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  • 1.
    Fritzell, Peter
    et al.
    Department of Orthopedic Surgery, Falun Hospital, Falun, Sweden.
    Hägg, Olle
    Department of Orthopedic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
    Jonsson, Dick
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Nordwall, Anders
    Department of Orthopedic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
    Appelgren, G. (Contributor)
    Halmstad.
    Berg, S. (Contributor)
    Uppsala.
    B. Branth, B. (Contributor)
    Stockholm.
    Cederlund, C. G. (Contributor)
    Göteborg.
    Elkan, P. (Contributor)
    Stockholm.
    Hedlund, R. (Contributor)
    Stockholm.
    Kogler, H. (Contributor)
    Örebro.
    Leufvén, C. (Contributor)
    Eskilstuna.
    Németh, G. (Contributor)
    Stockholm.
    Neumann, P. (Contributor)
    Göteborg.
    Nilsson, M. (Contributor)
    Stockholm.
    Nordenström, K. (Contributor)
    Karlstad.
    Ohlin, A. (Contributor)
    Malmö.
    Ordeberg, G. (Contributor)
    Uppsala.
    Reigo, Tomas (Contributor)
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Sahlstrand, T. (Contributor)
    Helsingborg.
    Sandberg, R. (Contributor)
    Karlstad.
    Skogland, L. (Contributor)
    Oslo.
    Strömqvist, B. (Contributor)
    Lund.
    Tropp, Hans (Contributor)
    Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Norrköping.
    Tullberg, T. (Contributor)
    Stockholm.
    Wikström, T. (Contributor)
    Sundsvall.
    Willén, J. (Contributor)
    Göteborg.
    Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish lumbar spine study: A multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group2004In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 29, no 4, p. 421-434Article in journal (Refereed)
    Abstract [en]

    Study Design. A cost-effectiveness study was performed from the societal and health care perspectives. Objective. To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. Summary of Background Data. A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. Patients and Methods. A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector ( direct costs), and costs associated with production losses ( indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain ( VAS), functional disability (Owestry), and return to work. Results. The societal total cost per patient ( standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 ( 254,000) vs. SEK 636,000 ( 208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 ( 60,100) vs. 65,200 ( 38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio ( ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 ( 600 - 5,900), for back pain: SEK 5,200 ( 1,100 - 11,500), for Oswestry: SEK 11,300 ( 1,200 - 48,000), and for return to work: SEK 4,100 ( 100 21,400). Conclusion. For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.

  • 2.
    Glendor, Ulf
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Jonsson, Dick
    Halling, A.
    Lindqvist, Kent
    Direct and indirect costs of dental trauma in Sweden: a 2-year prospective study of children and adolescents2001In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, Vol. 29, no 2, p. 150-160Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study total costs, including direct costs (health care service, loss of personal property, medicine and transport) and indirect costs (loss of production or leisure) of dental trauma to children and adolescents with special reference to predictors.

    METHODS: The study was based on a random sample of 192 children and adolescents with a dental trauma reported to an insurance company and prospectively followed up by telephone interviews over a period of 2 years.

    RESULTS: On average, health care service costs represented 2,955 SEK (SD=3,818) and total costs 4,569 SEK (SD=3,053) for dental trauma to permanent teeth, and 837 SEK (SD=898) and 1,746 SEK (SD=1,183) for trauma to primary teeth. The most extensive type of indirect cost was loss of production or leisure, which averaged 1,286 SEK (SD=1,830) for injuries to permanent teeth and 699 SEK (SD=1,239) for injuries to primary teeth. Multiple regression analysis of demographic and dental injury variables showed that complicated trauma was of special importance to costs for permanent and primary teeth injuries. The average relative increase in total costs to patients and companions for complicated injury to permanent teeth was 140% (95% confidence interval [CI], 66-248%) for patients and 132% (95% CI, 54-249%) for companions. Lack of access to a dental clinic near the place of residence could increase the average total costs of injuries to permanent teeth by 91% for companions (95% CI, 20-204%) and for primary teeth by 134% (95% CI, 38-296%).

    CONCLUSIONS: Dental traumas result in both direct and indirect costs, with a predominance of direct costs. The direct costs primarily depend on degree of severity, while indirect costs are mostly due to compromised access to health care service. Traumas to permanent teeth are especially costly and, due to additional maintenance, the care may continue for several years. This study has drawn attention to the significant implications of dental trauma to patient and companion, a new area where further studies are warranted.

  • 3.
    Götherström, Ulla-Christel
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    A comparative study of text telephone and videophone relay services2004In: Technology and Disability, ISSN 1055-4181, Vol. 16, no 2, p. 101-109Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to compare text telephone relay service and videophone relay service. The target group was people borne deaf. The following aspects were investigated: (1) socioeconomic costs, (2) costs of different actors, (3) qualitative aspects of the services, (4) outcomes (intermediate effects and quality of life). The study was longitudinal and measurements were made at three occasions. Data collection was made by post-mailed questionnaires. Of the 41 respondents, 16 persons had access to the text telephone relay service only and 25 persons had access to text telephone relay service supplemented with videophone relay service. The ratings of the quality of the services and the outcomes were significantly higher for videophone relay service than for text telephone relay service (at a 95%-level). The incremental cost was approximately SEK 40 000, or EUR 4 510 (1 EUR = 8.87 SEK, as of 31 December 2000) higher per person and year for the group with access to both text telephone relay service and videophone relay service compared with the group with access to text telephone relay service only.

  • 4.
    Götherström, Ulla-Christel
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, The Institute of Technology.
    A socioeconomic model for evaluation of postal and telecommunication services for disabled persons2004In: Technology and Disability, ISSN 1055-4181, Vol. 16, no 2, p. 91-99Article in journal (Refereed)
    Abstract [en]

    The Swedish National Post and Telecom Agency provides services in the postal and telecommunication area for disabled persons. The text telephone relay service, videophone relay service, free directory enquiries and extended rural postal service are aimed for various groups of persons with disabilities. The aim of this study was to develop a socioeconomic model for assessing such telecommunication services for disabled persons. The model development included the WHO Classification ICIDH-2 and ICF, literature review, reference panel opinions, expert opinions and pilot studies. The developed model encompasses quality of the services, costs and outcomes. The quality of the services refers to quality in structure and process. Costs for different actors are included, e.g. the user, family members, county councils, local authorities and the government. Outcomes of the services refer to intermediate outcomes (direct communicative outcomes) and generic outcomes (quality of life). The socioeconomic model is general and is applicable to different rehabilitation interventions.

  • 5.
    Hallert, Eva
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Jonsson, Dick
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
    Rheumatoid arthritis is already expensive during the first year of the disease (the Swedish TIRA Project)2004In: Rheumatology, ISSN 1462-0324, Vol. 43, no 11, p. 1374-1382Article in journal (Refereed)
    Abstract [en]

    Objective. To calculate direct and indirect costs in early rheumatoid arthritis (RA) and to characterize patients generating high and low costs respectively.

    Methods. Two hundred and ninety-seven patients with recent-onset (≤12 months) RA were recruited. Clinical/laboratory data and 'health assessment questionnaire' (HAQ) were registered at inclusion and after 3, 6 and 12 months. After 6 and 12 months, the patients completed a questionnaire concerning health-care utilization and days lost from work. A cut-off point for direct costs was set at 34 000 Swedish kronor (3675) defining one-third of the patients as a high-cost group and two-thirds as low-cost group. Indirect costs were calculated for patients aged <65 yr.

    Results. Two hundred and eleven patients completed the HAQ on both occasions. Indirect costs exceeded direct costs by a factor of 2.3. Sixty three per cent experienced work disability during the first year and were identified as the 'high-indirect-cost group'. Indirect costs accounted for >70% of total costs. Direct costs included ambulatory health care (76%), hospitalization (12%) and medication (9%). Men aged ≥65 yr had low costs compared with younger men and women of all ages. In multiple logistic regression tests, HAQ, high levels of IgM rheumatoid factor (IgM RF) and poor hand function increased the odds of entering the high-direct-cost group, and poor hand function and pain increased the odds of entering the high-indirect-cost group.

    Conclusions. Substantial costs were incurred during the first year after diagnosis of early RA, mainly due to work disability. Indirect costs were two to three times higher than direct costs. High levels of IgM RF, high HAQ score, poor hand function and pain increased the odds of entering high-cost groups.

  • 6.
    Hallert, Eva
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Schmidt, Andrea
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Jonsson, Dick
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Sjukdomsförlopp, kostnader och livskvalitet vid nydebuterad reumatoid artrit2007Report (Other academic)
    Abstract [en]

    Rheumatoid  arthritis  (RA)  is  a  chronic  progressive  inflammatory   disease, associated with tissue destruction and functional disability. The yearly incidence of RA in Sweden is 25/100 000 and the prevalence is 0.5-0.7%, with women being more often affected than men. The economic consequences of the disease are substantial  for the  individual  and  their  families  and  for the society  as a whole.   Previous   studies   have   reported   that   early   treatment   limits   joint destruction and improves functional outcome.

    In 1996 a multicenter study TIRA was started in Linköping in cooperation with 10 rheumatology units and Center for Medical Technology Assessment (CMT) TIRA is the Swedish acronym for ‘early intervention  in rheumatoid  arthritis’. The   main   goal   was   to   obtain   early   diagnosis,   rapid   multiprofessional intervention  and  a  regular  follow-up.  Further,  the  TIRA  project  aimed  at forming  a research  database  and health economic  evaluation  in patients  with recent-onset RA.

    This study describes disease activity, functional ability, direct and indirect costs as well as self-reported health and quality of life (QoL) in patients with recent- onset RA, during the first 3 years after diagnosis.

    320 subjects were enrolled in the study from January 1996 through April 1998, 2/3  being  women.  At  inclusion  most  patients  had  high  disease  activity  and impaired functional capacity. More than half of patients < 65 were on sick leave and a few were already early retired.

    Highly significant improvements were seen within the first 3 months regarding disease  activity  and functional  ability,  but 15% of the patients  had sustained high or moderate disease activity throughout the study period, despite traditional treatment. The scores of ‘Health Assessment Questionnaire’ (HAQ) were similar for men and women at baseline, but had a less favourable course in women, who also had DMARDs  more frequently prescribed,  suggesting  that women might have a more severe disease.

    At inclusion QoL did not differ between groups concerning different housing, marital   status,   income   or  other  socio-demographic   factors.   Most  patients experienced their health as worse compared with others of the same age. During the first 2 years QoL was improved as well as general mobility and ability to perform activities of daily living. During year 3 a slight deterioration was noted.

    The average direct costs per patient during the first year was SEK 36 000 and indirect costs SEK 89 000 (price level of 2001). All direct costs decreased from year 1 to 3, except costs of drugs and surgery which on the contrary increased. Indirect costs were substantially unchanged over the years. Sick-leave decreased but was offset by an increase in early retirement. Indirect costs were 2-3 times higher than direct costs.

    More than 90% of the patients were satisfied or very satisfied with treatment and availability and information from the medical staff in the participating hospitals.

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    Sjukdomsförlopp, kostnader och livskvalitet vid nydebuterad reumatoid artrit : En treårsuppföljning inom TIRA-projektet
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  • 7.
    Hanson, J
    et al.
    Karolinska Inst, NW Stockholm Med Area, Stockholm, Sweden CMT, Linkoping, Sweden.
    Belfrage, H
    Karolinska Inst, NW Stockholm Med Area, Stockholm, Sweden CMT, Linkoping, Sweden.
    Bergman, B
    Karolinska Inst, NW Stockholm Med Area, Stockholm, Sweden CMT, Linkoping, Sweden.
    Forsling, K
    Karolinska Inst, NW Stockholm Med Area, Stockholm, Sweden CMT, Linkoping, Sweden.
    Jonsson, Dick
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment.
    Lidberg, L
    Karolinska Inst, NW Stockholm Med Area, Stockholm, Sweden CMT, Linkoping, Sweden.
    Multi-problem persons in Stockholm: multi-care consumation and estimated costs - a file study of psychiatrically disturbed offenders2000In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 54, p. 10-10Conference paper (Other academic)
  • 8.
    Johansson, Torsten
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
    Bachrach-Lindström, Margareta
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
    Jonsson, Dick
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
    The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips2006In: International Orthopaedics, ISSN 0341-2695, Vol. 30, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    We randomised 143 patients –age 75 years or older–with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

  • 9.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Cost-Utility Analysis of Rehabilitation of Patients with SchizophreniaManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The socioeconomic cost for schizophrenia is high and there is a growing interest to consider the economic consequences of introducing new rehabilitation methods in health care and other sectors of society. In order to facilitate health policy making and medical decision-making in health care from a health economic perspective, broad socioeconomic evaluations of different rehabilitation methods for patients with schizophrenia are necessary.

    Aims of the study: To compare two rehabilitation strategies for patients with schizophrenia in Sweden. The new method of rehabilitation was based on interagency co-operation and teamwork involving the county council, local authorities, labor market policy agencies and the social insurance office. The alternative treatment method was traditional rehabilitation activities. The rehabilitation methods were compared with respect to differences in socioeconomic costs, transfer payments and quality of life.

    Methods: It was a pre/post intervention cohort study in Sweden conducted in 1998. Data were gathered prospectively by postal questionnaires from 52 consecutively included, unemployed schizophrenic patients during a period of 6 months before and 6 months after a rehabilitation intervention. The patients had been ill for five years on average. The mean age was 29 years and the proportion of women was 56%. Data on costs, transfer payments and quality of life (EuroQol) were registered.The analytical method used was cost-utility analysis.

    Results: The new rehabilitation program improved health status by 26% (p=0.007) and health related quality of life by 27% (p=0.0002), which corresponded with a change in quality adjusted life years. The total socioeconomic costs decreased, by 28% (p=0.018), SEK 19 000 per patient. The healthcare costs decreased by 51% (p=0.005) and the costs for the labor market policy agencies decreased by 90% (p=0.004). There were no significant changes in costs for the local authorities and the social insurance oflice at the 5% level. There were no changes in transfer pay- .ments at the 5% level, SEK 49 000/patient.

    Discussion: The co-operative strategy in the rehabilitation of patients with schizophrenia was cost-effective for health care and society. The cohort design allowed for some uncertainty over time. However, the patients' health status had been constant for a long period before the intervention, so the impact is minimized. In order to study long-term changes in social insurance expenditures and indirect costs, the time period for the studies must be longer.

    Conclusion: Interagency co-operation in rehabilitation saved money for health care and society and improved health status, health related quality of life and quality adjusted life years. It is necessary to discuss the principles for shared financial responsibility as well as incentives for monitoring resource allocations in the field of rehabilitation. Additional studies, preferably long-term, randomized, controlled trials, are needed. In the search for predictors of cost-effective rehabilitation technologies,studies of the impact of motivation on costs and quality of life are useful.

  • 10.
    Jonsson, Dick
    Linköping University, The Tema Institute, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Disability, rehabilitation and health economic assessment2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Disability caused by long-term illnesses and diseases involves welfare losses through human suffering and huge societal costs. Rehabilitation of disabled individuals is a complex and growing field where health economic assessment studies could play a role in health policy and medical decision-making.

    Aims: The overall aim was the application of a multidisdplinary framework of health economic assessment of rehabilitation technologies for disabled individuals. A specific aim was to examine the costs for some disabilitygroups, and another aim was to examine the cost-effectiveness of certain rehabilitation technologies for disabled individuals.

    Methods: Six empirical studies were used. Cost analyses were applied to disabilities caused by long-term illnesses (Paper I), rheumatic· diseases (Paper II), and severe schiwphrenia (Paper III). A cost-effectivenessanalysis was performed on the rehabilitation of disabled patients with severe schizophrenia {Paper IV). Costutilily analyses were carried out on the rehabilitation of disabled patients with long-term illnesses (Paper V)and schizophrenia (Paper VI).

    Results: The socioeconomic costs for the studied disability groups was SEK 1.9 billion for severe schizophrenia, SEK 25.6 billion for long term illness and SEK 62 billion for rheumatic diseases. The proportions of indirect productivity costs were considerable, 67-92% of total costs, and the social insurance expenditures were also high. Rehabilitation technologies based on co-operation between resource providers for disabled patients with schizophrenia improved health status by 26%, health-related quality of life by 27% and quality adjusted life years (QALY's). The costs for health care decreased significantly by 51% and sociely by 28%. Early rehabilitation of disabled patients with severe schizophrenia improved health status, social functioning and increased the health care costs. Rehabilitation of disabled patients with long-term illnesses did not improve health statu..~, quality of life and QALY's in the short run. The costs decreased for health care and the indirect costs increased. In optimizing the cost-effectiveness of rehabilitation technologies, disabled individuals must be precisely defined into homogeneous groups that match well-defined rehabilitation technologies. The costs for all resource providers in rehabilitation must be included in the cost concept in order to avoid underestimation of the socioeconomic costs. A financial analysis of transfer payments was valuable from a decision-maker perspective. The EuroQol-instrumem was sensitive in detecting significant changesin health status and health related qualily of life. One of the shortcomings in the study design i,s due to the lack of resources for health economic assessment studies. Long-term, randomized, controlled studies arc needed.

    Conclusions: The application of the framework for health economic assessment to the rehabilitation of disabled individuals showed that the costs for disabilities in society were high, as was the proportion of indirectcosts. Co-operation among resource providers involved in rehabilitation can increase quality of life and save money for health care and society.

  • 11.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Arts and Sciences.
    Socio-Economic Analysis of Rehabilitation in Primary Health CareManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aim was to compare a new strategy for rehabilitation based on coordinated teamwork with traditional health care activities for patients with longterm illnesses in primary health care with respect to costs and health related quality of life.

    Methods and data: This was a 3-month, prospective, controlled study in primary health care where a trial group of health care centers with rehabilitation teams (n=665) was compared with a control group of health care centers working with traditional health care activities without co-ordinated teams (n=665). The data collection was carried out for 12 months during the years 1993 and 1994 in 6 geographically defined areas. All individuals in the regions were consecutively included after being on sick leave for more than 30 days. The patients were followed upduring a period of three months using postal questionnaires. The analytical method was cost-utility analysis.

    Results: The team based rehabilitation strategy did not improve health related quality of life (p=0.46) compared with traditional rehabilitation. The total costs for health care was 9% lower (p=0.51) and the indirect costs for loss of production was 8% higher (p=0.02) for the trial group. Social insurance expenditures were 9% higher for the trial group (p=0.14).

    Discussion: It was not possible to form any reliable conclusions from this short term study about whether rehabilitation teams reduced health status and health related quality of life, as the differences were small but also negative. The perspective of analysis is important, from a health care perspective the teams were cost saving but from a broader socioeconomic perspective the teams lead to increased costs for society. The inclusion of indirect costs in cost-effectiveness analyses andcost-utility analyses requires further exploration. The time period was probably too short for capturing long-term effects.

    Conclusions: Rehabilitation teams in primary health care do not improve health related quality of life within a short-term perspective, reduce costs for health care but increase indirect costs and social insurance expenditures compared with traditional health care activities. In order to improve quality of life for those with longterm illnesses and decrease society's costs for rehabilitation, rehabilitation strategiesfor people with different illnesses may be developed into more specialized strategies for specific patient groups, defined into homogenous treatment groups that matchwell-defined rehabilitation. For further research long-term studies are needed.

  • 12.
    Jonsson, Dick
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Ferraz-Nunes, José
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Socioeconomic evaluation of mental health as a base for financing mental health care in Sweden2003In: International Advances in Economic Research, ISSN 1083-0898, E-ISSN 1573-966X, Vol. 8, p. 107-118Article in journal (Refereed)
  • 13.
    Jonsson, Dick
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Hass, Ursula
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    Persson, Jan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment. Linköping University, The Institute of Technology.
    The Cost of the Swedish Handicap Service System: Implications for Technology Assessment1995In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 11, no 2, p. 269-275Article in journal (Refereed)
    Abstract [en]

    The total cost of the Swedish handicap system is estimated at US $ 10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.

  • 14.
    Jonsson, Dick
    et al.
    Linköping University, The Tema Institute. Linköping University, Faculty of Arts and Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Socioeconomic costs of rheumatic diseases - Implications for technology assessment2000In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 16, no 4, p. 1193-1200Article in journal (Refereed)
    Abstract [en]

    Objectives: To study the socioeconomic impact of rheumatic illness in Sweden and to discuss the consequences for technology assessment studies.

    Methods: A cost-of-illness study based on data from official statistics and treatment studies.

    Results: The total socioeconomic cost was 52 billion Swedish kronor (SEK) in 1994. The imbalance between direct (10% of total) and indirect costs (90effectiveness of the healthcare sector, the need for new treatment methods, appropriate information systems, and technology assessment studies as well as the institutional arrangements for rehabilitation and basic medical research.

    Conclusions: A discussion of solutions for financial cooperation between county councils and regional social insurance offices should be considered. The new biotechnological pharmaceuticals will increase the cost for drugs in health care about 20 times, but the total socioeconomic cost for society may remain at the same level due to a decrease of inpatient costs and indirect costs for loss of production as well as a decrease of transfer payments from social insurance. It is unavoidable that the new pharmaceuticals require priority discussions and active resource allocation in health care and in other sectors of society.

  • 15.
    Jonsson, Dick
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Wålinder, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia1995In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 92, no 3, p. 199-201Article in journal (Refereed)
    Abstract [en]

    The costs and effects of clozapine treatment of refractory schizophrenic patients have been discussed recently. This study shows that 18 months of clozapine treatment results in an improvement of symptoms and social functioning in approximately 70% of treatment-refractory schizophrenic patients, compared with treatment with conventional neuroleptics during a similar period of time. Treatment with clozapine reduces the cost of inpatient care but places increased demands on active rehabilitation resources in outpatient care. This leads to increased total costs in a short-term perspective, but clozapine treatment is cost-saving for annual maintenance therapy. These costs must be weighed against the positive effects on psychotic symptoms and social functioning.

  • 16.
    Jonsson, Dick
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Wålinder, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden1994In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 48, no 5, p. 311-313Article in journal (Refereed)
    Abstract [en]

    The aim of the study is to examine the socioeconomic costs of treatment of therapy-refractory schizophrenic patients. The patients usually have a great need for health care and remain in institutions for long periods of time. The method is retrospective, and the data refer to patients who received treatment at the Department of Psychiatry, University Hospital in Linköping, Sweden in 1990. The total annual health care cost for treatment of therapy-refractory schizophrenia is estimated to be SEK 4.8 million (USD 1 = SEK 7.7). Inpatient care amounts to 93% of the total cost, and the cost of outpatient care to 6%. The cost of drugs and laboratory services corresponds to 1 % of the total cost. The high cost of inpatient care and the low cost of outpatient care may indicate that a redistribution of resources from inpatient to outpatient care is necessary. A generalization of the results indicates that the total annual cost of treating all therapy-refractory schizophrenic patients in Sweden is approximately SEK 1.9 billion. The result highlights the need for discussions concerning alternative treatment methods but also focuses on the importance of using health economic evaluations within psychiatry.

  • 17.
    Lindberg, Malou
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Ahlner, Johan
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Ekström, Tommy
    Linköping University, Department of Medicine and Care, Pulmonary Medicine. Linköping University, Faculty of Health Sciences.
    Jonsson, Dick
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Möller, Margareta
    Linköping University, Department of Neuroscience and Locomotion. Linköping University, Faculty of Health Sciences.
    Asthma nurse practice improves outcomes and reduces costs in primary health care2002In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 1, p. 73-78Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to elucidate the care of patients with asthma in primary health care from medical, patient self-management, health, quality of live, and health economic perspectives.

    Methods. Asthma nurse practice (ANP), an alternative asthma self-management strategy, was compared with traditional asthma care in primary health care in southern Sweden regarding medical history, lifestyle, self-management, symptoms caused by asthma, effects on sick leave, state of health, quality of life and health care costs. The first part of the investigation comprised a retrospective study of a randomly selected sample of patient records of asthmatics (n=152). The second part, lasting 3 months, was prospective and included consecutive patients visits (n=347).

    Results. The ANP approach showed better results in most of the evaluated outcomes such as asthma quality documentation and self-management and the number of asthma symptoms was significantly lower. From a health economic perspective the results were encouraging with respect to ANP.

    Conclusion. This alternative asthma strategy, ANP, improved asthma care in primary health care and resulted in economic advantages in the health care sector. However the result may only be generalized to other practices working with asthma nurses in the same way.

  • 18.
    Nordfeldt, Sam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Jonsson, Dick
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. A cost-of-illness study2001In: Acta Paediatrica, ISSN 0001-656X, Vol. 90, no 2, p. 137-142Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe costs and other short-term effects of severe hypoglycaemia in children and adolescents with type 1 diabetes. The study comprised a geographic population of 129 patients <19 y of age with families prospectively registering detailed data after self-reported severe hypoglycaemia. In the period Jan.-Dec. 1998, 16 events were reported with unconsciousness and 95 events without unconsciousness but needing the assistance of another person. Of all events, 20-30% had effects requiring the assistance of people other than parents, school absence, parents' absence from work, extra transport and/or telephone calls. Patient (family) activities were cancelled after 10% (5%) of events. Increased worry for parents was reported after 8% and poor sleep after 7% of events. Hospital visits took place at 5% and hospitalizations at 3% of all events. Patients with severe hypoglycaemia indicated lower global quality of life (p=0.0114). The average socio-economic burden for events of severe hypoglycaemia was estimated at EURO 17,400 yearly per 100 type 1 diabetes patients. Average cost was estimated at EURO 239 per event of severe hypoglycaemia with unconsciousness or EURO 478 yearly per patient with unconsciousness, and EURO 63 per event of severe hypoglycaemia without unconsciousness but needing assistance from another person or EURO 307 yearly per patient in this category. These are conservative estimates and do not include unpaid time and other intangibles, possible road traffic accidents, disabling or premature deaths. Conclusions: The results suggest the potential for socio-economic savings and increased quality of life for patients and families from severe hypoglycaemia prevention programs.

  • 19.
    Nordfeldt, Sam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Jonsson, Dick
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Increasing response rate in data registration and follow-up of type 1 diabetes children and adolescents: A prospective population study 1992–971999In: Practical Diabetes International, ISSN 1357-8170, Vol. 16, no 4, p. 101-106Article in journal (Refereed)
    Abstract [en]

    Aims: This study considers how a local diabetes team can develop a system for patient data registration and follow-up to enhance quality control and health economic analysis, and how a high response rate for patient data can be achieved.

    Patients and methods: A geographic population of yearly 120-130 intensively treated type 1 diabetes children. <19 years of age was studied. A prospective patient questionnaire monitored: blood glucose and urine testing, insulin doses, acute complications, medications for hypertension and epilepsy, tobacco and snuff use, and any open questions and needs of the patient. This was completed before every visit to the out-patient department and used as a database for consultation. Data were thereafter registered in regular computer software, and analysed on a yearly basis.

    Results: Response rate increased with time to near 100%. There was a time gain for diabetes nurse and physician. Many patients found the questionnaire good for overviewing treatment and easy to complete, whereas some found it was irksome and boring. The total cost of the method was <160 SEK/patient year.

    Conclusions: A very high patient data response rate can be achieved over years by a patientsupportive questionnaire integrated in the treatment program. Treatment and outcome analysis can then be performed locally at low costs. The combination of a patient questionnaire with regular hard- and software is easy to create, manage and develop. Benefits for diabetes team and patients exceed the total cost.

  • 20.
    Sennfält, K
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Reichard, R
    Hultkrantz, R
    Wong, JB
    Jonsson, Dick
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Cost-effectiveness of interferon alfa-2b with and without ribavirin as therapy for chronic hepatitis C in Sweden2001In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 36, no 8, p. 870-876Article in journal (Refereed)
    Abstract [en]

    Background: Recent trials have shown that treatment with a combination of interferon alfa-2b and ribavirin results in sustained loss of detectable hepatitis C-virus (HCV) RNA in a higher proportion of patients than treatment with interferon alone. Combination therapy, however, is two to three times as expensive as monotherapy. Methods: Based on data from recent randomized clinical trials and a previously published decision model, we developed a Markov model to estimate the cost-effectiveness of initial combination therapy with interferon and ribavirin versus interferon alone for previously untreated patients with chronic HCV infection in Sweden. Clinical praxis and quality adjustments were based on expert estimates and costs were gathered from different health care providers in Sweden. Results: Combination therapy for 24 or 48 weeks, compared to interferon alone, prolonged quality adjusted life expectancy by 0.5 to 1.1 years at marginal cost-effectiveness ratios of US$ 1,400 to US$ 6,000 per DQALY (discounted quality-adjusted life-year) for patients with genotype 1. In genotype 1, 48 weeks compared to 24 weeks of combination therapy prolonged quality adjusted life expectancy by 0.6 years at a marginal cost-effectiveness ratio of $US 9,800 per DQALY. For patients with genotype non-1, combination therapy for 24 or 48 weeks, compared to interferon alone, prolonged quality adjusted life expectancy by 2.3 years, with combination therapy for 24 weeks being money-saving. The results were robust in sensitivity analyses. Conclusion: Combination therapy with interferon and ribavirin increased quality-adjusted life expectancy and was cost-effective for patients with chronic hepatitis C.

  • 21.
    Söderlin, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
    Kautianen, Hannu
    Rheumatism Foundation Hospital, Heinola, Finland.
    Jonsson, Dick
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Leirisalo-Repo, Marjatta
    Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Huch, Finland.
    The costs of early inflammatory joint disease: a population-based study in southern Sweden2003In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 32, no 4, p. 216-224Article in journal (Refereed)
    Abstract [en]

    Objective: To study the costs and use of healthcare for patients during the first months with early joint inflammation, in a population-based prospective referral study in Southern Sweden.

    Methods: Adult patients with arthritis for <3 months and with onset of symptoms between 1 May 1999 and 1 May 2000 were referred from primary health centres to rheumatologists. Four clinical assessments were performed during a 6-month follow-up period. The direct medical costs for inpatient stays, outpatient visits, visits to general practitioners, and visits to health professionals, as well as costs for medication, radiographs, and laboratory tests were recorded from the onset of the disease up to 6 months of follow-up. Indirect costs for sick leave were also recorded.

    Results: Fifty-six of 71 referred patients agreed to participate. Thirteen (23%) had RA, 21 (38%) had reactive arthritis (ReA), 14 (25%) had undifferentiated arthritis, and eight (14%) had other arthritides. The median cost per patient in the entire group was USD 3362. The median cost per patient in the RA group was USD 4385, and USD 4085 in the ReA group. There was no statistically significant difference in the median costs per patient in the different diagnostic groups. Sick leave accounted for 44% of the total costs in the entire group, and 46% and 47%, respectively, in the RA and ReA groups.

    Conclusion: The costs of early arthritis are already considerable during the first months of the disease following the onset of the symptoms. The indirect costs due to sick leave accounted for nearly half of the costs.

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