Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden.

OBJECTIVE: Iron deficiency is a common but treatable comorbidity in chronic heart failure (CHF) that is associated with impaired health-related quality-of-life (HRQoL). This study evaluates the cost-effectiveness of the intravenous iron preparation ferric carboxymaltose (FCM) for the treatment of iron deficiency in CHF from a Swedish healthcare perspective. METHODS: A cost-effectiveness analysis with a time horizon of 24 weeks was performed to compare FCM treatment with placebo. Data on health outcomes and medical resource use were mainly taken from the FAIR-HF trial and combined with Swedish cost data. An incremental cost-effectiveness ratio (ICER) was calculated as well as the change in per-patient costs for primary care and hospital care. RESULTS: In the FCM group compared with placebo, quality-adjusted life years (QALYs) are higher (difference = 0.037 QALYs), but so are per-patient costs [(difference = SEK 2789 (€303)]. Primary care and hospital care equally share the additional costs, but within hospitals there is a major shift of costs from inpatient care to outpatient care. The ICER is SEK 75,389 (€8194) per QALY. The robustness of the result is supported by sensitivity analyses. CONCLUSIONS: Treatment of iron deficiency in CHF with FCM compared with placebo is estimated to be cost-effective. The ICER in the base case scenario is twice as high as previously thought, but noticeably below SEK 500,000 (€54,300) per QALY, an informal average reference value used by the Swedish Dental and Pharmaceutical Benefits Agency. Increased HRQoL and fewer hospitalizations are the key drivers of this result

A maximum likelihood estimator of a Markov model for disease activity in Crohn's disease and ulcerative colitis for annually aggregated partial observations.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases that have a remitting, relapsing nature. During relapse, they are treated with drugs and surgery. The present study was based on individual data from patients diagnosed with CD or UC at Herlev University Hospital, Copenhagen, Denmark, during 1991 to 1993. The data were aggregated over calendar years; for each year, the number of relapses and the number of surgical operations were recorded. Our aim was to estimate Markov models for disease activity in CD and UC, in terms of relapse and remission, with a cycle length of 1 month. The purpose of these models was to enable evaluation of interventions that would shorten relapses or postpone future relapses. An exact maximum likelihood estimator was developed that disaggregates the yearly observations into monthly transition probabilities between remission and relapse. These probabilities were allowed to be dependent on the time since start of relapse and on the time since start of remission, respectively. The estimator, initially slow, was successfully optimized to shorten the execution time. The estimated disease activity model for CD fits well to observed data and has good face validity. The disease activity model is less suitable for UC due to its transient nature through the presence of curative surgery

Can people afford to pay for health care? : New evidence on financial protection in Sweden

This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance.The incidence of catastrophic health spending is low in Sweden compared to many countries in Europe due to relatively high levels of public spending on health, and health coverage policy carefully designed to protect children and adolescents from co-payments.Catastrophic spending on health is concentrated among poor people. The drivers of financial hardship are dental care and medical products on average, but among the poorest quintile, the largest contributor to catastrophic spending is outpatient medicines. There is also substantial socioeconomic inequality in unmet need for dental care and prescribed medicines.User charges (co-payments) are widespread in the Swedish health system. Although there are age-related exemptions and annual caps in place to protect some people from some co-payments, both policies could be improved. The results of this analysis suggest that more could be done to protect poor households, including action to lower access barriers and out-of-pocket payments for people receiving social benefits

Costs and quality of life in multiple sclerosis patients with spasticity.

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

Obesity and Surgical Treatment – A Cost-Effectiveness Assessment for Sweden

<p class="MsoNormal" style="margin: 0cm 0cm 12pt;"><span style="mso-ansi-language: EN-US;" lang="EN-US"><span style="font-size: small;"><span style="font-family: Times New Roman;">Background:<br />The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI).<span style="color: black;"> The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries.</span> While diet and exercise are the cornerstones of weight management, pharmaco&shy;therapy is often needed to achieve and maintain desired weight loss.<span style="mso-spacerun: yes;">&nbsp; </span>In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.</span></span></span></p><p class="MsoNormal" style="margin: 0cm 0cm 12pt;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><span style="mso-ansi-language: EN-US;" lang="EN-US">Objective: <br /></span><span style="mso-ansi-language: EN-GB;" lang="EN-GB">The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP) surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT), in Sweden from a healthcare perspective. With the model we also seeked to identify the lower cut-off point using BMI criteria, for the surgical intervention to be cost-effective. </span></span></span></p><p class="MsoNormal" style="margin: 0cm 0cm 12pt;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><span style="mso-ansi-language: EN-US;" lang="EN-US">Methods:<br />A</span><span style="mso-ansi-language: EN-GB;" lang="EN-GB"> micro-simulation model with an underlying Markov methodology was developed, that simulates individual patients. It simulates the outcomes of the patients in terms of treatment costs, life years, and quality adjusted life years (QALY) over his/her remaining lifetime. The costs are presented in SEK in the year 2006 price level (1 SEK &asymp; 0.11 EUR &asymp; 0.14 USD).</span></span></span></p><p class="MsoNormal" style="margin: 0cm 0cm 12pt;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><span style="mso-ansi-language: EN-US;" lang="EN-US">Results: <br />We estimated that the incremental cost per QALY gained will not exceed SEK 33,000 per QALY in patients with BMI &lt; 35. In patients with BMI &gt; </span><span style="mso-ansi-language: EN-GB;" lang="EN-GB">35 kg/m², gastric bypass surgery has lower costs compared to conventional treatment. </span></span></span></p><span style="font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: SV; mso-bidi-language: AR-SA;" lang="EN-US">Conclusion:</span><span style="font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-GB; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: SV; mso-bidi-language: AR-SA;" lang="EN-GB"> <br />Gastric bypass surgery is a cost-effective intervention compared to conventional treatment consisting of watchful waiting, diet and exercise.</span

Obesity, survival, and hospital costs-findings from a screening project in sweden.

AbstractObjectiveOur aims were to estimate 1) the costs of hospital treatment and 2) the value of lost production due to early death associated with overweight and obese patients, and then to extrapolate the findings to national costs.MethodsWe use regression models to analyze survival, expected number of days in hospital treatment for patients with different body mass index (BMI), and costs with data obtained from screening of 33,196 middle-aged subjects living in Malmö, Sweden, and collected during a 15-year follow-up period. We subsequently scale up costs to national aggregate level using the BMI prevalence data from the screening project to the national population.ResultsThe total excess hospital (somatic, psychiatric) care cost (Swedish krona or SEK) for the national health-care budget, excess as compared to normal weight patients for obese (BMI > 30) and overweight (25 ≤ BMI < 30) was estimated to SEK2155 million per annum (US$269 million, assuming US$1 = SEK8), or about 2.3% of total hospital care costs in Sweden. The corresponding indirect costs due to early death were estimated to SEK2935 million (US$367 million). For males at age 55, the potential hospital costs saving, excluding costs of the intervention that could be gained by an intervention that successfully and safely could alter the weight of an obese individual to become normal weight, was estimated on average to SEK4434 (US$554) per annum.ConclusionHospital treatment costs are found to be higher for obese and overweight patients than for normal weight patients indicating potential cost savings especially on indirect costs by effective, safe and low cost weight-loss intervention