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173 records – page 1 of 18.

A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain.

https://arctichealth.org/en/permalink/ahliterature61395
Source
Pain. 2005 Jun;115(3):273-83
Publication Type
Article
Date
Jun-2005
Author
Jensen IB
Bergström G
Ljungquist T
Bodin L
Author Affiliation
Section for Personal Injury Prevention, Karolinska Institutet, Box 127 18, 112 94 Stockholm, Sweden. irene.jensen@cns.ki.se
Source
Pain. 2005 Jun;115(3):273-83
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Adult
Back Pain - economics - rehabilitation
Cognitive Therapy
Comparative Study
Cost-Benefit Analysis
Delivery of Health Care - utilization
Employment
Female
Follow-Up Studies
Health Care Costs
Humans
Male
Middle Aged
Neck Pain - economics - rehabilitation
Pensions
Physical Therapy (Specialty) - economics - organization & administration
Program Evaluation
Quality of Life
Rehabilitation - economics - organization & administration
Research Support, Non-U.S. Gov't
Sick Leave
Abstract
The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain.
PubMed ID
15911154 View in PubMed
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Accuracy of routine echocardiographic measurements made by an inexperienced examiner through tele-instruction.

https://arctichealth.org/en/permalink/ahliterature68989
Source
J Telemed Telecare. 1996;2(3):148-54
Publication Type
Article
Date
1996
Author
J E Afset
P. Lunde
K. Rasmussen
Author Affiliation
Department of Medicine, Kirkenes Hospital, Norway.
Source
J Telemed Telecare. 1996;2(3):148-54
Date
1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cost-Benefit Analysis
Echocardiography - economics - methods
Female
Humans
Male
Medically underserved area
Middle Aged
Norway
Reproducibility of Results
Research Support, Non-U.S. Gov't
Telemedicine - economics - methods
Video Recording
Abstract
The reproducibility and accuracy of routine echocardiographic measurements made by an inexperienced doctor using tele-instruction were evaluated. Thirty-eight patients were first examined at a local hospital by an inexperienced doctor instructed by a specialist 450 km away at a university hospital. The specialist then examined the patients at the local hospital using the same equipment, after an average of 50 days. The accuracy of M-mode and quantitative Doppler measurements was comparable to that observed in reproducibility studies made under normal examination conditions. There were no systematic measurement errors. No important M-mode information was missed except evidence of left ventricular hypertrophy in six patients. In the two-dimensional examination there were differences of clinical significance in only three patients. There were no clinically important differences in the Doppler quantification of mitral and aortic regurgitation. Tele-instructed echocardiography is also an excellent educational tool, allowing an inexperienced examiner gradually to take responsibility for the local echocardiographic service.
PubMed ID
9375049 View in PubMed
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Adding formoterol to budesonide in moderate asthma--health economic results from the FACET study.

https://arctichealth.org/en/permalink/ahliterature10200
Source
Respir Med. 2001 Jun;95(6):505-12
Publication Type
Article
Date
Jun-2001
Author
F. Andersson
E. Stahl
P J Barnes
C G Löfdahl
P M O'Byrne
R A Pauwels
D S Postma
A E Tattersfield
A. Ullman
Author Affiliation
AstraZeneca R&D Lund, Sweden. fredrik.l.andersson@astrazeneca.com
Source
Respir Med. 2001 Jun;95(6):505-12
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Aged
Anti-Asthmatic Agents - economics - therapeutic use
Asthma - drug therapy - economics
Budesonide - economics - therapeutic use
Cost Savings
Cost-Benefit Analysis
Drug Therapy, Combination
Ethanolamines - economics - therapeutic use
Great Britain
Health Care Costs
Humans
Middle Aged
Normal Distribution
Research Support, Non-U.S. Gov't
Spain
Sweden
Abstract
The FACET (Formoterol and Corticosteroid Establishing Therapy) study established that there is a clear clinical benefit in adding formoterol to budesonide therapy in patients who have persistent symptoms of asthma despite treatment with low to moderate doses of an inhaled corticosteroid. We combined the clinical results from the FACET study with an expert survey on average resource use in connection with mild and severe asthma exacerbations in the U.K., Sweden and Spain. The primary objective of this study was to assess the health economics of adding the inhaled long-acting beta2-agonist formoterol to the inhaled corticosteroid budesonide in the treatment of asthma. The extra costs of adding the inhaled beta2-agonist formoterol to the corticosteroid budesonide in asthmatic patients in Sweden were offset by savings from reduced use of resources for exacerbations. For Spain the picture was mixed. Adding formoterol to low dose budesonide generated savings, whereas for moderate doses of budesonide about 75% of the extra formoterol costs could be recouped. In the U.K., other savings offset about half of the extra cost of formoterol. All cost-effectiveness ratios are within accepted cost-effectiveness ranges reported from previous studies. If productivity losses were included, there were net savings in all three countries, ranging from Euro 267-1183 per patient per year. In conclusion, adding the inhaled, long-acting beta2-agonist formoterol to low-moderate doses of the inhaled corticosteroid budesonide generated significant gains in all outcome measures with partial or complete offset of costs. Adding formoterol to budesonide can thus be considered to be cost-effective.
PubMed ID
11421509 View in PubMed
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Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature22339
Source
Ann Oncol. 1997 Jan;8(1):65-70
Publication Type
Article
Date
Jan-1997
Author
J. Norum
B. Vonen
J A Olsen
A. Revhaug
Author Affiliation
Department of Oncology, University of Tromsø, Norway.
Source
Ann Oncol. 1997 Jan;8(1):65-70
Date
Jan-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols - economics - therapeutic use
Chemotherapy, Adjuvant - economics
Colorectal Neoplasms - drug therapy - economics - mortality - pathology - surgery
Colostomy
Cost-Benefit Analysis
Female
Fluorouracil - administration & dosage - economics
Follow-Up Studies
Health Care Costs
Humans
Length of Stay - economics
Levamisole - administration & dosage - economics
Male
Middle Aged
Norway - epidemiology
Quality of Life
Research Support, Non-U.S. Gov't
Survival Analysis
Survival Rate
Travel - economics
Abstract
BACKGROUND: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. PATIENTS AND METHODS: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. RESULTS: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by 3,369 pounds. The median QoL was 0.83 (0-1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted life-year (QALY) to be between 4,800 pounds and 16,800 pounds. CONCLUSION: Using a cut-off point level of 20,000 pounds per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5%. Adjuvant chemotherapy does not affect short-term QoL.
PubMed ID
9093709 View in PubMed
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Adjuvant cyclophosphamide, methotrexate, fluorouracil (CMF) in breast cancer--is it cost-effective?

https://arctichealth.org/en/permalink/ahliterature20056
Source
Acta Oncol. 2000;39(1):33-9
Publication Type
Article
Date
2000
Author
J. Norum
Author Affiliation
Department of Oncology, University Hospital of Tromsø, Norway. jannorum@fagmed.uit.no
Source
Acta Oncol. 2000;39(1):33-9
Date
2000
Language
English
Publication Type
Article
Keywords
Antineoplastic Combined Chemotherapy Protocols - economics - therapeutic use
Breast Neoplasms - drug therapy - economics
Chemotherapy, Adjuvant - economics
Cisplatin - administration & dosage - economics
Cost-Benefit Analysis
Female
Fluorouracil - administration & dosage - economics
Humans
Methotrexate - administration & dosage - economics
Middle Aged
Norway
Prognosis
Quality-Adjusted Life Years
Research Support, Non-U.S. Gov't
Abstract
Adjuvant chemotherapy (ACT) may expose patients to morbidity, with little gain in outcome. Treatment with CMF (cyclophosphamide, methotrexate, fluorouracil) has been the standard ACT in several countries for decades. In this model, efficacy, tolerability and quality of life data from the English-language literature were incorporated with Norwegian standard ACT practice and cost data in a cost-effectiveness/cost-utility approach. The CMF efficacy was calculated as 2.45 years saved per patient treated. The quality of life was assumed diminished by 0.33 (0-1 scale) for 6 months and the life years gained were valued Q = 0.86. An 85% dose intensity was employed, one British pound ( 1) was calculated as 12 NOK and a 5% discount rate was used. The total cost of adjuvant CMF, including amounts spent on drugs, administration, travelling and production loss, was calculated to 2365- 6253, depending on the method chosen. Money spent on drugs alone constituted 13-34%. The cost per life year saved was measured as 2170- 5737. A cost-utility approach revealed a cost per quality-adjusted life year (QALY) of 2973- 7860. Adjuvant CMF in breast cancer is cost-effective in Norway.
PubMed ID
10752651 View in PubMed
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Alcohol advice in primary health care--is it a wise use of resources?

https://arctichealth.org/en/permalink/ahliterature10882
Source
Health Policy. 1998 Jul;45(1):47-56
Publication Type
Article
Date
Jul-1998
Author
L. Lindholm
Author Affiliation
Umeå University, Sweden. Lars.Lindholm@epih.umu.se
Source
Health Policy. 1998 Jul;45(1):47-56
Date
Jul-1998
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alcohol Drinking - adverse effects - mortality - prevention & control
Cohort Studies
Comparative Study
Cost Savings
Cost-Benefit Analysis
Health Care Rationing - economics
Health Policy
Health Services Research
Humans
Middle Aged
Primary Health Care - economics
Quality of Life
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
Many attempts to calculate costs caused by the use of alcohol in accordance with the cost-of-illness method have been reported in the literature. However, in a decision-making perspective and with a focus on what possible interventions to undertake, cost-benefit or cost-effectiveness studies are more useful. In this study the cost-effectiveness of advice aimed at reducing 'heavy' drinking to 'moderate' drinking is calculated. Results from controlled trials, showing the short-range effects of advice, are combined with observations from long-term epidemiological studies showing the association between alcohol consumption and total mortality. This study shows that advice from primary health care staff has a potential to be a very cost-effective means of intervention. The crucial point seems to be the number of people that makes durable changes in consumption. If about 1% make lasting changes a brief intervention is relatively cost-effective (20,000 ECU/YLS), and if about 10% change resources will be saved in health care. Important effects such as increased quality of life and decreasing production losses are not taken into account.
PubMed ID
10183012 View in PubMed
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An economic analysis of screening for diabetic retinopathy.

https://arctichealth.org/en/permalink/ahliterature47596
Source
J Telemed Telecare. 2002;8(1):32-5
Publication Type
Article
Date
2002
Author
Siri Bjørvig
Monika A Johansen
Kristian Fossen
Author Affiliation
Norwegian Centre for Telemedicine, University Hospital of Tromsø, Norway. siri.bjorvig@telemed.no
Source
J Telemed Telecare. 2002;8(1):32-5
Date
2002
Language
English
Publication Type
Article
Keywords
Computer Communication Networks
Cost-Benefit Analysis
Diabetic Retinopathy - diagnosis - economics
Humans
Mass Screening - economics - methods
Norway
Research Support, Non-U.S. Gov't
Telemetry - economics
Abstract
The costs of telemedicine screening for diabetic retinopathy were examined in a trial conducted in northern Norway, involving the University Hospital of Tromsø (UHT) and the primary care centre in Alta, approximately 400 km away. In Alta, specially trained nurses examined 42 diabetic patients using a digital camera to obtain images of the retina. The images were then sent by email to an eye specialist at the UHT. A cost-minimization analysis showed that at low workloads, for example 20 patients per annum, telemedicine was more expensive than conventional examination: NKr8555 versus NKr428 per patient. However, at higher workloads, telemedicine was cheaper. For example, at 200 patients per annum, telemedicine cost NKr971 and conventional examination cost NKr1440 per patient. The break-even point occurred at a patient workload of 110 per annum. Given that there are some 250 diabetic patients in Alta, telemedicine screening is the cheaper service for the public sector.
PubMed ID
11809082 View in PubMed
Less detail
Source
Best Pract Res Clin Rheumatol. 2004 Apr;18(2):203-18
Publication Type
Article
Date
Apr-2004
Author
Joanne E Homik
Maria Suarez-Almazor
Author Affiliation
562 Heritage Medical Research Centre, University of Alberta, Edmonton, Alta. T6G 2S2, Canada. joanne.homik@ualberta.ca
Source
Best Pract Res Clin Rheumatol. 2004 Apr;18(2):203-18
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Anti-Inflammatory Agents, Non-Steroidal - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - economics
Cost-Benefit Analysis
Cyclooxygenase Inhibitors - economics - therapeutic use
Health Care Costs
Immunoglobulin G - economics - therapeutic use
Receptors, Tumor Necrosis Factor - therapeutic use
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Rheumatology - economics
Abstract
Economic analyses have the potential to put all of the positive and negative outcomes of an intervention into perspective to aid decision making. The quality of the data upon which the analysis is based has an impact on the resulting quality of the analysis itself. Analysis of cost-effectiveness requires the input of many types of data, and where data are not available, assumptions must be made. There are many instances where the analysis may go wrong, and it is important to remain cognizant of these. The critical parts of the analysis, which have also been identified in quality assessment tools, include the following: design of the study question, sources of probability estimates and cost data, sensitivity analysis, and the interpretation of results. If the readers are able to identify the assumptions of the analysis they are better equipped to judge the validity. We have reviewed economic analyses relating to two hot economic topics in rheumatology. These are the cost-effectiveness of cyclooxygenase-2 (COX-2) inhibitors for 'arthritis' and cost-effectiveness of anti-tumor necrosis factor alpha (anti-TNF) agents for rheumatoid arthritis (RA). The results of the COX-2 analyses vary by review. Some show cost savings, while others calculate a significant cost in order to achieve any change in quality of life. Given the unanswered questions that still exist, it seems reasonable to conclude that COX-2 inhibitors may be cost effective when used in patients at a high risk of GI complications. Unanswered questions remain regarding the concomitant use of low-dose ASA and proton pump inhibitors and how they may affect the results of these economic analyses. The cost-effectiveness of anti-TNF agents has not been explored in as much detail as that of the COX-2 agents. Two studies have presented cost-effectiveness models that include a hypothetical biologic agent. Two economic analyses report on the cost-effectiveness of etanercept compared with traditional disease-modifying anti-rheumatic drugs (DMARDs) in methotrexate-resistant and methotrexate-naïve patients with RA. Both the analyses show that etanercept has a cost-effectiveness ratio of around 40,000 US dollars for every patient who achieves an American College of Rheumatology 20% improvement score (ACR 20) within a 6-month period. A cost-utility analysis was published regarding the use of infliximab in methotrexate resistant RA. It showed a cost-utility ratio of 3400:34,000 Euro per quality adjusted life year (QALY) gained, depending on the country evaluated (Sweden and the UK, respectively). An important finding in all three studies was that indirect costs dominate costs in RA; therefore, they should be included in all future analyses of this disease.
PubMed ID
15121040 View in PubMed
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An economic evaluation of screening for Chlamydia trachomatis in adolescent males.

https://arctichealth.org/en/permalink/ahliterature75124
Source
JAMA. 1993 Nov 3;270(17):2057-64
Publication Type
Article
Date
Nov-3-1993
Author
M. Genç
L. Ruusuvaara
P A Mårdh
Author Affiliation
Uppsala University Centre for STD Research, Sweden.
Source
JAMA. 1993 Nov 3;270(17):2057-64
Date
Nov-3-1993
Language
English
Publication Type
Article
Keywords
Adolescent
Azithromycin - therapeutic use
Carboxylic Ester Hydrolases - urine
Chlamydia Infections - diagnosis - drug therapy - prevention & control - urine
Chlamydia trachomatis
Cost-Benefit Analysis
Decision Support Techniques
Doxycycline - therapeutic use
Humans
Immunoenzyme Techniques - economics
Male
Mass Screening - economics - methods
Research Support, Non-U.S. Gov't
Sweden
Abstract
OBJECTIVE--To assess the cost-effectiveness of identifying asymptomatic carriers of Chlamydia trachomatis among adolescent males. DESIGN--Cost-effectiveness analysis based on cohort analytic studies previously reported and average salaries and costs of medical care in Sweden. SETTING--Adolescent males attending a primary care center for routine health checks. PARTICIPANTS--Estimates of costs and benefits are based on a cohort of 1000 adolescent males and their female contacts. INTERVENTION--Screening with enzyme immunoassay (EIA), either on leukocyte esterase (LE)--positive urine samples (LE-EIA screening) or on all urine samples (EIA screening), was compared with no screening (no treatment or contact tracing). The effects of confirming positive EIA results with a blocking assay and alternative antibiotic regimens on the outcome of the screening strategies were also evaluated. RESULTS--Compared with no screening, the LE-EIA and EIA screening strategies reduced the overall costs when the prevalence of chlamydial infection in males exceeded 2% and 10%, respectively. Enzyme immunoassay screening achieved an overall cure rate that was 12.2% to 12.6% (95% confidence interval) better, but reduced the incremental savings by at least $2144 per cured male, in comparison with LE-EIA screening. Confirmation of positive EIA results reduced the overall cost of the LE-EIA screening strategy when the prevalence of C trachomatis among males was less than 8%. Compared with a 7-day course of doxycycline, a single oral dose of azithromycin administered under supervision in the clinic improved the cure rates of both EIA and LE-EIA screening strategies by 15.1% to 16.3% and 11.2% to 12.0%, respectively, while reducing the corresponding overall costs by 5% and 9%, respectively, regardless of the prevalence of chlamydial infection in males. CONCLUSION--The use of LE-EIA screening combined with treatment of positive cases with azithromycin was the most cost-effective intervention strategy focusing on asymptomatic male carriers of C trachomatis. Positive EIA results should be confirmed when screening low-risk populations.
Notes
Comment In: JAMA. 1993 Nov 3;270(17):2097-88411579
PubMed ID
8411572 View in PubMed
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173 records – page 1 of 18.