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Lindholm, L., Sjölin, G., Jonsson, A., Abraham-Nordling, M., Wallin, G. & Filipsson Nyström, H. (2025). Analysis of cost and treatment effects in the care given for Graves' disease: a Swedish cost–utility analysis. Endocrinology, Diabetes and Metabolism, 8(2), Article ID e70034.
Open this publication in new window or tab >>Analysis of cost and treatment effects in the care given for Graves' disease: a Swedish cost–utility analysis
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2025 (English)In: Endocrinology, Diabetes and Metabolism, E-ISSN 2398-9238, Vol. 8, no 2, article id e70034Article in journal (Refereed) Published
Abstract [en]

Background: Guidelines in healthcare should be evidence-based, satisfy patient needs and improve patient outcome.

Methods: We performed a cost–utility analysis in Graves' disease (GD) and estimated incremental costs after the introduction of a national guideline adding the Graves' Recurrent Events After Therapy (GREAT) score with genetic determinants (GREAT+) to predict recurrence, a thyroid nurse, preoperative calcium/vitamin D treatment and thyroid-stimulating immunoglobulins.

Findings: Antithyroid drugs (ATDs) were less costly, achieved 0.88 quality-adjusted life years (QALYs) over 8 years and dominated over radioactive iodine (RAI) treatment. The relevant incremental cost-effectiveness ratio was ATD versus thyroid surgery (Tx). Tx was more costly than ATD but was also more effective. The incremental cost-effectiveness ratio was equal to 40,488 Euro per QALY gained. In recurrent GD, the QALY weight for surgery after ATD was 0.76 compared with 0.79 when surgery was the initial treatment. If individuals requiring surgery could be identified at start of first treatment, QALYs would be higher (6.32) and the cost lower (13,945 Euro). The net cost increase after the new guideline was 17.6%, which was partially an effect from more time being spent with the thyroid nurse. If the GREAT+ score was also applied, the total increased net cost was 14.8% if 24% of the tested patients changed treatment to Tx.

Interpretation: Tx was more cost-effective than RAI when ablative treatment is advocated. Prediction score for recurrence directing patients to earlier Tx is cost-effective and enables the introduction of a specialist thyroid nurse. Health economic evaluations should accompany future guidelines.

Place, publisher, year, edition, pages
John Wiley & Sons, 2025
Keywords
cost-effectiveness analysis, Graves' disease, health economics, ICER, QALY
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-236664 (URN)10.1002/edm2.70034 (DOI)001428043900001 ()2-s2.0-86000228607 (Scopus ID)
Funder
Nyckelfonden
Available from: 2025-03-26 Created: 2025-03-26 Last updated: 2025-03-26Bibliographically approved
Goedecke, J. H., Danquah, I., Abidha, C. A., Agyemang, C., Albers, H. M., Amoah, S., . . . Olsson, T. (2025). Omics approach for personalised prevention of type 2 diabetes mellitus for African and European populations (OPTIMA): a protocol paper. BMJ Open, 15(4), Article ID e099108.
Open this publication in new window or tab >>Omics approach for personalised prevention of type 2 diabetes mellitus for African and European populations (OPTIMA): a protocol paper
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2025 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 15, no 4, article id e099108Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The prevalence of type 2 diabetes (T2D) within sub-Saharan Africa (SSA) is increasing. Despite the pathophysiology of T2D differing by ethnicity and sex, risk stratification and guidelines for the prevention of T2D are generic, relying on evidence from studies including predominantly Europeans. Accordingly, this study aims to develop ethnic-specific and sex-specific risk prediction models for the early detection of dysglycaemia (impaired glucose tolerance and T2D) to inform clinically feasible, culturally acceptable and cost-effective risk management and prevention strategies using dietary modification in SSA and European populations.

METHODS AND ANALYSIS: This multinational collaboration will include the prospective cohort data from two African cohorts, the Middle-Aged Soweto Cohort from South Africa and the Research on Obesity and Diabetes among African Migrants Prospective cohort from Ghana and migrants living in Europe, and a Swedish cohort, the Pre-Swedish CArdioPulmonary bioImage Study. Targeted proteomics, as well as targeted and untargeted metabolomics, will be performed at baseline to discover known and novel ethnic-specific and sex-specific biomarkers that predict incident dysglycaemia in the different longitudinal cohorts. Dietary patterns that explain maximum variation in the biomarker profiles and that associate with dysglycaemia will be identified in the SSA and European cohorts and used to build the prototypes for dietary interventions to prevent T2D. A comparative cost-effectiveness analysis of the dietary interventions will be estimated in the different populations. Finally, the perceptions of at-risk participants and healthcare providers regarding ethnic-specific and sex-specific dietary recommendations for the prevention of T2D will be assessed using focus group discussions and in-depth interviews in South Africa, Ghana, Germany (Ghanaian migrants) and Sweden.

ETHICS AND DISSEMINATION: Ethical clearance has been obtained from all participating sites. The study results will be disseminated at scientific conferences and in journal publications, and through community engagement events and diabetes organisations in the respective countries.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2025
Keywords
diabetes mellitus, type 2, health economics, nutrition & dietetics, preventive medicine
National Category
Epidemiology Public Health, Global Health and Social Medicine Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-238618 (URN)10.1136/bmjopen-2025-099108 (DOI)001473007800001 ()40262963 (PubMedID)2-s2.0-105003900065 (Scopus ID)
Funder
Vinnova, 2022-00547Swedish Research Council, 2022-00924Knut and Alice Wallenberg Foundation, 2020.0239
Available from: 2025-05-13 Created: 2025-05-13 Last updated: 2025-05-13Bibliographically approved
Vu Nu, A., Van Hoang, M., Lindholm, L., Sahlen, K.-G., Nguyen, C. T. & Sun, S. (2024). A systematic review on the direct approach to elicit the demand-side cost-effectiveness threshold: implications for low- and middle-income countries. PLOS ONE, 19(2), Article ID e0297450.
Open this publication in new window or tab >>A systematic review on the direct approach to elicit the demand-side cost-effectiveness threshold: implications for low- and middle-income countries
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2024 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 2, article id e0297450Article, review/survey (Refereed) Published
Abstract [en]

Several literature review studies have been conducted on cost-effectiveness threshold values. However, only a few are systematic literature reviews, and most did not investigate the different methods, especially in-depth reviews of directly eliciting WTP per QALY. Our study aimed to 1) describe the different direct approach methods to elicit WTP/QALY; 2) investigate factors that contribute the most to the level of WTP/QALY value; and 3) investigate the relation between the value of WTP/QALY and GDP per capita and give some recommendations on feasible methods for eliciting WTP/QALY in low- and middle-income countries (LMICs). A systematic review concerning select studies estimating WTP/QALY from a direct approach was carried out in seven databases, with a cut off date of 03/2022. The conversion of monetary values into 2021 international dollars (i$) was performed via CPI and PPP indexes. The influential factors were evaluated with Bayesian model averaging. Criteria for recommendation for feasible methods in LMICs are made based on empirical evidence from the systematic review and given the resource limitation in LMICs. A total of 12,196 records were identified; 64 articles were included for full-text review. The WTP/QALY method and values varied widely across countries with a median WTP/QALY value of i$16,647.6 and WTP/QALY per GDP per capita of 0.53. A total of 11 factors were most influential, in which the discrete-choice experiment method had a posterior probability of 100%. Methods for deriving WTP/QALY vary largely across studies. Eleven influential factors contribute most to the level of values of WTP/QALY, in which the discrete-choice experiment method was the greatest affected. We also found that in most countries, values for WTP/QALY were below 1 x GDP per capita. Some important principles are addressed related to what LMICs may be concerned with when conducting studies to estimate WTP/QALY.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2024
National Category
Economics Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-221104 (URN)10.1371/journal.pone.0297450 (DOI)001164302700087 ()38329955 (PubMedID)2-s2.0-85184572881 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2025-04-24Bibliographically approved
Vu Quynh, M., Van Minh, H., Lindholm, L., Sun, S., Kim, G. B. & Sahlen, K.-G. (2024). Acceptability of the use of health related quality of life measurements for decision-making in healthcare science in Vietnam: a qualitative study. BMJ Open, 14(8), Article ID e082405.
Open this publication in new window or tab >>Acceptability of the use of health related quality of life measurements for decision-making in healthcare science in Vietnam: a qualitative study
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2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 8, article id e082405Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This study was conducted with the objective of exploring the usage of health-related quality of life (HRQOL) outcomes and willingness of health technology assessment (HTA) and public health stakeholders to use the EQ-5D-5L instrument in healthcare decision-making processes in Vietnam.

METHOD: In this qualitative study, 11 interviews were held with key stakeholders involved in healthcare decision-making for HTA between June 2021 and June 2022. The interviewees included members of the Vietnamese pharmacoeconomic council and public-health professionals from a diverse array of regions of Vietnam. The data collection involved obtaining verbal consent, warm-up discussions and interviews conducted via Zoom, with subsequent verification by interviewees. The analysis employed a theoretical thematic approach, adopting a deductive methodology to identify and analyse underlying ideas and meanings within the empirical data.

RESULTS: This study highlights the general importance and viability of HRQOL measures, and more particularly the EQ-5D-5L instrument, in healthcare decision-making in Vietnam. Challenges have been identified, including insufficient recognition, interpretation, standardisation and educational initiatives relating to HRQOL measurements. This study advocates for official training programmes on HRQOL measurements, guidelines for the application of the EQ-5D-5L and an open HRQOL database in Vietnam. Concerns regarding validity and outcome variation in HRQOL measurements underline the necessity for continuous psychometric properties assessments and regular updates to national HRQOL data in the Vietnamese context.

CONCLUSION: HRQOL outcomes are important, and Vietnamese stakeholders express a readiness to employ the EQ-5D-5L in healthcare decision-making, especially HTA. Nevertheless, HRQOL measurements, including the EQ-5D-5L, are currently inadequately used in Vietnam, and further efforts are required to improve utilisation.

Keywords
health economics, health policy, quality of life
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-229569 (URN)10.1136/bmjopen-2023-082405 (DOI)001311630200001 ()39179276 (PubMedID)2-s2.0-85202267350 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-09-16 Created: 2024-09-16 Last updated: 2025-04-24Bibliographically approved
Meili, K. W., Hjelte, J., Lindholm, L. & Månsdotter, A. (2024). Capability inequality: Does disadvantage or plurality matter more for policy?: A Swedish cross-sectional study on the population distribution and group differences of capability using CALY-SWE. Social Sciences & Humanities Open, 10, Article ID 100961.
Open this publication in new window or tab >>Capability inequality: Does disadvantage or plurality matter more for policy?: A Swedish cross-sectional study on the population distribution and group differences of capability using CALY-SWE
2024 (English)In: Social Sciences & Humanities Open, ISSN 2590-2911, Vol. 10, article id 100961Article in journal (Refereed) Published
Abstract [en]

A better understanding of population distributions of capability and inequalities is relevant for public health and social welfare. We surveyed 3639 representatively sampled individuals on background characteristics and on self-reported capability using the capability-adjusted life years Sweden (CALY-SWE) questionnaire, which enables aggregating attribute-level answers into a quality weight score.

We analysed the resulting capability distribution by comparing subgroups. Subgroups were formed along axes of inequality that we selected based on theoretical reasoning and relevance. We stratified into groupings of plurality and disadvantage, based on the human dignity principle and the needs and solidarity principle featured in the Swedish platform for healthcare priority-setting. While disadvantage factors come with inherent need-related disadvantages that explain inequality, such as unemployment, no such normatively acceptable reason exist for plurality factors, such as gender.

The results averaged per individual showed marked inequalities for the disadvantage groups of individuals with poor self-rated health, long-term sick leave unemployment, and payment difficulties. For plurality groups, the largest inequalities occurred in groups with lower education and groups residing in urban areas, but generally inequalities were lower than disadvantage groups.

On the population level, the largest aggregated disability inequalities occurred for self-reported ever NEET (persons who were ever involuntarily not in employment, education or training from age 16 to 29) and payment difficulties groups. Additionally, we assessed the contribution of covariates to these inequalities by counterfactually altering one covariate at a time in a multinomial logistic model of the CALY-SWE attribute-level answers. The most relevant covariates were employment situation, financial difficulties, income, and age group.

For policy-making, this indicates the importance of both plurality and disadvantage inequality axes. Prioritization should adopt nuanced contextualizations of inequality when broadening the perspective beyond healthcare to wider public health and social welfare, for example, elderly care and education.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
CALY-SWE, Capability approach, Inequality, Sweden, Distributive justice, Prioritization
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-226020 (URN)10.1016/j.ssaho.2024.100961 (DOI)2-s2.0-85195194086 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00143
Available from: 2024-06-11 Created: 2024-06-11 Last updated: 2024-06-12Bibliographically approved
Vu Thi Quynh, M., Lindholm, L., Minh, H. V., Sun, S., Giang, K. B. & Sahlen, K.-G. (2024). Cost-effectiveness of consolidation durvalumab for inoperable stage III non-small cell lung cancer in Vietnam. BMJ Open, 14(8), Article ID e083895.
Open this publication in new window or tab >>Cost-effectiveness of consolidation durvalumab for inoperable stage III non-small cell lung cancer in Vietnam
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2024 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 8, article id e083895Article in journal (Refereed) Published
Abstract [en]

Background: This study aimed to assess the cost-effectiveness of durvalumab as a treatment option for patients with inoperable stage III non-small cell lung cancer (NSCLC) from healthcare and partial societal perspectives in Vietnam.

Method: A lifetime partitioned survival model was used to evaluate the costs and quality-adjusted life years (QALYs) associated with consolidation durvalumab in comparison with the standard of care alone. Local costs and utilities were incorporated into the model. In the base-case analysis, no discount was applied to the acquisition cost of durvalumab. Scenario-based, one-way and probabilistic-sensitivity analyses were conducted.

Results: The base-case analysis revealed that the intervention resulted in an increase of 1.38 life years or 1.08 QALYs for patients, but the intervention was not deemed cost-effective from either perspective in the base-case analysis. However, with a 70% reduction in the durvalumab acquisition cost, the intervention was observed to be cost-effective when evaluated from a healthcare perspective and when examining the undiscounted results from a partial societal standpoint.

Conclusion: This study provides evidence regarding the cost-effectiveness of durvalumab for the treatment of inoperable stage III NSCLC in Vietnam for various scenarios. The intervention was not cost-effective at full acquisition cost, but it is important to acknowledge that cost-effectiveness arguments alone cannot solely guide decision-makers in Vietnam; other criteria, such as budget impact and ethical concerns, are crucial factors to consider in decision-making processes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
health economics, lung diseases, chemotherapy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-232377 (URN)10.1136/bmjopen-2024-083895 (DOI)001317547400001 ()39214656 (PubMedID)2-s2.0-85203112287 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-11-28 Created: 2024-11-28 Last updated: 2024-11-28Bibliographically approved
Meili, K. W., Mulhern, B., Ssegonja, R., Norström, F., Feldman, I., Månsdotter, A., . . . Lindholm, L. (2024). Eliciting a value set for the Swedish capability-adjusted life years instrument (CALY-SWE). Quality of Life Research, 33(1), 59-72
Open this publication in new window or tab >>Eliciting a value set for the Swedish capability-adjusted life years instrument (CALY-SWE)
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2024 (English)In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 33, no 1, p. 59-72Article in journal (Refereed) Published
Abstract [en]

Purpose: Our aim was to elicit a value set for Capability-Adjusted Life Years Sweden (CALY-SWE); a capability-grounded quality of life instrument intended for use in economic evaluations of social interventions with broad consequences beyond health.

Methods: Building on methods commonly used in the quality-adjusted life years EQ-5D context, we collected time-trade off (TTO) and discrete choice experiment (DCE) data through an online survey from a general population sample of 1697 Swedish participants. We assessed data quality using a score based on the severity of inconsistencies. For generating the value set, we compared different model features, including hybrid modeling of DCE and TTO versus TTO data only, censoring of TTO answers, varying intercept, and accommodating for heteroskedasticity. We also assessed the models’ DCE logit fidelity to measure agreement with potentially less-biased DCE data. To anchor the best capability state to 1 on the 0 to 1 scale, we included a multiplicative scaling factor.

Results: We excluded 20% of the TTO answers of participants with the largest inconsistencies to improve data quality. A hybrid model with an anchor scale and censoring was chosen to generate the value set; models with heteroskedasticity considerations or individually varying intercepts did not offer substantial improvement. The lowest capability weight was 0.114. Health, social relations, and finance and housing attributes contributed the largest capability gains, followed by occupation, security, and political and civil rights.

Conclusion: We elicited a value set for CALY-SWE for use in economic evaluations of interventions with broad social consequences.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Quality-adjusted life year, Time trade-off, Discrete choice experiment, Capability approach, Hybrid modeling, Economic evaluation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-214379 (URN)10.1007/s11136-023-03507-w (DOI)001064459600002 ()37695477 (PubMedID)2-s2.0-85170367443 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00143Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00143
Available from: 2023-09-13 Created: 2023-09-13 Last updated: 2024-04-29Bibliographically approved
Shimanda, P. P., Shumba, T. W., Brunström, M., Iipinge, S. N., Söderberg, S., Lindholm, L. & Norström, F. (2024). Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 13(5), Article ID e032442.
Open this publication in new window or tab >>Preventive interventions to reduce the burden of rheumatic heart disease in populations at risk: a systematic review
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2024 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 13, no 5, article id e032442Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Rheumatic heart disease (RHD) is a devastating yet preventable condition that disproportionately affects low-middle-income countries and indigenous populations in some high-income countries. Various preventive interventions have been implemented across the globe, but evidence for the effectiveness of these measures in reducing the incidence or prevalence of acute rheumatic fever and RHD is scattered. This systematic review aims to assess the effectiveness of preventive interventions and identify the strategies used to reduce the burden of RHD.

METHODS AND RESULTS: A comprehensive search was conducted to identify relevant studies on RHD prevention interventions including interventions for primordial, primary, and secondary prevention. Effectiveness measures for the interventions were gathered when available. The findings indicate that school-based primary prevention services targeting the early detection and treatment of Group A Streptococcus pharyngitis infection with penicillin have the potential to reduce the incidence of Group A Streptococcus pharyngitis and acute rheumatic fever. Community-based programs using various prevention strategies also reduced the burden of RHD. However, there is limited evidence from low-middle-income countries and a lack of rigorous evaluations reporting the true impact of the interventions. Narrative synthesis was performed, and the methodological quality appraisal was done using the Joanna Briggs Institute critical appraisal tools.

CONCLUSIONS: This systematic review underscores the importance of various preventive interventions in reducing the incidence and burden of Group A Streptococcus pharyngitis, acute rheumatic fever, and RHD. Rigorous evaluations and comprehensive analyses of interventions are necessary for guiding effective strategies and informing public health policies to prevent and reduce the burden of these diseases in diverse populations.

REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42020170503.

Place, publisher, year, edition, pages
American Heart Association, 2024
Keywords
RHD prevention, acute rheumatic fever, rheumatic heart disease, systematic review
National Category
Health Sciences Public Health, Global Health and Social Medicine
Research subject
cardiovascular disease; Public health; Epidemiology
Identifiers
urn:nbn:se:umu:diva-221473 (URN)10.1161/JAHA.123.032442 (DOI)001215553400035 ()38390809 (PubMedID)2-s2.0-85187199895 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2024-02-23 Created: 2024-02-23 Last updated: 2025-04-24Bibliographically approved
Sun, S., Stenberg, E., Luo, N., Franklin, K. A., Lindholm, L., Sahlen, K.-G. & Cao, Y. (2024). SF-6D normative values among patients undergoing bariatric surgery: results based on real-world evidence from the Scandinavian obesity surgery registry (SOREG). Obesity Surgery, 34, 558-567
Open this publication in new window or tab >>SF-6D normative values among patients undergoing bariatric surgery: results based on real-world evidence from the Scandinavian obesity surgery registry (SOREG)
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2024 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 34, p. 558-567Article in journal (Refereed) Published
Abstract [en]

Background: The SF-6D index can be used to calculate quality-adjusted life years in economic evaluations, which is required by reimbursement agencies and national advisory bodies, including the Swedish ones. However, despite that SF-36 has been largely applied among patients undergoing bariatric surgery, almost no study has accessed the short form six-dimensions (SF-6D) after bariatric surgery.

Aim: To establish normative values for the SF-6D index among patients undergoing bariatric surgery.

Materials and Methods: All patients who received bariatric surgery in Sweden between 2011–01-01 and 2019–03-31 were obtained from the Scandinavian Obesity Surgery Registry (SOReg). Information includes patients’ sociodemographic characteristics, details regarding the procedure, and postsurgical conditions. The SF-36 is applied at baseline and at follow-up years 1, 2, and 5. The multiple sequential imputation method was applied to handle missingness on SF-6D items. Based on the UK tariff, the SF-6D preference scores were calculated. The normative values for the mean (SD) SF-6D index were reported by timepoint and surgical complications for men and women, respectively. Multivariate analyses were applied to investigate how the SF-6D index is associated with timepoint, controlling for age, sex, BMI, and comorbidities in a stepwise manner.

Results: The SF-6D index increased at 1 year relative to baseline and was roughly maintained at the same level at 2 years. The normative value of the SF-6D index can be used in economic evaluations for bariatric surgery. 

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Bariatric surgery, Health preference, Normative value, Quality-adjusted life years, Real-world data, SF-6D
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-219487 (URN)10.1007/s11695-023-07024-0 (DOI)001137720100005 ()38189900 (PubMedID)2-s2.0-85181716238 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018–00896
Available from: 2024-01-24 Created: 2024-01-24 Last updated: 2025-03-26Bibliographically approved
Tungu, M. M., Mujinja, P. G., Amani, P. J., Mwangu, M. A., Kiwara, A. D. & Lindholm, L. (2023). Health, wealth, and medical expenditures among the elderly in rural Tanzania: experiences from Nzega and Igunga districts. BMC Health Services Research, 23(1), Article ID 1040.
Open this publication in new window or tab >>Health, wealth, and medical expenditures among the elderly in rural Tanzania: experiences from Nzega and Igunga districts
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2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1040Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The per capita health expenditure (HE) and share of gross domestic product (GDP) spending on elderly healthcare are expected to increase. The gap between health needs and available resources for elderly healthcare is widening in many developing countries, like Tanzania, leaving the elderly in poor health. These conditions lead to catastrophic HEs for the elderly. This study aimed to analyse the association between measures of health, wealth, and medical expenditure in rural residents aged 60 years and above in Tanzania.

METHODS: The data of this study were collected through a cross-sectional household survey to residents aged 60 years and above living in Nzega and Igunga districts using a standardised World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) and European Quality of Life Five Dimension (EQ-5D) questionnaires. The quality of life (QoL) was estimated using EQ-5D weights. The wealth index was generated from principal component analysis (PCA). The linear regression analyses (outpatient/inpatient) were performed to analyse the association between measures of health, wealth, medical expenditure, and socio-demographic variables.

RESULTS: This study found a negative and statistically significant association between QoL and HE, whereby HE increases with the decrease of QoL. We could not find any significant relationship between HE and social gradients. In addition, age influences HE such that as age increases, the HE for both outpatient and inpatient care also increases.

CONCLUSION: The health system in these districts allocate resources mainly according to needs, and social position is not important. We thus conclude that the elderly of lower socio-economic status (SES) was subjected to similar health expenditure as those of higher socio-economic status. Health, not wealth, determines the use of medical expenditures.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Elderly, EQ-5D, Health expenditure, QoL, Tanzania, Wealth index
National Category
Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:umu:diva-215073 (URN)10.1186/s12913-023-09943-1 (DOI)001081960300001 ()37773117 (PubMedID)2-s2.0-85172825682 (Scopus ID)
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2025-04-24Bibliographically approved
Projects
Network: Swedish Research Network on Economic Analysis of Public Health [2012-01452_Forte]; Umeå UniversityCapability Adjusted Life years (CALYs) - a novel measure for evaluating welfare interventions [2018-01550_Forte]; Umeå University; Publications
Meili, K. W., Månsdotter, A., Richter Sundberg, L., Hjelte, J. & Lindholm, L. (2022). An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire. PLOS ONE, 17(2), Article ID e0263231.
Capability-adjusted life-years (CALYs) - a novel measure for evaluating welfare interventions [2018-00143_Forte]; Umeå University; Publications
Meili, K. W. (2024). Capability for broader cost-effectiveness in public health and social welfare: developing, valuing, and applyingcapability-adjusted life years Sweden (CALY-SWE). (Doctoral dissertation). Umeå: Umeå UniversityMeili, K. W., Jonsson, H., Lindholm, L. & Månsdotter, A. (2022). Perceived changes in capability during the COVID-19 pandemic: A Swedish cross-sectional study from June 2020. Scandinavian Journal of Public Health, 50(1), 102-110Meili, K. W., Hjelte, J., Lindholm, L. & Månsdotter, A.Capability inequality: Does disadvantage or plurality matter more for policy?: A Swedish cross-sectional study on the population distribution and group differences of capability using CALY-SWE. Meili, K. W., Hjelte, J., Jonsson, F., Löfgren, C., Månsdotter, A. & Lindholm, L.NEET prevention through Sweden’s youth payroll tax cut: Evaluating cost-effectiveness using CALY-SWE.
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1633-2179

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