Helseøkonomiske evalueringer av skuldersmerte, kolorektal cancer og skoliose

Key conclusions In Paper I, a cost-of-illness (COI) study on shoulder pain in Sweden, showed that the mean health care cost per patient was €326 during 6 months, and physiotherapy treatments accounted for 60% of this cost. The mean annual total cost was €4 139 per patient. Of this, sick leave accounted for 84% of the cost, but different methods for estimating sick leave cost can provide very different results. In Paper II a semi-Markov model with 70 health states was presented and validated. We tracked age and time since specific health states using tunnels and a three-dimensional data matrix. The structure and complexity of the model and the variety of data sources implied that we faced parameter and methodological uncertainty, as well as modelling uncertainty. Therefore, the model was validated using face, internal, cross and external validation. The main result from Paper II was the validation, and this revealed a satisfactory match with other models and empirical estimates of both the cost of colorectal cancer treatment and survival time, which are the two main outcomes of the model. We performed no preceding calibration of the model. In Paper III, we found that altered decisions about palliative treatment can increase the average CRC cost substantially. Reducing the recurrence rate by better surgery and implementing preventive efforts like screening of asymptomatic persons could have a considerable cost-effectiveness potential. Further, we saw that expectations about the future are important for cost and survival estimates. Because many evaluations have time horizons of 20-40 years, PSA that is based on parameter probability distributions estimated from “yesterday’s data” can be misleading. In Paper IV, we compare costs in screening and non-screening scenarios using a cost-minimization analysis. Many relevant factors can be assumed to differ from country to country. We found that the cost-effectiveness of screening is heavily dependent on (i) the percent of the non-screened that receive some kind of treatment (surgery or bracing) for their scoliosis, and (ii) the share of surgery versus bracing, in both screened and non-screened children. We also found that it is more cost-effective to screen girls only rather than screening all children

Health Literacy in the Norwegian Population. English Summary. In Befolkningens helsekompetanse, del I. The International Health Literacy Population Survey 2019 – 2021 (HLS19) – et samarbeidsprosjekt med nettverket M-POHL tilknyttet WHO-EHII

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Health Literacy in Five Immigrant Populations in Norway: Pakistan, Poland, Somalia, Turkey, and Vietnam. English summary. In Helsekompetansen i fem innvandrerpopulasjoner i Norge: Pakistan, Polen, Somalia, Tyrkia og Vietnam. Befolkningens helsekompetanse, del II

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Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

<p>Abstract</p> <p>Background</p> <p>Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden.</p> <p>Methods</p> <p>The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model.</p> <p>Results</p> <p>204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third.</p> <p>Conclusions</p> <p>The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.</p

Risiko- og sårbarhetsanalyser for kommunene Lørenskog, Rælingen og Skedsmo: hovedrapport

Alle landets kommuner er pålagt å utarbeide en kommunal risiko- og sårbarhetsanalyse (ROS-analyse). Dette er slått fast i ”Lov om kommunal beredskapsplikt, sivile beskyttelsestiltak og sivilforsvaret”. Kommunens politiske ledelse er ansvarlig for at det blir utført risiko- og sårbarhetsanalyser, og at disse blir fulgt opp. Kommunene Lørenskog, Rælingen og Skedsmo har valgt å utarbeide felles risiko- og sårbarhetsanalyser. Styringsgruppen nedsatte fire arbeidsgrupper som fikk i oppdrag å utarbeide en rekke risikoanalyser for kommunene. Sluttrapporten oppsummerer arbeidet med risiko- og sårbarhetsanalysene. Begrepet risiko står sentralt i arbeidet med denne typen analyser. Risikoen ved en ulykkes-hendelse skal gi et bilde av hvor stor fare det er knyttet til den enkelte ulykkeshendelsen. I kapittel 3 gis en generell oversikt over risikobildet for kommunene. Her ser vi på hvilke typer forhold som spesielt representerer en risiko. Disse er blant annet: brann i offentlige- og private bygg, brann/eksplosjon i industri eller bensinstasjoner, alvorlige trafikkulykker, jernbaneulykker, fly- og helikopterhavari, strømbrudd, vann og avløp (lekkasjer og forurensing), skogbrann, flom, smittsomme sykdommer og atomtrussel. I kapittel 4 retter vi oss mot enkeltforhold og presenterer resultatene fra risikoanalysene som ble utarbeidet for 23 utvalgte og potensielle ulykkeshendelser. De enkelte hendelser ble rangert etter hvor stor risiko de representerer med hensyn til konsekvenskategorien liv og helse dersom den aktuelle ulykkeshendelse skulle inntreffe, samt for kategoriene miljøverdier og økonomiske verdier der disse er relevante å trekke inn som mulige negative konsekvenser. Ulykkeshendelsene ble sortert i kategoriene høy risiko, middels risiko og lav risiko. Med hensyn til konsekvenser for liv og helse var det følgende ulykkeshendelser som kom i kategorien høy risiko: 1) Fjerdingby skole - snølast på skoletak, 2) Matbåren smitte og 3) Epidemi og smittsom sykdom. Hendelsene som hadde høy risiko mht økonomi var: 1) Fjerdingby skole - snølast på skoletak, og 2) Epidemi og smittsom sykdom. Øvrige hendelsers risiko er redegjort for i tabell 1 nedenfor og i kapittel 4. I tabell 1 og kapittel 4 presenteres også de mest aktuelle tiltakene for å redusere risikoen knyttet til de 23 hendelsene som det er utarbeidet risikoanalyser for. Tiltak som er blitt foreslått spenner fra tekniske tiltak til tiltak rettet mot opplæring, prosedyrer og organisatoriske forhold. En rekke av tiltakene bør kunne inngå i de berørte kommuner og institusjonenes budsjetter eller innarbeides i deres daglige rutine. Enkelte tiltak synes imidlertid å kreve politiske vedtak om økonomiske midler for å kunne bli realisert, hvor det for noen av disse sannsynligvis vil være nyttig at kommunene samarbeider for å realisere kostnadseffektive tiltak. Arbeidet med risiko- og sårbarhetsanalyser er en kontinuerlig prosess, der kommunene ved jevne mellomrom bør foreta slike analyser. I kapittel 5 foreslår styringsgruppen risiko-objekter eller hendelser kommunene bør vurdere å analysere neste gang det arbeides med risiko- og sårbarhetsanalyse

Nye eldre – nye former for frivillighet? Frivillighetsmønstre og motivbegrunnelser sett i lys av endringer i verdier, utdanningsnivå og mestring

Morgendagens eldre forventes å utgjøre en betydelig ressurs for frivillig sektor. Mer ressurser i kraft av bedre helse, økt utdanning og mestring trekker i den retning. Samtidig kan mer individualistiske verdier trekke motsatt vei eller endre motivasjonsgrunnlaget for frivillighet. I denne studien setter vi søkelys på potensial for økt frivillighet ved å undersøke dagens og morgensdagens eldres engasjement og motivasjon for frivillig arbeid. Studien bygger på data fra 2609 (55–66 år) og 1560 (67–80 år) respondenter fra Den norske studien av livsløp, aldring og generasjon (NorLAG) fra 2017. Vi finner at høyere utdanning, bedre helse og individualistiske verdier signifikant predikerer økt frivillig deltagelse. Kun individualistiske verdier har sammenheng med mer aktiv frivillighet (≥ 3 timer per uke). Høyere utdanning er signifikant assosiert med mer vilje til å forplikte seg til frivillig arbeid. Videre finner vi at økt mestringsfølelse henger sammen med samfunnsnyttige motiver, mens individualistiske verdier er assosiert med mer egennyttige motiver. Funnene gir generelt grunn for optimisme rundt frivillig engasjement blant morgendagens eldre. Samtidig peker funnene mot at potensialet er betinget av frivillige organisasjoners evne til å tilpasse seg en mer refleksiv og individualisert form for frivillighet

A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis

Summary of background data Adolescent idiopathic scoliosis can progress and affect the health related quality of life of the patients. Research shows that screening is effective in early detection, which allows for bracing and reduced surgical rates, and may save costs, but is still controversial from a health economic perspective. Study design Model based cost minimisation analysis using hospital’s costs, administrative data, and market prices to estimate costs in screening, bracing and surgical treatment. Uncertainty was characterised by deterministic and probabilistic sensitivity analyses. Time horizon was 6 years from first screening at 11 years of age. Objective To compare estimated costs in screening and non-screening scenarios (reduced treatment rates of 90%, 80%, 70% of screening, and non-screening Norway 2012). Methods Data was based on screening and treatment costs in primary health care and in hospital care settings. Participants were 4000, 12-year old children screened in Norway, 115190 children screened in Hong Kong and 112 children treated for scoliosis in Norway in 2012. We assumed equivalent outcome of health related quality of life, and compared only relative costs in screening and non-screening settings. Incremental cost was defined as positive when a non-screening scenario was more expensive relative to screening. Results Screening per child was € 8.4 (95% CrI 6.6 to10.6), € 10350 (8690 to 12180) per patient braced, and € 45880 (39040 to 55400) per child operated. Incremental cost per child in non-screening scenario of 90% treatment rate was € 13.3 (1 to 27), increasing from € 1.3 (−8 to 11) to € 27.6 (14 to 44) as surgical rates relative to bracing increased from 40% to 80%. For the 80% treatment rate non-screening scenario, incremental cost was € 5.5 (−6 to 18) when screening all, and € 11.3 (2 to 22) when screening girls only. For the non-screening Norwegian scenario, incremental cost per child was € -0.1(−14 to 16). Bracing and surgery were the main cost drivers and contributed most to uncertainty. Conclusions With the assumptions applied in the present study, screening is cost saving when performed in girls only, and when it leads to reduced treatment rates. Cost of surgery was dominating in non-screening whilst cost of bracing was dominating in screening. The economic gain of screening increases when it leads to higher rates of bracing and reduced surgical rates

Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

Background: Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. Methods: The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. Results: 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. Conclusions: The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warrante