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Johansson, K., Norström, F., Nordyke, K. & Myléus, A. (2019). Celiac Dietary Adherence Test simplifies Determining Adherence to a Gluten-Free Diet in Swedish Adolescents. Journal of Pediatric Gastroenterology and Nutrition - JPGN
Open this publication in new window or tab >>Celiac Dietary Adherence Test simplifies Determining Adherence to a Gluten-Free Diet in Swedish Adolescents
2019 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: The aims of the study were to ascertain whether the Celiac Dietary Adherence Test (CDAT) could contribute in determining adherence to a gluten-free diet in celiac disease patients and to evaluate the diet adherence and well-being of a study population five years after a celiac disease screening known as “Exploring the Iceberg of Celiacs in Sweden”.

Methods: Through the screening, 90 adolescents (born 1997) were diagnosed with biopsy-proven celiac disease at twelve-years of age. Of them, 70 (78%) came to a five-year follow-up where anti–tissue transglutaminase antibodies 2 (TG2-IgA) was tested and a questionnaire was filled in, including CDAT, which consists of seven questions related to adherence. Non-parametrical tests were utilized to determine associations between adherence measures.

Results: Among the adolescents, 86% were adherent to a gluten-free diet five years after screening, 38% reported their general well-being as excellent, 50% very well, and 12% well. Statistically significant associations were seen between TG2-IgA and the CDAT score (p=0.033), and the self-reported adherence question and the CDAT score (p < 0.001).

Conclusions: The screening-detected adolescents reported a high level of well-being and adherence to a gluten-free diet five years after screening. We conclude that the CDAT can be used in clinical practice as an estimation of adherence to a gluten-free diet. It would be most suitable to use in conjunction with currently used adherence measures, but can also be used as a stand-alone method when others are not accessible.

Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162417 (URN)10.1097/MPG.0000000000002451 (DOI)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-22
Norström, F., Waenerlund, A.-K., Lindholm, L., Nygren, R., Sahlén, K.-G. & Brydsten, A. (2019). Does unemployment contribute to poorer health-related quality of life among Swedish adults?. BMC Public Health, 19, Article ID 457.
Open this publication in new window or tab >>Does unemployment contribute to poorer health-related quality of life among Swedish adults?
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 457Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Previous studies have shown that unemployment has negative impacts on various aspects of health. However, little is known about the effect of unemployment on health-related quality of life. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender.

METHODS: As part of a cross-sectional study, a questionnaire was sent to 2500 randomly selected individuals aged 20 to 64 years living in Sweden in 2016. The questionnaire included the EuroQol 5 dimensions (EQ-5D) instrument and was answered by 967 individuals (39%). Quality-adjusted life year (QALY) scores were derived from the EQ-5D responses. Of the respondents, 113 were unemployed and 724 were employed. We used inverse probability-weighted propensity scores in our analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were used as covariates in our analyses.

RESULTS: There was a statistically significant lower QALY score by 0.096 points for the unemployed compared to the employed. There were also statistically significant more problems due to unemployment for usual activities (6.6% more), anxiety/depression (23.6% more), and EQ-5D's Visual Analogue Scale (7.5 point lower score). Grouped analyses indicated a larger negative health effect from becoming unemployed for men, those who are married, and young individuals.

CONCLUSIONS: In our study, we show that the health deterioration from unemployment is likely to be large, as our estimated effect implies an almost 10% worse health (in absolute terms) from being unemployed compared to being employed. This further highlights that unemployment is a public health problem that needs more focus. Our study also raises further demands for determining for whom unemployment has the most negative effects and thus suggesting groups of individuals who are in greatest need for labor market measures.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
EuroQol 5 dimensions, Labor market, Propensity scores, Quality-adjusted life years
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
urn:nbn:se:umu:diva-158631 (URN)10.1186/s12889-019-6825-y (DOI)000467017800001 ()31035994 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00647
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-06-13Bibliographically approved
Zingmark, M., Norström, F., Lindholm, L., Dahlin-Ivanoff, S. & Gustafsson, S. (2019). Modelling long-term cost-effectiveness of health promotion for community-dwelling older people. European Journal of Ageing
Open this publication in new window or tab >>Modelling long-term cost-effectiveness of health promotion for community-dwelling older people
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2019 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380Article in journal (Refereed) Epub ahead of print
Abstract [en]

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Senior meetings, Preventive home visit, QALYs, Booster session, Health economy, Multi-professional
National Category
Occupational Therapy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-158632 (URN)10.1007/s10433-019-00505-1 (DOI)
Available from: 2019-05-03 Created: 2019-05-03 Last updated: 2019-05-08
Baroudi, M., Petersen, S., Namatovu, F., Annelie, C., Ivarsson, A. & Norström, F. (2019). Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups. BMC Public Health, 19, Article ID 139.
Open this publication in new window or tab >>Preteen children’s health related quality of life in Sweden: changes over time and disparities between different sociodemographic groups
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 139Article in journal (Refereed) Published
Abstract [en]

Background: Assessing disparities in health-related quality of Life (HRQoL) is important as a part of health-related disparities in the society. The aim of this study was to explore HRQoL among 12-year-olds in Sweden in terms of differences between years 2005 and 2009 and disparities related to sociodemographic background.

Methods: During the school years 2005 and 2009, a total of 18,325 sixth grade students in Sweden were invited to a celiac disease screening study; 13,279 agreed to participate. Jointly with the celiac screening, the children answered a questionnaire that included EuroQol 5 Dimensions-youth (EQ-5D-Y) and their parents responded to separate questionnaires about their own and their child’s country of birth, family structure, their employment status, occupation, and education. In total 11,009 child-parent questionnaires were collected. Logistic regression was used to study differences in HRQoL between 2005 and 2009, and between various sociodemographic subgroups.

Results: Compared with 2005, children in 2009 reported more pain (OR: 1.20, 95% CI: 1.1–1.3) and more mood problems (OR: 1.35, 95% CI: 1.2–1.5). In general, girls reported more pain and mood problems and had more disparities than boys. There were no significant differences based on parents’ occupation, however, children of parents with low or medium education levels reported less “mood problems” than those of parents with high education levels (OR: 0.65, 95% CI: 0.46–0.92) and (OR: 0.84, 95% CI: 0.73–0.96), respectively. A slight variation was seen in HRQoL between children with different migration background. Girls living in small municipalities reported more pain (OR: 1.51, 95% CI: 1.14–2.01), and problems performing usual activities (OR: 3.77, 95% CI: 2.08–6.84), compared to girls living in large municipalities. In addition, children living with two parents had less mood problems than children living in other family constellations.

Conclusion: More children reported pain and mood problems in 2009 compared with 2005. To study future trends, health outcomes among children in Sweden should continue to be reported periodically. More efforts should be invested to increase the awareness of health-related disparities as highlighted in this study especially for girls living in small municipalities and children of parents with high education level.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Preteen children health, Health inequity, Quality of life, HRQoL, Sociodemographic disparities
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-155944 (URN)10.1186/s12889-019-6429-6 (DOI)000457471800001 ()30704442 (PubMedID)
Funder
Swedish Research Council, 521-2004-7093Swedish Research Council, 521-2007-2953Swedish Research Council Formas, 222-2004-1918Swedish Research Council Formas, 222-2007-1394
Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-25Bibliographically approved
Norström, F., van der Pals, M., Myléus, A., Hammarroth, S., Högberg, L., Isaksson, A., . . . Carlsson, A. (2018). Impact of Thyroid Autoimmunity on Thyroid Function in 12-year-old Children With Celiac Disease. Journal of Pediatric Gastroenterology and Nutrition - JPGN, 67(1), 64-68
Open this publication in new window or tab >>Impact of Thyroid Autoimmunity on Thyroid Function in 12-year-old Children With Celiac Disease
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2018 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 67, no 1, p. 64-68Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Celiac disease (CD) is associated with thyroid autoimmunity and other autoimmune diseases. However, data are lacking regarding the relationship between thyroid autoimmunity and thyroid function, especially in regard to CD. Our aim was to investigate the impact of thyroid autoimmunity on thyroid function in 12-year-old children with CD compared to their healthy peers.

METHODS: A case-referent study was conducted as part of a CD screening of 12-year-olds. Our study included 335 children with CD and 1,695 randomly selected referents. Thyroid autoimmunity was assessed with antibodies against thyroid peroxidase (TPOAb). Thyroid function was assessed with thyroid stimulating hormone and free thyroxine.

RESULTS: TPOAb positivity significantly increased the risk of developing hypothyroidism in all children. The odds ratios (with 95% confidence intervals) were: 5.3 (2.7-11) in healthy 12-year-olds, 10 (3.2-32) in screening-detected CD cases, 19 (2.6-135) in previously diagnosed CD cases, and 12 (4.4-32) in all CD cases together. Among children with TPOAb positivity, hypothyroidism was significantly more common (odds ratio 3.1; 95% CI 1.03-9.6) in children with CD (10/19) than in children without CD (12/46).

CONCLUSIONS: The risk of thyroid dysfunction due to thyroid autoimmunity is larger for those with CD than their healthy peers. Our study indicate that a gluten-free diet does not reduce the risk of thyroid dysfunction. Further studies are required for improved understanding of the role of the gluten-free diet for the risk of autoimmune diseases in children with CD.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Gastroenterology and Hepatology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-144634 (URN)10.1097/MPG.0000000000001903 (DOI)000441421500019 ()29373441 (PubMedID)
Available from: 2018-02-08 Created: 2018-02-08 Last updated: 2019-05-21Bibliographically approved
Cameron, D., Ubels, J. & Norström, F. (2018). On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review. Global Health Action, 11(1), Article ID 1447828.
Open this publication in new window or tab >>On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review
2018 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, no 1, article id 1447828Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system.

OBJECTIVES: The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data.

METHODS: A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations.

RESULTS: Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made.

CONCLUSIONS: Most national C/E thresholds identified in our review fall within the WHO's recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis.

Place, publisher, year, edition, pages
Abingdon: Taylor & Francis, 2018
Keywords
C/E thresholds, HALE, QALY, WTP, cost-effective, decision-making, healthy adjusted life expectancy, international, systematic review, willing-to-pay
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-146351 (URN)10.1080/16549716.2018.1447828 (DOI)000428251200001 ()29564962 (PubMedID)
Available from: 2018-04-06 Created: 2018-04-06 Last updated: 2018-08-07Bibliographically approved
Zingmark, M., Nilsson, I., Norström, F., Sahlén, K.-G. & Lindholm, L. (2017). Cost effectiveness of an intervention focused on reducing bathing disability. European Journal of Ageing, 14(3), 233-241
Open this publication in new window or tab >>Cost effectiveness of an intervention focused on reducing bathing disability
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2017 (English)In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 14, no 3, p. 233-241Article in journal (Refereed) Published
Abstract [en]

The onset of bathing disability among older people is critical for a decline in functioning and has implications for both the individuals’ quality of life and societal costs. The aim of this study was to evaluate longterm cost effectiveness of an intervention targeting bathing disability among older people. For hypothetical cohorts of community-dwelling older people with bathing disability, transitions between states of dependency and death were modelled over 8 years including societal costs. A five-state Markov model based on states of dependency was used to evaluate Quality-adjusted life years (QALYs) and costs from a societal perspective. An intervention group was compared with a no intervention control group. The intervention focused on promoting safe and independent performance of bathing-related tasks. The intervention effect, based on previously published trials, was applied in the model as a 1.4 increased probability of recovery during the first year. Over the full follow-up period, the intervention resulted in QALY gains and reduced societal cost. After 8 years, the intervention resulted in 0.052 QALYs gained and reduced societal costs by €2410 per person. In comparison to the intervention cost, the intervention effect was a more important factor for the magnitude of QALY gains and long-term societal costs. The intervention cost had only minor impact on societal costs. The conclusion was that an intervention targeting bathing disability among older people presents a cost-effective use of resources and leads to both QALY gains and reduced societal costs over 8 years.

Keywords
Cost effectiveness, QALY, Occupational therapy intervention, Reablement
National Category
Occupational Therapy Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-100062 (URN)10.1007/s10433-016-0404-1 (DOI)000409468500003 ()
Note

Orginally published in manuscript form with title: Recovery from bathing disability among older people - modeling long term cost-effectiveness of an occupational therapy intervention

Available from: 2015-02-20 Created: 2015-02-20 Last updated: 2018-06-07Bibliographically approved
Stewart Williams, J., Norström, F. & Ng, N. (2017). Disability and ageing in China and India – decomposing the effects of gender and residence: Results from the WHO study on global ageing and adult health (SAGE). BMC Geriatrics, 17, Article ID 197.
Open this publication in new window or tab >>Disability and ageing in China and India – decomposing the effects of gender and residence: Results from the WHO study on global ageing and adult health (SAGE)
2017 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 197Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: China and India are the world's two most populous countries. Although their populations are growing in number and life expectancies are extending they have different trajectories of economic growth, epidemiological transition and social change. Cross-country comparisons can allow national and global insights and provide evidence for policy and decision-making. The aim of this study is to measure and compare disability in men and women, and in urban and rural dwellers in China and India, and assess the extent to which social and other factors contribute to the inequalities.

METHODS: National samples of adults aged 50 to 79 years in China (n = 11,694) and India (n = 6187) from the World Health Organization (WHO) longitudinal Study on global AGEing and adult health (SAGE) Wave 1 were analysed. Stratified multiple linear regressions were undertaken to assess disability differences by sex and residence, controlling for other biological and socioeconomic determinants of disability. Oaxaca-Blinder decomposition partitioned the two-group inequalities into explained and unexplained components.

RESULTS: In both countries women and rural residents reported more disability. In India, the gender inequality is attributed to the distribution of the determinants (employment, education and chronic conditions) but in China about half the inequality is attributed to the same. In India, more than half of the urban rural inequality is attributed to the distribution of the determinants (education, household wealth) compared with under 20% in China.

CONCLUSIONS: Education and employment were important drivers of these measured inequalities. Overall inequalities in disability among older adults in China and India were shaped by gender and residence, suggesting the need for policies that target women and rural residents. There is a need for further research, using both qualitative and quantitative methods, to question and challenge entrenched practices and institutions and grasp the implications of global economic and social changes that are impacting on population health and ageing in China and India.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Inequalities, Residence, Rural, Developing countries, Oaxaca-Blinder, Decomposition
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-139574 (URN)10.1186/s12877-017-0589-y (DOI)000408762800001 ()28859630 (PubMedID)
Available from: 2017-09-19 Created: 2017-09-19 Last updated: 2018-06-09Bibliographically approved
Norström, F., Janlert, U. & Hammarström, A. (2017). Is unemployment in young adulthood related to self-rated health later in life?: Results from the Northern Swedish cohort. BMC Public Health, 17, Article ID 529.
Open this publication in new window or tab >>Is unemployment in young adulthood related to self-rated health later in life?: Results from the Northern Swedish cohort
2017 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, article id 529Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Many studies have reported that unemployment has a negative effect on health. However, little is known about the long-term effect for those who become unemployed when they are young adults. Our aim was to examine how unemployment is related to long-term self-rated health among 30 year olds, with an emphasis on how health differs in relation to education level, marital status, previous health, occupation, and gender.

METHODS: In the Northern Swedish Cohort, 1083 teenagers (~16 years old) were originally invited in 1981. Of these, 1001 participated in the follow-up surveys in 1995 and 2007. In our study, we included participants with either self-reported unemployment or activity in the labor force during the previous three years in the 1995 follow-up so long as they had no self-reported unemployment between the follow-up surveys. Labor market status was studied in relation to self-reported health in the 2007 follow-up. Information from the 1995 follow-up for education level, marital status, self-reported health, and occupation were part of the statistical analyses. Analyses were stratified for these variables and for gender. Analyses were performed with logistic regression, G-computation, and a method based on propensity scores.

RESULTS: Poor self-rated health in 2007 was reported among 43 of the 98 (44%) unemployed and 159 (30%) of the 522 employed subjects. Unemployment had a long-term negative effect on health (odds ratio with logistic regression 1.74 and absolute difference estimates of 0.11 (G-computation) and 0.10 (propensity score method)). At the group level, the most pronounced effects on health were seen in those with upper secondary school as their highest education level, those who were single, low-level white-collar workers, and women.

CONCLUSIONS: Even among those becoming unemployed during young adulthood, unemployment is related to a negative long-term health effect. However, the effect varies among different groups of individuals. Increased emphasis on understanding the groups for whom unemployment is most strongly related to ill health is important for future research so that efforts can be put towards those with the biggest need. Still, our results can be used as the basis for deciding which groups should be prioritized for labor-market interventions.

Place, publisher, year, edition, pages
BioMed Central, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; Epidemiology
Identifiers
urn:nbn:se:umu:diva-135658 (URN)10.1186/s12889-017-4460-z (DOI)000403023700004 ()28558793 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2011–0839Swedish Research Council Formas, 259–2012-37
Available from: 2017-06-01 Created: 2017-06-01 Last updated: 2018-06-09Bibliographically approved
Neumann, A., Lindholm, L., Norberg, M., Schoffer, O., Klug, S. J. & Norström, F. (2017). The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program. European Journal of Health Economics, 18(7), 905-919
Open this publication in new window or tab >>The cost-effectiveness of interventions targeting lifestyle change for the prevention of diabetes in a Swedish primary care and community based prevention program
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2017 (English)In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 18, no 7, p. 905-919Article in journal (Refereed) Published
Abstract [en]

Background: Policymakers need to know the cost-effec-tiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting. Methods: A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied. Analyses were done deterministically and probabilistically based on Monte Carlo simulation for six different scenarios defined by sex and age groups (30, 50, 70 years). Cost and quality adjusted life year (QALY) differences between no intervention and intervention and incremental cost-effectiveness ratios (ICERs) were estimated and visualized in cost-effectiveness planes (CE planes) and cost-effectiveness acceptability curves (CEA curves). Results: All ICERs were cost-effective and ranged from 3833 € /QALY gained (women, 30 years) to 9215 € /QALY gained (men, 70 years). The CEA curves showed that the probability of the intervention being cost-effective at the threshold value of 50,000 € per QALY gained was very high for all scenarios ranging from 85.0 to 91.1%. Discussion/conclusion: The prevention or the delay of the onset of T2D is feasible and cost-effective. A small investment in healthy lifestyle with change in physical activity and diet together with weight loss are very likely to be cost-effective.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2017
Keywords
Markov model, cost-effectiveness, diabetes, prevention, lifestyle change
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-123560 (URN)10.1007/s10198-016-0851-9 (DOI)000406690000009 ()27913943 (PubMedID)
Available from: 2016-07-06 Created: 2016-07-06 Last updated: 2018-06-07Bibliographically approved
Projects
Is better public health worth the price? - A health economic evaluation of increased staffing in home care [2015-00647_Forte]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0457-2175

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