Cost-effectiveness of alendronate in the treatment of low bone mineral density in the time of price competition

Background: Norwegian guidelines recommend treatment with bisphosphonates for women considered at high risk of osteoporosis. Alendronate is the most used bisphosphonate. Recently the price of alendronate has fallen by 75% due to the expiring of the patent. This may influence the cost effectiveness of the drug. Objective: To estimate the incremental costs and effects of treating postmenopausal, osteopenic women with alendronate in addition to calcium and vitamin D instead of calcium and vitamin D alone. Design: Markov model with seven health states: well, well after fracture, mild hip fracture sequela, moderate hip fracture sequela, severe hip fracture sequela, vertebral sequela and dead. The model encompasses three events: hip, vertebral and forearm fracture. Data sources: Literature searches in the databases Medline, EMBASE and Cochrane to identify data on fracture incidence, efficacy, of alendronate and quality of life. Costs are estimated using Norwegian fee schedules for 2006. Mortality rates for 2006 from Statistics Norway. Target population: Postmenopausal women, aged 65-75 with femoral neck T-score between -1.5 and -2.5 living in Oslo. Time horizon: Until death or age of 100. Perspective: Broad health care Interventions: Four years of treatment with alendronate. Offset time three years. Outcome measures: The results are expressed as incremental costs, incremental quality adjusted life years, and costs per QALY gained. Results: Treatment with alendronate was cost saving and more effective for all groups. Results of sensitivity analysis: The results of the one-way sensitivity analyses indicate that this conclusion is robust to any realistic change of the model input. Limitations: Results apply mainly to postmenopausal, Caucasian women in Oslo. Conclusions: The results indicate that treatment with alendronate, at the current price level, is cost saving and more effective compared to no treatment for a wide group of wome

Estimating the future burden of hip fractures in Norway. A NOREPOS study.

Background: The incidence rate of hip fractures seems to be declining in many western countries. However, due to the ageing of the population, the number of fractures may still be on the rise. No papers so far have quantified the future burden of hip fractures in terms of both health loss (as measured in disability adjusted life years DALY) and costs. The purpose of this paper is to assess the future health and economic burden of hip fractures. Methods: We collected population projections from Statistics Norway up until the year 2040. The medium projection was used for the base case analysis. Fracture rates for 2008 were estimated based on information from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database (NORHip), which includes information about all hip fractures in Norway. Future fracture rate was assumed to decline by 0.7% per year in the base case. We used the same assumptions as the global burden of disease project on years of remaining life and disability weights. Cost of hip fracture was based on the published literature. In sensitivity analyses, we assessed the impact of changing underlying assumptions on demographic change, development in hip fracture rate, assumed life expectancy and choice of disability weights. Results: Assuming a medium population growth and a continued decline in fracture rate, our estimates indicate that health lost to hip fractures will approximately double, from 32,850 DALYs in 2020 to 60,555 in 2040. Over the same period, costs are estimated to increase by 65%. Sensitivity analyses indicate that estimates are highly sensitive to assumptions on both population growth, fracture rate development, disability weights and assumed life expectancy. Conclusion: The burden of hip fractures in terms of DALYs lost and cost incurred is likely to increase even if the fracture rate continues to decline.publishedVersio

Conference handbook: 12th International Conference: Association for Language Awareness (ALA) Hamar, Norway, July 1–4, 2014

Norsk: Den tolvte internasjonale forskningskonferansen om språkbevissthet ble arrangert ved Høgskolen i Hedmark 1.-4. juli 2014. Dette er sammendrag av innleggene ved konferansen og konferansens program.English: The 12th international research conference of the Association for Language Awareness (ALA) was arranged by Hedmark University College July 1st–4th, 2014. The abstracts and the program are published here

A propriedade sem registro : o contrato e aquisição da propriedade imóvel na perspectiva civil-contitucional

Orientador : Prof. Dr. Eroulths Cortiano JuniorTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Jurídicas, Programa de Pós-Graduação em Direito. Defesa: Curitiba, 12/08/2014Inclui referênciasResumo: Esta tese objetiva uma releitura da obrigatoriedade do registro nas aquisições da propriedade imóvel, a partir do reconhecimento do contrato como dotado de função social, que realiza, igualmente, a função social como liberdade de acesso aos bens. A propriedade imobiliária no Direito Civil brasileiro está qualificada como direito real, conforme o art. 1225, I, do Código Civil, e sua transferência negocial se orienta pelo sistema da separação parcial dos planos dos direitos obrigacionais e reais, o qual prevê a necessidade do contrato de transmissão (compra e venda, doação ou permuta) com posterior registro no Cartório Imobiliário, nos termos do art. 1245 e seguintes. A Constituição Federal de 1988 garante o direito de propriedade, que deve atender à sua função social, considerando-a como direito fundamental (art. 5.o, XXII e XXIII) e como princípio geral da ordem econômica (art. 170, II e III). A necessária interação entre o Direito Civil e a Constituição, sob a supremacia hierárquica desta, conduz a entender que o direito de propriedade atual, para além da literalidade do Código Civil, deve nortear-se pela sintonia entre ambos os diplomas legais, mas a partir da observação dos princípios e dos valores constitucionais. O Direito Civil-Constitucional surge, então, como uma opção de desenvolvimento do pensamento jurídico, que visa oferecer espaço de reflexão que supere a dogmática unicamente codificada, pois, com fundamento nos princípios e na axiologia constitucional, auxilia na ressignificação de institutos clássicos, como a propriedade e o contrato. O acesso à propriedade, então, pode ser considerado para além da letra da lei, o que permite relevar o registro, com a funcionalização do contrato que, a partir de sua teleologia, da solidariedade, da alteridade e da boa-fé, pode ser o elemento constitutivo da propriedade, com base no caso concreto. A aplicação direta e imediata da Constituição nas relações interprivadas favorece a ressignificação do contrato, que alçará significado de título suficiente para garantir o direito à propriedade (acesso). A complexidade e a pluralidade das relações sociais conduzem a uma transição do modelo abstrato e individualista da propriedade para o da propriedade concreta, que se constrói na funcionalização como liberdade(s) com vistas à realização das necessidade da pessoa concretamente considerada.Abstract: The aim of this thesis is to re-read the mandatory registration on acquisition of immovable property, from the social function of contract's recognition, which also performs its social function as freedom of access to assets. The immovable property in the Brazilian Civil Law is qualified as a real right, according to art. 1225, I, Civil Code, and its negotiating transferring is guided by the partial separation between obligations and real rights, which predicts the registration of transmission's contract (sale, donation or exchange) with the state registration authority, according to art. 1245 and on Civil Code. The 1988 Federal Constitution guarantees the right to property, which must meet its social function, considering it as a fundamental right (art. 5, XXII and XXIII) and as a general principle of economic order (art. 170, II and III). The necessary interaction between the civil law and the Constitution, under the hierarchical supremacy of this leads to understand that the current property law, beyond its literal meaning of the Civil Code, shall be guided by the line between the two enactments, but from the observation of constitutional principles and values.The Civil-constitutional Law arises, then, as an option for legal thinking development, which aims to provide a reflection space that overcomes the consolidated dogmatic, therefore, on the basis of principles and the constitutional axiology, assists in reframing classical institutes, as property and contract. The access to the property can then be considered beyond the letter of the law, which allows to release the register, with the functionalization's contract which, from its teleology, solidarity, alterity and good faith, may be the constituent element of the property, based on the case. The direct and immediate constitutional applying in privates relations cooperate to the contract redefinition, which obtain the sufficient title to guarantee the right to property (access). The complexity and plurality of social relations lead to a transition from abstract and individualistic model of property to concrete one which is constructed on functionalization as freedom (s) to intending to accomplish persons needs concretely considered

Let's do it in Teams! What is required to build trust in projects when the interaction takes place virtually?

Master in Business Administration (MBA) - Nord universitet 202

Registry data for use in health technology assessments in Norway- Oppourtunities and challenges

Decisions on uptake of medicines and medical devices on health insurance schemes are increasingly based on a health technology assessment (HTA) process. In Norway, the process has included reimbursement of outpatient medicines for two decades. During the past years, in-patient medicines, medical devices and more recently vaccines are all included in the HTA system. In the present article, we outline the Norwegian HTA system including its central components and partners. HTA as a scientific approach puts evidence on efficacy, safety and value of interventions into a broader perspective, explicitly considering relevant factors, among these legal, ethical and organisational aspects of the intervention. Although several combinations of aspects are possible, the most common is an assessment of the relative effectiveness and cost-effectiveness of the intervention. Randomised controlled trials have long been considered the mainstay for assessment of clinical effectiveness pre-launch, while registry data have been used to inform safety post-lunch, by pharmacovigilance. Recently, we have seen a move towards more use of “real world evidence”, i.e. data from non-RCT sources, mainly from registries. A model-based approach is often used to assess cost-effectiveness, in this context, different types of evidence from different sources are often synthesized. In this paper we describe the central components of HTA with special emphasis on different observational data sources, such as the unique Norwegian health registries. We finally speculate on future directions for use of observational data in HTA, both in a global and Norwegian setting

Estimating QUALY gains in applied studies: A review of cost-utility analyses published in 2010

Reimbursement agencies in several countries now require health outcomes to be measured in terms of quality-adjusted life-years (QALYs), leading to an immense increase in publications reporting QALY gains. However, there is a growing concern that the various ‘multi-attribute utility’ (MAU) instruments designed to measure the Q in the QALY yield disparate values, implying that results from different instruments are incommensurable. By reviewing cost-utility analyses published in 2010, we aim to contribute to improved knowledge on how QALYs are currently calculated in applied analyses; how transparently QALY measurement is presented; and how large the expected incremental QALY gains are. We searched Embase, MEDLINE and NHS EED for all cost-utility analyses published in 2010. All analyses that had estimated QALYs gained from health interventions were included. Of the 370 studies included in this review, 48 % were pharmacoeconomic evaluations. Active comparators were used in 71 % of studies. The median incremental QALY gain was 0.06, which translates to 3 weeks in best imaginable health. The EQ-5D-3L is the dominant instrument used. However, reporting of how QALY gains are estimated is generally inadequate. In 55 % of the studies there was no reference to which MAU instrument or direct valuation method QALY data came from. The methods used for estimating expected QALY gains are not transparently reported in published papers. Given the wide variation in utility scores that different methodologies may assign to an identical health state, it is important for journal editors to require a more transparent way of reporting the estimation of incremental QALY gains. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited