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  • 1.
    Lindvall, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Vaezghasemi, Masoud
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Stevens, Katherine J.
    School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Feasibility, reliability and validity of the health-related quality of life instrument Child Health Utility 9D (CHU9D) among school-aged children and adolescents in Sweden2021In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 19, no 1, article id 193Article in journal (Refereed)
    Abstract [en]

    Background: This study was conducted in a general population of schoolchildren in Sweden, with the aim to assess the psychometric properties of a generic preference-based health related quality of life (HRQoL) instrument, the Swedish Child Health Utility 9D (CHU9D), among schoolchildren aged 7–15 years, and in subgroups aged 7–9, 10–12 and 13–15 years.

    Methods: In total, 486 school aged children, aged 7–15 years, completed a questionnaire including the CHU9D, the Pediatric quality of life inventory 4.0 (PedsQL), KIDSCREEN-10, questions on general health, long-term illness, and sociodemographic characteristics. Psychometric testing was undertaken of feasibility, internal consistency reliability, test–retest reliability, construct validity, factorial validity, concurrent validity, convergent validity and divergent validity.

    Results: The CHU9D evidenced very few missing values, minimal ceiling, and no floor effects. The instrument achieved satisfactory internal consistency (Cronbach’s Alfa > 0.7) and strong test–retest reliability (r > 0.6). Confirmatory factor analyses supported the proposed one-factor structure of the CHU9D. For child algorithm, RMSEA = 0.05, CFI = 0.95, TLI = 0.94, and SRMR = 0.04. For adult algorithm RMSEA = 0.04, CFI = 0.96, TLI = 0.95, and SRMR = 0.04. The CHU9D utility value correlated moderately or strongly with KIDSCREEN-10 and PedsQL total scores (r > 0.5–0.7). The CHU9D discriminated as anticipated on health and on three of five sociodemographic characteristics (sex, age, and custody arrangement, but not socioeconomic status and ethnic origin).

    Conclusions: This study provides evidence that the Swedish CHU9D is a feasible, reliable and valid measure of preference-based HRQoL in children. The study furthermore suggests that the CHU9D is appropriate for use among children 7–15 years of age in the general population, as well as among subgroups aged 7– 9, 10–12 and 13–15 years.

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  • 2.
    Meili, Kaspar Walter
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Mulhern, Brendan
    Centre for Health Economics Research and Evaluation, University of Technology Sidney, Ultimo, Australia.
    Ssegonja, Richard
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Respiratory, Allergy and Sleep Medicine Research Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Månsdotter, Anna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Hjelte, Jan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Eliciting a value set for the Swedish capability-adjusted life years instrument (CALY-SWE)2024In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 33, no 1, p. 59-72Article in journal (Refereed)
    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.

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  • 3.
    Månsdotter, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ekman, Björn
    Department of Clinical Sciences, Malmö (IKVM), Division of Social Medicine and Global Health (SMGH), Lund University, Lund, Sweden.
    Meili, Kaspar Walter
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Hagberg, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Region Örebro University, Örebro, Sweden.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindholm, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Towards capability-adjusted life years in public health and social welfare: results from a Swedish survey on ranking capabilities2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 12, article id e0242699Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of this study was to rank capabilities and suggest a relevant set of capabilities for the Swedish context to inform the development of capability-adjusted life years (CALYs). CALYs is a quality of life measure for policy making based on the capability approach by Amartya Sen.

    MATERIALS AND METHODS: A Swedish governmental review proposed the following 10 relevant capabilities: time, financial situation, mental/physical health, political resources, knowledge, living environment, occupation, social relations, security, and housing. Researchers in health-related disciplines from 5 universities ranked these capabilities from 1 to 10 (most to least important) in a web-based cross-sectional survey; 115 of 171 responses were eligible.

    RESULTS: Health, social relations, and financial situation were deemed most important. Stratification by gender, research field, and age group revealed few differences. We found that it was possible to rank capabilities and that health, social relations, and financial situation were ranked highest by a non-representative sample of researchers and doctoral students from health-related disciplines at five Swedish universities.

    CONCLUSIONS: The revealed ranking is dependent on the metric and must be further explored. The findings support continued development of CALYs for monitoring and evaluating outcomes in public health and social-welfare interventions.

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  • 4. Nystrand, Camilla
    et al.
    Sampaio, Filipa
    Hoch, Jeffrey S.
    Osman, Fatumo
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    The cost-effectiveness of a culturally tailored parenting program: estimating the value of multiple outcomes2021In: Cost Effectiveness and Resource Allocation, E-ISSN 1478-7547, Vol. 19, no 1, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Parenting programs can be economically attractive interventions for improving the mental health of both parents and their children. Few attempts have been made to analyse the value of children's and parent's outcomes simultaneously, to provide a qualified support for decision making.

    Methods: A within trial cost-effectiveness evaluation was conducted, comparing Ladnaan, a culturally tailored parenting program for Somali-born parents, with a waitlist control. Quality-adjusted life years (QALY) for parents were estimated by mapping the General Health Questionnaire-12 to Euroqol's EQ-5D-3L to retrieve utilities. Behavioural problems in children were measured using the Child Behaviour Checklist (CBCL). Intervention costs were estimated for the trial. A net benefit regression framework was employed to study the cost-effectiveness of the intervention, dealing with multiple effects in the same analysis to estimate different combinations of willingness-to pay (WTP) thresholds.

    Results: For a WTP of roughly euro300 for a one point improvement in total problems on the CBCL scale (children), Ladnaan is cost-effective. In contrast, the WTP would have to be roughly euro580,000 per QALY (parents) for it to be cost-effective. Various combinations of WTP values for the two outcomes (i.e., CBCL and QALY) may be used to describe other scenarios where Ladnaan is cost-effective.

    Conclusions: Decision-makers interested in multiple effects must take into account combinations of effects in relation to budget, in order to obtain cost-effective results. A culturally adapted parenting program may be cost-effective, depending on the primary outcome, or multiple outcomes of interest.

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  • 5.
    Sampaio, Filipa
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lavelle, Tara A.
    Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, MA, Boston, United States.
    Skokauskas, Norbert
    Regional Centre for Child and Youth Mental Health and Child Welfare, IPH, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Child and Adolescent Mental Health Services, St. Olav Hospital, Trondheim, Norway.
    The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review2022In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 31, p. 1655-1670Article, review/survey (Refereed)
    Abstract [en]

    Economic evaluations can help decision makers identify what services for children with neurodevelopmental disorders provide best value-for-money. The aim of this paper is to review the best available economic evidence to support decision making for attention deficit-hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children and adolescents. We conducted a systematic review of economic evaluations of ADHD and ASD interventions including studies published 2010–2020, identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and consequences were included. The quality of the studies was assessed using the Drummond checklist. We identified ten studies of moderate-to-good quality on the cost-effectiveness of treatments for ADHD and two studies of good quality of interventions for ASD. The majority of ADHD studies evaluated pharmacotherapy (n = 8), and two investigated the economic value of psychosocial/behavioral interventions. Both economic evaluations for ASD investigated early and communication interventions. Included studies support the cost-effectiveness of behavioral parenting interventions for younger children with ADHD. Among pharmacotherapies for ADHD, different combinations of stimulant/non-stimulant medications for children were cost-effective at willingness-to-pay thresholds reported in the original papers. Early intervention for children with suspected ASD was cost-effective, but communication-focused therapy for preschool children with ASD was not. Prioritizing more studies in this area would allow decision makers to promote cost-effective and clinically effective interventions for this target group.

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  • 6.
    Sampaio, Filipa
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, BMC, Uppsala, Sweden.
    Nystrand, Camilla
    Department of Public Health and Caring Sciences, Uppsala University, BMC, Uppsala, Sweden.
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Sciences, Uppsala University, BMC, Uppsala, Sweden.
    Mihalopoulos, Cathrine
    School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.
    Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations2024In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 33, no 2, p. 323-355Article, review/survey (Refereed)
    Abstract [en]

    A comprehensive review of the economic evidence on parenting interventions targeting different aspects of child health is lacking to support decision-making. The aim of this review is to provide an up to date synthesis of the available health economic evidence for parenting interventions aiming to improve child health. A systematic review was conducted with articles identified through Econlit, Medline, PsychINFO, and ERIC databases. Only full economic evaluations comparing two or more options, considering both costs and outcomes were included. We assessed the quality of the studies using the Drummond checklist. We identified 44 studies of varying quality that met inclusion criteria; 22 targeting externalizing behaviors, five targeting internalizing problems, and five targeting other mental health problems including autism and alcohol abuse. The remaining studies targeted child abuse (n = 5), obesity (n = 3), and general health (n = 4). Studies varied considerably and many suffered from methodological limitations, such as limited costing perspectives, challenges with outcome measurement and short-time horizons. Parenting interventions showed good value for money in particular for preventing child externalizing and internalizing behaviors. For the prevention of child abuse, some programs had the potential of being cost-saving over the longer-term. Interventions were not cost-effective for the treatment of autism and obesity. Future research should include a broader spectrum of societal costs and quality-of-life impacts on both children and their caregivers.

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  • 7.
    Wijana, Moa Bråthén
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala, Sweden.
    Feldman, Inna
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
    Ssegonja, Richard
    Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory, Allergy- and Sleep Medicine Research Unit, Uppsala University, Uppsala, Sweden.
    Enebrink, Pia
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Ghaderi, Ata
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption2021In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 21, no 1, article id 374Article in journal (Refereed)
    Abstract [en]

    Background: Self-harming behaviors in adolescents cause great suffering and can lead to considerable costs to the healthcare system. The aim of the current study was to investigate the cost of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) and to compare the adolescent’s healthcare consumption 1 year before and 1 year after treatment.

    Method: The study had a within group design with repeated measures. The clinical outcomes and the cost of ICT treatment are based on a sample of 49 participants who were previously enrolled in an intervention trial. Participants with significantly improved clinical outcomes (self-harm behavior, or general mental health symptoms) were defined as treatment responders. Calculation of changes in healthcare consumption is based on 25 participants who gave their consent to participate in a retrospective collection of healthcare data from medical records, including inpatient and outpatient care, and prescribed medication.

    Results: The average estimated cost of ICT per person was €5293. There were no significant differences between the cost of healthcare consumption 1 year before and after ICT, but the results suggested that the adolescents consumed less inpatient and specialized care after treatment. There was a significantly higher cost of psychotropic medication after treatment explained by a higher consumption of central stimulants. Treatment responders (general mental health problems) reduced their consumption of healthcare resources significantly more than non-responders, especially regarding hospital visits and total health care costs.

    Conclusions: Good response to the ICT in terms of improved general mental health symptoms seems to be associated with reduced healthcare consumption during the post-treatment period. However, controlled studies with larger sample sizes are needed to draw causal conclusions. The results of this study should be interpreted with caution as it is based on a small sample and attrition rate was high. Trial registration: This study has been registered with the ISRCTN: 15885573.

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