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Age-specific direct healthcare costs attributable to diabetes in a Swedish population: a register-based analysis.

https://arctichealth.org/en/permalink/ahliterature93267
Source
Diabet Med. 2008 Jun;25(6):732-7
Publication Type
Article
Date
Jun-2008
Author
Wiréhn A-B
Andersson A.
Ostgren C J
Carstensen J.
Author Affiliation
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. ann-britt.wirehn@lio.se
Source
Diabet Med. 2008 Jun;25(6):732-7
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Aged
Child
Child, Preschool
Cost-Benefit Analysis - economics - statistics & numerical data
Cross-Sectional Studies
Diabetes Mellitus - epidemiology - therapy
Female
Humans
Infant
Male
Middle Aged
Primary Health Care - economics
Registries
Sweden - epidemiology
Abstract
AIMS: The aim of this population-based study was to explore the age-specific additional direct healthcare cost for patients with diabetes compared with the non-diabetic population. METHODS: In 1999-2005, patients with diabetes in the Swedish county of Ostergötland (n = 20,876) were identified from an administrative database. Cost data on the healthcare expenditure in primary healthcare, out-patient hospital care and in-patient care for the entire county population (n = approximately 415,000) in 2005 were extracted from a cost per patient (CPP) database, which includes information on all utilized healthcare resources in the county. Data on drug sales were obtained from the Swedish Prescribed Drug Register. RESULTS: The cost per person was 1.8 times higher in patients with diabetes than in the non-diabetic population, 7.7 times higher in children and 1.3 times higher in subjects aged > 75 years. The additional cost per person for diabetes was euro 1971; euro 3930 and euro 1367, respectively, for children and subjects aged > 75 years. The proportion of total additional diabetes costs attributable to in-patient care increased with age from 25 to 50%; in-patient care was the most expensive component at all ages except in children, for whom visiting a specialist was most expensive. The diabetes-related segment of the total healthcare cost was 6.6%, increasing from 2.0% in children to 10.3% in the age group 65-74 years, declining to 6.2% in the oldest age group. CONCLUSIONS: The direct medical cost of diabetes varies considerably by age. Knowledge about the influence of age on healthcare costs to society will be important in future planning of diabetes management.
PubMed ID
18435778 View in PubMed
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An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials.

https://arctichealth.org/en/permalink/ahliterature80464
Source
Osteoporos Int. 2006 Dec;17(12):1781-93
Publication Type
Article
Date
Dec-2006
Author
Borgström F.
Jönsson B.
Ström O.
Kanis J A
Author Affiliation
Stockholm Health Economics, Vasagatan 38, 2nd floor, SE-111 21 Stockholm, Sweden. fredrik.b@healtheconomics.se
Source
Osteoporos Int. 2006 Dec;17(12):1781-93
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density Conservation Agents - economics - therapeutic use
Clinical Trials, Phase III
Cost-Benefit Analysis - economics
Female
Fractures, Bone - epidemiology - etiology
Health Care Costs
Humans
Markov Chains
Organometallic Compounds - economics - therapeutic use
Osteoporosis, Postmenopausal - drug therapy - economics - epidemiology
Quality of Life
Quality-Adjusted Life Years
Risk factors
Sweden - epidemiology
Thiophenes - economics - therapeutic use
Treatment Outcome
Abstract
INTRODUCTION: Strontium ranelate is a new therapy for the treatment and prevention of osteoporosis that has been shown in two phase III clinical trials (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and the Treatment Of Peripheral OSteoporosis Study [TROPOS] trials) to reduce the risk of osteoporotic fractures at the vertebral, non-vertebral and hip level in postmenopausal women. The aim of this study was to estimate the potential cost-effectiveness of strontium ranelate in the treatment of osteoporosis in postmenopausal Swedish patients. METHODS: A Markov cohort model was adapted to fit patients corresponding to the patients in the SOTI and TROPOS clinical trials. The model was populated with Swedish cost and epidemiological data. In the base case, the cost-effectiveness was estimated for 69-year old women with low bone mineral density (BMD) and prevalent vertebral fractures (SOTI) and for 77-year old women with low BMD (TROPOS). The cost-effectiveness analysis had a societal perspective. RESULTS: In the base case analysis, the cost per quality-adjusted life years (QALY) gained of strontium ranelate patients compared to no treatment patients was estimated at SEK 472,586 and SEK 259,643, including costs in added life years, based on the SOTI and the TROPOS trials, respectively. Excluding cost in added life years, the cost per QALY gained was estimated at SEK 336,420 (SOTI) and SEK 165,680 (TROPOS). In subgroup analyses, in patients 74 years and older with a T-score lower than -2.4 and patients older than 80 years of age, strontium ranelate was found to be cost saving compared to no treatment. CONCLUSIONS: The results in the base case analyses and the sensitivity analyses of this study indicate that, compared to no treatment, strontium ranelate is cost-effective in the treatment of postmenopausal women with low BMD.
PubMed ID
17009083 View in PubMed
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Assessing the health and economic impact of galantamine treatment in patients with Alzheimer's disease in the health care systems of different countries.

https://arctichealth.org/en/permalink/ahliterature179004
Source
Drugs Aging. 2004;21(10):677-86
Publication Type
Article
Date
2004
Author
Jaime Caro
Maribel Salas
Alexandra Ward
Denis Getsios
Kristen Migliaccio-Walle
Frances Garfield
Author Affiliation
Caro Research Institute, Concord, Massachusetts, USA.
Source
Drugs Aging. 2004;21(10):677-86
Date
2004
Language
English
Publication Type
Article
Keywords
Alzheimer Disease - drug therapy - economics
Australasia
Canada
Cost-Benefit Analysis - economics
Delivery of Health Care - economics
Europe
Galantamine - economics - therapeutic use
Humans
Long-Term Care - economics
Models, Economic
Placebos - economics
Abstract
Cholinesterase inhibitors have been shown to improve cognitive function and improve or maintain global function.
To estimate the long-term economic impact of treating patients with Alzheimer's disease with galantamine in seven healthcare systems: Australia, Canada, Finland, New Zealand, Sweden, the Netherlands and the UK.
The time until patients require full-time care (FTC), defined as the consistent requirement for a significant amount of care giving and supervision each day, and the associated costs were evaluated using the 'Assessment of Health Economics in Alzheimer's Disease (AHEAD)' model. Efficacy data were obtained from three clinical trials comparing galantamine with placebo and local cost and resource use data were determined for each country. Forecast costs reported in Euros (2001 value), were made for up to 10 years in each healthcare system. All costs were determined from a perspective somewhat broader than that of a comprehensive payer, including social services. Both benefits and costs were discounted at 3%.
Galantamine (16 mg/day) is predicted to delay the need for FTC by 6.8%, thus the cumulative cost of care over 10 years is expected to be reduced, and this offsets much or all of the cost of galantamine. Approximately five patients need to be treated to avoid 1 year of FTC. In each healthcare system, FTC was estimated to account for 61-92% of the cost. Savings were estimated for most of the countries. For those countries with an expected expense, there were reasonable costs per FTC month avoided (euro553, discounted) and costs per quality-adjusted life year gained (euro25,000).
In addition to the clinical benefits associated with galantamine treatment, the savings predicted from delaying FTC may offset the treatment costs.
PubMed ID
15287825 View in PubMed
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At what coronary risk level is it cost-effective to initiate cholesterol lowering drug treatment in primary prevention?

https://arctichealth.org/en/permalink/ahliterature52363
Source
Eur Heart J. 2001 Jun;22(11):919-25
Publication Type
Article
Date
Jun-2001
Author
M. Johannesson
Author Affiliation
Centre for Health Economics, Stockholm School of Economics, Stockholm, Sweden.
Source
Eur Heart J. 2001 Jun;22(11):919-25
Date
Jun-2001
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Antilipemic Agents - economics - therapeutic use
Comparative Study
Coronary Disease - drug therapy - economics - prevention & control
Cost-Benefit Analysis - economics - methods
Female
Humans
Male
Middle Aged
Risk factors
Sensitivity and specificity
Sex Factors
Sweden - epidemiology
Abstract
BACKGROUND: The entire risk factor profile should be taken into account when considering initiating cholesterol lowering drug treatment. Recent treatment guidelines are therefore based on the absolute risk of coronary heart disease. We estimated at what coronary risk it is cost-effective to initiate cholesterol lowering drug treatment in primary prevention for men and women of different ages in Sweden. METHODS: The cost-effectiveness was estimated as the incremental cost per quality-adjusted life-year (QALY) gained of cholesterol lowering drug treatment. Treatment was assumed to lower the risk of coronary heart disease by 31%. The analysis was carried out from a societal perspective including both direct and indirect costs of the intervention and morbidity, and the full future costs of decreased mortality. The coronary risk, in a Markov model of coronary heart disease, was raised until the cost per QALY gained corresponded to a specific threshold value per QALY gained. Three different threshold values were used: $40,000, $60,000 and $100,000 per QALY gained. RESULTS: The risk cut-off value for when treatment is cost-effective varied with age and gender. If society is willing to pay $60,000 to gain a QALY it was cost-effective to initiate treatment if the 5-year-risk of coronary heart disease exceeded 2.4% for 35-year-old men, 4.6% for 50-year-old men, and 10.4% for 70-year-old men. The corresponding risk cut-off values for women were 2.0%, 3.5% and 9.1%. CONCLUSIONS: The results can serve as a basis for treatment guidelines based on cost-effectiveness.
PubMed ID
11428815 View in PubMed
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Can cost-effectiveness analysis integrate concerns for equity? Systematic review.

https://arctichealth.org/en/permalink/ahliterature125304
Source
Int J Technol Assess Health Care. 2012 Apr;28(2):125-32
Publication Type
Article
Date
Apr-2012
Author
Mira Johri
Ole Frithjof Norheim
Author Affiliation
Departement of Health Administration, University of Montreal, Montreal, Canada. mira.johri@umontreal.ca
Source
Int J Technol Assess Health Care. 2012 Apr;28(2):125-32
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Canada
Cost-Benefit Analysis - economics - methods
Decision Support Techniques
Health Resources - economics - statistics & numerical data
Health Services Accessibility - economics - statistics & numerical data
Health Status Disparities
Humans
Quality-Adjusted Life Years
Social Justice - economics
Social Welfare
Abstract
The aim of this study was to promote approaches to health technology assessment (HTA) that are both evidence-based and values-based. We conducted a systematic review of published studies describing formal methods to consider equity in the context of cost-effectiveness analysis (CEA).
Candidate studies were identified through an unrestricted search of the Pub Med and EMBASE databases. The search closed on January 20, 2011. We identified additional studies by consulting experts and checking article bibliographies. Two authors independently reviewed each candidate study to determine inclusion and extracted data from studies retained for review. In addition to documenting methods, data extraction identified implicit and explicit notions of fairness. Data were synthesized in narrative form. Study quality was not assessed.
Of the 695 candidate articles, 51 were retained for review. We identified three broad methods to facilitate quantitative consideration of equity concerns in economic evaluation: integration of distributional concerns through equity weights and social welfare functions, exploration of the opportunity costs of alternative policy options through mathematical programming, and multi-criteria decision analysis.
Several viable techniques to integrate equity concerns within CEA now exist, ranging from descriptive approaches to the quantitative methods studied in this review. Two obstacles at the normative level have impeded their use in decision making to date: the multiplicity of concepts and values discussed under the rubric of equity, and the lack of a widely accepted normative source on which to ground controversial value choices. Clarification of equity concepts and attention to procedural fairness may strengthen use of these techniques in HTA decision making.
PubMed ID
22494637 View in PubMed
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Comparison of cost-effectiveness of tuberculosis screening of close contacts and foreign-born populations.

https://arctichealth.org/en/permalink/ahliterature196361
Source
Am J Respir Crit Care Med. 2000 Dec;162(6):2079-86
Publication Type
Article
Date
Dec-2000
Author
K. Dasgupta
K. Schwartzman
R. Marchand
T N Tennenbaum
P. Brassard
D. Menzies
Author Affiliation
Respiratory Epidemiology Unit, McGill University, Montreal, QC, Canada.
Source
Am J Respir Crit Care Med. 2000 Dec;162(6):2079-86
Date
Dec-2000
Language
English
Publication Type
Article
Keywords
Cohort Studies
Contact Tracing - economics - methods - statistics & numerical data
Cost-Benefit Analysis - economics - statistics & numerical data
Emigration and Immigration - statistics & numerical data
Humans
Markov Chains
Mass Screening - economics - methods - statistics & numerical data
Population Surveillance - methods
Prospective Studies
Quebec
Sensitivity and specificity
Treatment Outcome
Tuberculosis, Pulmonary - diagnosis - drug therapy - economics - transmission
Abstract
Although tuberculosis (TB) screening of immigrants has been conducted for over 50 yr in many industrialized countries, its cost- effectiveness has never been evaluated. We prospectively compared the yield and cost-effectiveness of two immigrant TB screening programs, using close-contact investigation and passive case detection. Study subjects included all immigration applicants undergoing radiographic screening, already arrived immigrants requiring surveillance for inactive TB, and close contacts of active cases resident in Montreal, Quebec, Canada, who were referred from June 1996 to June 1997 to the Montreal Chest Institute (MCI), a referral center specializing in respiratory diseases. For all subjects seen, demographic data, investigations, diagnoses, and therapy were abstracted from administrative data bases and medical charts. Estimated costs of detecting and treating each prevalent active case and preventing future active cases, based on federal and provincial health reimbursement schedules, were compared with the costs for passively diagnosed cases of active TB. Over a period of 1 yr, the three programs detected 27 cases of prevalent active TB and prevented 14 future cases. As compared with passive case detection, close-contact investigation resulted in net savings of $815 for each prevalent active case detected and treated and of $2,186 for each future active case prevented. The incremental cost to treat each case of prevalent active TB was $39,409 for applicant screening and $24,225 for surveillance, and the cost of preventing each case was $33,275 for applicants and $65,126 for surveillance. Close-contact investigation was highly cost effective and resulted in net savings. Immigrant applicant screening and surveillance programs had a significant impact but were much less cost effective, in large part because of substantial operational problems.
Notes
Comment In: Am J Respir Crit Care Med. 2001 Jan;163(1):1-211208612
PubMed ID
11112118 View in PubMed
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Cost-effectiveness and accuracy of prenatal Down syndrome screening strategies: should the combined test continue to be widely used?

https://arctichealth.org/en/permalink/ahliterature139334
Source
Am J Obstet Gynecol. 2011 Feb;204(2):175.e1-8
Publication Type
Article
Date
Feb-2011
Author
Jean Gekas
Audrey Durand
Emmanuel Bujold
Maud Vallée
Jean-Claude Forest
François Rousseau
Daniel Reinharz
Author Affiliation
Laboratoire de Simulations des Dépistages, Unité de Diagnostic Prénatal, Service de Génétique Médicale, Québec City, Québec, Canada. jean.gekas@mail.chuq.qc.ca
Source
Am J Obstet Gynecol. 2011 Feb;204(2):175.e1-8
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Canada
Computer simulation
Cost-Benefit Analysis - economics
Down Syndrome - diagnosis - economics
Female
Humans
Mass Screening - economics
Pregnancy
Pregnancy Trimester, First
Pregnancy Trimester, Second
Prenatal Care - economics
Prenatal Diagnosis - economics
Abstract
We analyzed the cost-effectiveness (CE) and performances of commonly used prenatal Down syndrome (DS) screening strategies.
We performed computer simulations to compare 8 screening options by applying empirical data from Serum, Urine, and Ultrasound Screening Study trials on the population of 110,948 pregnancies. Screening strategies outcomes, CE ratios, and incremental CE ratios were measured.
The most CE DS screening strategy was the contingent screening method (CE ratio of Can$26,833 per DS case). Its incremental CE ratio compared to the second-most CE strategy (serum integrated screening) was Can$3815 per DS birth detected. Among the procedures respecting guidelines, our results identified the combined test as the screening strategy with the highest CE ratio (Can$47,358) and the highest number of procedure-related euploid miscarriages (n = 71).
In regard to CE, contingent screening is the best choice. The combined test, which is the most popular screening strategy, shows many limitations.
PubMed ID
21074138 View in PubMed
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"Cost-effectiveness" estimates result in flawed decision-making in listing drugs for reimbursement.

https://arctichealth.org/en/permalink/ahliterature187673
Source
Can J Public Health. 2002 Nov-Dec;93(6):421-5
Publication Type
Article
Author
Roy West
E Keith Borden
Jean-Paul Collet
Nigel S B Rawson
Robert S Tonks
Author Affiliation
Division of Community Health, Memorial University of Newfoundland, Health Sciences Centre, St. John's, NF A1B 3V6. roywest@mun.ca
Source
Can J Public Health. 2002 Nov-Dec;93(6):421-5
Language
English
Publication Type
Article
Keywords
Canada
Cost-Benefit Analysis - economics
Decision Making
Drug Costs
Economics, Pharmaceutical
Humans
Insurance, Health, Reimbursement - economics
Questionnaires
Abstract
Facing financial pressures, the provinces and territories have chosen to use "cost-effectiveness" for making decisions about drug listings. This study examines the scientific basis for the procedures used to determine cost-effectiveness in 5 Canadian provinces.
Questionnaires were mailed to key provincial informants asking about the respondent's expertise and role, the administrative and scientific basis for decision-making, organizational structures and other factors in the scientific evaluation and decision-making process, and the transparency of the process. There were also questions about the data required and received and their importance, the place of cost-effectiveness and other economic impact evaluations, the data sources for them, and the use of follow-up monitoring to evaluate the decisions made.
Information required by the provinces for decision-making about cost-effectiveness is not available to them at the time of their decisions about listing new medications. The primary sources of data on both efficacy and cost-effectiveness are pharmaceutical companies. Efficacy information is generated in a scientifically rigorous manner, whereas the effectiveness and cost data are estimates potentially subject to biases and evaluated by judgement (expert opinion) alone. Moreover, there is no collaboration in the assessment process between provinces. The outcomes are large differences between provinces in the decisions made and, hence, in the pharmaceuticals accessible to residents.
Current methods for making decisions about provincial drug listings are based on inadequate data, and the lack of consistency in the provinces' decisions suggest they may be scientifically flawed. We recommend establishing a single national scientific review committee, with re-evaluation of each drug's cost-effectiveness after a suitable period of monitored use.
PubMed ID
12448863 View in PubMed
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Cost effectiveness of alendronate for the treatment of male osteoporosis in Sweden.

https://arctichealth.org/en/permalink/ahliterature70999
Source
Bone. 2004 Jun;34(6):1064-71
Publication Type
Article
Date
Jun-2004
Author
Fredrik Borgström
Olof Johnell
Bengt Jönsson
Niklas Zethraeus
Shuvayu S Sen
Author Affiliation
Stockholm Health Economics, Sweden. frederick.b@healtheconomics.se
Source
Bone. 2004 Jun;34(6):1064-71
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alendronate - economics - therapeutic use
Cost-Benefit Analysis - economics - statistics & numerical data
Humans
Male
Markov Chains
Middle Aged
Osteoporosis - drug therapy - economics - epidemiology
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
BACKGROUND: One third of all the hip fractures occur in men. The risk for mortality following hip fracture is higher for men compared to women. The Fracture Intervention Trial (FIT) showed that the bisphosphonate alendronate reduces the risk of fractures and increases bone mineral density (BMD) in osteoporotic women. Similar effects of alendronate were observed in men in some other trials. There are also results demonstrating alendronate to be cost-effective in the treatment of osteoporosis in women. OBJECTIVE: To investigate the cost effectiveness of alendronate for male osteoporosis in Sweden by assuming the same relative risk reduction of fractures in men as for women, based on the FIT trial. DESIGN: A Markov model earlier used to analyze cost effectiveness of alendronate in treatment of postmenopausal osteoporosis in Sweden was adapted to fit a cohort of Swedish men. Cost effectiveness of alendronate vs. no treatment was assessed by transitioning men in the model over time between different health states. TIME HORIZON: The patients were followed from start of intervention until 100 years of age or death. In the base-case alendronate was assumed to have a fracture-risk-reducing effect for 10 years; a treatment duration period of 5 years followed by a 5-year period where the effect declined linearly to zero. RESULTS: Taking a societal perspective treating a 71-year-old man (mean age in the FIT) with low BMD and prior vertebral fracture (VFA) with alendronate was found to be associated with a cost of 14,843 per quality adjusted life year (QALY) gained. CONCLUSIONS: The results in this study indicate that treating osteoporotic men with alendronate was projected to be cost-effective, under the assumption of the same fracture-risk-reducing effect of alendronate for men as for women.
PubMed ID
15193554 View in PubMed
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Cost-effectiveness of an invasive strategy in unstable coronary artery disease; results from the FRISC II invasive trial. The Fast Revascularisation during InStability in Coronary artery disease.

https://arctichealth.org/en/permalink/ahliterature192308
Source
Eur Heart J. 2002 Jan;23(1):31-40
Publication Type
Article
Date
Jan-2002
Author
M. Janzon
L A Levin
E. Swahn
Author Affiliation
Institution of Medicine and Care, Linköping University, Sweden
Source
Eur Heart J. 2002 Jan;23(1):31-40
Date
Jan-2002
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care - economics
Coronary Artery Disease - complications - economics - mortality
Cost-Benefit Analysis - economics
Electrocardiography - economics
Endpoint Determination
Female
Fibrinolytic Agents - economics - therapeutic use
Follow-Up Studies
Health Care Costs
Hospitalization - economics
Humans
Male
Myocardial Infarction - complications - economics - mortality
Platelet Glycoprotein GPIIb-IIIa Complex - economics - therapeutic use
Prospective Studies
Scandinavia - epidemiology
Sensitivity and specificity
Survival Analysis
Ventricular Function, Left - physiology
Abstract
The utilization and timing of revascularization in unstable coronary artery disease varies, which could have important consequences for patients and for treatment costs. The FRISC II invasive trial compared an early invasive strategy vs a non-invasive strategy with respect to the composite end-point of death and myocardial infarction as well as costs.
A total of 2457 patients, median age 66 years, comprising 70% men, were randomized. We prospectively recorded the patients' use of the health service. The results were analysed in a societal perspective. There was a significant 1.7% absolute reduction in deaths and a 3.7% absolute reduction in deaths and myocardial infarctions in the invasive compared to the non-invasive group after 12 months. During the initial hospitalization a patient in the invasive group spent on average 3.9 more days in hospital than a patient in the non-invasive group. Opposite results were found for rehospitalizations. The difference in mean total costs is SEK 23 876 (P
Notes
Comment In: Eur Heart J. 2002 Jan;23(1):1-311741352
Comment In: Eur Heart J. 2002 Oct;23(20):1634; author reply 1634-512323166
PubMed ID
11741360 View in PubMed
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43 records – page 1 of 5.