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Cost-effectiveness of a health intervention program with risk reductions for getting demented: results of a Markov model in a Swedish/Finnish setting.

https://arctichealth.org/en/permalink/ahliterature133388
Source
J Alzheimers Dis. 2011;26(4):735-44
Publication Type
Article
Date
2011
Author
Yanlei Zhang
Miia Kivipelto
Alina Solomon
Anders Wimo
Author Affiliation
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Source
J Alzheimers Dis. 2011;26(4):735-44
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Aging - psychology
Cost-Benefit Analysis
Data Interpretation, Statistical
Dementia - economics - mortality - prevention & control
Early Medical Intervention - economics
Finland - epidemiology
Health Care Costs
Humans
Markov Chains
Models, Statistical
Monte Carlo Method
Quality-Adjusted Life Years
Risk assessment
Risk Reduction Behavior
Sweden - epidemiology
Abstract
Risk scores based on modifiable factors have recently been developed for dementia. This study aims to estimate the cost-effectiveness of a potential preventive intervention program meant to lower the score related to increased dementia risk. Analyses were based on a Markov model adapted to Swedish circumstances. Risk score categories and risk probabilities were derived from the Cardiovascular Risk Factors, Aging and Incidence of Dementia (CAIDE) study in Finland. Figures of costs, utilities, and mortality were obtained from literature or databases. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to investigate the robustness of the model and to identify which model inputs had most impact on the results. In the base case, the usual care had a cost of 621,000 SEK and utilities of 11.8438 quality-adjusted life year (QALYs). The intervention had a cost of 599, 026 SEK and utilities of 11.8950 QALYs. The cost was 21,974 SEK lower in the intervention with 0.0511 QALYs gained over a 20 years horizon, indicating absolute dominance. The support for cost-effectiveness was insensitive to changes in the value of QALY for demented, mortality, and risk of dementia. If the intervention program was assumed to run every year, the incremental cost-effectiveness ratio did not show absolute dominance but was still under the willingness-to-pay level. The probabilistic sensitivity analysis indicated cost effectiveness in 67% of the samplings given a willingness-to-pay level of 600,000 SEK/year. This is a promising outlook for future research on preventive interventions in dementia, emphasizing the need of conducting multi-domain randomized trials.
PubMed ID
21709377 View in PubMed
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Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

https://arctichealth.org/en/permalink/ahliterature118731
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Publication Type
Article
Date
Jan-2013
Author
Lene Halling Hastrup
Christian Kronborg
Mette Bertelsen
Pia Jeppesen
Per Jorgensen
Lone Petersen
Anne Thorup
Erik Simonsen
Merete Nordentoft
Author Affiliation
Region Zealand, Psychiatric Research Unit, Roskilde, Denmark. lhhs@regionsjaelland.dk
Source
Br J Psychiatry. 2013 Jan;202(1):35-41
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antipsychotic Agents - therapeutic use
Community Mental Health Services - economics - organization & administration
Cost-Benefit Analysis
Denmark
Diagnosis-Related Groups - economics
Early Medical Intervention - economics
Family Therapy - economics
Health Care Costs - statistics & numerical data
Health Services - utilization
Humans
Intention to Treat Analysis
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Care Team - economics
Patient Education as Topic - economics
Psychotic Disorders - economics - therapy
Schizophrenia - economics - therapy
Single-Blind Method
Socialization
Young Adult
Abstract
Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited.
To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment.
An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken.
The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%.
The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.
PubMed ID
23174515 View in PubMed
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Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective: results from a prospective intervention study.

https://arctichealth.org/en/permalink/ahliterature283694
Source
Br J Cancer. 2016 Sep 27;115(7):770-5
Publication Type
Article
Date
Sep-27-2016
Author
Fredrik Liedberg
Ulf Gerdtham
Katarina Gralén
Sigurdur Gudjonsson
Staffan Jahnson
Irene Johansson
Oskar Hagberg
Staffan Larsson
Anna-Karin Lind
Annica Löfgren
Jenny Wanegård
Hanna Åberg
Mef Nilbert
Source
Br J Cancer. 2016 Sep 27;115(7):770-5
Date
Sep-27-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Catchment Area (Health)
Cost-Benefit Analysis
Creatinine - blood
Cystoscopy
Delayed Diagnosis - economics
Early Detection of Cancer - economics
Early Medical Intervention - economics
Female
Health Care Costs
Hematuria - diagnosis - economics - etiology - nursing
Hotlines
Humans
Interviews as Topic
Male
Middle Aged
Program Evaluation
Prospective Studies
Referral and Consultation
Sweden - epidemiology
Time-to-Treatment
Urinary Bladder Neoplasms - diagnosis - economics - epidemiology - surgery
Urology - organization & administration
Abstract
The delay between onset of macroscopic haematuria and diagnosis of bladder cancer is often long.
We evaluated timely diagnosis and health-care costs for patients with macroscopic haematuria given fast-track access to diagnostics. During a 15-month period, a telephone hotline for fast-track diagnostics was provided in nine Swedish municipalities for patients aged ?50 years with macroscopic haematuria. The control group comprised 101 patients diagnosed with bladder cancer in the same catchment area with macroscopic haematuria who underwent regular diagnostic process.
In all 275 patients who called 'the Red Phone' hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14-104) days and 50 (IQR 27-165) days in the intervention and the control group, respectively (P=0.03). The median health-care costs were lower in the intervention group (655 (IQR 655-655) EUR) than in the control group (767 (IQR 490-1096) EUR) (P=0.002).
Direct access to urologic expertise and fast-track diagnostics is motivated for patients with macroscopic haematuria to reduce diagnostic intervals and lower health-care expenditures.
Notes
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PubMed ID
27560554 View in PubMed
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