Skip header and navigation

Refine By

   MORE

7 records – page 1 of 1.

The comparison of trial data-based and registry data-based cost-effectiveness of infliximab treatment for rheumatoid arthritis in Sweden using a modeling approach.

https://arctichealth.org/en/permalink/ahliterature115153
Source
Value Health. 2013 Mar-Apr;16(2):251-8
Publication Type
Article
Author
Ingrid Lekander
Gisela Kobelt
Patrick Svarvar
Tryggve Ljung
Ronald van Vollenhoven
Fredrik Borgström
Author Affiliation
i3 Innovus, Stockholm, Sweden. ingrid.lekander@ki.se
Source
Value Health. 2013 Mar-Apr;16(2):251-8
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - economics
Cohort Studies
Cost-Benefit Analysis - methods
Data Collection - standards
Female
Humans
Male
Methotrexate - economics - therapeutic use
Middle Aged
Models, Economic
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic - statistics & numerical data
Registries - statistics & numerical data
Sweden
Abstract
To evaluate the precision of the predictive cost-effectiveness assessment based on a phase 3 clinical trial with infliximab for the treatment of rheumatoid arthritis in Swedish clinical practice.
Three patient cohorts were identified: the patients included in the infliximab trial (ATTRACT), patients initially treated with infliximab from a Swedish registry (STURE), a subset of these registry patients meeting inclusion criteria for the ATTRACT trial was the third patient cohort; two sets of assumptions in relation to the efficacy data were evaluated: "ATTRACT" (efficacy data over the duration of the trial) and "STURE" (effectiveness data over 10 years). In addition, the impact of including the placebo effect for the comparator was evaluated as a basis for the calculation of cost-effectiveness by using a modeling approach. A health economic model was utilized to estimate the cost per quality-adjusted life-year (QALY) gained.
The results for the three patient cohorts ranged from cost saving to a cost per QALY gained of €2,400 and €24,900 to €26,000 when the ATTRACT and STURE assumptions were used, respectively. Sensitivity analyses indicated that the inclusion of placebo effect had the largest effect on the results, increasing the cost per QALY gained to approximately €50,000 for all patient cohorts.
The treatment effect of infliximab measured in clinical trials and clinical practice results in comparable cost-effectiveness ratios, as calculated by using a modeling approach, whereas the assumptions made in relation to the effectiveness data and the chosen comparator have a large impact on the results. This reinforces the value of early modeling studies based on randomized clinical trial data, but assumptions made need to be carefully assessed.
PubMed ID
23538176 View in PubMed
Less detail

Cost-effectiveness analysis of a low-dose contraceptive levonorgestrel intrauterine system in Sweden.

https://arctichealth.org/en/permalink/ahliterature266641
Source
Acta Obstet Gynecol Scand. 2015 Aug;94(8):884-90
Publication Type
Article
Date
Aug-2015
Author
Nathaniel Henry
Charlie Hawes
Julia Lowin
Ingrid Lekander
Anna Filonenko
Helena K Kallner
Source
Acta Obstet Gynecol Scand. 2015 Aug;94(8):884-90
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cohort Studies
Contraceptives, Oral - economics
Cost Savings
Cost-Benefit Analysis
Female
Humans
Intrauterine Devices, Medicated - economics
Levonorgestrel - administration & dosage - economics
Models, Economic
Pregnancy
Pregnancy, Unplanned
Sweden
Young Adult
Abstract
To evaluate the cost-effectiveness of a novel intrauterine system, levonorgestrel intrauterine system 13.5 mg vs. oral contraception, in women at risk of unintended pregnancy.
Cost-effectiveness model using efficacy and discontinuation data from published articles.
Societal perspective including direct and indirect costs.
Women at risk of unintended pregnancy using reversible contraception.
An economic analysis was conducted by modeling the different health states of women using contraception over a 3-year period. Typical use efficacy rates from published articles were used to determine unintended pregnancy events. Discontinuation rates were used to account for method switching.
Cost-effectiveness was evaluated in terms of the incremental cost per unintended pregnancy avoided. In addition, the incremental cost per quality-adjusted life-year was calculated.
Levonorgestrel intrauterine system 13.5 mg generated costs savings of € 311,000 in a cohort of 1000 women aged 15-44 years. In addition, there were fewer unintended pregnancies (55 vs. 294) compared with women using oral contraception.
Levonorgestrel intrauterine system 13.5 mg is a cost-effective method when compared with oral contraception. A shift in contraceptive use from oral contraception to long-acting reversible contraception methods could result in fewer unintended pregnancies, quality-adjusted life-year gains, as well as cost savings.
PubMed ID
26015090 View in PubMed
Less detail

Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment.

https://arctichealth.org/en/permalink/ahliterature101528
Source
Int J Technol Assess Health Care. 2011 Jul;27(3):193-200
Publication Type
Article
Date
Jul-2011
Author
Gisela Kobelt
Ingrid Lekander
Andrea Lang
Bernd Raffeiner
Costantino Botsios
Pierre Geborek
Author Affiliation
Lund University and European Health Economics.
Source
Int J Technol Assess Health Care. 2011 Jul;27(3):193-200
Date
Jul-2011
Language
English
Publication Type
Article
Abstract
Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28]
PubMed ID
21736857 View in PubMed
Less detail

Cost-effectiveness of real-world infliximab use in patients with rheumatoid arthritis in Sweden.

https://arctichealth.org/en/permalink/ahliterature98419
Source
Int J Technol Assess Health Care. 2010 Jan;26(1):54-61
Publication Type
Article
Date
Jan-2010
Author
Ingrid Lekander
Fredrik Borgström
Patrick Svarvar
Tryggve Ljung
Cheryl Carli
Ronald F van Vollenhoven
Author Affiliation
i3 Innovus and MMC, LIME, Stockholm, Sweden. ingrid.lekander@i3innovus.com
Source
Int J Technol Assess Health Care. 2010 Jan;26(1):54-61
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Age Distribution
Antibodies, Monoclonal - adverse effects - economics - therapeutic use
Antirheumatic Agents - adverse effects - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - economics - mortality
Cost of Illness
Cost-Benefit Analysis
Disease Progression
Humans
Markov Chains
Quality-Adjusted Life Years
Registries - statistics & numerical data
Sex Distribution
Sweden
Abstract
OBJECTIVES: The objective of this study was to estimate the cost-effectiveness of infliximab use in patients with rheumatoid arthritis (RA) in Swedish clinical practice, based on patient-level data from the Stockholm TNF-alpha follow-up registry (STURE). METHODS: Real-world patient-level data on infliximab use from the STURE registry were implemented in a Markov cohort model, in which health states of functional status were classified according to the Health Assessment Questionnaire Disability Index (HAQ-five categories) and twenty-eight joint count Disease Activity Score (DAS28). The transition probabilities between HAQ and DAS28 states during treatment, as well as discontinuation rates were modeled based on data from the registry for patients using infliximab as their first-line biological treatment. The transition probabilities in the comparator arm, that is, disease progression without biologic treatment, as well as mortality rates, costs, and utilities were based on published literature. The analysis had a societal cost perspective. RESULTS: Infliximab was associated with an incremental gain in quality-adjusted life-years of 1.02 and an incremental cost of 23,264 euros per patient compared with progression without biologic treatment, producing an incremental cost-effectiveness ratio (ICER) of 22,830 euros (SEK211,136 or US$31,230). Sensitivity analyses of input parameters and model assumptions produced ICERs in the range from 18,000 euros to 47,000 euros. CONCLUSIONS: Results from base-case and sensitivity analyses fell well below established benchmarks for cost-effectiveness in Sweden. The results, therefore, indicated that infliximab treatment for RA has provided good societal value for money in Swedish clinical practice, compared with a scenario of no biological treatment.
PubMed ID
20059781 View in PubMed
Less detail

The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice.

https://arctichealth.org/en/permalink/ahliterature120576
Source
Eur J Health Econ. 2013 Dec;14(6):863-73
Publication Type
Article
Date
Dec-2013
Author
Ingrid Lekander
Fredrik Borgström
Jörgen Lysholm
Ronald F van Vollenhoven
Staffan Lindblad
Pierre Geborek
Gisela Kobelt
Author Affiliation
LIME/MMC, Karolinska Institute, Stockholm, Sweden, ingrid.lekander@ki.se.
Source
Eur J Health Econ. 2013 Dec;14(6):863-73
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Antibodies, Monoclonal - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy
Cost-Benefit Analysis
Disease Progression
Drug Therapy, Combination
Humans
Immunoglobulin G - economics - therapeutic use
Quality-Adjusted Life Years
Receptors, Tumor Necrosis Factor - therapeutic use
Retrospective Studies
Sex Factors
Sweden
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Abstract
The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed.
Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs).
TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from euro 50,000 to euro 120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness.
These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator.
PubMed ID
22990378 View in PubMed
Less detail

Cost of unintended pregnancy in Norway: a role for long-acting reversible contraception.

https://arctichealth.org/en/permalink/ahliterature278202
Source
J Fam Plann Reprod Health Care. 2015 Apr;41(2):109-15
Publication Type
Article
Date
Apr-2015
Author
Nathaniel Henry
Max Schlueter
Julia Lowin
Ingrid Lekander
Anna Filonenko
James Trussell
Finn Egil Skjeldestad
Source
J Fam Plann Reprod Health Care. 2015 Apr;41(2):109-15
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Contraception - economics
Contraception Behavior - statistics & numerical data
Cost-Benefit Analysis
Female
Humans
Norway
Pregnancy
Pregnancy, Unplanned
Young Adult
Abstract
The objective of this study was to quantify the cost burden of unintended pregnancies (UPs) in Norway, and to estimate the proportion of costs due to imperfect contraceptive adherence. Potential cost savings that could arise from increased uptake of long-acting reversible contraception (LARC) were also investigated.
An economic model was constructed to estimate the total number of UPs and associated costs in women aged 15-24 years. Adherence-related UP was estimated using 'perfect use' and 'typical use' contraceptive failure rates. Potential savings from increased use of LARC were projected by comparing current costs to projected costs following a 5% increase in LARC uptake.
Total costs from UP in women aged 15-24 years were estimated to be 164 million Norwegian Kroner (NOK), of which 81.7% were projected to be due to imperfect contraceptive adherence. A 5% increase in LARC uptake was estimated to generate cost savings of NOK 7.2 million in this group.
The cost of UP in Norway is substantial, with a large proportion of this cost arising from imperfect contraceptive adherence. Increased LARC uptake may reduce the UP incidence and generate cost savings for both the health care payer and contraceptive user.
Notes
Cites: Contraception. 2003 Jul;68(1):3-1012878280
Cites: Contraception. 2007 Mar;75(3):168-7017303484
Cites: Acta Obstet Gynecol Scand. 2009;88(5):569-7419253060
Cites: Contraception. 2008 Oct;78(4):271-8318847574
Cites: Natl Vital Stat Rep. 2008 Apr 14;56(15):1-25, 2818578105
Cites: Tidsskr Nor Laegeforen. 2007 Nov 1;127(21):2803-517987070
Cites: Natl Health Stat Report. 2012 Oct 18;(60):1-2524988814
Cites: Contraception. 2013 Feb;87(2):154-6122959904
Cites: Contraception. 2011 May;83(5):397-40421477680
Cites: Obstet Gynecol. 2010 Mar;115(3):495-50220177279
Cites: Hum Reprod. 2007 Sep;22(9):2422-717599942
PubMed ID
25537792 View in PubMed
Less detail

Hospital comparison of stroke care in Sweden: a register-based study.

https://arctichealth.org/en/permalink/ahliterature291973
Source
BMJ Open. 2017 Sep 07; 7(9):e015244
Publication Type
Journal Article
Date
Sep-07-2017
Author
Ingrid Lekander
Carl Willers
Elisabeth Ekstrand
Mia von Euler
Birgitta Fagervall-Yttling
Lena Henricson
Konstantinos Kostulas
Mikael Lilja
Katharina S Sunnerhagen
Jörg Teichert
Hélène Pessah-Rasmussen
Author Affiliation
Ivbar Institute AB and Medical Management Center, LIME, Karolinska Institutet, Stockholm, Sweden.
Source
BMJ Open. 2017 Sep 07; 7(9):e015244
Date
Sep-07-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Female
Hospitals - statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Outcome Assessment (Health Care)
Registries
Retrospective Studies
Socioeconomic Factors
Stroke - mortality - therapy
Sweden - epidemiology
Treatment Outcome
Abstract
The objective of this study was to estimate the level of health outcomes and resource use at a hospital level during the first year after a stroke, and to identify any potential differences between hospitals after adjusting for patient characteristics (case mix).
Data from several registries were linked on individual level: seven regional patient administrative systems, Swedish Stroke Register, Statistics Sweden, National Board of Health and Welfare and Swedish Social Insurance Agency. The study population consisted of 14?125 patients presenting with a stroke during 2010. Case-mix adjusted analysis of hospital differences was made on five aspects of health outcomes and resource use, 1?year post-stroke.
The results indicated that 26% of patients had died within a year of their stroke. Among those who survived, almost 5% had a recurrent stroke and 40% were left with a disability. On average, the patients had 22 inpatient days and 23 outpatient visits, and 13% had moved into special housing. There were significant variations between hospitals in levels of health outcomes achieved and resources used after adjusting for case mix.
Differences in health outcomes and resource use between hospitals were substantial and not entirely explained by differences in patient mix, indicating tendencies of unequal stroke care in Sweden. Healthcare organisation of regions and other structural features could potentially explain parts of the differences identified.
Notes
Cites: Eur J Public Health. 2015 Feb;25 Suppl 1:1-2 PMID 25690122
Cites: Stroke. 2003 Jan;34(1):122-6 PMID 12511762
Cites: Stroke. 2015 Sep;46(9):2491-7 PMID 26304862
Cites: J Stroke Cerebrovasc Dis. 2013 May;22(4):491-9 PMID 23545319
Cites: J Stroke Cerebrovasc Dis. 2006 Jul-Aug;15(4):139-43 PMID 17904066
Cites: Eur J Heart Fail. 2016 Sep;18(9):1132-40 PMID 27108481
Cites: BMJ Innov. 2015 Oct;1(4):145-150 PMID 26692351
Cites: Osteoporos Int. 2006;17(5):637-50 PMID 16283064
Cites: Europace. 2008 Apr;10(4):403-11 PMID 18326853
Cites: Cerebrovasc Dis. 2004;17(1):21-7 PMID 14530634
Cites: Stroke. 2014 Nov;45(11):3374-80 PMID 25293667
Cites: Int J Stroke. 2017 Oct;12 (8):802-814 PMID 28375069
Cites: PLoS One. 2017 Apr 6;12 (4):e0174861 PMID 28384164
Cites: Cerebrovasc Dis. 2001 Aug;12 (2):131-8 PMID 11490107
Cites: N Engl J Med. 2010 Dec 23;363(26):2477-81 PMID 21142528
Cites: Health Econ. 2015 Dec;24 Suppl 2:116-39 PMID 26633872
Cites: J Am Heart Assoc. 2016 Jan 21;5(1):null PMID 26796252
Cites: Milbank Q. 2002;80(3):569-93, v PMID 12233250
Cites: Scand J Rheumatol. 2009 Nov-Dec;38(6):409-18 PMID 19922015
Cites: Eur Neuropsychopharmacol. 2011 Oct;21(10):718-79 PMID 21924589
Cites: Lancet Neurol. 2009 Apr;8(4):345-54 PMID 19233730
Cites: Int J Stroke. 2016 Jul;11(5):593-603 PMID 26956032
Cites: Stroke. 2007 Apr;38(4):1384-6 PMID 17322093
Cites: Cerebrovasc Dis. 2004;17 (2-3):134-42 PMID 14707413
Cites: Int J Technol Assess Health Care. 2004 Summer;20(3):375-80 PMID 15446769
Cites: Med Care. 2013 Sep;51(9):782-8 PMID 23942219
Cites: Health Econ. 2015 Dec;24 Suppl 2:38-52 PMID 26633867
Cites: BMC Health Serv Res. 2015 Oct 13;15:466 PMID 26464109
Cites: Eur J Neurol. 2012 Jan;19(1):155-62 PMID 22175760
Cites: Int J Clin Pract. 2008 May;62(5):708-16 PMID 18355236
Cites: BMJ Open. 2016 Feb 02;6(2):e009243 PMID 26839011
PubMed ID
28882906 View in PubMed
Less detail

7 records – page 1 of 1.