid treatment of elderly patients with hip fracture (oral presentation): Cost-effectiveness and value of information analysis2011Konferensbidrag (Refereegranskat)
  • 7.
    Bartha, Erzsebet
    et al.
    Karolinska University Hospital, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Brodtkorb, Thor-Henrik
    RTI Health Solut, Sweden.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Kalman, Sigridur
    Karolinska University Hospital, Sweden.
    Value of information: interim analysis of a randomized, controlled trial of goal-directed hemodynamic treatment for aged patients2013Ingår i: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

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

    Methods

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

    Results

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

    Conclusions

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

  • 8.
    Bartha, Erzsebet
    et al.
    Karolinska Institute, CLINTEC, Div of Anesthesiology.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Hommel, Ami
    Lund University, Dept of Health Sciences.
    Thorngren, Karl-Göran
    Lund University Hospital, Dept of Orthopedics.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Kalman, Sigridur
    Karolinska Institute, CLINTEC, Div of Anestesiology.
    Cost-effectiveness Analysis of Goal-directed Hemodynamic Treatment of Elderly Hip Fracture Patients: Before Clinical Research Starts2012Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 117, nr 3, s. 519-530Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 9.
    Bergenholtz, Gunnar
    et al.
    Varsaparken Gothenburg.
    Axelsson, Susanna
    Varsaparken, Gothenburg.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Statens beredning för medicinsk utvärdering, Stockholm.
    Frisk, Fredrik
    Varsaparken, Gothenburg.
    Hakeberg, Magnus
    Varsaparken, Gothenburg.
    Kvist, Thomas
    Varsaparken, Gothenburg.
    Norlund, Anders
    Varsaparken, Gothenburg.
    Petersson, Arne
    Varsaparken, Gothenburg.
    Portenier, Isabelle
    Varsaparken, Gothenburg.
    Sandberg, Hans
    Varsaparken, Gothenburg.
    Tranæus, Sofia
    Varsaparken, Gothenburg.
    Mejare, Ingegerd
    Varsaparken, Gothenburg.
    Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.2013Ingår i: Singapore dental journal, ISSN 0377-5291, Vol. 34, nr 1, s. 1-12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 10.
    Bergstrom, Eva-Karin
    et al.
    Vastra Gotaland Reg, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Moberg Sköld, Ulla
    Univ Gothenburg, Sweden.
    Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12-to 15-Year-Olds in Sweden2019Ingår i: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 53, nr 3, s. 339-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Vastra Gotaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the "low" subgroup, those with 1-3 into the "moderate" subgroup and those with amp;gt;= 4 into the "high" subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12. (C) 2019 S. Karger AG, Basel

  • 11.
    Boman, Kurt
    et al.
    Umeå University, Sweden .
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Gustavsson, Mats
    Primary Health Care Unit, Sweden .
    Olofsson, Mona
    Umeå University, Sweden .
    Renstrom, Gun-Britt
    Skelleftea County Hospital, Sweden .
    Johansson, Lars
    Umeå University, Sweden .
    Telemedicine improves the monitoring process in anticoagulant treatment2012Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 18, nr 6, s. 312-316Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 12.
    Broden, Josephine
    et al.
    Malmo Univ, Sweden; Swedish Publ Dent Serv, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Fransson, Helena
    Malmo Univ, Sweden.
    Cost-effectiveness of pulp capping and root canal treatment of young permanent teeth2019Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 77, nr 4, s. 275-281Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To contribute with information on cost-effectiveness of pulp capping and root canal treatment of posterior permanent vital teeth in children and adolescents with pulp exposures due to caries. Material and methods: Cost-effectiveness by means of a Markov simulation model was studied in a Scandinavian setting. In a simulated 12-year-old patient, treatment of pulpal exposure of a permanent tooth, either by the initial treatment pulp capping or root canal treatment, was followed for 9 years until the patient was 21. The model was based on outcome data obtained from published literature and cost data based on reference prices. Results: In the simulated case, with the annual failure probalility (AFP) of 0.034 for pulp capping, the total cost for an initial treatment with pulp capping and any anticipated following treatments during the 9 years, was 367 EUR lower than for a root canal treatment as the initial treatment. After an initial treatment with pulp capping 10.4% fewer teeth, compared with initial root canal treatment, were anticipated to be extracted. Pulp capping was thus considered to be the cost-effective alternative. The sensitivity analyses showed that the AFP of a tooth requiring a root canal treatment after an initial pulp capping needed to be 0.2 before root canal treatment may be considered being the cost-effective treatment. Conclusions: This model analysis indicated initial treatment by pulp capping to be cost-effective compared to root canal treatment in children and adolescents with pulp exposures due to caries.

  • 13.
    Christell, Helena
    et al.
    Malmo Univ, Sweden; Helsingborg Hosp, Sweden.
    Gullberg, Joanna
    Malmo Univ, Sweden.
    Nilsson, Kenneth
    Malmo Univ, Sweden.
    Olofsson, Sofia Heidari
    Malmo Univ, Sweden.
    Lindh, Christina
    Malmo Univ, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Willingness to pay for osteoporosis risk assessment in primary dental care2019Ingår i: Health Economics Review, ISSN 2191-1991, E-ISSN 2191-1991, Vol. 9, artikel-id UNSP 14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundFragility fracture related to osteoporosis among postmenopausal women is a significant cause of morbidity. The care and aftercare of these fractures are associated with substantial costs to society. A main problem is that many individuals suffer from osteoporosis without knowing it before a fracture happens. Dentists may have an important role in early identification of individuals with osteoporosis by assessment of dental radiographs already included in the dental examination. The aim of this study was therefore to investigate postmenopausal womens preferences for an osteoporosis risk assessment in primary dental care.ResultsMost respondents (129 of 144 (90%)) were willing to pay for an osteoporosis risk assessment in primary dental care. The overall mean willingness to pay (WTP) including respondents that denoted none or zero WTP was 44.60 Euro (CI 95% 38.46-50.74 Euro) (median 34.75 Euro). A majority (80.6%) of the respondents that denoted WTP also gave a motivation for their answer. The two most common reasons denoted for being willing to pay for osteoporosis risk assessment were the importance of early diagnosis and preventive care to avoid fractures (41.0%) and the importance of knowledge of a risk of osteoporosis (26.4%). A majority of respondents (67.8%) considered it valuable if dental clinics would offer osteoporosis risk assessment.ConclusionsPostmenopausal women seem to find it valuable to be offered osteoporosis risk assessment in primary dental care and are willing to pay for such a risk assessment. From a societal perspective early diagnosis of osteoporosis by risk assessment in primary dental care could prevent osteoporotic related fractures and benefit womens health and quality of life, as well as have a major impact on the health-care budget in terms of cost-savings.

  • 14.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    How to include relatives and productivity loss in a cost‐effectiveness analysis2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

    Delarbeten
    1. Is the societal approach wide enough to include relatives?: incorporating relatives' costs and effects in a cost-effectiveness analysis.
    Öppna denna publikation i ny flik eller fönster >>Is the societal approach wide enough to include relatives?: incorporating relatives' costs and effects in a cost-effectiveness analysis.
    2010 (Engelska)Ingår i: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 8, nr 1, s. 25-35Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

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

    Ort, förlag, år, upplaga, sidor
    Springer, 2010
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-53069 (URN)10.2165/11313910-000000000-00000 (DOI)20038191 (PubMedID)
    Anmärkning

    The previous status of this article was Manuscript.

    Tillgänglig från: 2010-01-15 Skapad: 2010-01-15 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    2. In pursuit of QALY weights for relatives: Empirical estimates in relatives caring for older people
    Öppna denna publikation i ny flik eller fönster >>In pursuit of QALY weights for relatives: Empirical estimates in relatives caring for older people
    2008 (Engelska)Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 9, nr 3, s. 285-292Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

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

    Ort, förlag, år, upplaga, sidor
    SpringerLink, 2008
    Nyckelord
    Economics, Relatives, Caregivers, QALY weight
    Nationell ämneskategori
    Ekonomi och näringsliv
    Identifikatorer
    urn:nbn:se:liu:diva-16948 (URN)10.1007/s10198-007-0076-z (DOI)
    Tillgänglig från: 2009-03-02 Skapad: 2009-02-26 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Direct valuation of health state among patients with chest pain: Does income level matter
    Öppna denna publikation i ny flik eller fönster >>Direct valuation of health state among patients with chest pain: Does income level matter
    (Engelska)Manuskript (preprint) (Övrig (populärvetenskap, debatt, mm))
    Abstract [en]

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

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

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

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

    Nyckelord
    Outcome research, QALY, income, cost-effectiveness analysis
    Nationell ämneskategori
    Ekonomi och näringsliv
    Identifikatorer
    urn:nbn:se:liu:diva-16952 (URN)
    Anmärkning

    This paper will not be published.

    Tillgänglig från: 2009-02-26 Skapad: 2009-02-26 Senast uppdaterad: 2017-01-11Bibliografiskt granskad
    4. Do individuals consider expected income when valuing health states?
    Öppna denna publikation i ny flik eller fönster >>Do individuals consider expected income when valuing health states?
    2008 (Engelska)Ingår i: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 24, nr 4, s. 488-494Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

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

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

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

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

    Nyckelord
    Cost-effectiveness analysis, Valuation, Health state utility, Expected income
    Nationell ämneskategori
    Ekonomi och näringsliv
    Identifikatorer
    urn:nbn:se:liu:diva-16949 (URN)10.1017/S0266462308080641 (DOI)
    Tillgänglig från: 2009-03-02 Skapad: 2009-02-26 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
  • 15.
    Davidson, Thomas
    Linköpings universitet, Ekonomiska institutionen.
    The creation of a cluster A case study of Malaysia's Multimedia Super Corridor2002Självständigt arbete på avancerad nivå (magisterexamen)Studentuppsats
    Abstract [en]

    Multinational companies (MNCs) often choose to locate near other MNCs in order to gain advantages from each other. This is one ingredient in creating a cluster, an area composed of companies, institutions and/or organisations, sharing a similar technology or knowledge base with mutual benefits for the cluster participants. Market forces have created the majority of the clusters in the world. Still, governments frequently aim at creating clusters in order to promote regional development and growth. This is the case with the Multimedia Super Corridor (MSC) in Malaysia that was launched in 1996. My purpose with this thesis is to examine if the creation and running of the MSC has had economical benefits for Malaysia and to examine the MSC’s potential to become profitable and productive. The MSC is a new technological area and it is still under construction. The return on investment seems to be negative and the area is dependent on the Malaysian government for its development. The infrastructure, political and economical factors seem, according to my analysis, to be sufficient for creating the MSC. However, the low level of human resource is a problem for the cluster. Furthermore, Malaysia’s comparative advantage does not seem to be in high-technology production but rather in high-quality manufacturing. Even though the MSC is unlikely to develop into a world leading high-technology cluster, it can help to transfer Malaysia into a new phase of development.

  • 16.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Ekermo, Bengt
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Transfusionsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Gaines, Hans
    Lesko, Birgitta
    Akerlind, Britt
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Klinisk mikrobiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk mikrobiologi.
    The cost-effectiveness of introducing nucleic acid testing to test for hepatitis B, hepatitis C, and human immunodeficiency virus among blood donors in Sweden2011Ingår i: TRANSFUSION, ISSN 0041-1132, Vol. 51, nr 2, s. 421-429Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 17.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    CMT rapport: kostnader och kostnadseffektivitet av ett införande av dabigatran hos patienter med förmaksflimmer2011Rapport (Övrigt vetenskapligt)
    Abstract [sv]

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

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

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

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

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

  • 18.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    The cost of atrial fibrillation in Sweden (Poster)2010Ingår i: Value in Health, Malden: Wiley Periodicals, Inc , 2010, s. 350-350Konferensbidrag (Refereegranskat)
  • 19.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    The Cost of Thromboembolic Events and their Prevention among Patients with Atrial Fibrillation2011Ingår i: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 2, nr 4, s. 00-00Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

     

  • 20.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Oldgren, Jonas
    Uppsala University, Sweden .
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden2013Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr 3, s. 177-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 21.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Krevers , Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    In pursuit of QALY weights for relatives: Empirical estimates in relatives caring for older people2008Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 9, nr 3, s. 285-292Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 22.
    Davidson, Thomas
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Krevers, Barbro
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik.
    Levin, Lars-Åke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi.
    Identification and Estimation of Relatives' QALY Weights for Use in Health Economic Evaluations2006Ingår i: ECHE, 6th European Conference in Health Economics,2006, 2006Konferensbidrag (Övrigt vetenskapligt)
  • 23.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Ake
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Is the societal approach wide enough to include relatives?: incorporating relatives' costs and effects in a cost-effectiveness analysis.2010Ingår i: Applied Health Economics and Health Policy, ISSN 1175-5652, E-ISSN 1179-1896, Vol. 8, nr 1, s. 25-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 24.
    Davidson, Thomas
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Levin, Lars-Åke
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Do individuals consider expected income when valueing health states?2007Ingår i: iHEA, the 6th world congress on health economics,2007, 2007Konferensbidrag (Refereegranskat)
    Abstract [en]

       

  • 25.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Do individuals consider expected income when valuing health states?2008Ingår i: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 24, nr 4, s. 488-494Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 26.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Kostnaden för förmaksflimmer i Östergötland2006Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Förmaksflimmer (FF) är den vanligaste förekomna arytmin i Sverige. Att ha FF innebär en ökad risk för att drabbas av stroke och den huvudsakliga behandlingen går därför ut på att motverka stroke genom antikoagulationsbehandling med warfarin. Det finns tidigare ingen beräkning på hur mycket FF kostar i Sverige och med anledning av att nya behandlingsmetoder och läkemedel kan förväntas komma inom en snar framtid finns ett behov av att veta hur mycket resurser som FF förbrukar idag. Syftet med den här rapporten var därför att beräkna kostnaden för FF i Östergötland. Detta gjordes genom att samtliga relevanta kostnadsposter identifierades och kvantifierades till lämpliga enheter. Därefter beräknades kostnaden i en modell, både för dagens situation men också genom en prognos för de närmaste åren. Fokus har varit på de komplikationer som FF ger ökad risk för, samt behandlingar för att minska denna risk. Behandlingen syftar oftast inte till att bota själva flimret utan till att motverka de risker för komplikationer som FF för med sig.

    Tre möjliga alternativ för patienter med FF inkluderades i beräkningen; behandling med warfarin, behandling med ASA eller ingen behandling. Endast patienter med måttlig eller hög risk för stroke inkluderades i beräkningen. Endast omkring 50 procent av alla patienterna får idag warfarin vilket betyder att underbehandling föreligger eftersom nästan alla patienter med FF är rekommenderade att behandlas med warfarin.Den totala kostnaden för FF i Östergötland har beräknats till 137 miljoner kronor år 2006 och prognostiserats till 155 miljoner kronor år 2008 och 177 miljoner kronor år 2010, vilket är en ökning med nästan 30 procent på fyra år. Om endast de direkta kostnaderna inkluderas är kostnaden 115 miljoner kronor år 2006. Kostnaden för stroke är den största enskilda kostnaden och står för 84 procent av den totala kostnaden när även de indirekta kostnaderna inkluderas.

    Eftersom prevalensen av FF stiger hos personer över 60 år och är mycket hög hos personer över 80 år förväntas antalet personer med FF öka i takt med att andelen äldre i samhället ökar. Denna ökning förväntas fortsätta under lång tid vilket leder till kraftigt ökade kostnader för samhället till följd av FF. Eftersom nya behandlingar för att både bota flimret samt att motverka stroke är under utveckling är det dock möjligt att detta på sikt kan hålla ner kostnaderna jämfört med beräkningen i denna rapport.

  • 27.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Närståendes konsekvenser: Hur kan de inkluderas i den hälsoekonomiska analysen?2008Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Denna rapport har skrivits vid Centrum för utvärdering av medicinsk teknologi (CMT) vid Linköpings Universitet. Ekonomiskt stöd har utgått från Landstinget i Östergötland med syftet att tjäna som metodstöd för den som använder och bedömer hälsoekonomiska utvärderingsstudier. Dessutom har ekonomiska medel tillhandahållits från Apoteket AB:s forskningsfond som en del i ett större projekt, vilket studerar vad som är med och inte med i en hälsoekonomisk utvärdering.

    I rapporten diskuteras hur närståendes konsekvenser skulle kunna inkluderas i en hälsoekonomisk analys. Stora delar av detta område är relativt outforskat och stöter på en mängd metodproblem. Detta har gjort att det många gånger inte går att ge tydliga rekommendationer i dagsläget. Rapporten visar dock att närståendes konsekvenser kan vara av stor vikt i en hälsoekonomisk analys, och ett viktigt första steg är att dessa konsekvenser uppmärksammas. Vidare forskning kommer krävas för att säkerställa att närståendes konsekvenser kan mätas, värderas och inkluderas i analysen på ett korrekt sätt.    Rapporten vänder sig i första hand till dem som har viss erfarenhet av hälsoekonomiska utvärderingar. Den är dock skriven så att även den oinvigde ska kunna ta del av den. I det senare fallet kan den dock behöva kompletteras med litteratur som redogör för hälsoekonomiska utvärderingar i helhet. Ett stort tack till alla dem som vid seminarier eller annat tillfälle har gett värdefulla kommentarer på projektet.

    Linköping, 2008-05-29

    Thomas Davidson, Lars-Åke Levin

  • 28.
    Davidson, Thomas
    et al.
    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.
    Using the costs of added life-years in a cost-effectiveness analysis2005Ingår i: HTAi, 2nd Annual HTAi Meeting - Bringing HTA into practice,2005, 2005Konferensbidrag (Övrigt vetenskapligt)
  • 29.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Bergström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    En pilotstudie av självtestning vid behandling med oral antikoagulantia: Hälsoekonomiska aspekter2013Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    För att undvika uppkomst av tromboembolier som t.ex. ischemisk stroke vid diagnoser som leder till ökad risk för att blodet koagulerar används antikoagulations (AK) läkemedel, vanligt förekommande är sk vitamin Kantagonister (AVK-läkemedel) där warfarin (Waran®) är vanligast. AVKläkemedel behöver återkommande testning för att säkerställa effektiv behandling. Denna testning sker normalt vid AK-mottagningar men kan också genomföras av patienterna själva genom självtestning.

    Den här pilotstudien studerar patienter som självtestar sin AVKläkemedelsbehandling i Östergötland med fokus på kostnader och kostnadseffektivitet.

    Studien har en före- efter design under 12 månader där patienterna är sina egna kontroller. Patientkohorten består av 20 patienter med AVK-läkemedelsbehandling. Det primära utfallsmåttet är tid inom terapeutiskt intervall före och efter självskattning. Patienterna fick vid 3 tillfällen fylla i instrumenten EQ-5D och SF-36 samt svara på frågor avseende hur mycket de hypotetiskt skulle vara beredda att betala (willingness-to-pay) för att använda självtestning.

    Medelåldern var 56 år och 67 procent var män. Andel av behandlingstiden inom terapeutiskt intervall var mellan 57 och 100 procent, med ett medel på 86 procent. Mindre blödning inträffade hos 3 patienter men ingen tromboembolisk episod påvisades. Studien är för liten för att säkerställa några kliniska skillnader. Totalt beräknas självtestning kosta 180 kronor per tillfälle, vilket var lägre än de 370 kronor som varje test hos AK-mottagningen innebar. Patienternas livskvalitet (mätt i QALY-vikter) visade en tendens till att stiga under de studerade 12 månaderna. Betalningsviljan sjönk från 11 526 kronor vid baseline till 6 490 kronor efter ett år. Eftersom kostnader har besparats och effekterna förväntas vara likvärdiga är självtestning en kostnadseffektiv åtgärd. Då det dessutom har visats att det finns en samhällelig betalningsvilja för utrustningen stärker detta resultatet att självtestning är kostnadseffektivt hos den studerade patientgruppen.

    Rapportens resultat tyder på att självtestning leder till lägre kostnader, samt en tendens till förbättrad livskvalitet för patienterna. Inga kliniska skillnader har påvisats. Detta gör att självtestning i rapporten har ansetts vara enkostnadseffektiv åtgärd. Detta är dock en liten pilotstudie och dess resultat behöver verifieras i större studier.

  • 30.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Lindelof, Ann
    Region Östergötland, Närsjukvården i östra Östergötland.
    Wallen, Torbjorn
    Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Vastervik Hospital, Sweden.
    Lindahl, Tomas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Hallert, Claes
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Medicinkliniken ViN. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Point-of-care monitoring of warfarin treatment in community dwelling elderly - A randomised controlled study2015Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 21, nr 5, s. 298-301Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 31.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Lyth, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Direct valuation of health state among patients with chest pain: Does income level matterManuskript (preprint) (Övrig (populärvetenskap, debatt, mm))
    Abstract [en]

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

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

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

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

  • 32.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Swedish Council Health Technology Assessment, Sweden.
    Rohlin, Madeleine
    Malmö University, Sweden.
    Hultin, Margareta
    Karolinska Institute, Sweden.
    Jemt, Torsten
    University of Gothenburg, Sweden; Branemark Clin, Sweden.
    Nilner, Krister
    Malmö University, Sweden.
    Sunnegardh-Gronberg, Karin
    Umeå University, Sweden.
    Tranaeus, Sofia
    Swedish Council Health Technology Assessment, Sweden; Malmö University, Sweden; Karolinska Institute, Sweden.
    Nilsson, Mats
    County Hospital Ryhov, Sweden.
    Reimbursement systems influence prosthodontic treatment of adult patients2015Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 73, nr 6, s. 414-420Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 33.
    Davidson, Thomas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University Sweden.
    Tranaeus, Sofia
    Health Technology Assessment-Odontology, Faculty of Odontology, Malmö University; Swedish Agency for Health Technology Assessment of Social Services (SBU); Karolinska Institutet, Dept of Dental Medicine, Hudding.
    Time to Assess Cost-Effectiveness of Technologies in Dentistry2016Ingår i: International Journal of Dentistry and Oral Health, ISSN 2378-7090, Vol. 2, nr 5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry.

    Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry.

    Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done.

    Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.

  • 34.
    Eckard, Nathalie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Walfridsson, Håkan
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Cost-Effectiveness of Catheter Ablation Treatment for Patients with Symptomatic Atrial Fibrillation2009Ingår i: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 1, nr 8, s. 461-470Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 35.
    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)2008Ingår i: SMDM Europe,2008, 2008Konferensbidrag (Övrigt vetenskapligt)
  • 36.
    Frisk, Fredrik
    et al.
    nstitute for Postgraduate Dental Education, Jönköping, Sweden.
    Kvist, Thomas
    University of Gothenburg, Sweden .
    Axelsson, Susanna
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Bergenholtz, Gunnar
    University of Gothenburg, Sweden .
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Mejare, Ingegerd
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Norlund, Anders
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Petersson, Arne
    Malmö University, Sweden .
    Sandberg, Hans
    Karolinska Institutet, Stockholm, Sweden.
    Tranaeus, Sofia
    SBU (Swedish Council on Health Technology Assessment), Stockholm, Sweden.
    Hakeberg, Magnus
    University of Gothenburg, Sweden .
    Pulp exposures in adults - choice of treatment among Swedish dentists2013Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 37, nr 3, s. 153-161Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 37.
    Hedin, Christina
    et al.
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Sjödahl, Rune
    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.
    Aldman, Åke
    Västerviks sjukhus, Västervik, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Kammerlind, Ann-Sofie
    Region Jönköpings län, Jönköping, Sweden.
    Nodbrant, Per
    Onkologiska kliniken, Länssjukhuset Ryhov, Jönköping, Sweden.
    Agrup, Måns
    Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten.
    Theodorsson, Elvar
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Intraoperativ strålbehandling vid primar operation for bröstcancer: TARGIT-A-studien ej konklusiv2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, artikel-id EWFFArtikel, forskningsöversikt (Refereegranskat)
    Abstract [sv]

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

  • 38.
    Heibert Arnlind, Marianne
    et al.
    Statens beredning för medicinsk utvärdering.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Hälsoekonomi i relation till kvalitets- och förbättringsarbete i vården2012Ingår i: Kvalitetsarbete för bättre och säkrare vård / [ed] Gun Nordström och Bodil Wilde-Larsson, Lund: Studentlitteratur, 2012, 1, s. 219-238Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 39.
    Heintz, Emelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Swedish Council on Health Technology Assessment (SBU), Stockholm.
    Arnberg, Karl
    The Dental and Pharmaceutical Benefits Agency (TLV) Stockholm.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Liliemark, Jan
    Swedish Council on Health Technology Assessment (SBU), Stockholm and The county councils' group on new drug therapies (NLT), The Swedish Association of Local Authorities and Regions (SALAR), Stockholm.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Swedish Council on Health Technology Assessment (SBU), Stockholm.
    The impact of health economic evaluations in Sweden.2014Ingår i: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, ISSN 2212-0289, Vol. 108, nr 7, s. 375-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 40.
    Heintz, Emelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Gerber-Grote, Andreas
    Institut für Qualität und Wirtschaftlichkeit Gesundheitswes, Germany.
    Ghabri, Salah
    Department of Economic and Public Health Evaluation, Haute Autorite Sante, France.
    Hamers, Francoise F.
    Department of Economic and Public Health Evaluation, Haute Autorite de Sante, France.
    Prevolnik Rupel, Valentina
    Institute for Economic Research, Slovenia.
    Slabe-Erker, Renata
    Institute for Econ Research, Slovenia.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Is There a European View on Health Economic Evaluations? Results from a Synopsis of Methodological Guidelines Used in the EUnetHTA Partner Countries2016Ingår i: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 34, nr 1, s. 59-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 41.
    Hultin, Margareta
    et al.
    Karolinska Institute, Sweden .
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Gynther, Goran
    Karolinska Institute, Sweden Visby Hospital, Sweden .
    Helgesson, Gert
    Karolinska Institute, Sweden .
    Jemt, Torsten
    University of Gothenburg, Sweden Public Dent Health Serv, Sweden .
    Lekholm, Ulf
    Public Dent Health Serv, Sweden .
    Nilner, Krister
    Malmö University, Sweden .
    Nordenram, Gunilla
    Karolinska Institute, Sweden .
    Norlund, Anders
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Rohlin, Madeleine
    Malmö University, Sweden .
    Sunnegardh-Gronberg, Karin
    Umeå University, Sweden .
    Tranaeus, Sofia
    Karolinska Institute, Sweden Swedish Council Health Technology Assessment, Sweden .
    Oral Rehabilitation of Tooth Loss: A Systematic Review of Quantitative Studies of OHRQoL2012Ingår i: International Journal of Prosthodontics, ISSN 0893-2174, E-ISSN 1139-9791, Vol. 25, nr 6, s. 543-552Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

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

  • 42.
    Husberg, Magnus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Non-medical costs during the first year after diagnosis in two cohorts of patients with early rheumatoid arthritis, enrolled 10 years apart2017Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 36, nr 3, s. 499-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to calculate non-medical costs during year 1 after diagnosis in two cohorts of patients with early rheumatoid arthritis enrolled 1996–1998 and 2006–2009. Clinical data were collected regularly in both cohorts. Besides information about healthcare utilization and days lost from work, patients reported non-medical costs for aids/devices, transportation, formal and informal care. Formal care was valued as full labour cost for official home help (€42.80/h) and informal care from relatives and friends as opportunity cost of leisure time, corresponding to 35% of labour cost (€15/h). In both cohorts, only 2% used formal care, while more than 50% used informal care. Prescription of aids/devices was more frequent in cohort 2 and more women than men needed aids/devices. Help with transportation was also more common in cohort 2. Women in both cohorts needed more informal care than men, especially with personal care and household issues. Adjusting for covariates in regression models, female sex remained associated with higher costs in both cohorts. Non-medical costs in cohort 2 were €1892, €1575 constituting informal care, corresponding to 83% of non-medical costs. Total non-medical costs constituted 25% of total direct costs and 11% of total direct and indirect costs. Informal care accounted for the largest part of non-medical costs and women had higher costs than men. Despite established social welfare system, it is obvious that family and friends, to a large extent, are involved in informal care of patients with early RA, and this may underestimate the total burden of the disease.

  • 43.
    Häggman-Henrikson, B.
    et al.
    Malmö University, Sweden; Umeå University, Sweden; Malmö University, Sweden.
    Alstergren, P.
    Malmö University, Sweden; SCON, Sweden; Skåne University Hospital, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Malmö University, Sweden.
    Hogestatt, E. D.
    Lund University, Sweden.
    Ostlund, P.
    Umeå University, Sweden; Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Tranaeus, S.
    Umeå University, Sweden; Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Vitols, S.
    Swedish Agency Health Technology Assessment and Assessment, Sweden; Karolinska Institute, Sweden.
    List, T.
    Malmö University, Sweden; SCON, Sweden; Skåne University Hospital, Sweden.
    Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis2017Ingår i: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 44, nr 10, s. 800-826Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients amp;gt;= 18 years with chronic (amp;gt;= 3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [ temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

  • 44.
    Iwarsson, Erik
    et al.
    Karolinska University Hospital, Sweden.
    Jacobsson, Bo
    Gothenburg University, Sweden; Institute Public Heatlh, Norway.
    Dagerhamn, Jessica
    Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Swedish Agency Health Technology Assessment and Assessment, Sweden.
    Bernabe, Eduardo
    Kings Coll and St Thomas Hospital, England.
    Heibert Arnlind, Marianne
    Karolinska Institute, Sweden.
    Analysis of cell-free fetal DNA in maternal blood for detection of trisomy 21, 18 and 13 in a general pregnant population and in a high risk population - a systematic review and meta-analysis2017Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 96, nr 1Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    IntroductionThe aim of this study was to review the performance of non-invasive prenatal testing (NIPT) for detection of trisomy 21, 18 and 13 (T21, T18 and T13) in a general pregnant population as well as to update the data on high-risk pregnancies. Material and methodsSystematic review and meta-analysis. PubMed, Embase and the Cochrane Library were searched. Methodological quality was rated using QUADAS and scientific evidence using GRADE. Summary measures of diagnostic accuracy were calculated using a bivariate random-effects model. ResultsIn a general pregnant population, there is moderate evidence that the pooled sensitivity is 0.993 (95% CI 0.955-0.999) and specificity was 0.999 (95% CI 0.998-0.999) for the analysis of T21. Pooled sensitivity and specificity for T13 and T18 was not calculated in this population due to the low number of studies. In a high-risk pregnant population, there is moderate evidence that the pooled sensitivities for T21 and T18 are 0.998 (95% CI 0.981-0.999) and 0.977 (95% CI 0.958-0.987) respectively, and low evidence that the pooled sensitivity for T13 is 0.975 (95% CI 0.819-0.997). The pooled specificity for all three trisomies is 0.999 (95% CI 0.998-0.999). ConclusionsThis is the first meta-analysis using GRADE that shows that NIPT performs well as a screen for trisomy 21 in a general pregnant population. Although the false positive rate is low compared with first trimester combined screening, women should still be advised to confirm a positive result by invasive testing if termination of pregnancy is under consideration.

  • 45.
    Kastenbom, Lisa
    et al.
    Umea Univ, Sweden.
    Falsen, Alexandra
    Umea Univ, Sweden.
    Larsson, Pernilla
    Region Östergötland, Folktandvården. Malmo Univ, Sweden;.
    Sunnegardh-Gronberg, Karin
    Umea Univ, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Costs and health-related quality of life in relation to caries2019Ingår i: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 19, nr 1, artikel-id 187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Dental caries remains a common and expensive disease for both society and affected individuals. Furthermore, caries often affect individuals health-related quality of life (HRQoL). Health economic evaluations are needed to understand how to efficiently distribute dental care resources. This study aims to evaluate treatment costs and QALY weights for caries active and inactive adult individuals, and to test whether the generic instrument EQ-5D-5 L can distinguish differences in this population. Methods A total of 1200 randomly selected individuals from dental clinics in Vasterbotten County, Sweden, were invited to participate. Of these, 79 caries active and 179 caries inactive patients agreed to participate (response rate of 21.7%). Inclusion criteria were participants between 20 and 65 years old and same caries risk group categorization in two consecutive check-ups between 2014 and 2017. Results Treatment costs showed to be twice as high in the caries active group compared to the caries inactive group and were three times higher in the caries active age group 20-29 compared to the caries inactive age group 20-29. Differences between the groups was found for number of intact teeth according to age groups. In the EQ-5D-5 L instrument, more problems relating to the dimension anxiety/depression was seen in the caries active group. QALY weights showed tendencies (non-significant) to be lower in the caries active group. Conclusions These findings highlight the need for efficient treatments and prevention strategies as well as adequate money allocation within dentistry. However, further research is needed to assess appropriate instruments for health economic evaluations.

  • 46.
    Levin, Lars-Åke
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Sobocinski, Piotr Doliwa
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Kull, Viveka Frykman
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Leif
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.2015Ingår i: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, nr 2, s. 207-14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.

    METHODS AND RESULTS: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.

    CONCLUSION: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.

  • 47.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Hälsoekonomisk analys av hemtandvård jämfört med tandvård på stationära kliniker för äldre vid särskilda boenden2013Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Förbättrade livsbetingelser, såsom social välfärd och folkhälsa, har medfört en ökad medellivslängd i Sverige. Äldre har med tiden kommit att utgöra en allt större andel av befolkningen. Stora satsningar på tandhälsovård har medfört att fler äldre har de flesta egna tänder i behåll i hög ålder. Tidigare utförda rehabiliterande tandvårdsåtgärder, som till exempel kronor, broar och implantat, kan komplicera munvården och därigenom påverka allmänhälsan, om förmågan till egenvård sviktar. Åldrandet innebär för många ökad sjuklighet och behov av ett flertal läkemedel. Såväl hälso- och sjukvårdskostnaderna, som  tandvårdskostnaderna förväntas öka kraftigt de närmaste 15-25 åren.

    Nuvarande ersättningssystem för tandvården medför att kostnadsökningen för de allra äldsta främst belastar landstingen. Landstingen ska enligt tandvårdslagen se till att uppsökande verksamhet och nödvändig tandvård erbjuds vissa äldre och funktionshindrade med omfattande omvårdnadsbehov. Dessa grupper ska erbjudas avgiftsfri munhälsobedömning och nödvändig tandvård enligt samma avgiftssystem som inom den öppna hälso- och sjukvården. Munhälsobedömning upphandlas av landstingets tandvårdsenhet. Nödvändig tandvård erbjuds utifrån behov och vårdtagaren har själv rätt att välja vårdgivare.

    Syftet med studien var att analysera och diskutera samhällsekonomiska konsekvenser av hemtandvård jämfört med tandvård på stationär klinik, vid nödvändig tandvård för äldre personer på särskilda boenden.

    Intervjuer har genomförts med personal på särskilda boenden, beställare av nödvändig tandvård samt sakkunniga forskare. För att belysa de ekonomiska aspekterna av de olika vårdformerna har kostnadsanalyser och kostnadseffektivitetsanalyser genomförts. Dessutom har ett flertal viktiga aspekter identifierats för att kartlägga marknaden för nödvändig tandvård utifrån ett bredare perspektiv. Marknaden för nödvändig tandvård har också analyserats med hänsyn till den asymmetriska information som råder mellan de olika aktörerna och respektive aktörs incitament att nyttomaximera.

    Analyserna visar att kostnaden för hemtandvård i medeltal är lägre än för tandvård vid stationär klinik vid utförande av nödvändig tandvård. Hemtandvård förväntas i genomsnitt vara positivt för de äldres livskvalitet, och är därmed kostnadseffektivt för den genomsnittlige patienten. Eftersom de äldres förutsättningar för tandvård varierar är det viktigt att olika vårdformer kan erbjudas. Kostnaden skiljer sig åt för de olika aktörerna, och det krävs ett samhällsekonomiskt perspektiv för att undvika suboptimering av resurser. Det krävs en bred och öppen samverkan mellan alla involverade aktörer för att få till en effektiv och ekonomiskt försvarbar tandvård av god kvalitet.

  • 48.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ordell, Sven
    Region Östergötland, Folktandvården.
    Sjöstrom, O.
    Oral Care AB, Sweden.
    Zimmerman, M.
    Oral Care AB, Sweden.
    Sjogren, P.
    Oral Care AB, Sweden.
    Health economic analyses of domiciliary dental care and care at fixed clinics for elderly nursing home residents in Sweden2015Ingår i: Community Dental Health, ISSN 0265-539X, Vol. 32, nr 1, s. 39-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 49.
    Mejare, I A
    et al.
    Malmö University, Sweden Swedish Council Health Technology Assessment, Sweden .
    Axelsson, S
    Swedish Council Health Technology Assessment, Sweden .
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Frisk, F
    Institute Postgrad Dent Educ, Sweden University of Gothenburg, Sweden .
    Hakeberg, M
    University of Gothenburg, Sweden .
    Kvist, T
    University of Gothenburg, Sweden .
    Norlund, A
    Swedish Council Health Technology Assessment, Sweden .
    Petersson, A
    Malmö University, Sweden .
    Portenier, I
    University of Geneva, Switzerland .
    Sandberg, H
    Karolinska Institute, Sweden .
    Tranaeus, S
    Swedish Council Health Technology Assessment, Sweden .
    Bergenholtz, G
    University of Gothenburg, Sweden .
    Diagnosis of the condition of the dental pulp: a systematic review2012Ingår i: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 45, nr 7, s. 597-613Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

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

  • 50.
    Nordenram, Gunilla
    et al.
    Karolinska Institutet, Department of Dental Medicine, Sweden.
    Davidson, Thomas
    The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Gynther, Göran
    Karolinska Institutet, Department of Dental Medicine, Sweden; Oral and Maxillofacial Centre, Visby Hospital, Sweden.
    Helgesson, Gert
    Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Sweden.
    Hultin, Margareta
    Karolinska Institutet, Department of Dental Medicine, Sweden.
    Jemt, Torsten
    Department of Prosthetic Dentistry/Dental Material Science, The Sahlgrenska Academy, Göteborg University, Sweden; Brånemark Clinic, Public Dental health Care Service, Region of Västra Götaland, Sweden.
    Lekholm, Ulf
    Clinic of Odontology, Public Dental health Service, West Region of Sweden, Sweden; Sahlgrenska Academy at University of Göteborg, Sweden.
    Nilner, Krister
    Faculty of Odontology, Malmö University, Sweden.
    Norlund, Anders
    The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Rohlin, Madeleine
    Faculty of Odontology, Malmö University, Sweden.
    Sunnegårdh-Grönberg, Karin
    Department of Odontology, Umeå University, Sweden.
    Tranæus, Sofia
    Karolinska Institutet, Department of Dental Medicine, Sweden; The Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: a systematic review with meta-synthesis.2013Ingår i: Acta odontologica Scandinavica, ISSN 1502-3850, Vol. 71, nr 3-4, s. 937-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

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