Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Norrbacka, SE-171 76, Stockholm, Sweden. kristina.burstrom@smd.sll.se
Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996-1997 Survey of Living Conditions, interviews with a representative sample (16-84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.
The aim of this study was to investigate whether any consistent pattern exists with respect to the cost-effectiveness of hypertension treatment and age, based on the results of randomized drug trials. Data about age, entry diastolic blood pressure, and relative risks of coronary heart disease (CHD) and stroke from 19 randomized trials were used to derive point estimates of the cost-effectiveness of each trial. The relationship between age and cost per life-year gained was then estimated by regression analysis, controlling for entry diastolic blood pressure. The regression analysis shows a statistically significant average decrease in the cost per life-year gained of about SEK 15,000 per year of older age for both men and women ($1 = SEK 6). Sensitivity analysis showed that the improvement in cost-effectiveness with age was stable towards various assumptions, but that the magnitude of the improvement varied greatly with the discount rate. Based on the results of randomized drug trials, it is concluded that the cost-effectiveness of hypertension treatment improves with patient age for both men and women.
We estimate the income-related inequality in Sweden with respect to life-years and quality-adjusted life-years (QALYs). We use a large data set from Sweden with over 40,000 individuals followed up for 10-16 years, to estimate the survival and quality-adjusted survival in different income groups. For both life-years and QALYs, we discover inequalities in health favouring the higher income groups. For men (women) in the youngest age-group (20-29 years), the number of QALYs is 43.7 (45.7) in the lowest income decile and 47.2 (49.0) in the highest income decile.
The severity of lung disease in cystic fibrosis (CF) may be related to the type of mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, and to environmental and immunological factors. Since pulmonary disease is the main determinant of morbidity and mortality in CF, it is important to identify factors that can explain and predict this variation. The aim of this longitudinal study of the whole Swedish CF population over age 7 years was to correlate genetic and clinical data with the rate of decline in pulmonary function. The statistical analysis was performed using the mixed model regression method, supplemented with calculation of relative risks for severe lung disease in age cohorts.The severity of pulmonary disease was to some extent predicted by CFTR genotype. Furthermore, the present investigation is the first long-term study showing a significantly more rapid deterioration of lung function in patients with concomitant diabetes mellitus. Besides diabetes mellitus, pancreatic insufficiency and chronic Pseudomonas colonization were found to be negative predictors of pulmonary function. In contrast to several other reports, we found no significant differences in lung function between genders. Patients with pancreatic sufficiency have no or only a slight decline of lung function with age once treatment is started, but an early diagnosis in this group is desirable.
Health-related quality of life (HRQoL) measured on population level may be useful to guide policies for health. This study aims to describe the HRQoL; in EQ-5D dimensions, mean rating scale (RS) scores and mean EQ-5D index values, in the general population, by certain disease and socio-economic groups, in Stockholm County 1998. The EQ-5D self-classifier and a RS were included in the 1998 cross-sectional postal Stockholm County public health survey to a representative sample (n = 4950, 20-88 years), 63% response rate. Mean RS score ranged from 0.90 (20-29 years) to 0.69 (80-88 years), mean EQ-5D index value ranged from 0.89 (20-29 years) to 0.74 (80-88 years). For different diseases mean RS scores ranged from 0.80 (asthma) to 0.69 (angina pectoris), mean EQ-5D index values ranged from 0.79 (asthma) to 0.66 (low back pain). The mean health state scores (RS and EQ-5D index) were 0.06 lower in the unskilled manual group than in the higher non-manual group after controlling for age and sex (p
A measurement experiment regarding willingness to pay for antihypertensive therapy is reported. A new type of binary willingness to pay question is used, that allows for different degrees of certainty with respect to the responses. Mean willingness to pay is derived from a simple expected utility model and estimated using maximum likelihood methods. The estimated parameters are highly significant, with predicted signs, and imply a mean willingness to pay of about SEK 800 ($130) per month. The explanatory power of the equation that only includes 'certain' yes/no responses is, as expected, much higher than that of the equation where only 'uncertain' responses are included.
In this methodological study the results of a Swedish pilot study about willingness to pay for antihypertensive therapy are presented. The aim of the study was to test the feasibility of the contingent valuation (CV) method in this area. Open-ended and discrete CV questions were compared in a mail questionnaire. The open-ended CV question did not work well. The answers to the discrete question, analysed by logistic regression analysis, indicated a willingness to pay in the range SEK 2500-5000 per year for antihypertensive therapy. Further studies should be undertaken to explore the reliability and the validity of the CV method.
OBJECTIVE: To measure the willingness to pay for a reduction in the number of micturitions and urinary leakages for patients with urge incontinence. PATIENTS AND METHODS: A self-administered questionnaire with a binary willingness-to-pay question was administered to 541 patients in Sweden with urge or mixed incontinence; 461 questionnaires were returned. The reduction in micturitions and urinary leakages valued in the willingness-to-pay question was varied randomly between 25% and 50% in two different subsamples. Information was also collected about the number of micturitions and urinary leakage, health-related quality of life and socio-economic characteristics of the patients in the study. RESULTS: Quality of life was significantly related to the severity of the symptoms and was worse than that of the sex- and age-matched general Swedish population. The median (mean) willingness to pay per month was 240 (530) Swedish krona (SEK, 1 Pound = SEK 11.50) for a 25% reduction in micturitions and leakages and SEK 470 (1030) for a 50% reduction in micturitions and leakages. As hypothesized, the willingness to pay was significantly related to the size of the reduction in micturitions and leakages, the initial number of micturitions and leakages, and income. CONCLUSIONS: Patients with incontinence problems are willing to pay substantial amounts for a reduction in the number of micturitions and leakages.
To compare the costs of health care programs, with the benefits, the values of changes in health status must be expressed in monetary terms. The development of methods to estimate willingness to pay for changes in health status is therefore of interest. This paper reports the results of a contingent valuation study measuring willingness to pay for reductions in angina pectoris attacks. An innovative study design allowed analysis on the data on willingness to pay using two approaches, a binary question and a bidding-game technique. Percentage reductions in anginal attacks were varied randomly in different subsamples, and data were collected about angina pectoris status, attack rate, and income to test the internal validity of the contingent valuation method. Willingness to pay for a 50% reduction in the attack rate for three months was estimated to be about SEK 2,500 ($345) with the binary approach, and about SEK 2,100 ($290) using the bidding-game technique. Regression analyses showed that income, angina pectoris status, attack rate, and percentage reduction in attack rate were all related to willingness to pay, in agreement with the authors' hypothesis.
