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  • 1.
    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.

  • 2.
    Duvetorp, Albert
    et al.
    Skane Univ Hosp, Sweden.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Engerstedt Mattsson, Emma
    LEO Pharma AS, Denmark.
    Ryttig, Lasse
    LEO Pharma AS, Denmark.
    A Cost-utility Analysis of Calcipotriol/Betamethasone Dipropionate Aerosol Foam versus Ointment for the Topical Treatment of Psoriasis Vulgaris in Sweden2019Ingår i: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 99, nr 4, s. 393-399Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Psoriasis is a chronic inflammatory disorder that imposes a substantial economic burden. We conducted a cost-utility analysis from a Swedish healthcare payers perspective using a decision-tree model with a 12-week time horizon. Patients with psoriasis vulgaris could have two 4-week cycles of topical treatment with calcipotriol 50 mu g/g and betamethasone 0.5 mg/g as dipropionate (Cal/BD) foam or Cal/BD ointment before progressing to phototherapy/methotrexate. In the base-case analysis, Cal/BD foam dominated over Cal/BD ointment. The increased efficacy of Cal/BD foam resulted in fewer consultations and a decreased risk of progressing to phototherapy/methotrexate. Although Cal/BD foam costs more than Cal/BD ointment, this was offset by lower costs for phototherapy/methotrexate or consultation visits. Sensitivity analyses revealed that the base-case net monetary benefit was robust to plausible variations in key parameters. In conclusion, Cal/BD foam was predicted to be more cost-effective than Cal/BD ointment in the treatment of psoriasis vulgaris.

  • 3.
    Milberg, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH Öst.
    Liljeroos, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden; Malarsjukhuset Hosp, Sweden.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Can a single question about family members sense of security during palliative care predict their well-being during bereavement? A longitudinal study during ongoing care and one year after the patients death2019Ingår i: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 18, artikel-id 63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundIt has been recognised that more evidence about important aspects of family members sense of security during palliative care is needed. The objectives of the study was: i) to discover what variables are associated with family members feeling secure during palliative care; ii) to develop a model of family members sense of security during palliative care, and iii) to evaluate if family members sense of security during ongoing palliative care predicts well-being during bereavement.MethodsBetween September 2009 and October 2010, 227 family members (of patients admitted to six Swedish palliative home care units) participated in the study (participation rate 75%) during ongoing care and 158 participated also 1 year after the patients death (70%). They answered a single question regarding the family members sense of security during the palliative care period. The question was constructed and validated by the researchers. Data were also collected using other questions and validated instruments and analysed stepwise with Generalized Linear Models (ordinal multinomial distribution and logit link).ResultsSixteen variables were positively related to family members sense of security during ongoing palliative care. The five variables with the highest importance were selected into the model (listed in decreasing importance): Family members mastery; nervousness and stress; self-efficacy; patient having gynaecological cancer; family members perceived quality of life. Moreover, the family members sense of security during ongoing palliative care predicted ten variables indicating their well-being 1 year after the patients death, e.g. psychological well-being, complicated grief symptoms, health related quality of life.ConclusionsThe findings reveal possibilities to identify family members at risk of negative adjustment to bereavement in clinical practice and may help to develop interventions to support family members during ongoing palliative care.

  • 4.
    Lyth, Johan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Lind, Leili
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Persson, Hans L.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Can a telemonitoring system lead to decreased hospitalization in elderly patients?2019Ingår i: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, artikel-id UNSP 1357633X19858178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Growing populations of elderly patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) require more healthcare. A four-year telehealth intervention - the Health Diary system based on digital pen technology - was implemented. We hypothesized that study patients with advanced COPD or HF would have lower rates of hospitalization when using the Health Diary. The aim was to investigate the effects of the intervention on healthcare costs and the number of hospitalizations, as well as other care required in COPD and HF patients. Methods Patients were introduced to the telemonitoring system which was supervised by a specialized hospital-based home care (HBHC) unit. Staff associated with this unit were responsible for the healthcare provided. The study included patients with COPD or HF, aged amp;gt;= 65 years who were frequently hospitalized due to exacerbations - at least two inpatient episodes within the last 12 months. Observed number of hospitalizations and total healthcare costs were compared with the expected values, which were calculated using the generalized estimating equations (GEE) method. Results A total of 36 COPD and 58 HF patients with advanced stages of disease were included. The number of hospitalizations was significantly reduced for both HF and COPD patients participating in telemonitoring. Accordingly, hospitalization costs were significantly reduced for both groups, but the total healthcare cost was not significantly different from the expected costs. Conclusion A telemonitoring system, the Health Diary, combined with a specialized HBHC unit significantly decreases the need for hospital care in elderly patients with advanced HF or COPD without increasing total healthcare costs.

  • 5.
    Lindholm, Daniel
    et al.
    AstraZeneca RandD, Sweden.
    Sarno, Giovanna
    Uppsala Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Svennblad, Bodil
    Uppsala Univ, Sweden.
    Hasvold, Lars Pal
    AstraZeneca, Sweden.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    James, Stefan K.
    Uppsala Univ, Sweden.
    Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction2019Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, nr 15, s. 1175-1181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries. Methods Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006-2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age amp;gt;= 65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI. Results We studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had amp;gt;= 2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor. Conclusions The majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures.

  • 6.
    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.

  • 7.
    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

  • 8.
    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.

  • 9.
    Lundberg, Kristina
    et al.
    Jonkoping Univ, Sweden; Univ Boras, Sweden.
    Kjellstrom, Sofia
    Jonkoping Univ, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Univ Boras, Sweden.
    Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones2019Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 26, nr 2, s. 480-495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively. Aim: This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones. Design: Abductive qualitative design. Participants and research context: Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali. Ethical considerations: The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014). Findings: Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties. Discussion/conclusion: These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

  • 10.
    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).

  • 11.
    Persson, Lennart
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Lyth, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Lind, Leili
    Linköpings universitet, Institutionen för medicinsk teknik, Avdelningen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Elderly patients with COPD require more health care than elderly heart failure patients do in a hospital-based home care setting2019Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, s. 1569-1581Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Elderly patients with advanced stages of COPD or chronic heart failure (CHF) often require hospitalization due to exacerbations. We hypothesized that telemonitoring supported by hospital-based home care (HBHC) would detect exacerbations early, thus, reducing the number of hospitalization. We also speculated that patients with advanced COPD or CHF would present differences regarding exacerbation frequency and the need of HBHC. Methods: The Health Diary system, based on digital pen technology, was employed. Patients aged amp;gt;= 65 years with amp;gt;= 2 hospitalizations the previous year were included. Exacerbations were categorized and treated as either COPD or CHF exacerbation by an experienced physician. All HBHC contacts (home visits or telephone consultations) were registered. Results: Ninety-four patients with advanced diseases were enrolled (36 COPD and 58 CHF subjects) of which 53 subjects (19 COPD and 34 CHF subjects) completed the 1-year study period. Death was the major reason for not finalizing the study. Compared to the 1-year prior inclusion, the intervention significantly reduced hospitalization. Although COPD subjects were younger with less comorbidity, exacerbations and HBHC contacts were significantly greater in this group. Conclusions: COPD subjects exhibit exacerbations more frequently, mainly due to disease characteristics, thus, demanding much more HBHC.

  • 12.
    Siverskog, Jonathan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Estimating the marginal cost of a life year in Sweden's public healthcare sector2019Ingår i: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 20, nr 5, s. 751-762Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although cost-effectiveness analysis has a long tradition of supporting healthcare decision-making in Sweden, there are no clear criteria for when an intervention is considered too expensive. In particular, the opportunity cost of healthcare resource use in terms of health forgone has not been investigated empirically. In this work, we therefore seek to estimate the marginal cost of a life year in Sweden's public healthcare sector using time series and panel data at the national and regional levels, respectively. We find that estimation using time series is unfeasible due to reversed causality. However, through panel instrumental variable estimation we are able to derive a marginal cost per life year of about SEK 370,000 (EUR 39,000). Although this estimate is in line with emerging evidence from other healthcare systems, it is associated with uncertainty, primarily due to the inherent difficulties of causal inference using aggregate observational data. The implications of these difficulties and related methodological issues are discussed.

  • 13.
    Klompstra, Leonie
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Ekdahl, Anne W.
    Lund Univ, Sweden.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Milberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH Öst.
    Eckerblad, Jeanette
    Karolinska Inst, Sweden.
    Factors related to health-related quality of life in older people with multimorbidity and high health care consumption over a two-year period2019Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, artikel-id 187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe prevalence of multimorbidity is increasing worldwide, and older people with multimorbidity are frequent users of health care services. Since multimorbidity has a significant negative impact on Health-related Quality of Life (HrQoL) and is more common in older age it would be expected that factors related to HrQoL in this group might have been thoroughly researched, but this is not the case. Furthermore, it is important to look at old people living at home, considering the shift from residential to home-based care. Therefore, we aim to investigate factors that are related to HrQoL in older people with multimorbidity and high health care consumption, living at home.MethodsThis is a secondary analysis of a RCT study conducted in a municipality in south-eastern Sweden. The study had a longitudinal design with a two-year follow-up period assessing HrQoL, symptom burden, activities of daily living, physical activity and depression.ResultsIn total, 238 older people with multimorbidity and high health care consumption, living at home were included (mean age 82, 52% female). A multiple linear regression model including symptom burden, activities of daily living and depression as independent variables explained 64% of the HrQoL. Higher symptom burden, lower ability in activities of daily living and a higher degree of depression were negatively related to HrQoL. Depression at baseline and a change in symptom burden over a two-year period explained 28% of the change in HrQoL over a two-year period variability. A higher degree of depression at baseline and negative change in higher symptom burden were related to a decrease in HrQoL over a two-year period.ConclusionIn order to facilitate better delivery of appropriate health care to older people with high health care consumption living at home it is important to assess HrQoL, and HrQoL over time. Symptom burden, activities of daily living, depression and change in symptom burden over time are important indicators for HrQoL.Trial registrationClinicaltrials.gov identifier: NCT01446757, the trial was registered prospectively with the date of trial registration October 5(th), 2011.

  • 14.
    Jernberg, Tomas
    et al.
    Karolinska Inst, Sweden.
    Lindholm, Daniel
    Uppsala Clin Res Ctr, Sweden.
    Hasvold, Lars Pal
    AstraZeneca Nord, Norway.
    Svennblad, Bodil
    Uppsala Clin Res Ctr, Sweden.
    Bodegard, Johan
    AstraZeneca Nord, Norway.
    Andersson, Karolina Sundell
    AstraZeneca RandD, Sweden.
    Thuresson, Marcus
    Statisticon, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 4, artikel-id e027199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD). Design Cohort study linking morbidity, mortality and medication data from Swedish national registries. Participants First-time users of GLD during 2007-2016. Outcomes Predicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled. Results 260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD-prior MI and 22 550 (9%) had IHD+ MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (+/- prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (amp;lt; 60 years) patients had a relative greater risk compared with older patients. Conclusions T2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.

  • 15.
    Sandstedt, Mårten
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    De Geer, Jakob
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Henriksson, Lilian
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Janzon, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Persson, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Alfredsson, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Long-term prognostic value of coronary computed tomography angiography in chest pain patients.2019Ingår i: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 60, nr 1, s. 45-53Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Coronary computed tomography angiography (CCTA) is increasingly used to detect coronary artery disease (CAD), but long-term follow-up studies are still scarce. Purpose To evaluate the prognostic value of CCTA in patients with suspected CAD. Material and Methods A total of 1205 consecutive CCTA patients with chest pain were classified as normal coronary arteries, non-obstructive CAD, or obstructive CAD. The primary outcome was major adverse cardiac event (MACE), defined as a composite outcome including cardiac death, myocardial infarction, unstable angina pectoris, or late revascularization (after >90 days). Results Over 7.5 years follow-up (median = 3.1 years), Kaplan-Meier estimates demonstrated a MACE in 1.0%, 4.6%, and 20.7% in normal coronary arteries, non-obstructive CAD, and obstructive CAD, respectively. Log rank test for pairwise comparisons showed significant differences between non-obstructive CAD and normal coronary arteries ( P = 0.023) and between obstructive CAD and normal coronary arteries ( P < 0.001). In a multivariable analysis, adjusting for classical risk factors, non-obstructive CAD and obstructive CAD were independent predictors of MACE, with hazard ratios (HR) of 3.22 ( P = 0.041) and 25.18 ( P < 0.001), respectively. Conclusion Patients with normal coronary arteries have excellent long-term prognosis, but the risk for MACE increases with non-obstructive and obstructive CAD. Both non-obstructive and obstructive CAD are independently associated with future ischemic events.

  • 16.
    Jonasson, Lise-Lotte
    et al.
    Univ Boras, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Univ Boras, Sweden.
    Bremer, Anders
    Univ Boras, Sweden; Linnaeus Univ, Sweden.
    Managers experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training2019Ingår i: Journal of Healthcare Leadership, ISSN 1179-3201, E-ISSN 1179-3201, Vol. 11, s. 63-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives demands and nursing staffs work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care. Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data. Results: The results show that managers perceive the central ethical conflicts relate to the older persons autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives perspective of their loved ones needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons. Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented.

  • 17.
    Jaarsma, Pier
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Gelhaus, Petra
    Region Östergötland. Institute for Ethics, History and Philosophy of Medicine, University of Muenster, Muenster, Germany.
    Medium-Range Narratives as a Complementary Tool to Principle-Based Prioritization in Sweden: Test Case "ADHD"2019Ingår i: Journal of Bioethical Inquiry, ISSN 1176-7529, E-ISSN 1872-4353, Vol. 16, nr 1, s. 113-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this paper, for the benefit of reflection processes in clinical and in local, regional, and national priority-setting, we aim to develop an ethical theoretical framework that includes both ethical principles and medium-range narratives. We present our suggestion in the particular case of having to choose between treatment interventions for attention deficit hyperactivity disorder (ADHD) and treatment interventions for other conditions or diseases, under circumstances of scarcity. In order to arrive at our model, we compare two distinct ethical approaches: a generalist (principles) approach and a particularist (narratives) approach. Our focus is on Sweden, because in Sweden prioritization in healthcare is uniquely governmentally regulated by the “ethics platform.” We will present a (fictional) scenario to analyse the strengths and weaknesses of the generalist principled perspective of the ethics platform and the particularist perspective of narrative ethics. We will suggest an alternative (moderately particularist) approach to prioritization, which we dub a “principles plus medium-range narratives” approach. Notwithstanding the undeniably central role of principles in distributive justice, we claim that medium-range narratives concerning individuals or groups who stand to benefit or lose from ADHD prioritization practices should also be read or listened to and taken into account at all levels of priority-setting. These narratives are expected to ethically optimize clinical priority-setting, as well as that undertaken at local, regional, and national levels.

  • 18.
    Turesson, Christina
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Hand- och plastikkirurgiska kliniken US.
    Kvist, Joanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Patients' needs during a surgical intervention process for Dupuytren's disease.2019Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, nr 6, s. 666-673Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease.

    MATERIALS AND METHODS: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework.

    RESULTS: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently.

    CONCLUSIONS: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process.

  • 19.
    Gustavsson, Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Patients with multiple needs for healthcare and priority to the worse off2019Ingår i: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, nr 2, s. 261-266Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a growing body of literature which suggests that decisions about healthcare priority setting should take into account the extent to which patients are worse off. However, such decisions are often based on how badly off patients are with respect to the condition targeted by the treatment whose priority is under consideration (condition-specific severity). In this paper I argue that giving priority to the worse off in terms of condition-specific severity does not reflect the morally relevant sense of being worse off. I conclude that an account of giving priority to the worse off relevant for healthcare priority setting should take into account how badly off patients are when all of their conditions are considered (holistic severity).

  • 20.
    El-Alti, Leila
    et al.
    Univ Gothenburg, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Munthe, Christian
    Univ Gothenburg, Sweden.
    Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?2019Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 27, nr 1, s. 45-59Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In contrast to standardized guidelines, personalized medicine and person centered care are two notions that have recently developed and are aspiring for more individualized health care for each single patient. While having a similar drive toward individualized care, their sources are markedly different. While personalized medicine stems from a biomedical framework, person centered care originates from a caring perspective, and a wish for a more holistic view of patients. It is unclear to what extent these two concepts can be combined or if they conflict at fundamental or pragmatic levels. This paper reviews existing literature in both medicine and related philosophy to analyze closer the meaning of the two notions, and to explore the extent to which they overlap or oppose each other, in theory or in practice, in particular regarding ethical assumptions and their respective practical implications.

  • 21.
    Åhlund, Kristina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Department of Physiotherapy, NU Hospital Group, Trollhättan, Sweden.
    Ekerstad, Niklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
    Bäck, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlson, Bjorn W.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden2019Ingår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, s. 577-586Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.

    Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.

    Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p<0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).

    Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

  • 22.
    Gustavsson, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kultur och estetik. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Juth, Niklas
    LIME, Stockholm Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden..
    Principles of Need and the Aggregation Thesis2019Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 27, nr 2, s. 77-92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications.

  • 23.
    Marcusson, Jan
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Nord, Magnus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Johansson, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Dannapfel, Petra
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Thomas, Kristin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Poksinska, Bozena
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Sverker, Annette
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Olaison, Anna
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Socialt arbete. Linköpings universitet, Filosofiska fakulteten.
    Cedersund, Elisabet
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Kelfve, Susanne
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Motel-Klingebiel, Andreas
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen Åldrande och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Hellstrom, Ingrid
    Norrkoping Univ, Sweden.
    Kullberg, Agneta
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Socialt arbete. Linköpings universitet, Filosofiska fakulteten.
    Böttiger, Ylva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Dong, Huan-Ji
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Wass, Malin
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Pedagogik och didaktik. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Lyth, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e027847Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

    Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

    Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

  • 24.
    Sandberg, Johanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Persson, Bo
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Statsvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Garpenby, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    The dilemma of knowledge use in political decision-making: National Guidelines in a Swedish priority-setting context2019Ingår i: Health Economics, Policy and Law, ISSN 1744-1331, E-ISSN 1744-134X, Vol. 14, nr 4, s. 425-442Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a growing recognition of the importance of evidence to support allocative policy decisions in health care. This study is based on interviews with politicians in four regional health authorities in Sweden. Drawing on theories of strategic use of knowledge, the article analyses how politicians perceive and make use of expert knowledge represented by the National Guidelines, embracing both a scientific and a political rationale. As health care is an organisation with a dual basis for legitimacy – at the same time a political and an action organisation – it affects knowledge use. We investigate how the context of health care priority setting influences the conditions for knowledge use among regional politicians. Our findings illustrate the dilemma of political decision-makers and how they prefer to use expert knowledge. The politicians use this policy instrument in a legitimising fashion, as it will fit into the current political debate on more equal care. As an instrument for resource allocation the politicians noted that ‘facts’ per se could not provide them with a sufficient basis for legitimising their governing of health care. The dualistic organisational context makes knowledge important as a political weapon in negotiations with the medical profession.

  • 25.
    Lindh Åstrand, Lotta
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Hoffmann, Mikael
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Hammar, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Spetz Holm, Anna-Clara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Use of hormone therapy (HT) among Swedish women with contraindications - A pharmacoepidemiological cohort study2019Ingår i: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 123, s. 55-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess how women in Sweden with breast cancer (BC), endometrial cancer (EC), and/or pulmonary embolism (PE) were dispensed menopausal hormone therapy (HT). Study design: A retrospective study of Swedish women aged 40 years or more on 31 December 2005 (n = 2,863,643), followed through to December 2011. The study analysed three mandatory national healthcare registries: the Swedish Prescribed Drug Register, the National Inpatient Register and the Cancer Register. New users were defined as having a first dispensation after at least a 9-month break, and thus were possible to identify from April 2006. New users with at least one of the diagnoses BC, EC or PE before the first dispensation were classified as having a relative or absolute contraindication for HT. Main outcome measures: The relative risks of having HT dispensed after being diagnosed with BC, EC and/or PE. Results: In total, 171,714 women had at least one of the diagnoses BC, EC or PE. The relative risk of having hormone therapy dispensed (current and new users) after being diagnosed with any of the diagnoses was significantly lower (PE, IRR 0.11, 95% CI 0.10-0.12;/ BC, IRR 0.12, 95% CI 0.11-0.13; EC, IRR 0.43, CI 0.40-0.46) than for women without these diagnoses. Conclusions: One in about 250 women started treatment with HT after being diagnosed with BC, PE or EC. Swedish prescribers seem to be well aware of the recommendations for HT use in women with contraindications. A few women, however, are prescribed HT despite having BC, EC or PE, possibly after careful evaluation of the risks and benefits and giving informed consent. Women with a history of PE were prescribed transdermal HT to a larger extent than women in general, in line with results from observational studies.

  • 26.
    Sandman, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Hofmann, Bjorn
    Norwegian Univ Sci and Technol NTNU Gjovik, Norway; Univ Oslo, Norway.
    Why We Dont Need "Unmet Needs"! On the Concepts of Unmet Need and Severity in Health-Care Priority Setting2019Ingår i: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 27, nr 1, s. 26-44Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified and analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity (and where other features also equals each other).

  • 27.
    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.

  • 28.
    Sandman, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Liliemark, Jan
    Linköpings universitet.
    Withholding and withdrawing treatment for cost-effectiveness reasons: Are they ethically on par?2019Ingår i: Bioethics, ISSN 0269-9702, E-ISSN 1467-8519, Vol. 33, nr 2, s. 278-286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost-effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost-effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision.

  • 29.
    Ågren, Axel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Äldres ensamhet i media: mellan "epidemi" och individuell upplevelse2019Ingår i: Mind, ISSN 2002-4282, nr 2, s. 4s. 36-39Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Ensamhet är idag en fråga som berör och får stor uppmärksamhet i massmedia. I ny forskning riktas blicken mot hur äldres ensamhet beskrivs i svensk dagspress idag, vilken bland annat visat att ensamhet främst kopplas till äldre samt att fokus ligger vid äldreomsorg och inte ensamhet i sig.

  • 30.
    Flume, Mathias
    et al.
    Kassenärztliche Vereinigung Westfalen-Lippe (KVWL), Dortmund, Germany.
    Bardou, Marc
    CIC INSERM 1432, CHU CHU Dijon-Bourgogne, Dijon Cedex, France.
    Capri, Stefano
    School of Economics and Management, Cattaneo-LIUC University, Castellanza (Varese), Italy.
    Sola-Morales, Oriol
    Health innovation technology Transfer, Barcelona, Spain.
    Cunningham, David
    Cunningham Healthcare Advisory, Croydon, Surrey, UK.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Postma, Maarten J.
    Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
    Touchot, Nicolas
    groupH, London, UK.
    Approaches to manage affordability of high budget impact medicines in key EU countries2018Ingår i: Journal of market access and health policy, ISSN 2001-6689, Vol. 6, nr 1, artikel-id 1478539.Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The launch of hepatitis C (HCV) drugs such as sofosbuvir or ledipasvir has fostered the question of affordability of novel high budget impact therapies even in countries with high domestic product. European countries have developed a variety of mechanisms to improve affordability of such therapies, including affordability thresholds, price volume agreements or caps on individual product sales, and special budgets for innovative drugs. While some of these mechanisms may help limit budget impact, there are still significant progresses to be made in the definition and implementation of approaches to ensure affordability, especially in health systems where the growth potential in drug spending and/or in the patient contribution to health insurance are limited. Objectives: In this article, we will review how seven countries in western Europe are approaching the question of affordability of novel therapies and are developing approaches to continue to reward new sciences while limiting budget impact. We will also discuss the question of affordability of cost-effective but hugely expensive therapies and the implications for payers and for the pharmaceutical industry. Results: There is clearly not one solution that is used consistently across countries but rather a number of tools that are combined differently in each country. This illustrates the difficulty of managing affordability within different legal frameworks and within different health care system architectures.

  • 31.
    Ekerstad, Niklas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. NU NAL Uddevalla Hosp Grp, Sweden.
    Östberg, Göran
    NU Hosp Grp, Sweden.
    Johansson, Maria
    NU Hosp Grp, Sweden.
    Karlson, Björn W.
    NU Hosp Grp, Sweden; Univ Gothenburg, Sweden.
    Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care?2018Ingår i: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 12, s. 233-240Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Our aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction. Design: TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards. Setting: This study was conducted in the NAL-Uddevalla county hospital in western Sweden. Participants: In this follow-up to the TREEE study, 229 frail patients, aged amp;gt;= 75 years, in need of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean age was 85 years and 65% were female. Intervention: Direct admittance to an acute elderly care unit with structured, systematic interdisciplinary CGA-based care, compared to conventional acute medical care via the emergency room. Measurements: The primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale. Results: The response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: "Did you get the nursing from the ward staff that you needed?" (p=0.003), "Are you satisfied with the information you received on your diseases and medication?" (p=0.016), and "Are you satisfied with the planning before discharge from the hospital?" (p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question (p=0.027). Conclusion: Acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room.

  • 32.
    Dragioti, Elena
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Larsson, Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Association of insomnia severity with well-being, quality of life and health care costs: A cross-sectional study in older adults with chronic pain (PainS65+)2018Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, nr 2, s. 414-425Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundInsomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well-being, quality of life and health care costs. MethodsThe sample included 2790 older individuals (median age=76; interquartile range [IQR]=70-82) with chronic pain. The participants completed a postal survey assessing basic demographic data, pain intensity and frequency, height, weight, comorbidities, general well-being, quality of life and the insomnia severity index (ISI). Data on health care costs were calculated as costs per year (Euro prices) and measured in terms of outpatient and inpatient care, pain drugs, total drugs and total health care costs. ResultsThe overall fraction of clinical insomnia was 24.6% (moderate clinical insomnia: 21.9% [95% CI: 18.8-23.3]; severe clinical insomnia: 2.7% [95% CI: 1.6-3.2]). Persons who reported clinical insomnia were more likely to experience pain more frequently with higher pain intensity compared to those reported no clinically significant insomnia. Mean total health care costs were Euro 8469 (95% CI: Euro4029-Euro14,271) for persons with severe insomnia compared with Euro 4345 (95% CI: Euro4033-Euro4694) for persons with no clinically significant insomnia. An association between severe insomnia, well-being, quality of life, outpatient care, total drugs costs and total health care costs remained after controlling for age, sex, pain intensity, frequency, body mass index and comorbidities using linear regression models. ConclusionsOur results determine an independent association of insomnia with low health-related quality of life and increased health care costs in older adults with chronic pain. SignificanceThe concurrence and the severity of insomnia among older adults with chronic pain were associated with decreased well-being and quality of life, and increased health care costs to society.

  • 33.
    Wallerstedt, Susanna M.
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Balancing early access with uncertainties in evidence for drugs authorized by prospective case series - systematic review of reimbursement decisions2018Ingår i: British Journal of Clinical Pharmacology, ISSN 0306-5251, E-ISSN 1365-2125, Vol. 84, nr 6, s. 1146-1155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimsTo review clinical and cost-effectiveness evidence underlying reimbursement decisions relating to drugs whose authorization mainly is based on evidence from prospective case series. MethodsA systematic review of all new drugs evaluated in 2011-2016 within a health care profession-driven resource prioritization process, with a market approval based on prospective case series, and a reimbursement decision by the Swedish Dental and Pharmaceutical Benefits Agency (TLV). Public assessment reports from the European Medicines Agency, published pivotal studies, and TLV, Scottish Medicines Consortium and National Institute of Health and Care Excellence decisions and guidance documents were reviewed. ResultsSix drug cases were assessed (brentuximab vedotin, bosutinib, ponatinib, idelalisib, vismodegib, ceritinib). The validity of the pivotal studies was hampered by the use of surrogate primary outcomes and the absence of recruitment information. To quantify drug treatment effect sizes, the reimbursement agencies primarily used data from another source in indirect comparisons. TLV granted reimbursement in five cases, compared with five in five cases for Scottish Medicines Consortium and four in five cases for National Institute of Health and Care Excellence. Decision modifiers, contributing to granted reimbursement despite hugely uncertain cost-effectiveness ratios, were, for example, small population size, occasionally linked to budget impact, severity of disease, end of life and improved life expectancy. ConclusionFor drugs whose authorization is based on prospective case series, most applications for reimbursement within public health care are granted. The underlying evidence has limitations over and above the design per se, and decision modifiers are frequently referred to in the value-based pricing decision making.

  • 34.
    O'Donnell, Amy
    et al.
    Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
    Abidi, Latifa
    Department of Health Promotion, Maastricht University, Maastricht, Limburg, Netherlands.
    Brown, Jamie
    Research Department of Behavioural Science and Health, University College London, London, UK, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
    Karlsson, Nadine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Roback, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Skagerström, Janna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionstyrelsen, Enheten för forskningsstöd Ledningsstaben.
    Thomas, Kristin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Beliefs and attitudes about addressing alcohol consumption in health care: a population survey in England2018Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, nr 1, artikel-id 391Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Despite robust evidence for their effectiveness, it has proven difficult to translate alcohol prevention activities into routine health care practice. Previous research has identified numerous provider-level barriers affecting implementation, but these have been less extensively investigated in the wider population. We sought to: (1) investigate patients' beliefs and attitudes to being asked about alcohol consumption in health care; and (2) identify the characteristics of those who are supportive of addressing alcohol consumption in health care.

    METHODS: Cross-sectional household interviews conducted as part of the national Alcohol Toolkit Study in England between March and April 2017. Data were collected on age, gender, social grade, drinking category, and beliefs and attitudes to being asked about alcohol in routine health care. Unadjusted and multivariate-adjusted logistic regression models were performed to investigate associations between socio-demographic characteristics and drinking category with being "pro-routine" (i.e. 'agree completely' that alcohol consumption should be routinely addressed in health care) or "pro-personal" (i.e. 'agree completely' that alcohol is a personal matter and not something health care providers should ask about).

    RESULTS: Data were collected on 3499 participants, of whom 50% were "pro-routine" and 10% were "pro-personal". Those in social grade C1, C2, D and E were significantly less likely than those in AB of being "pro-routine". Women were less likely than men to be "pro-personal", and those aged 35-44 or 65 years plus more likely to be "pro-personal" compared with participants aged 16-24. Respondents aged 65 plus were twice as likely as those aged 16-24 to agree completely that alcohol consumption is a personal matter and not something health care providers should ask about (OR 2.00, 95% CI 1.34-2.99).

    CONCLUSIONS: Most adults in England agree that health care providers should routinely ask about patients' alcohol consumption. However, older adults and those in lower socio-economic groups are less supportive. Drinking status appears to have limited impact on whether people believe that alcohol is a personal matter and not something health care providers should ask about.

    REGISTRATION: Open Science Framework ( https://osf.io/xn2st/ ).

  • 35.
    Lundqvist, Martina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Husberg, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Ekdahl, Anne W.
    Karolinska Inst, Sweden; Lund Univ, Sweden.
    Cost-effectiveness of comprehensive geriatric assessment at an ambulatory geriatric unit based on the AGe-FIT trial2018Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, artikel-id 32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 36.
    Husberg, Magnus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Bernfort, Lars
    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. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Costs and disease activity in early rheumatoid arthritis in 1996-2000 and 2006-2011, improved outcome and shift in distribution of costs: a two-year follow-up2018Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 47, nr 5, s. 378-383Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To evaluate changes in healthcare utilization, costs, and disease activity from 1996 to 2011 for patients with early rheumatoid arthritis (RA).Method: Two cohorts of patients with early RA, included in 1996-1998 (T1) and 2006-2009 (T2), were followed regularly. Healthcare utilization, costs, and disease activity were compared between cohorts during 2years after diagnosis.Results: Disease activity was significantly improved in T2 vs T1. Drug costs increased in T2 vs T1 (EUR 911 vs EUR 535, respectively; p=0.017), and costs for RA-related hospitalization decreased. More than 90% in T2 were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion compared to 50% in T1. At 2year follow-up, levels were still amp;gt;90% in T2, while corresponding values in T1 were just above 70%. Comparing T2 to T1, total direct costs were slightly higher in T2 (EUR 3941 vs EUR 3364, respectively; ns), sick leave decreased (EUR 3511 vs EUR 5672; p=0.025), while disability pension increased slightly (EUR 4889 vs EUR 4244; ns), but total indirect costs remained unchanged (EUR 8400 vs EUR 9916; ns). Total direct and indirect costs did not differ between the cohorts (EUR 12342 in T2 vs EUR 13280 in T1; ns), and loss of productivity still represented the largest component of total costs.Conclusion: T2 patients were prescribed DMARDs earlier and more aggressively than T1 patients. Stable and better improvements in disease activity, function, and quality of life were achieved in T2 compared to T1. There was a shift within the components in direct costs and indirect costs, but total costs remained essentially unchanged.

  • 37.
    Ludvigsson, Mikael
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Bernfort, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Wressle, Ewa
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Milberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, LAH Öst.
    Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study2018Ingår i: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 26, nr 7, s. 741-751Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD.

    Design and Setting

    A prospective population-based study was undertaken on 85-year-old persons in Sweden.

    Measurements

    Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression.

    Results

    For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity.

    Conclusions

    SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy.

  • 38.
    Persson, Emil
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Andersson, David
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Back, Lovisa
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Johannisson, Emma
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Tinghög, Gustav
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Discrepancy between Health Care Rationing at the Bedside and Policy Level2018Ingår i: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 38, nr 7, s. 881-887Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Whether doctors at the bedside level should be engaged in health care rationing is a controversial topic that has spurred much debate. From an empirical point of view, a key issue is whether there exists a behavioral difference between rationing at the bedside and policy level. Psychological theory suggests that we should indeed expect such a difference, but existing empirical evidence is inconclusive. Objective. To explore whether rationing decisions taken at the bedside level are different from rationing decisions taken at the policy level. Method. Behavioral experiment where participants (n = 573) made rationing decisions in hypothetical scenarios. Participants (medical and nonmedical students) were randomly assigned to either a bedside or a policy condition. Each scenario involved 1 decision, concerning either a life-saving medical treatment or a quality-of-life improving treatment. All scenarios were identical across the bedside and policy condition except for the level of decision making. Results. We found a discrepancy between health care rationing at policy and bedside level for scenarios involving life-saving decisions, where subjects rationed treatments to a greater extent at the policy level compared to bedside level (35.6% v. 29.3%, P = 0.001). Medical students were more likely to ration care compared to nonmedical students. Follow-up questions showed that bedside rationing was more emotionally burdensome than rationing at the policy level, indicating that psychological factors likely play a key role in explaining the observed behavioral differences. We found no difference in rationing between bedside and policy level for quality-of-life improving treatments (54.6% v. 55.7%, P = 0.507). Conclusions. Our results indicate a robust bedside effect in the life-saving domain of health care rationing decisions, thereby adding new insights to the understanding of the malleability of preferences related to resource allocation.

  • 39.
    Shedrawy, Jad
    et al.
    Karolinska Inst, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Hergens, Maria-Pia
    Karolinska Inst, Sweden; Dept Communicable Dis Control and Prevent, Sweden.
    Askling, H. Helena
    Karolinska Inst, Sweden; Dept Communicable Dis Control and Prevent, Sweden.
    Estimating costs and health outcomes of publicly funded tick-born encephalitis vaccination: A cost-effectiveness analysis2018Ingår i: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 36, nr 50, s. 7659-7665Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The number of notified cases of Tick-Borne Encephalitis (TBE) in Sweden has been increasing the past years despite the increased use of TBE-vaccine not subsidized by the healthcare system. Stockholm County is a high endemic area and an earlier study has shown that low-income households have lower vaccination coverage even when they are at high risk. This paper aims to determine the cost-effectiveness of a publicly funded TBE vaccination program in Stockholm. Methods: In three different cohorts with individuals aged 3, 40 or 50 years, long-term costs and health outcomes of an out-of-pocket strategy (53% of the cohort is vaccinated on their own expenses) and a structured vaccination program (full cohort is vaccinated covered by the publicly funded health care system), were estimated using a Markov model. The Markov model predicts the costs and effects in term of Quality-adjusted Life Years (QALYs) over a lifetime horizon using a third-party healthcare payer perspective. The primary results are presented as an incremental cost effectiveness ratio (ICER) indicating the additional cost required to achieve one additional QALY with the structured vaccination program. Results: The results show that the structured vaccination program is associated with a gain in QALYs and increased costs compared with an out-of-pocket strategy. The calculated ICERs were 27 761, 99 527 and 160 827 SEK/QALY in cohorts of age 3, 40 and 50, respectively. The sensitivity analyses showed that the results are robust when varying different parameters. Conclusion: Given the setting of Stockholm county, this analysis shows a cost per QALY of a free vaccinations program, especially for children of 3 years old, below generally acceptable cost-effectiveness thresholds in Sweden. 

    Publikationen är tillgänglig i fulltext från 2019-10-30 16:53
  • 40.
    Malmqvist, Erik
    et al.
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för kultur och estetik. Linköpings universitet, Filosofiska fakulteten.
    Furberg, Elisabeth
    Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. University of Boras, Sweden.
    Ethical aspects of medical age assessment in the asylum process: a Swedish perspective.2018Ingår i: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 132, nr 3, s. 815-823Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    According to European regulations and the legislations of individual member states, children who seek asylum have a different set of rights than adults in a similar position. To protect these rights and ensure rule of law, migration authorities are commonly required to assess the age of asylum seekers who lack reliable documentation, including through various medical methods. However, many healthcare professionals and other commentators consider medical age assessment to be ethically problematic. This paper presents a simplified and amended account of the main findings of a recent ethical analysis of medical age assessment in the asylum process commissioned by the Swedish National Board of Health and Welfare. A number of ethical challenges related to conflicting goals, equality and fairness, autonomy and informed consent, privacy and integrity, and professional values and roles are identified and analysed. It is concluded that most of these challenges can be met, but that this requires a system where the assessment is sufficiently accurate and where adequate safeguards are in place. Two important ethical questions are found to warrant further analysis. The first is whether asylum seekers' consent to the procedure can be considered genuinely voluntary. The second is whether and how medical age assessments could affect negative public attitudes towards asylum seekers or discriminatory societal views more generally.

  • 41.
    Sandman, Lars
    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.
    Helgesson, Gert
    Karolinska institutet - LIME Stockholm, Sweden.
    Juth, Niklas
    Karolinska institutet - LIME Stockholm, Sweden.
    Etiskt problematiskt att begränsa rollen för kostnadseffektivitet [The ethical problems in limiting the role for cost-effectiveness]: Begränsad roll kan leda till godtycke och strida mot andra principer för prioriteringar i vården2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    In relation to the Swedish ethical platform for priority setting in health-care it is debated what role cost-effectiveness should play. In the article an ethical analysis is presented showing that a limited role risks leading to unequal priorities between similar needs in conflict with the human dignity and need-solidarity principles of the platform. It is also argued that resulting problems with effect comparability over different conditions and resulting equality problems with the current praxis can be mitigated through strategies like explicitly considering outcome measure and by adjusting the cost-effectiveness threshold under specific conditions.

  • 42.
    Hofmann, Bjorn
    et al.
    Norwegian Univ Sci and Technol NTNU, Norway; Univ Oslo, Norway.
    Bond, Ken
    CADTH, Canada.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Evaluating facts and facting evaluations: On the fact-value relationship in HTA2018Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 24, nr 5, s. 957-965Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of fake facts and truth production. Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of evaluating facts and the social-constructivist account of facting values. Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTAs own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of evaluating facts and the social-constructivist account of facting values, which we call factuation. We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this factuation is key to making HTA valuable to both individual decision makers and society as a whole.

  • 43.
    Ertzgaard, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Alwin, Jenny
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Sorbo, Ann
    Sahlgrens Acad, Sweden; Sodra Alvsborg Hosp, Sweden.
    Lindgren, Marie
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken.
    Sandsjo, Leif
    Univ Boras, Sweden.
    Evaluation of a self-administered transcutaneous electrical stimulation concept for the treatment of spasticity: a randomized placebo-controlled trial2018Ingår i: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 54, nr 4, s. 507-517Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patients everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mono, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each. followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patients own rehabilitation goals is recommended and may increase the value of the evaluated concept.

  • 44.
    Spreco, Armin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för verksamhetsstöd och utveckling, Verksamhetsutveckling vård och hälsa.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik och maskininlärning. Linköpings universitet, Filosofiska fakulteten.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Cowling, Benjamin John
    Univ Hong Kong, Peoples R China.
    Timpka, Toomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för verksamhetsstöd och utveckling, Verksamhetsutveckling vård och hälsa.
    Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009-20142018Ingår i: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 24, nr 10, s. 1868-1873Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The growing availability of big data in healthcare and public health opens possibilities for infectious disease control in local settings. We prospectively evaluated a method for integrated local detection and prediction (nowcasting) of influenza epidemics over 5 years, using the total population in Ostergotland County, Sweden. We used routine health information system data on influenza-diagnosis cases and syndromic telenursing data for July 2009-June 2014 to evaluate epidemic detection, peak-timing prediction, and peak-intensity prediction. Detection performance was satisfactory throughout the period, except for the 2011-12 influenza A(H3N2) season, which followed a season with influenza B and pandemic influenza A(H1N1) pdm09 virus activity. Peak-timing prediction performance was satisfactory for the 4 influenza seasons but not the pandemic. Peak-intensity levels were correctly categorized for the pandemic and 2 of 4 influenza seasons. We recommend using versions of this method modified with regard to local use context for further evaluations using standard methods.

  • 45.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Öhrn, Annica
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för verksamhetsstöd och utveckling.
    Gunnarsson, Anna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken.
    Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators2018Ingår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, artikel-id 113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Incident reporting (IR) in health care has been advocated as a means to improve patient safety. The purpose of IR is to identify safety hazards and develop interventions to mitigate these hazards in order to reduce harm in health care. Using qualitative methods is a way to reveal how IR is used and perceived in health care practice. The aim of the present study was to explore the experiences of IR from two different perspectives, including heads of departments and IR coordinators, to better understand how they value the practice and their thoughts regarding future application. Methods: Data collection was performed in Ostergotland County, Sweden, where an electronic IR system was implemented in 2004, and the authorities explicitly have advocated IR from that date. A purposive sample of nine heads of departments from three hospitals were interviewed, and two focus group discussions with IR coordinators took place. Data were analysed using qualitative content analysis. Results: Two main themes emerged from the data: "Incident reporting has come to stay" building on the categories entitled perceived advantages, observed changes and value of the IR system, and "Remaining challenges in incident reporting" including the categories entitled need for action, encouraged learning, continuous culture improvement, IR system development and proper use of IR. Conclusions: After 10 years, the practice of IR is widely accepted in the selected setting. IR has helped to put patient safety on the agenda, and a cultural change towards no blame has been observed. The informants suggest an increased focus on action, and further development of the tools for reporting and handling incidents.

  • 46.
    Luedecke, Daniel
    et al.
    Univ Med Ctr Hamburg Eppendorf, Germany.
    Bien, Barbara
    Med Univ Bialystok, Poland.
    McKee, Kevin
    Dalarna Univ, Sweden.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Mestheneos, Elizabeth
    50 Hellas, Greece.
    Di Rose, Mirko
    Natl Inst Hlth and Sci Aging, Italy.
    von dem Knesebeckl, Olaf
    Univ Med Ctr Hamburg Eppendorf, Germany.
    Kofahl, Christopher
    Univ Med Ctr Hamburg Eppendorf, Germany.
    For better or worse: Factors predicting outcomes of family care of older people over a one-year period. A six-country European study2018Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 4, artikel-id e0195294Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period. Methods Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries (Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyads status at follow-up. Results Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems (OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change. Discussion The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.

  • 47.
    Ekerstad, Niklas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. NU NAL Uddevalla Hosp Grp, Sweden.
    Pettersson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Alexander, Karen
    Duke Clin Res Inst, NC USA.
    Andersson, David
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Nationalekonomi. Linköpings universitet, Filosofiska fakulteten.
    Eriksson, Sofia
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Janzon, Magnus
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Lindenberger, Marcus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Swahn, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Alfredsson, Joakim
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Frailty as an instrument for evaluation of elderly patients with non-ST-segment elevation myocardial infarction: A follow-up after more than 5 years2018Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, nr 17, s. 1813-1821Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background There is a growing body of evidence on the relevance of using frailty measures also in a cardiovascular context. The estimated time to death is crucial in clinical decision-making in cardiology. However, data on the importance of frailty in long-term mortality are very scarce. The aim of the study was to assess the prognostic value of frailty on mortality at long-term follow-up of more than 5 years in patients 75 years or older hospitalised for non-ST-segment elevation myocardial infarction. We hypothesised that frailty is independently associated with long-term mortality. Design This was a prospective, observational study conducted at three centres. Methods and results Frailty was assessed according to the Canadian Study of Health and Aging clinical frailty scale (CFS). Of 307 patients, 149 (48.5%) were considered frail according to the study instrument (degree 5-7 on the scale). The long-term all-cause mortality of more than 5 years (median 6.7 years) was significantly higher among frail patients (128, 85.9%) than non-frail patients (85, 53.8%), (P amp;lt; 0.001). In Cox regression analysis, frailty was independently associated with mortality from the index hospital admission to the end of follow-up (hazard ratio 2.06, 95% confidence interval 1.51-2.81; P amp;lt; 0.001) together with age (P amp;lt; 0.001), ejection fraction (P = 0.012) and Charlson comorbidity index (P = 0.018). Conclusions In elderly non-ST-segment elevation myocardial infarction patients, frailty was independently associated with all-cause mortality at long-term follow-up of more than 6 years. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in the context of cardiovascular patients with complex needs.

  • 48.
    Öhrn, Annica
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Region Östergötland, Centrum för hälso- och vårdutveckling.
    Ericsson, Carin
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för hälso- och vårdutveckling. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Andersson, Christer
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för hälso- och vårdutveckling.
    Elfström, Johan
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för hälso- och vårdutveckling.
    High Rate of Implementation of Proposed Actions for Improvement With the Healthcare Failure Mode Effect Analysis Method: Evaluation of 117 Analyses2018Ingår i: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425, Vol. 14, nr 1, s. 17-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aims of this study were to investigate what kind of impact the Healthcare Failure Mode Effect Analysis (HFMEA) had on the organization in 1 county council in Sweden and to evaluate the method of working for multidisciplinary teams performing HFMEA. Three main outcome measures were used: the quality of the documentation from the HFMEAs, fulfillment of the primary goal of the HFMEA, and, finally, whether proposed actions for improvement were implemented.

    METHODS: The study involved retrospective analysis of the documentation from 117 performed HFMEAs from 3 hospitals in the county council of Östergötland, Sweden, and interviews or questionnaires with team leaders and managers between 2006 and 2010.

    RESULTS: A proposed change in the organizational structure was the most common issue in the analyses. Eighty-nine percent of the written reports were of high quality. A median of 10 serious risks were detected, and 10 proposed actions (median) were made. In 78% of the HFMEAs, all or a large part of these had been implemented a few years afterward. We were unable to find factors that promoted the rate of implementation of proposed actions. Seventy-eight percent of the managers were completely satisfied with the results of the HFMEA. The mean cost per risk analysis was &OV0556;1909.

    CONCLUSIONS: Most of the proposed actions were implemented. The use of HFMEA can be improved using fewer team leaders but with more experience. The work involved in writing a report can be reduced without loss of impact on the organization.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

  • 49.
    Ekerstad, Niklas
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. NU NAL Uddevalla Hosp Grp, Sweden.
    Karlsson, Thomas
    Univ Gothenburg, Sweden.
    Soderqvist, Sara
    NU NAL Uddevalla Hosp Grp, Sweden.
    Karlson, Bjorn W.
    NU NAL Uddevalla Hosp Grp, Sweden; Univ Gothenburg, Sweden.
    Hospitalized frail elderly patients - atrial fibrillation, anticoagulation and 12 months outcomes2018Ingår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 13, s. 749-756Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objective: Multiple chronic conditions and recurring acute illness are frequent among elderly people. One such condition is atrial fibrillation (AF), which increases the risk of stroke up to fivefold. The aim of this study was to investigate the prevalence of AF among hospitalized frail elderly patients, their use of anticoagulation and their 12-month outcomes. Patients and methods: This was a clinical observational study of acutely hospitalized frail patients over the age of 75 years. The CHA2DS2-VASc Score was used to evaluate ischemic stroke risk in patients with AF. Clinically relevant outcomes were the composite of ischemic stroke and/or bleeding within 12 months, which was considered as primary in the analysis, ischemic stroke/transient ischemic attack (TIA), mortality, bleeding and hospital care consumption. Students (test, Fishers exact test, Mann Whitney U test and a Cox proportional hazards model were used for the analyses. Results: The prevalence of AF was 47%, and 63% of them were prescribed an anticoagulant. AF patients without anticoagulation were older, more often females, more often in residential care, and they had worse Mini Nutritional Assessment and activities of daily living scores. Of the patients without anticoagulation, 56% had a documented contraindication. In univariate analysis, there were significantly more events among AF patients without anticoagulation regarding the composite outcome of ischemic stroke and/or bleeding (hazard ratio [1112] 3.65, 95% CI = 1.70-7.86; p amp;lt; 0.001). When adjusting for potential confounders in Cox regression analysis, the difference remained significant (HR 4.54, 95% CI = 1.83-11.25; p = 0.001). Conclusion: The prevalence of AF in a hospitalized frail elderly population was 47%. Of these, 63% were prescribed anticoagulation therapy. Almost half of the patients without stroke pro-phylaxis had no documented contraindication. At 1 year, there were significantly more events in terms of ischemic stroke and/or bleeding among AF patients without anticoagulation therapy than among those with.

  • 50.
    Johannesen, Kasper M
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Claxton, Karl
    Centre for Health Economics, University of York, York, UK.
    Sculpher, Mark J.
    Centre for Health Economics, University of York, York, UK.
    Wailoo, Allan J
    Health Economics and Decision Science, University of Sheffield, Sheffield, UK.
    How to design the cost‐effectiveness appraisal process of new healthcare technologies to maximise population health: A conceptual framework2018Ingår i: Health Economics, ISSN 1057-9230, E-ISSN 1099-1050, Vol. 27, nr 2, s. e41-e54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper presents a conceptual framework to analyse the design of the cost‐effectiveness appraisal process of new healthcare technologies. The frameworkcharacterises the appraisal processes as a diagnostic test aimed at identifyingcost‐effective (true positive) and non‐cost‐effective (true negative) technologies.Using the framework, factors that influence the value of operating an appraisalprocess, in terms of net gain to popula tion health, are identified. The frame-work is used to gain insight into current policy questions including (a) howrigorous the process should be, (b) who should have the burden of proof, and(c) how optimal design changes when allowing for appeals, price reductions,resubmissions, and re‐evaluations.The paper demonstrates that there is no one optimal appraisal process and theprocess should be adapted over time and to the specific technology underassessment. Optimal design depends on country‐specific features of (future)technologies, for example, effect, price, and size of the patient population,which might explain the difference in appraisal processes across countries. Itis shown that burden of pro of should be placed on the producers and that theimpact of price reductions and patient access schemes on the producer's pricesetting should be considered when designing the appraisal process.

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