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Now showing items 1 - 16 of 31

  • Certified service dogs - A cost-effectiveness analysis appraisal

    Alwin, Jenny   Levin, Lars-Ake  

    IntroductionIndividuals with functional impairments or chronic diseases are often in need of assistance in their daily lives. For these individuals it is essential to find novel, cost-effective solutions to meet their needs. Service dogs are dogs that are specially trained to assist individuals with functional impairments and may be able to improve these individuals' quality of life at a reasonable cost, i.e. be cost effective. Cost-effectiveness analyses are used to illustrate the cost of an intervention in relation to its effects and provide important input to decision-makers when setting priorities.AimThe aim of this study is to assess the cost effectiveness of a certified physical service dog and a diabetes alert dog compared to a regular companion dog.MethodCosts, life years and quality-adjusted life years were estimated over a 10-year time horizon using a decision-analytic model built upon evidence from the"service and hearing dog project". The primary outcome was the incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year. The analysis was conducted from a societal perspective. Costs and effects were discounted with 3% per annum and reported in USD.ResultsCompared to a regular companion dog, a physical service dog is cost saving [-6,000 USD] and gives the dog owner more quality-adjusted life years [0.28]. The diabetes alert dog is also cost effective in comparison with a regular companion dog [-4,500 USD, 0.06 QALYs].ConclusionThis study indicates that a certified service dog is cost saving in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. The uncertainty of the analysis implies that further studies are needed in order to confirm these results. Nevertheless, physical service dogs and diabetes alert dogs show potential to be a valuable support and decision analytic models are useful tools to provide this information.
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  • Ethical Hurdles in the Prioritization of Oncology Care

    de Groot, Folkert   Capri, Stefano   Castanier, Jean-Claude   Cunningham, David   Flamion, Bruno   Flume, Mathias   Herholz, Harald   Levin, Lars-Ake   Sola-Morales, Oriol   Rupprecht, Christoph J.   Shalet, Natalie   Walker, Andrew   Wong, Olivier  

    With finite resources, healthcare payers must make difficult choices regarding spending and the ethical distribution of funds. Here, we describe some of the ethical issues surrounding inequity in healthcare in nine major European countries, using cancer care as an example. To identify relevant studies, we conducted a systematic literature search. The results of the literature review suggest that although prevention, access to early diagnosis, and radiotherapy are key factors associated with good outcomes in oncology, public and political attention often focusses on the availability of pharmacological treatments. In some countries this focus may divert funding towards cancer drugs, for example through specific cancer drugs funds, leading to reduced expenditure on other areas of cancer care, including prevention, and potentially on other diseases. In addition, as highly effective, expensive agents are developed, the use of value-based approaches may lead to unacceptable impacts on health budgets, leading to a potential need to re-evaluate current cost-effectiveness thresholds. We anticipate that the question of how to fund new therapies equitably will become even more challenging in the future, with the advent of expensive, innovative, breakthrough treatments in other therapeutic areas.
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  • Is excess weight a burden for older adults who suffer chronic pain?

    Dong, Huan-Ji   Larsson, Britt   Levin, Lars-Ake   Bernfort, Lars   Gerdle, Bjorn  

    BACKGROUND: Obesity and chronic pain are common comorbidities and adversely influence each other. Advanced age is associated with more comorbidities and multi-morbidities. In this study, we investigated the burden of overweight/obesity and its comorbidities and their associations with chronic pain in a random population sample of Swedish older adults.; METHODS: The cross-sectional analysis involved a random sample of a population=E2=89=A565years in south-eastern Sweden (N=3D6243). Data were collected from a postal questionnaire that addressed pain aspects, body mass index (BMI), and health experiences. Chronic pain was defined as pain during the previous three months. According to the 0-10 Numeric Rating Scale, pain scored =E2=89=A57 corresponds to severe pain. Binary logistic regression was used to determine the variables associated to pain aspects.; RESULTS: A total of 2633 (42%) reported chronic pain. More obese older adults (BMI =E2=89=A530kg/m2) experienced chronic pain (58%) than those who were low-normal weight (BMI <25kg/m2, 39%) or overweight (25=E2=89=A4BMI <30kg/m2, 41%). Obese elderly more frequently had pain in extremities and lower back than their peers. In the multivariate model, obesity (Odds Ratio (OR) 1.59, 95% Confidence Interval (CI) 1.33-1.91) but not overweight (OR 1.08, 95% CI 0.95-1.22) was associated with chronic pain. Obesity (OR 1.53, 95% CI 1.16-2.01) was also significantly related to severe pain. We also found other comorbidities - i.e., traumatic history (OR 2.52, 95% CI 1.99-3.19), rheumatic diseases (OR 5.21, 95% CI 4.54-5.97), age=E2=89=A585years (OR 1.66, 95% CI 1.22-2.25), and depression or anxiety diagnosis (OR 1.83, 95% CI 1.32-2.53) - showed stronger associations with pain aspects than weight status.; CONCLUSION: In older adults, excess weight (BMI 30 or above) is a potentially modifiable factor but not the only risk factor that is associated with chronic pain and severe pain. Future studies should investigate the effectiveness of interventions that treat comorbid pain and obesity in older adults.=20
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  • Long-term cost of spouses' informal support for dependent midlife stroke survivors

    Persson, Josefine   Levin, Lars-Ake   Holmegaard, Lukas   Redfors, Petra   Svensson, Mikael   Jood, Katarina   Jern, Christina   Blomstrand, Christian   Forsberg-Warleby, Gunilla  

    Objectives: Stroke is a major global disease that requires extensive care and support from society and relatives. The aim of this study was to identify and quantify the long-term informal support and to estimate the annual cost of informal support provided by spouses to their stroke surviving partner. Method: Data were based on the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. One-third of the spouses stated that they provided support to their stroke surviving partner. The magnitude of the support was assessed with a study-specific time-diary and was estimated for independent and dependent stroke survivors based on the scores of the modified Rankin Scale. To deal with skewed data, a two-part econometric model was used to estimate the annual cost of informal support. Result: Cohabitant dyads of 221 stroke survivors aged < 70 at stroke onset were included in the study. Spouses of independent stroke survivors (n =3D 188) provided on average 0.15 hr/day of practical support and 0.48 hr/day of being available. Corresponding figures for spouses of dependent stroke survivors (n =3D 33) were 5.00 regarding practical support and 9.51 regarding being available. The mean annual cost of informal support provided for independent stroke survivors was estimated at (sic)991 and (sic)25,127 for dependent stroke survivor. Conclusion: The opportunity cost of informal support provided to dependent midlife stroke survivors is of a major magnitude many years after stroke onset and should be considered in economic evaluations of health care.
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  • Prioritizing Rare Diseases:Psychological Effects Influencing Medical Decision Making

    Wiss, Johanna   Levin, Lars-Ake   Andersson, David   Tinghoeg, Gustav  

    Background. Measuring societal preferences for rarity has been proposed to determine whether paying premium prices for orphan drugs is acceptable. Objective. To investigate societal preferences for rarity and how psychological factors affect such preferences. Method. A postal survey containing resource allocation dilemmas involving patients with a rare disease and patients with a common disease, equal in severity, was sent out to a randomly selected sample of the population in Sweden (return rate 42.3%, n =3D 1270). Results. Overall, we found no evidence of a general preference for prioritizing treatment of patients with rare disease patients over those with common diseases. When treatment costs were equal, most respondents (42.7%) were indifferent between the choice options. Preferences for prioritizing patients with common diseases over those with rare diseases were more frequently displayed (33.3% v. 23.9%). This tendency was, as expected, amplified when the rare disease was costlier to treat. The share of respondents choosing to treat patients with rare diseases increased when presenting the patients in need of treatment in relative rather than absolute terms (proportion dominance). Surprisingly, identifiability did not increase preferences for rarity. Instead, identifying the patient with a rare disease made respondents more willing to prioritize the patients with common diseases. Respondents' levels of education were significantly associated with choicethe lower the level of education, the more likely they were to choose the rare option. Conclusions. We find no support for the existence of a general preference for rarity when setting health care priorities. Psychological effects, especially proportion dominance, are likely to play an important role when preferences for rarity are expressed.
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  • The Impact of Patients' Subjective Life Expectancy on Time Tradeoff Valuations

    Heintz, Emelie   Krol, Marieke   Levin, Lars-Ake  

    Background. Quality-adjusted life-year (QALY) calculations in economic evaluations are typically based on general public or patient health state valuations elicited with the time tradeoff method (TTO). Such health state valuations elicited among the general public have been shown to be affected by respondents' subjective life expectancy (SLE). This suggests that TTO exercises based on time frames other than SLE may lead to biased estimates. It has not yet been investigated whether SLE also affects patient valuations. Objective. To empirically investigate whether patients' SLE affects TTO valuations of their current health state. Methods. Patients with different severities of diabetic retinopathy were asked in a telephone interview to value their own health status using TTO. The TTO time frame (t) presented was based on age- and sex-dependent actuarial life expectancy. Patients were then asked to state their SLE. Simple and multiple regression techniques were used to assess the effect of the patients' SLE on their TTO responses. Results. In total, 145 patients completed the telephone interview. Patients' TTO values were significantly influenced by their SLE. The TTO value decreased linearly with every additional year of difference between t and the patients' SLE; that is, patients were more willing to give up years the shorter their SLE compared with t. Conclusion. Patients' SLE influenced their TTO valuations, suggesting that respondents' SLE may be the most appropriate time frame to use in TTO exercises in patients. The use of other time periods may bias the TTO valuations, as the respondents may experience the presented time frame as a gain or a loss. The effect seems to be larger in patient valuations than in general public valuations.
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  • Factors Associated with Life Satisfaction in Older Adults with Chronic Pain (PainS65+)

    Dong, Huan-Ji   Larsson, Britt   Dragioti, Elena   Bernfort, Lars   Levin, Lars-Ake   Gerdle, Bjorn  

    Background: Chronic pain in later life is a worldwide problem. In younger patients, chronic pain affects life satisfaction negatively; however, it is unknown whether this outcome will extend into old age. Objective: This study examines which factors determine life satisfaction in older adults who suffer from chronic pain with respect to socio-demographics, lifestyle behaviors, pain, and comorbidities. Methods: This cross-sectional study recruited a random sample of people >=3D 65 years old living in south-eastern Sweden (N=3D 6611). A postal survey addressed pain aspects and health experiences. Three domains from the Life Satisfaction Questionnaire (LiSat-11) were used to capture the individual's estimations of overall satisfaction (LiSat-life), somatic health (LiSat-somhealth), and psychological health (LiSat-psychhealth). Results: Respondents with chronic pain (2790, 76.2 +/- 7.4 years old) rated lower on life satisfaction than those without chronic pain, with medium effect size (ES) on LiSat-somhealth (r =3D 0.38, P < 0.001) and small ES on the other two domains (r < 0.3). Among the respondents with chronic pain, severe pain (OR 0.29-0.59) and pain spreading (OR 0.87-0.95) were inversely associated with all three domains of the LiSat-11. Current smoking, alcohol overconsumption, and obesity negatively affected one or more domains of the LiSat-11. Most comorbidities were negatively related to LiSat-somhealth, and some comorbidities affected the other two domains For example, having tumour or cancer negatively affected both LiSat-life (OR 0.62, 95% CI 0.44-0.88) and LiSat-somhealth (OR 0.42, 95% CI 0.24-0.74). Anxiety or depression disorders had a negative relationship both for LiSat-life (OR 0.54, 95% CI 0.38-0.78) and LiSat-psychhealth (OR 0.10, 95% CI 0.06-0.14). Conclusion: Older adults with chronic pain reported lower life satisfaction but the difference from their peers without chronic pain was trivial, except for satisfaction with somatic health. Pain management in old age needs to consider comorbidities and severe pain to improve patients' life satisfaction.
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  • Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration

    Freedman, Ben   Camm, John   Calkins, Hugh   Healey, Jeffrey S.   Rosenqvist, Marten   Wang, Jiguang   Albert, Christine M.   Anderson, Craig S.   Antoniou, Sotiris   Benjamin, Emelia J.   Boriani, Giuseppe   Brachmann, Hannes   Brachmann, Johannes   Brandes, Axel   Chao, Tze-Fan   Conen, David   Engdahl, Johan   Fauchier, Laurent   Fitzmaurice, David A.   Friberg, Leif   Gersh, Bernard J.   Gladstone, David J.   Glotzer, Taya V.   Gwynne, Kylie   Hankey, Graeme J.   Harbison, Joseph   Hillis, Graham S.   Hills, Mellanie T.   Kamel, Hooman   Kirchhof, Paulus   Kowey, Peter R.   Krieger, Derk   Lee, Vivian W. Y.   Levin, Lars-Ake   Lip, Gregory Y. H.   Lobban, Trudie   Lowres, Nicole   Mairesse, Georges H.   Martinez, Carlos   Neubeck, Lis   Orchard, Jessica   Piccini, Jonathan P.   Poppe, Katrina   Potpara, Tatjana S.   Puererfellner, Helmut   Rienstra, Michiel   Sandhu, Roopinder K.   Schnabel, Renate B.   Siu, Chung-Wah   Steinhubl, Steven   Svendsen, Jesper H.   Svennberg, Emma   Themistoclakis, Sakis   Tieleman, Robert G.   Turakhia, Mintu P.   Tveit, Arnljot   Uittenbogaart, Steven B.   Van Gelder, Isabelle C.   Verma, Atul   Wachter, Rolf   Yan, Bryan P.  

    Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country-and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.
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  • Long-term QALY-weights among spouses of dependent and independent midlife stroke survivors

    Persson, Josefine   Aronsson, Mattias   Holmegaard, Lukas   Redfors, Petra   Stenlof, Kaj   Jood, Katarina   Jern, Christina   Blomstrand, Christian   Forsberg-Warleby, Gunilla   Levin, Lars-Ake  

    The aim of this study was to investigate whether the dependency of midlife stroke survivors had any long-term impact on their spouses' QALY-weights. Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. Health-related quality of life was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. Spouses of dependent and independent stroke survivors were categorized according to their scores on the modified Rankin Scale. An ordinary least squares regression analysis was used to evaluate whether the dependency of the stroke survivors had any impact on the spouses' QALY-weights. Cohabitant dyads of 247 stroke survivors aged < 70 at stroke onset and 245 dyads of controls were included in the study. Spouses of dependent stroke survivors (n =3D 50) reported a significant lower mean QALY-weight of 0.69 in comparison to spouses of independent stroke survivors (n =3D 197) and spouses of controls, (n =3D 245) who both reported a mean QALY-weight of 0.77. The results from the regression analysis showed that higher age of the spouse and dependency of the stroke survivor had a negative association with the spouses' QALY-weights. The QALY-weights for spouses of dependent midlife stroke survivors were significantly reduced compared to spouses of independent midlife stroke survivors. This indicates that the inclusion of spouses' QALYs in evaluations of early treatment and rehabilitation efforts to reduce stroke patients' dependency would capture more of the total effect in dyads of stroke survivors.
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  • A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.

    Levin, Lars-Ake   Husberg, Magnus   Sobocinski, Piotr Doliwa   Kull, Viveka Frykman   Friberg, Leif   Rosenqvist, Marten   Davidson, Thomas  

    AIMS: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.; METHODS AND RESULTS: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of 55 400.; CONCLUSION: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life. Published on behalf of the European Society of Cardiology. All rights reserved. =C2=A9 The Author 2014. For permissions please email: journals.permissions@oup.com.
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  • Designing an optimal screening program for unknown atrial fibrillation:a cost-effectiveness analysis

    Aronsson, Mattias   Svennberg, Emma   Rosenqvist, Marten   Engdahl, Johan   Al-Khalili, Faris   Friberg, Leif   Frykman, Viveka   Levin, Lars-Ake  

    Aims The primary objective of this study was to use computer simulations to suggest an optimal age for initiation of screening for unknown atrial fibrillation and to evaluate if repeated screening will add value. Methods and results In the absence of relevant clinical studies, this analysis was based on a simulation model. More than two billion different designs of screening programs for unknown atrial fibrillation were simulated and analysed. Data from the published scientific literature and registries were used to construct the model and estimate lifelong effects and costs. Costs and effects generated by 2 147 483 648 different screening designs were calculated and compared. Program designs that implied worse clinical outcome and were less cost-effective compared to other programs were excluded from the analysis. Seven program designs were identified, and considered to be cost effective depending on what the health-care decision makers are ready to pay for gaining a quality-adjusted life-year (QALY). Screening at the age of 75 implied the lowest cost per gained QALY ((sic)n4 800/QALY). Conclusion In conclusion, examining the results of more than two billion simulated screening program designs for unknown atrial fibrillation, seven designs were deemed cost-effective depending on how much we are prepared to pay for gaining QALYs. Our results showed that repeated screening for atrial fibrillation implied additional health benefits to a reasonable cost compared to one-off screening.
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  • Economic analysis of ticagrelor therapy from a U.S. perspective: results from the PLATO study.

    Cowper, Patricia A   Pan, Wenqin   Anstrom, Kevin J   Kaul, Padma   Wallentin, Lars   Davidson-Ray, Linda   Nikolic, Elisabet   Janzon, Magnus   Levin, Lars-Ake   Cannon, Christopher P   Harrington, Robert A   Mark, Daniel B  

    BACKGROUND: Based on results of the PLATO (Platelet Inhibition and Patient Outcomes) trial comparing ticagrelor with clopidogrel therapy, the U.S. Food and Drug Administration approved ticagrelor in 2011 for reducing thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) with the proviso that it be taken with low-dose aspirin.; OBJECTIVES: This study sought to assess the cost and cost effectiveness of ticagrelor therapy relative to clopidogrel in treating ACS patients from the perspective of the U.S. health care system.; METHODS: We estimated within-trial resource use and costs using U.S. low-dose aspirin patients in PLATO (n =3D 547). Quality-adjusted life expectancy was estimated using the total PLATO population (n =3D 18,624), combined with baseline risk and long-term survival data from an external ACS patient cohort. Study drugs were valued at current costs. Cost effectiveness was assessed, as was the sensitivity of results to sampling and methodological uncertainties.; RESULTS: One year of ticagrelor therapy, relative to that of generic clopidogrel, cost $29,665/quality-adjusted life-year gained, with 99% of bootstrap estimates falling under a $100,000 willingness-to-pay threshold. Results were robust to extensive sensitivity analyses, including variations in clopidogrel cost, exclusion of costs in extended years of life, and a recalibrated estimate of survival reflecting a lower underlying mortality risk in the United States.; CONCLUSIONS: For PLATO-eligible ACS patients, a U.S. perspective comparison of the current standard of dual antiplatelet therapy of aspirin with clopidogrel versus aspirin plus ticagrelor showed that the ticagrelor regimen increased life expectancy at an incremental cost well within accepted benchmarks of good value for money. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872). Copyright =C2=A9 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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  • Population screening of 75- and 76-year-old men and women for silent atrial fibrillation (STROKESTOP)

    Friberg, Leif   Engdahl, Johan   Frykman, Viveka   Svennberg, Emma   Levin, Lars-Ake   Rosenqvist, Marten  

    Atrial fibrillation (AF) is important because it is common and is a major cause of stroke unless treated with oral anticoagulant. The prevalence of AF increases with age as does the risk of stroke. At 75 years the risk from age alone is so high that current guidelines recommend anticoagulation even in the absence of other risk factors. Atrial fibrillation is often asymptomatic and only discovered by chance or when a stroke already has occurred. We have launched a major screening study for silent AF in which 25 000 Swedes aged 75 and 76 years are randomized to either participate in a screening programme using ambulant intermittent electrocardiogram (ECG) recording to detect silent AF, or act as a control group. Patients in whom AF is detected are offered cardiological examination and anticoagulant treatment according to current guidelines. The cohort and the controls will be followed prospectively for 5 years after the inclusion of the first participant. An interim analysis will be made after 3 years. Our hypothesis is that screening for AF will reduce stroke incidence in the screened population, and that this screening will prove to be cost effective. Secondary endpoints are: any thromboembolic event, intracranial bleeding, other major bleeding, first ever diagnosis of dementia, death from any cause, and a composite of these endpoints.
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  • Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording.

    Aronsson, Mattias   Svennberg, Emma   Rosenqvist, Marten   Engdahl, Johan   Al-Khalili, Faris   Friberg, Leif   Frykman-Kull, Viveka   Levin, Lars-Ake  

    AIMS: The aim of this study was to estimate the cost-effectiveness of 2 weeks of intermittent screening for asymptomatic atrial fibrillation (AF) in 75/76-year-old individuals.; METHODS AND RESULTS: The cost-effectiveness analysis of screening in 75-year-old individuals was based on a lifelong decision analytic Markov model. In this model, 1000 hypothetical individuals, who matched the population of the STROKESTOP study, were simulated. The population was analysed for different parameters such as prevalence, AF status, treatment with oral anticoagulation, stroke risk, utility, and costs. In the base-case scenario, screening of 1000 individuals resulted in 263 fewer patient-years with undetected AF. This implies eight fewer strokes, 11 more life-years, and 12 more quality-adjusted life years (QALYs) per 1000 screened individuals. The screening implies an incremental cost of 50 012, resulting in a cost of 4313 per gained QALY and 6583 per avoided stroke.; CONCLUSIONS: With the use of a decision analytic simulation model, it has been shown that screening for asymptomatic AF in 75/76-year-old individuals is cost-effective. Published on behalf of the European Society of Cardiology. All rights reserved. =C2=A9 The Author 2015. For permissions please email: journals.permissions@oup.com.
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  • Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting.

    Nilsson, Staffan   Andersson, Agneta   Janzon, Magnus   Karlsson, Jan-Erik   Levin, Lars-Ake  

    OBJECTIVE: To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care.; DESIGN: Prospective observational study with follow-up.; SETTING: Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden.; PATIENTS: All patients =E2=89=A5 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days.; MAIN OUTCOME MEASURES: Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre.; RESULTS: A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n =3D 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n =3D 29, 43%; p =3D 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p =3D 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA.; CONCLUSION: The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.=20
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  • Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden.

    Davidson, Thomas   Husberg, Magnus   Janzon, Magnus   Oldgren, Jonas   Levin, Lars-Ake  

    AIMS: Patients with atrial fibrillation have a significantly increased risk of thromboembolic events such as ischaemic stroke, and patients are therefore recommended to be treated with anticoagulation treatment. The most commonly used anticoagulant consists of vitamin K antagonist such as warfarin. A new oral anticoagulation treatment, dabigatran, has recently been approved for stroke prevention among patients with atrial fibrillation. The purpose of this study was to estimate the cost-effectiveness of dabigatran as preventive treatment of stroke and thromboembolic events compared with warfarin in 65-year-old patients with atrial fibrillation in Sweden.; METHODS AND RESULTS: A decision analytic simulation model was used to estimate the long-term (20-year) costs and effects of the different treatments. The outcome measures are the number of strokes prevented, life years gained, and quality-adjusted life years (QALYs) gained. Costs and effect data are adjusted to a Swedish setting. Patients below 80 years of age are assumed to start with dabigatran 150 mg twice a day and switch to 110 mg twice a day at the age of 80 years due to higher bleeding risk. The price of dabigatran in Sweden is 2.82 (Swedish kronor 25.39) per day for both doses. The cost per QALY gained for dabigatran compared with warfarin is estimated at 7742, increasing to 12 449 if dabigatran is compared with only well-controlled warfarin treatment.; CONCLUSION: Dabigatran is a cost-effective treatment in Sweden, as its incremental cost-effectiveness ratio is below the normally accepted willingness to pay limit.
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