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Willis M.,Swedish Institute for Health Economics | Asseburg C.,ESiOR Oy | He J.,Janssen Global Services LLC
Journal of Medical Economics | Year: 2013

Objective: This study constructed the Economic and Health Outcomes Model for type 2 diabetes mellitus (ECHO-T2DM), a long-term stochastic microsimulation model, to predict the costs and health outcomes in patients with T2DM. Naturally, the usefulness of the model depends upon its predictive accuracy. The objective of this work is to present results of a formal validation exercise of ECHO-T2DM. Methods: The validity of ECHO-T2DM was assessed using criteria recommended by the International Society for Pharmacoeconomics and Outcomes Research/Society for Medical Decision Making (ISPOR/SMDM). Specifically, the results of a number of clinical trials were predicted and compared with observed study end-points using a scatterplot and regression approach. An F-test of the best-fitting regression was added to assess whether it differs statistically from the identity (45°) line defining perfect predictions. In addition to testing the full model using all of the validation study data, tests were also performed of microvascular, macrovascular, and survival outcomes separately. The validation tests were also performed separately by type of data (used vs not used to construct the model, economic simulations, and treatment effects). Results: The intercept and slope coefficients of the best-fitting regression line between the predicted outcomes and corresponding trial end-points in the main analysis were -0.0011 and 1.067, respectively, and the R2 was 0.95. A formal F-test of no difference between the fitted line and the identity line could not be rejected (p=0.16). The high R2 confirms that the data points are closely (and linearly) associated with the fitted regression line. Additional analyses identified that disagreement was highest for macrovascular end-points, for which the intercept and slope coefficients were 0.0095 and 1.225, respectively. The R2 was 0.95 and the estimated intercept and slope coefficients were 0.017 and 1.048, respectively, for mortality, and the F-test was narrowly rejected (p=0.04). The sub-set of microvascular end-points showed some tendency to over-predict (the slope coefficient was 1.095), although concordance between predictions and observed values could not be rejected (p=0.16). Limitations: Important study limitations include: (1) data availability limited one to tests based on end-of-study outcomes rather than time-varying outcomes during the studies analyzed; (2) complex inclusion and exclusion criteria in two studies were difficult to replicate; (3) some of the studies were older and reflect outdated treatment patterns; and (4) the authors were unable to identify published data on resource use and costs of T2DM suitable for testing the validity of the economic calculations. Conclusions: Using conventional methods, ECHO-T2DM simulated the treatment, progression, and patient outcomes observed in important clinical trials with an accuracy consistent with other well-accepted models. Macrovascular outcomes were over-predicted, which is common in health-economic models of diabetes (and may be related to a general over-prediction of event rates in the United Kingdom Prospective Diabetes Study [UKPDS] Outcomes Model). Work is underway in ECHO-T2DM to incorporate new risk equations to improve model prediction. © 2013 All rights reserved: reproduction in whole or part not permitted.


Norlin J.M.,Umeå University | Norlin J.M.,Swedish Institute for Health Economics | Steen Carlsson K.,Swedish Institute for Health Economics | Steen Carlsson K.,Skåne University Hospital | And 3 more authors.
British Journal of Dermatology | Year: 2012

Background As moderate to severe psoriasis is a systemic disease with large effects on health-related quality of life, generic measures that include overall health, not only skin involvement, are necessary. Knowledge about the relationship between the generic preference-based EuroQol 5D (EQ-5D) and dermatology-specific measures in psoriasis is limited. Objectives To analyse EQ-5D, the Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI) in patients with moderate to severe psoriasis in Swedish clinical practice by demographic characteristics, to compare EQ-5D among patients vs. Swedish population values, and to analyse the relationships between EQ-5D, DLQI and PASI. Methods This observational cohort study was based on PsoReg, the Swedish National Registry for Systemic Treatment of Psoriasis. EQ-5D was compared among patients with psoriasis vs. a defined general population in Sweden, retrieved from a previous study. Relationships between measures were examined with correlation tests and regression analysis. Results In total, 2450 patients (1479 men and 971 women) were included. Median EQ-5D, DLQI and PASI scores were 0·769, 4 and 4·7, respectively. Patients with psoriasis had a significantly lower EQ-5D compared with the defined general population. EQ-5D correlated moderately with DLQI (-0·55) and weakly with PASI (-0·25) (P < 0·001). Conclusions When assessing psoriasis treatments and making decisions about treatment guidelines and resource allocation, EQ-5D, DLQI and PASI provide a useful set of complementary tools, answering to different needs. If EQ-5D is not included in the original trial the second-best option in cost-effectiveness studies is to use mapping between DLQI and EQ-5D. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.


Persson U.,Lund University | Persson U.,Swedish Institute for Health Economics | Svensson J.,Swedish Institute for Health Economics | Pettersson B.,Sharp and Dohme MSD
Applied Health Economics and Health Policy | Year: 2012

Sweden has experienced a national value-based pricing (VBP) system for innovative outpatient drugs operated by the Pharmaceutical Benefits Board LFN (now called the Dental and Pharmaceutical Benefits agency TLV) since 2002. VBP has the character of a monopoly system, leading to reimbursement decisions where usage of new medicines is limited to subgroups and not the population for which the drug is approved. VBP relies on a broad societal perspective, encouraging innovations by signaling to firms that value-adding treatments are demanded. However, the VBP system is operated without a drug budget responsibility. The budget responsibility lies at the regional level, not operating VBP, thus an intrinsic conflict is built into the system.The aim of this article is to suggest a modification to the current reimbursement system in Sweden where payment for pharmaceuticals is split between the regional and national levels. The system is expected to make new innovative pharmaceuticals accessible to a larger number of patients and provide more consumer surplus without reducing the producer surplus. In short, the county councils pay the marginal cost of production while the state pays for the innovation. © 2012 Springer International Publishing AG. All rights reserved.


Ghatnekar O.,Swedish Institute for Health Economics | Hjalte F.,Swedish Institute for Health Economics | Taylor M.,University of York
Acta Oncologica | Year: 2010

Background. Chronic myeloid leukemia (CML) is a progressive disease, consisting of three phases, chronic, accelerated and blast phase. Treatment with imatinib has demonstrated high response rates and improved prognosis for patients with CML. The emergence of imatinib resistance is a major concern. Dasatinib is an oral kinase inhibitor of BCR-ABL that has been developed for treating CML patients across all phases of disease who are resistant or intolerant to imatinib. Objectives. The objective of this study was to assess the cost-effectiveness of dasatinib versus high-dose imatinib treatment in chronic phase CML patients, resistant to lower doses of imatinib (≤600 mg) in Sweden. Methods and data. A Markov simulation model was adapted to Swedish treatment practice. The model was populated with efficacy data from clinical trials, resource utilisation by expert opinion, published quality of life data and unit prices from official price lists. A life-long, societal perspective was used and sensitivity analyses were performed to test the robustness of the results. Results. The results showed that chronic phase CML patients resistant to standard dose imatinib gain on average 0.67 life-years, or 0.62 quality adjusted life-years, when treated with dasatinib 140 mg/day compared with high-dose imatinib 800 mg/day. The incremental societal cost amounts to EUR 4 250 during the lifetime period, or EUR6880 per QALY gained. Conclusion. The results indicate that dasatinib is a cost-effective treatment among imatinib-resistant CML patients in Sweden in comparison to imatinib 800 mg/daily. © 2010 Informa UK Ltd.


Steen Carlsson K.,Swedish Institute for Health Economics | Persson U.,Swedish Institute for Health Economics
Journal of Medical Economics | Year: 2014

Objective: To evaluate long-run cost-effectiveness in a Swedish setting for liraglutide compared with sulphonylureas (glimepiride) or sitagliptin, all as add-on to metformin for patients with type 2 diabetes insufficiently controlled with metformin in monotherapy. Methods: The IHE Cohort Model of Type 2 Diabetes was used to evaluate clinical and economic outcomes from a societal perspective. Model input data were obtained from two clinical trials, the Swedish National Diabetes Register and the literature. Cost data reflected year 2013 price level. The robustness of results was checked with one-way-sensitivity analysis and probability sensitivity analysis. Results: The cost per QALY gained for liraglutide (1.2 mg) compared to SU (glimepiride 4 mg), both as add-on to metformin, ranged from SEK 226,000 to SEK 255,000 in analyzed patient cohorts. The cost per QALY for liraglutide (1.2 mg) vs sitagliptin (100 mg) as second-line treatment was lower, ranging from SEK 149,000 to SEK 161,000. Costs of preventive treatment were driving costs, but there was also a cost offset from reduced costs of complications of ∼20%. Notable cost differences were found for nephropathy, stroke, and heart failure. The predicted life expectancy with liraglutide increased the cost of net consumption for liraglutide. Limitations: The analysis was an ex-ante analysis using model input data from clinical trials which may not reflect effectiveness in real-world clinical practice in broader patient populations. This limitation was explored in the sensitivity analysis. The lack of specific data on loss of production due to diabetes complications implied that these costs may be under-estimated. Conclusions: Treatment strategies with liraglutide 1.2 mg improved the expected quality-of-life and increased costs when compared to SU and to sitagliptin for second-line add-on treatments. The cost per QALY for liraglutide was in the range considered medium by Swedish authorities. © 2014 Informa UK Ltd.


Ghatnekar O.,Swedish Institute for Health Economics | Bondesson A.,County of Skane | Persson U.,Swedish Institute for Health Economics | Eriksson T.,Lund University
BMJ Open | Year: 2013

Objective: To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits. Method: Published data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature. Results: The total cost for the LIMM model was €290 compared to €630 for standard care, in spite of a €39 intervention cost. The main cost offset arose from avoided drug-related readmissions in the Admission part (€262) whereas only €66 was offset in the Discharge part as a result of fewer outpatient visits and correction time. The reduced disutility was estimated to 0.005 quality-adjusted life-years (QALY), indicating that LIMM was a dominant alternative. The probability that the intervention would be cost-effective at a zero willingness to pay for a gained QALY compared to standard care was estimated to 98%. Conclusions: The LIMM medication reconciliation (at admission and discharge) and medication review was both cost-saving and generated greater utility compared to standard care, foremost owing to avoided drug-related hospital readmissions. When implementing such a review process with a multidisciplinary team, it may be important to consider a learning curve in order to capture the full advantage.


Hjalte F.,Swedish Institute for Health Economics | Asseburg C.,Swedish Institute for Health Economics | Tennvall G.R.,Swedish Institute for Health Economics
Journal of the European Academy of Dermatology and Venereology | Year: 2010

Background Atopic dermatitis (AD) affects health and quality of life and it has great impact on both health-care costs and costs to the society. Objectives The objective of this study was to develop a model to analyse the cost-effectiveness of a barrier-strengthening moisturizing cream as maintenance therapy compared with no treatment after initial treatment with betamethasone valerate in adult patients with AD in Sweden. A further aim was to apply a similar health-economic analysis for Denmark, Norway and Finland. Methods A Markov simulation model was developed including data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate AD treated with either a moisturizing cream or no treatment, (ii) resource utilization and quality of life data, and (iii) unit prices from official price lists. A societal perspective was used and the analysis was performed according to treatment practice in Sweden. The model simulation was also applied for Denmark, Norway and Finland with inclusion of country-specific unit costs. Sensitivity analyses were performed to test the robustness of the results. Results The results from the present analyses of treatment for patients with moderate AD indicate that maintenance treatment with a moisturizing cream during eczema-free periods could be cost-effective in a societal perspective. Similar results were obtained for Sweden, Denmark, Norway and Finland. Conclusions According to the analysis, treatment with a moisturizing cream was found to be a cost-effective option compared with no treatment in eczema-free periods in adult patients with AD in the four Nordic countries. © 2009 European Academy of Dermatology and Venereology.


Jonsen A.,Lund University | Bengtsson A.A.,Lund University | Hjalte F.,Swedish Institute for Health Economics | Petersson I.F.,Lund University | And 2 more authors.
Lupus | Year: 2015

Objective To study the annual direct and indirect costs in systemic lupus erythematosus (SLE) and how age, disease manifestations, disease activity, and organ damage influence total costs and predicted costs for SLE. Methods Clinical data on all patients with a diagnosis of SLE living in a defined area in southern Sweden during eight years were linked to health authority registries and the social insurance system which contain data on cost. Cost data on four matched population controls for each patient were also extracted. The controls were matched for age, sex, and area of residence. Results Data from 127 patients with SLE and 508 population controls were extracted. The mean annual total cost for SLE patients was SEK 180,520 ($30,093); the highest costs were found in the subgroup with nephritis SEK 229,423 ($38,246). The total costs for the patient group were significantly higher (p < 0.05) compared to the population controls of SEK 59,985 ($10,000). Of the total costs, 72% were due to indirect costs, 3% to SLE-specific pharmaceuticals, and the remaining 25% were in- and outpatient related costs. During the study period, inpatient days decreased by 60%, while outpatient contacts increased by 25%. Age (inverse relation), increasing disease activity, and acquired organ damage were significant predictors of total costs (all p < 0.05). Conclusion The total annual costs for unselected SLE patients were found to be three times those for matched population controls. Important predictors of total costs were found. © 2015 The Author(s).


Hjalte F.,Swedish Institute for Health Economics | Berggren A.-C.,Mundipharma AB | Bergendahl H.,Karolinska University Hospital | Hjortsberg C.,Swedish Institute for Health Economics
Journal of Pain and Symptom Management | Year: 2010

Context: Treatment with strong opioids is connected with frequent and problematic side effects. One of the most common side effects is opioid-induced constipation (OIC). The discomfort of OIC can limit the effectiveness of pain therapy. Because constipation typically persists for as long as opioid therapy is administered, its effects on the quality of life (QoL) of patients need to be taken seriously. Data and published studies on the cost implications of OIC are, however, scarce. Objectives: To estimate the direct and indirect costs of OIC in a defined patient population during treatment with strong opioids. Methods: The study is based on patient data from a Swedish noninterventional study, UPPSIKT. The cost analysis is based on 197 patients treated with strong opioids over a six-month period. Direct and indirect costs in this article are calculated per patient-month, and the cost for OIC is estimated as the difference in mean costs between months with and without constipation. Results: The total costs per patient-month for patients with severe constipation are significantly higher than those for patients with mild, moderate, or no constipation. Patients with severe constipation have the highest total costs, Euro (EUR) 1525 per patient-month, whereas patients with mild, moderate, and no problems cost EUR 1196, EUR 1088, and EUR 1034, respectively. Conclusion: Opioid use is costly to society, and the costs vary with OIC severity. OIC is discomforting, affects the QoL of patients, and can limit an effective pain therapy. © 2010 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved.


Hellgren J.,Capio Lundby Hospital | Cervin A.,Helsingborg Hospital | Nordling S.,Swedish Institute for Health Economics | Bergman A.,Swedish Institute for Health Economics | Cardell L.O.,Karolinska University Hospital
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2010

Background: The common cold and allergic rhinitis constitute a global health problem that affects social life, sleep, school and work performance and is likely to impose a substantial economic burden on society because of absence from work and reduced working capacity. This study assesses the loss of productivity as a result of both allergic rhinitis and the common cold in the Swedish working population. Methods: Four thousand questionnaires were sent to a randomized adult population, aged 18-65 years, in Sweden, stratified by gender and area of residence (metropolitan area vs rest of the country). The human capital approach was used to assign monetary value to lost productivity in terms of absenteeism (absence from work), presenteeism (reduced working capacity while at work) and caregiver absenteeism (absence from work to take care of a sick child). Results: Thousand two hundred and thirteen individuals responded, response rate 32%. The mean productivity loss was estimated at 5.1 days or € 653 per worker and year, yielding a total productivity loss in Sweden of € 2.7 billion a year. Of the total costs, absenteeism (44%) was the dominant factor, followed by presenteeism (37%) and caregiver absenteeism (19%). Poisson regression analyses revealed that women, people in the 18-29 year age group, and respondents with 'doctor-diagnosed asthma' reported more lost days than the rest of the group. Conclusion: In Sweden, the cost of rhinitis is € 2.7 billion a year in terms of lost productivity. A reduction in lost productivity of 1 day per individual and year would potentially save € 528 million. © 2009 John Wiley & Sons A/S.

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