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A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.

https://arctichealth.org/en/permalink/ahliterature267230
Source
Europace. 2015 Feb;17(2):207-14
Publication Type
Article
Date
Feb-2015
Author
Lars-Åke Levin
Magnus Husberg
Piotr Doliwa Sobocinski
Viveka Frykman Kull
Leif Friberg
Mårten Rosenqvist
Thomas Davidson
Source
Europace. 2015 Feb;17(2):207-14
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Asymptomatic Diseases
Atrial Fibrillation - complications - diagnosis - economics
Brain Ischemia - diagnosis - etiology
Cost-Benefit Analysis
Electrocardiography - economics
Electrocardiography, Ambulatory - economics
Humans
Markov Chains
Mass Screening - economics
Quality-Adjusted Life Years
Secondary Prevention - economics
Stroke - diagnosis - economics - etiology
Sweden
Abstract
The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.
The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.
Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.
PubMed ID
25349228 View in PubMed
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The impact of health economic evaluations in Sweden.

https://arctichealth.org/en/permalink/ahliterature266499
Source
Z Evid Fortbild Qual Gesundhwes. 2014;108(7):375-82
Publication Type
Article
Date
2014
Author
Emelie Heintz
Karl Arnberg
Lars-Åke Levin
Jan Liliemark
Thomas Davidson
Source
Z Evid Fortbild Qual Gesundhwes. 2014;108(7):375-82
Date
2014
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis - economics
Cross-Cultural Comparison
Decision Making, Organizational
Delivery of Health Care - economics
Forecasting
Health Priorities - economics
Health Resources - economics - trends
Humans
Insurance, Dental - economics - trends
Insurance, Pharmaceutical Services - economics - trends
National Health Programs - economics
Reimbursement Mechanisms - economics - trends
Sweden
Abstract
The responsibility for healthcare in Sweden is shared by the central government, county councils and municipalities. The counties and municipalities are free to make their own prioritizations within the framework of the state healthcare laws. To guide prioritization of healthcare resources in Sweden, there is consensus that cost-effectiveness constitutes one of the three principles. The objective of this paper is to describe how cost-effectiveness, and hence health economic evaluations (HEE), have a role in pricing decisions, reimbursement of pharmaceuticals as well as the overall prioritization and allocation of resources in the Swedish healthcare system. There are various organizations involved in the processes of implementing health technologies in the Swedish healthcare system, several of which consider or produce HEEs when assessing different technologies: the Dental and Pharmaceutical Benefits Agency (TLV), the county councils' group on new drug therapies (NLT), the National Board of Health and Welfare, the Swedish Council on Health Technology Assessment (SBU), regional HTA agencies and the Public Health Agency of Sweden. The only governmental agency that has official and mandatory guidelines for how to perform HEE is TLV (LFNAR 2003:2). Even though HEEs may seem to have a clear and explicit role in the decision-making processes in the Swedish healthcare system, there are various obstacles and challenges in the use and dissemination of the results.
PubMed ID
25444295 View in PubMed
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Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden.

https://arctichealth.org/en/permalink/ahliterature123099
Source
Eur Heart J. 2013 Jan;34(3):177-83
Publication Type
Article
Date
Jan-2013
Author
Thomas Davidson
Magnus Husberg
Magnus Janzon
Jonas Oldgren
Lars-Åke Levin
Author Affiliation
Center for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, Linköping SE-581 83, Sweden. thomas.davidson@liu.se
Source
Eur Heart J. 2013 Jan;34(3):177-83
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - economics - therapeutic use
Atrial Fibrillation - drug therapy - economics
Benzimidazoles - economics - therapeutic use
Cost-Benefit Analysis
Drug Costs
Humans
Life expectancy
Quality-Adjusted Life Years
Stroke - economics - prevention & control
Sweden
Warfarin - economics - therapeutic use
beta-Alanine - analogs & derivatives - economics - therapeutic use
Abstract
Patients with atrial fibrillation have a significantly increased risk of thromboembolic events such as ischaemic stroke, and patients are therefore recommended to be treated with anticoagulation treatment. The most commonly used anticoagulant consists of vitamin K antagonist such as warfarin. A new oral anticoagulation treatment, dabigatran, has recently been approved for stroke prevention among patients with atrial fibrillation. The purpose of this study was to estimate the cost-effectiveness of dabigatran as preventive treatment of stroke and thromboembolic events compared with warfarin in 65-year-old patients with atrial fibrillation in Sweden.
A decision analytic simulation model was used to estimate the long-term (20-year) costs and effects of the different treatments. The outcome measures are the number of strokes prevented, life years gained, and quality-adjusted life years (QALYs) gained. Costs and effect data are adjusted to a Swedish setting. Patients below 80 years of age are assumed to start with dabigatran 150 mg twice a day and switch to 110 mg twice a day at the age of 80 years due to higher bleeding risk. The price of dabigatran in Sweden is €2.82 (Swedish kronor 25.39) per day for both doses. The cost per QALY gained for dabigatran compared with warfarin is estimated at €7742, increasing to €12 449 if dabigatran is compared with only well-controlled warfarin treatment.
Dabigatran is a cost-effective treatment in Sweden, as its incremental cost-effectiveness ratio is below the normally accepted willingness to pay limit.
Notes
Comment In: Eur Heart J. 2013 Jan;34(3):166-722809680
PubMed ID
22733833 View in PubMed
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Economic evaluation of an expanded caries-preventive program targeting toddlers in high-risk areas in Sweden.

https://arctichealth.org/en/permalink/ahliterature301590
Source
Acta Odontol Scand. 2019 May; 77(4):303-309
Publication Type
Journal Article
Date
May-2019
Author
Maria Anderson
Thomas Davidson
Göran Dahllöf
Margaret Grindefjord
Author Affiliation
a Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine , Karolinska Institutet , Stockholm , Sweden.
Source
Acta Odontol Scand. 2019 May; 77(4):303-309
Date
May-2019
Language
English
Publication Type
Journal Article
Keywords
Cariostatic Agents - economics
Child
Child, Preschool
Cost-Benefit Analysis
Dental Care - economics - statistics & numerical data
Dental Caries - economics - prevention & control
Female
Fluorides, Topical - economics - therapeutic use
Humans
Male
Oral Health - economics - statistics & numerical data
Oral Hygiene - economics
Pit and Fissure Sealants - economics - therapeutic use
Preventive Health Services
Randomized Controlled Trials as Topic
State Medicine - economics
Sweden
Abstract
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.
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.
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.
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.
www.controlled-trials.com (ISRCTN35086887).
PubMed ID
30636456 View in PubMed
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Value of information: interim analysis of a randomized, controlled trial of goal-directed hemodynamic treatment for aged patients.

https://arctichealth.org/en/permalink/ahliterature108826
Source
Trials. 2013;14:205
Publication Type
Article
Date
2013
Author
Erzsebet Bartha
Thomas Davidson
Thor-Henrik Brodtkorb
Per Carlsson
Sigridur Kalman
Author Affiliation
Karolinska Institute, CLINTEC, Division of Anaesthesiology and Department of Anaesthesia and Intensive Medicine, Karolinska University Hospital, Stockholm, Sweden. erzsebet.bartha@karolinska.se
Source
Trials. 2013;14:205
Date
2013
Language
English
Publication Type
Article
Keywords
Adrenergic beta-1 Receptor Agonists - administration & dosage - adverse effects - economics
Age Factors
Aged
Aged, 80 and over
Aging
Cost-Benefit Analysis
Data Interpretation, Statistical
Decision Support Techniques
Decision Trees
Dobutamine - administration & dosage - adverse effects - economics
Drug Costs
Female
Fluid Therapy - adverse effects - economics - mortality
Fracture Fixation - adverse effects - economics - mortality
Hemodynamics - drug effects
Hip Fractures - diagnosis - economics - mortality - physiopathology - surgery
Hospital Costs
Humans
Male
Markov Chains
Postoperative Complications - economics - mortality - physiopathology - prevention & control
Probability
Quality of Life
Quality-Adjusted Life Years
Research Design
Risk assessment
Risk factors
Sweden
Time Factors
Treatment Outcome
Uncertainty
Abstract
A randomized, controlled trial, intended to include 460 patients, is currently studying peroperative goal-directed hemodynamic treatment (GDHT) of aged hip-fracture patients. Interim efficacy analysis performed on the first 100 patients was statistically uncertain; thus, the trial is continuing in accordance with the trial protocol. This raised the present investigation's main question: Is it reasonable to continue to fund the trial to decrease uncertainty? To answer this question, a previously developed probabilistic cost-effectiveness model was used. That model depicts (1) a choice between routine fluid treatment and GDHT, given uncertainty of current evidence and (2) the monetary value of further data collection to decrease uncertainty. This monetary value, that is, the expected value of perfect information (EVPI), could be used to compare future research costs. Thus, the primary aim of the present investigation was to analyze EVPI of an ongoing trial with interim efficacy observed.
A previously developed probabilistic decision analytic cost-effectiveness model was employed to compare the routine fluid treatment to GDHT. Results from the interim analysis, published trials, the meta-analysis, and the registry data were used as model inputs. EVPI was predicted using (1) combined uncertainty of model inputs; (2) threshold value of society's willingness to pay for one, quality-adjusted life-year; and (3) estimated number of future patients exposed to choice between GDHT and routine fluid treatment during the expected lifetime of GDHT.
If a decision to use GDHT were based on cost-effectiveness, then the decision would have a substantial degree of uncertainty. Assuming a 5-year lifetime of GDHT in clinical practice, the number of patients who would be subject to future decisions was 30,400. EVPI per patient would be €204 at a €20,000 threshold value of society's willingness to pay for one quality-adjusted life-year. Given a future population of 30,400 individuals, total EVPI would be €6.19 million.
If future trial costs are below EVPI, further data collection is potentially cost-effective. When applying a cost-effectiveness model, statements such as 'further research is needed' are replaced with 'further research is cost-effective and 'further funding of a trial is justified'.
ClinicalTrials.gov NCT01141894.
Notes
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PubMed ID
23837606 View in PubMed
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