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Van Battum P.,Maastricht University | Schaper N.,Maastricht University | Prompers L.,Maastricht University | Apelqvist J.,Malmö University | And 14 more authors.
Diabetic Medicine | Year: 2011

Objectives The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres.Methods In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient.Results One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r = 0.75).Conclusions Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.


PubMed | Blekinge Wound Healing Center and Swedish Institute for Health Economics IHE
Type: Journal Article | Journal: International wound journal | Year: 2016

Resource use and costs for topical treatment of hard-to-heal ulcers based on data from the Swedish Registry of Ulcer Treatment (RUT) were analysed in patients recorded in RUT as having healed between 2009 and 2012, in order to estimate potential cost savings from reductions in frequency of dressing changes and healing times. RUT is used to capture areas of improvement in ulcer care and to enable structured wound management by registering patients with hard-to-heal leg, foot and pressure ulcers. Patients included in the registry are treated in primary care, community care, private care, and inpatient hospital care. Cost calculations were based on resource use data on healing time and frequency of dressing changes in Swedish patients with hard-to-heal ulcers who healed between 2009 and 2012. Per-patient treatment costs decreased from SEK38 223 in 2009 to SEK20 496 in 2012, mainly because of shorter healing times. Frequency of dressing changes was essentially the same during these years, varying from 14 to 16 per week. The total healing time was reduced by 38%. Treatment costs for the management of hard-to-heal ulcers can be reduced with well-developed treatment strategies resulting in shortened healing times as shown in RUT.


Ghatnekar O.,Swedish Institute for Health Economics IHE | Hjortsberg C.,Swedish Institute for Health Economics IHE | Gisslen M.,Gothenburg University | Lothgren M.,Janssen Cilag AB
PharmacoEconomics | Year: 2010

Introduction: Little is known regarding healthcare costs for HIV/AIDS patients in the era of highly active antiretroviral therapy (HAART) and subgroups of patients according to the severity and progression of HIV infection in Sweden. The objective of this study is therefore to describe the direct medical resource use and cost of healthcare for HIV patients at a university clinic in Sweden. Methods: A patient registry database for HIV treatment at the Department of Infectious Diseases, Sahlgrenska University Hospital, between 2000 and 2005 provided information on patient characteristics, antiretroviral drugs and dosages, tests and diagnostic procedures, outpatient visits and inpatient stays. The review used publicly available unit costs with a county council perspective, expressed in 2006 Euros. Results: Two hundred and eighty-five patients with a mean age of 38 years in 2000 (64% men) were followed for 1368 patient-years. They had a mean (median) of 6.3 (0) inpatient days, 4.1 (3.7) physician visits, 4.2 (3.8) nurse visits, 2.6 (0.7) counsellor visits and 11.5 (7.7) tests and diagnostic procedures per patient-year. Only 12 deaths were recorded during the study period, and the proportion of treated patients with successful treatment (HIV-RNA <50 copies/mL) increased from 74% to 92% during the period. The mean cost per patient-month amounted to h1069. The main cost driver was HIV drugs (51%), followed by inpatient stays (including hospitalizations for opportunistic infections; 22%), outpatient physician, nurse or therapist visits (19%) and diagnostics and tests (7%). All non-drug costs increased with a decreasing CD4 cell count. Conclusions: Overall, approximately half of the direct costs of HIV treatment were not related to antiretroviral treatment. The non-antiretroviral costs were inversely correlated with HIV-induced immune deficiency. © 2010 Adis Data Information BV. All rights reserved.


Glenngard A.H.,Swedish Institute for Health Economics IHE | Hjelmgren J.,RTI Health Solutions | Thomsen P.H.,University of Aarhus | Tvedten T.,Center for therapy and supervision
Nordic Journal of Psychiatry | Year: 2013

Background: The choice between different attention-deficit/hyperactivity disorder (ADHD) medications depends on different drug attributes. Economic evaluations of drugs often disregard the utility of other attributes compare with the drugs' efficacy. Aims: The aim of this study was to assess patient's preferences and elicit willingness-to-pay (WTP) for different drug attributes in the treatment of ADHD. Methods: 285 patients (117 parents for children below 15 years, 52 adolescents 15-17 years and 116 adults aged 18 years and above) from Sweden, Denmark and Norway completed a questionnaire concerning their ADHD drug treatment, and answered questions on their preferences using a discrete choice experiment (DCE). Included attributes were effectiveness, side-effects, dosing and price. Results: Effectiveness was the most important attribute, followed by side-effects and the number of dosings per day (all P < 0.001). The estimated monthly WTP for a drug generating full effectiveness, no side-effects and once-daily dosing was €790 for adolescents and €360 for adults. The estimated WTP for ADHD drugs with characteristics similar to existing drugs on the market was higher or in line with market prices (€37-180 for adolescents and €16-80 for adults). Regarding experience with current treatment, 19% of all patients in the study reported good functioning during the morning, day and evening. Conclusions: The gap between the monetary valuation of existing products and an optimally valued product suggest that there is room for improvements in the clinical management of ADHD. The results suggest that DCE is a method that can be used to value not only hypothetical scenarios but also can be used to value and distinguish between real-life scenarios. © 2013 Informa Healthcare.


Olofsson S.,Swedish Institute for Health Economics IHE | Wickstrom A.,Umeå University | Hager Glenngard A.,Swedish Institute for Health Economics IHE | Persson U.,Swedish Institute for Health Economics IHE | And 2 more authors.
BioDrugs | Year: 2011

Background: Sweden is a high endemic region for multiple sclerosis (MS), a neurologic disorder characterized by repeated inflammatory episodes affecting the CNS. The disease has its peak age of onset at approximately 30 years and affects women twice as often as men. The young age of onset makes MS one of the major causes of reduced capacity to work due to neurologic disease in Western society. Natalizumab (Tysabri®) is among the new generation of biologic drugs for the treatment of MS. Clinical studies have demonstrated that natalizumab is an effective treatment for preventing relapses and inflammatory activity. Objective: The aim of the study was to estimate the monetary value of treatment with natalizumab on the ability to work in patients with MS in Sweden, based on a direct measurement of weekly hours worked before and after 1 year of treatment with natalizumab. Methods:A sample of patients, consisting of all patients who had started treatment with natalizumab during the period June 2007-May 2008, was identified through the Swedish Multiple Sclerosis Register (SMSreg). Data about sex, age, disease severity, and disease duration were collected from the register. Data about type of work and work capacity (number of hours worked per week) were collected retrospectively through a postal questionnaire. The average hours worked per week was estimated at baseline (2 weeks before treatment started) and at follow-up (50 weeks after treatment started), and the change was assigned an economic value using the human capital approach. Results: This study showed that after 50 weeks of treatment with natalizumab, people with MS increased their productivity by 3.3 hours per week on average (p < 0.01), which corresponded to an economic value of €3216 per person per year (year 2007 values). A shorter duration of illness or being 25-35 years old was significantly associated with a greater productivity gain (p = 0.025 and p = 0.002, respectively). Conclusion: A shorter duration of illness and a lower age at the start of treatment were significantly associated with a greater productivity gain after 50 weeks of treatment with natalizumab, which indicates that it is more beneficial to initiate efficient therapy early in patients with MS. © 2011 Adis Data Information BV. All rights reserved.


Svensson J.,Swedish Institute for Health Economics IHE | Ghatnekar O.,Swedish Institute for Health Economics IHE | Lindgren A.,Lund University | Lindvall O.,Lund University | And 3 more authors.
Cerebrovascular Diseases | Year: 2012

Background: Stroke is one of the major causes of disability in the adult population and represents a heavy social and economic burden. Currently available therapeutic tools to support the recovery of impaired brain functions are quite limited. Animal studies have demonstrated that neuronal replacement and partial reconstruction of neural circuitry or modulation of the recovery process is possible with cell transplantation in the damaged adult brain. Stem cell therapy (SCT) may promote functional recovery also in stroke patients, thereby improving quality of life and reducing costs. Our aim was to estimate the potential societal value of SCT in stroke patients. Methods: We created a decision-analytic model in Microsoft Excel 2010 to assess life-long costs and quality-adjusted life years (QALYs) of SCT versus standard care for stroke patients from a societal perspective. The model structure consisted of 7 health states in accordance with the modified Rankin Scale (mRS). We modeled for age (55, 65, and 75 years), functional status at discharge (mRS 2, 3, and 4), effectiveness of SCT (50 and 25% increase in the probability to improve 1 mRS grade), mode of stem cell administration, risk of recurrent stroke, complications of intervention, and use of immunosuppressive drugs. The difference between an assumed societal willingness to pay for a QALY gain in Sweden (110,400 USD) and the cost per QALY gain resulting from the model was interpreted as the value of SCT. Results: Increased survival (1.06 life years) and improved functional status gave rise to an estimated gain of 1.34 QALY in a cohort of patients aged 55 with mRS 2 at hospital discharge. Although the SCT intervention increased costs by 64,014 USD (excluding cost of stem cells), the costs of intervention were offset mainly by decreased productivity losses. In total, the intervention saved 19,055 USD, i.e., at a price of 19,055 USD for stem cells, the SCT would be cost neutral. The societal value of SCT was 166,500 USD. Conclusions: The application of the health-economic model to Sweden shows that in younger stroke patients with moderate disability, the societal value of SCT given a zero price of stem cells is 166,500 USD. Although the transplantation itself is more costly, SCT offers potential for cost offset and cost savings in a long-term perspective by reducing the disability after stroke. The therapy appeared cost effective under a wide range of assumptions. Hence, further research and development in stem cells suitable for stroke therapy could potentially produce great value to society. © 2012 S. Karger AG, Basel.


Cardell L.-O.,Karolinska Institutet | Cardell L.-O.,Karolinska University Hospital | Olsson P.,Karolinska Institutet | Andersson M.,Skåne University Hospital | And 4 more authors.
npj Primary Care Respiratory Medicine | Year: 2016

Allergic rhinitis is a global illness with a well-recognised impact on quality of life and work performance. Comparatively little is known about the extent of its economic impact on society. The TOTALL study estimates the total cost of allergic rhinitis using a sample representing the entire Swedish population of working age. A questionnaire focused on allergic rhinitis was mailed out to a random population of Swedish residents, aged 18-65 years. Health-care contacts, medications, absenteeism (absence from work) and presenteeism (reduced working capacity at work) were assessed, and the direct and indirect costs of allergic rhinitis were calculated. Medication use was evaluated in relation to the ARIA guidelines. In all, 3,501 of 8,001 (44%) answered the questionnaire, and 855 (24%) of these reported allergic rhinitis. The mean annual direct and indirect costs because of allergic rhinitis were €210.3 and €750.8, respectively, resulting in a total cost of €961.1 per individual/year. Presenteeism represented 70% of the total cost. Antihistamines appear to be used in excess in relation to topical steroids, and the use of nasal decongestants was alarmingly high. The total cost of allergic rhinitis in Sweden, with a population of 9.5 million, was estimated at €1.3 billion annually. These unexpectedly high costs could be related to the high prevalence of disease, in combination with the previously often underestimated indirect costs. Improved adherence to guidelines might ease the economic burden on society. © 2016 Primary Care Respiratory Society UK/Macmillan Publishers Limited.


Svensson J.,Swedish Institute for Health Economics IHE | Borg S.,Swedish Institute for Health Economics IHE | Borg S.,Lund University | Nilsson P.,Skåne University Hospital
Acta Neurologica Scandinavica | Year: 2014

Background: The resource use and health-related quality of life (HRQoL) of patients with multiple sclerosis (MS) spasticity are not well known. The purpose of this study was to obtain estimates of resource utilization, costs, and HRQoL, for patients with different levels of MS spasticity in southern Sweden. Material and methods: Cross-sectional data on spasticity severity (using a Numerical Rating Scale, NRS), resource use and HRQoL (using EQ-5D) were collected using a patient questionnaire and chart review. Patients were recruited through a clinic in southern Sweden. The study reviews direct medical, direct non-medical and indirect costs. Results: Total costs were estimated to €114,293 per patient and year. Direct medical costs (€7898) accounted for 7% of total costs. Direct non-medical costs (€68,509) accounted for 60% of total costs. Total costs increased with severity of spasticity: for patients with severe spasticity, the total cost was 2.4 times greater than those for patients with mild spasticity. HRQoL decreased as spasticity increases. Conclusion: The results of this study show that MS spasticity is associated with a substantial burden on society in terms of costs and HRQoL. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.


Glenngard A.H.,Lund University | Glenngard A.H.,Swedish Institute for Health Economics IHE
Health Economics, Policy and Law | Year: 2013

In parallel to market-like reforms in Swedish primary care, the gathering and compilation of comparative information about providers, for example through survey tools, has been improved. Such information is increasingly being used to guide individuals' choice of provider and payers' assessments of provider performance, often without critically reflecting about underlying factors affecting the results. The purpose of this study was to analyze variation in patient satisfaction, with respect to organizational and structural factors, including the mix of registered individuals, among primary care providers, based on information from a national patient survey in primary care and register data in three Swedish county councils. Systematic variation in patient satisfaction was found with respect to both organizational and structural factors, including characteristics of registered individuals. Smaller practices and practices where a high proportion of all visits were with a doctor were associated with higher patient satisfaction. Also practices where registered individuals had a low level of social deprivation and a high overall illness on average were associated with higher patient satisfaction. Factors that are of relevance for how well providers perform according to patient surveys are more or less possible to control for providers. This adds to the complexity for the use of such information by individuals and payers to assess provider performance. Copyright © 2012 Cambridge University Press.


Rome A.,Lund University | Persson U.,Swedish Institute for Health Economics IHE | Ekdahl C.,Lund University | Gard G.,Lund University
Scandinavian Journal of Public Health | Year: 2010

Aims: To estimate the willingness to pay for health improvements among participants in the programme "Physical Activity on Prescription". The objective was also to examine predictors such as income, education level, health status, activity level and BMI, differences for long-and short-term health effects of physical activity and differences between a high-and low-intensity activity group. Methods: Willingness to pay (WTP) data were collected alongside a randomized, controlled trial in Sweden 2007, and 128 sedentary individuals, 20-80 years old (intervention/high-intensity group n=71, control/low-intensity group n=57), with lifestyle-related health problems answered open-ended questions in this contingent valuation study. Results: The highest mean WTP (E59/SEK 552) was stated for an immediate health improvement, but no significant differences compared with long-term health improvements. The high-intensity group showed higher WTP-values for all health improvements, but without significant differences compared with a low-intensity group. Regression analyses show strong associations between a higher level of education and the WTP for improved well-being and improved health, and also between income and the WTP for improved well-being. There are significant correlations between the WTPand the variables BMI, income and education level, as expected from economic theories. Conclusions: The willingness to pay for the health improvements of exercise is influenced by a higher education level, income and BMI. The highest WTP for a health outcome of physical activity is for an immediate health improvement. The results of this randomized controlled trial in primary health care may be of interest to decision makers when evaluating different approaches to promoting physical activity among people who are sedentary. © 2010 the Nordic Societies of Public Health.

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