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  • 1.
    Christensen, Sarah Friis
    et al.
    Department of Hematology Zealand University Hospital, Roskilde, Denmark.
    Svingel, Lise Skovgaard
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
    Kjærsgaard, Anders
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
    Stenling, Anna
    Novartis Sverige AB, Kista, Sweden.
    Darvalics, Bianka
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
    Paulsson, Björn
    Novartis Sverige AB, Kista, Sweden.
    Andersen, Christen Lykkegaard
    Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark; The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Christiansen, Christian Fynbo
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
    Stentoft, Jesper
    Department of Hematology Aarhus University Hospital, Aarhus, Denmark.
    Starklint, Jørn
    Department of Hematology, Holstebro Hospital, Holstebro, Denmark.
    Severinsen, Marianne Tang
    Department of Hematology Aalborg University Hospital, Aalborg, Denmark.
    Clausen, Mette Borg
    Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.
    Hilsøe, Morten Hagemann
    Department of Hematology, Hospital South West Jutland, Esbjerg, Denmark.
    Hasselbalch, Hans Carl
    Department of Hematology, Zealand University Hospital, Roskilde, Denmark.
    Frederiksen, Henrik
    Department of Hematology Odense University Hospital, Odense, Denmark.
    Mikkelsen, Ellen Margrethe
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
    Bak, Marie
    Department of Hematology Zealand University Hospital, Roskilde, Denmark; Department of Hematology Copenhagen University Hospital, Rigshospitalet, Denmark.
    Healthcare resource utilization in patients with myeloproliferative neoplasms: A Danish nationwide matched cohort study2022In: European Journal of Haematology, ISSN 0902-4441, E-ISSN 1600-0609Article in journal (Refereed)
    Abstract [en]

    Few studies have assessed healthcare resource utilization (HRU) in patients with Philadelphia-negative myeloproliferative neoplasms (MPN) using a matched cohort design. Further, no detailed assessment of HRU in the years preceding an MPN diagnosis exists. We conducted a registry-based nationwide Danish cohort study, including patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN diagnosed between January 2010 and December 2016. HRU data were summarized annually from 2 years before MPN diagnosis until emigration, death, or end of study (December 2017). We included 3342 MPN patients and 32 737 comparisons without an MPN diagnosis, matched on sex, age, region of residence, and level of education. During the study period, the difference in HRU (rate ratio) between patients and matched comparisons ranged from 1.0 to 1.5 for general practitioner contacts, 0.9 to 2.2 for hospitalizations, 0.9 to 3.8 for inpatient days, 1.0 to 4.0 for outpatient visits, 1.3 to 2.1 for emergency department visits, and 1.0 to 4.1 for treatments/examinations. In conclusion, MPN patients had overall higher HRU than the matched comparisons throughout the follow-up period (maximum 8 years). Further, MPN patients had substantially increased HRU in both the primary and secondary healthcare sector in the 2 years preceding the diagnosis.

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  • 2.
    Christensen, Sarah Friis
    et al.
    Department of Hematology, Zealand University Hospital, Roskilde, Denmark.
    Svingel, Lise Skovgaard
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
    Kjærsgaard, Anders
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
    Stenling, Anna
    Novartis, Kista, Sweden.
    Paulsson, Björn
    Novartis, Kista, Sweden.
    Andersen, Christen Lykkegaard
    Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark.
    Christiansen, Christian Fynbo
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
    Stentoft, Jesper
    Department of Hematology, Aarhus University Hospital, Aarhus, Denmark.
    Starklint, Jørn
    Department of Hematology, Holstebro Hospital, Holstebro, Denmark.
    Severinsen, Marianne Tang
    Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
    Clausen, Mette Borg
    Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark.
    Hilsøe, Morten Hagemann
    Department of Hematology, Hospital of South West Jutland, Esbjerg, Denmark.
    Frederiksen, Henrik
    Department of Hematology, Odense University Hospital, Odense, Denmark.
    Hasselbalch, Hans C.
    Department of Hematology, University of Copenhagen, Zealand University Hospital, Roskilde, Denmark.
    Bak, Marie
    Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark;Department of Hematology, Zealand University Hospital, Roskilde, Denmark.
    Mikkelsen, Ellen Margrethe
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
    Labor Market Attachment in Patients with Myeloproliferative Neoplasms: A Nationwide Matched Cohort Study2021In: Blood, ISSN 0006-4971, E-ISSN 1528-0020, Vol. 138, no Suppl 1, article id 3627Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Myeloproliferative neoplasms (MPNs) are characterized by a substantial symptom burden, risk of debilitating complications (e.g., thrombosis), and increased comorbidity. Recently, three comprehensive questionnaire studies (Mesa 2016, Harrison 2017, Jingbo 2018) have reported a high impact of MPNs on patients' ability to work. However, no registry-based studies have assessed labor market attachment (LMA) of MPN patients and matched nonMPN comparisons.

    AIM: To assess the pre- and post-diagnostic LMA of MPN patients and matched nonMPN comparisons.

    METHODS: We conducted a descriptive, registry-based nationwide cohort study, using data from the Danish National Chronic Myeloid Neoplasia Registry including all Danish MPN patients diagnosed between January 2010 and December 2016. Population-based cohorts of nonMPN comparisons were constructed by 1:10 matching on age, sex, level of education, and region of residence. Data on LMA were retrieved from the Danish Register for Evaluation of Marginalization, which holds information on all public transfer payments in Denmark. Data were linked using the unique civil registration number, which identifies all Danish citizens. The LMA endpoints were defined for each individual as working (not receiving any type of transfer payment), unemployed, receiving transfer payment for either sick leave, disability pension, age pension, or other health-related benefits (e.g., wage-subsidized employment). We assessed LMA weekly for each individual from two years before diagnosis until death, emigration, or two years after the diagnosis. For each cohort, we presented LMA as proportions with 95% confidence intervals (CIs), as well as the proportion of individuals who died during follow-up.

    RESULTS: The study included 3,342 MPN patients (1,140 essential thrombocythemia [ET]; 1,109 polycythemia vera [PV]; 533 myelofibrosis [MF]; and 560 unspecified MPN [MPN-U]) and 32,737 nonMPN comparisons (11,181 nonET; 10,873 nonPV; 5,217 nonPMF; and 5,466 nonMPN-U). The median age at time of diagnosis was: ET 67 years (interquartile range [IQR], 55-76); PV, 69 years (IQR, 61-77); PMF, 73 years (IQR, 66-79); and MPN-U, 72 years (IQR, 63-80).

    At time of MPN diagnosis, the majority of MPN patients and nonMPN comparisons received age pension (range: ET, 52.1% [95% CI, 49.2-55.0] to nonMF, 70.3% [95% CI, 69.1-71.6]). The proportions working were: ET, 35.1% (95% CI, 32.3-37.9) vs. nonET, 37.3% (95% CI, 36.5-38.2); PV, 22.6% (95% CI, 20.2-25.1) vs. nonPV, 30.8% (95% CI, 29.9-31.7); MF, 23.8% (95% CI, 20.2-27.4) vs. nonMF, 23.6% (95% CI, 22.5-24.8); and MPN-U, 22.1% (95% CI,18.7- 25.6) vs. nonMPN-U, 27.8% (95% CI, 26.6-29.0). Across MPN subtypes, a larger proportion of patients than comparisons were on sick leave: ET, 3.5% (95% CI, 2.4-4.6) vs. nonET, 1.3% (95% CI, 1.1-1.5); PV, 5.5% (95% CI, 4.2-6.8) vs. nonPV, 0.9% (95% CI, 0.7-1.1); MF (not applicable due to small numbers) vs. nonMF, 0.6% (95% CI, 0.4-0.8); and MPN-U, 3.0% (95% CI, 1.6- 4.5) vs. nonMPN-U, 1.0% (95% CI, 0.7-1.3). Regarding disability pension, the proportions ranged from 4.1% (95% CI, 2.4-5.8) to 5.0% (95% CI, 3.7-6.3) among patients and from 3.1% (95% CI, 2.6-3.6) to 4.7% (95% CI, 4.3-5.1) among comparisons. For both MPN patients and nonMPN comparisons, few were unemployed (≤3.3%) or received other health-related benefits (≤1.6%).

    Two years preceding diagnosis, the proportion of PV and MPN-U patients working was slightly lower than the matched comparisons: PV, 31.0% (95% CI, 28.4-33.8) vs. nonPV, 34.3% (95% CI, 33.5-35.2) and MPN-U, 28.2% (95% CI, 24.6-32.1) vs. nonMPN-U, 32.0% (95% CI, 30.7-33.2), while this difference was not observed between ET and MF patients and their respective comparisons.

    From two years before to two years after diagnosis, we observed slightly larger reductions in the proportion working among MPN patients than among comparisons. Among MPN patients, the proportion on sick leave including other health-related benefits, increased during the study period, while it remained unchanged among comparisons. The proportion of patients and comparisons on disability pension remained stable.

    CONCLUSION: Overall, our findings showed that Danish patients with ET, PV, MF, and MPN-U had slightly impaired LMA already two years before diagnosis and up to two years after diagnosis. Thus, fewer patients were working and more patients transferred to sick leave compared with matched individuals without MPN.

  • 3. Christensen, Sarah
    et al.
    Svingel, Lise
    Kjærsgaard, Anders
    Stenling, Anna
    Novartis Sverige AB, Kista, Sweden.
    Darvalics, Bianka
    Paulsson, Björn
    Andersen, Christen
    Christiansen, Christian
    Hasselbalch, Hans
    Stentoft, Jesper
    Starklint, Jørn
    Severinsen, Marianne
    Clausen, Mette
    Hilsøe, Morten
    Frederiksen, Henrik
    Mikkelsen, Ellen
    Bak, Marie
    Healthcare resource utilization in patients with myeloproliferative neoplasms: a nationwide matched cohort study2021In: HemaSphere, ISSN 2572-9241, Vol. 5, no S2, p. 529-530, article id EP1107Article in journal (Refereed)
    Abstract [en]

    Background: Myeloproliferative neoplasms (MPNs) are associated with severe complications and a substantial symptom burden – frequently emerging several years before diagnosis. Due to the chronic nature ofthe diseases, MPN patients have a lifelong need for treatment and care. However, only few studies have assessed MPN healthcare resource utilization (HRU) compared with matched cohorts, and no detailed assessments of HRU in the years preceding MPN diagnosis exist.

    Aims: To assess the pre- and post-diagnostic HRU of MPN patients compared with matched cohorts of nonMPN comparisons.

    Methods: We conducted this descriptive, register-based nationwide cohort study, utilizing data from the Danish National Chronic Myeloid Neoplasia Registry on all MPN patients diagnosed between January 2010 and December 2016, and data on HRU from the Danish National Patient Registry and the Danish National Health Service Registry. Populationbased cohorts of nonMPN comparisons were constructed by 1:10 matchingon age, sex, level of education, and region of residence. Data were linkedusing the unique civil registration number, which identifies all Danish citizens. HRU was summarized over each year for all cohorts from twoyears before date of MPN diagnosis and until emigration, death, or endof study (31 December 2017). HRU was calculated as annual number ofhealthcare contacts (inpatient days, outpatient consultations, treatmentsand examinations, and general practitioner [GP] visits) divided by person-years at risk and compared using rate ratios with 95% CI.

    Results: The study population included 3,342 MPN patients (1,140 essential thrombocythemia [ET]; 1,109 polycythemia vera [PV]; 533 primary myelofibrosis [PMF]; and 560 unspecified MPN [MPN-U]) and 32,737 nonMPN comparisons (11,181 nonET; 10,873 nonPV; 5,217 nonPMF; and 5,466 nonMPN-U). The median age was 67 (ET), 69 (PV), 73 (PMF), and 72 years (MPN-U), and the mean follow-up was 3.8 (ET), 3.8(PV), 3.1 (PMF), and 3.3 years (MPN-U). A total of 750 (22.4%) MPNpatients and 4,627 (14.1%) nonMPN comparisons died during follow-up.In nearly all years of follow-up, MPN patients had a higher HRU thannonMPN comparisons (Figure, rate ratio>1). Rate ratios for outpatientconsultations were largest at the time of diagnosis: ET, 2.7 (95%CI, 2.6-2.9); PV, 3.4 (95%CI, 3.2-3.6); PMF, 4.0 (95%CI, 3.7-4.4); and MPN-U,3.7 (95%CI, 3.4-4.0). For most MPN subtypes, rate ratios also peaked attime of diagnosis for treatment and examinations. In contrast, the largest rate ratio for PV was in the last year of follow-up: 3.5 (95%CI, 2.8-4.3). Across MPN subtypes, rate ratios for GP visits varied from 1.0 to1.5 during follow-up without any considerable fluctuations. Interestingly, increased rate ratios for inpatients days were evident 2 years before diagnosis: ET, 1.8 (95%CI, 1.7-1.9); PV, 1.3, (95%CI, 1.2-1.3); PMF, 1.4(95%CI, 1.2-1.5); and MPN-U, 1.7 (95%CI, 1.6-1.9). During follow-up,notable increases in rate ratios were observed, e.g., PMF 3.0 (95%CI 2.4-3.6) and PV 3.8 (95%CI 3.0-4.8) in year 5 and 7, respectively.

    Summary/Conclusion: Overall, compared with matched nonMPN comparisons, MPN patients had a higher HRU throughout the study period. This was consistent across MPN subtypes and HRU measures. Within the limitations of small numbers toward end of follow-up and lack ofmatching on comorbidity, our findings confirmed a consistent HRU burden after MPN diagnosis. Equally important, our study revealed substantial increases in HRU two years before MPN diagnosis, warrantingfurther exploration of the pre-diagnostic period, including the potentialbenefits of early detection.

  • 4. Jansson, S. A.
    et al.
    Stenling, A.
    AstraZeneca Nordic MC.
    Backman, H.
    Ronmark, E.
    Lindberg, A.
    Lundback, B.
    Health care costs of individuals with and without COPD in Sweden2010In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 13, no 7, p. A321-A321Article in journal (Other academic)
  • 5. Jansson, Sven-Arne
    et al.
    Backman, Helena
    Stenling, Anna
    AstraZeneca Nordic.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundbäck, Bo
    Costs of COPD by disease severity2011In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 38, no Suppl 55Article in journal (Refereed)
    Abstract [en]

    Background: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic and disabling diseases worldwide, and the societal costs are high.

    Aim: To estimate the societal costs of COPD in Sweden and to examine the relationship between disease severity and costs.

    Methods: The study sample was identified in earlier clinical examinations of general population cohorts within the OLIN (Obstructive Lung Disease in Northern Sweden) studies. The cohort consisted initially of 993 subjects fulfilling COPD spirometric criteria (GOLD). In 2009-2010, telephone interviews on resource utilization were made to a sample of 244 subjects, stratified by disease severity. Interviews were performed quarterly to minimize the risk of recall bias. A non-parametric Mann-Whitney U-test was used to test cost differences between groups; p-values adjusted by Bonferroni correction. Unit costs from 2010 were applied.

    Results: A highly significant relationship was found between disease severity and costs. The mean annual total cost per patient in relation to disease severity (GOLD) was: stage I €811; II €2,660; III €7,068; and IV €20,665. Indirect costs were higher than direct costs in all severity stages. For direct costs, main cost drivers were hospitalizations in stage III and IV, and drugs in stage I and II, respectively. The main cost driver in indirect costs was productivity loss due to early retirement, except in stage I where the driver was sick-leave. In comparison with a similar study performed in 1999 a numerical increase in mean annual total costs per patient was observed (ns).

    Conclusions: The results indicate that the societal costs of COPD in Sweden are substantial, and the costs increase considerably by disease severity.

  • 6.
    Jansson, Sven-Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenling, Anna
    AstraZeneca Nordic-Baltic, Department of Health Economics, SE-151 85 Södertälje, Sweden.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lundbäck, Bo
    Health economic costs of COPD in Sweden by disease severity: has it changed during a ten years period?2013In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, no 12, p. 1931-1938Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives of the presented study were to estimate societal costs of COPD in Sweden, the relationship between costs and disease severity, and possible changes in the costs during the last decade.

    METHODS: Subjects with COPD derived from the general population in Northern Sweden were interviewed by telephone regarding their resource utilisation and productivity losses four times quarterly during 2009-10. Mean annual costs were estimated for each severity stage of COPD.

    RESULTS: A strong relationship was found between disease severity and costs. Estimated mean annual costs per subject of mild, moderate, severe and very severe COPD amounted to 596 (SEK 5686), 3245 (SEK 30,957), 5686 (SEK 54,242), and 17,355 euros (SEK 165,569), respectively. The main cost drivers for direct costs were hospitalisations (for very severe COPD) and drugs (all other severity stages). The main cost driver for indirect costs was productivity loss due to sick-leave (for mild COPD) and early retirement (all other severity stages). Costs appeared to be lower in 2010 than in 1999 for subjects with severe and very severe COPD, but higher for those with mild and moderate COPD.

    CONCLUSION: Our results show that costs of COPD are strongly related to disease severity, and scaling the data to the whole Swedish population indicates that the total costs in Sweden amounted to 1.5 billion euros (SEK 13.9 bn) in 2010. In addition, costs have decreased since 1999 for subjects with severe and very severe COPD, but increased for those with mild and moderate COPD.

  • 7. Jansson, Sven-Arne
    et al.
    Rönmark, Eva
    Lindberg, Anne
    Bergelin, Anna
    AstraZeneca Sverige.
    Lundbäck, Bo
    Komorbiditet måste inkluderas vid beräkning av kostnader för KOL2009In: Svenska läkaresällskapets handlingar: Hygiea, ISSN 0349-1722, Vol. 118, no 1, p. 72-72Article in journal (Other academic)
    Abstract [sv]

    Bakgrund

    Kroniskt obstruktiv lungsjukdom (KOL) är en av de vanligast förekommande sjukdomarna i Sverige och medför stort lidande för de drabbade. De samhällsekonomiska kostnaderna till följd av sjukdomen är höga. Syftet med denna studie var att beräkna det totala antalet sjukhusinläggningar för både KOL och för andra sjukdomar i en kohort av individer med respektive utan sjukdomen KOL.

    Metod

    Studiepopulationen är identifierad sedan tidigare i genomförda kliniska undersökningar av populationsbaserade kohorter inom OLIN-studierna (Obstruktiv Lungsjukdom i Norra Sverige). Kohorten innehöll ursprungligen 993 individer, vilka alla uppfyllde kriterierna för KOL; samt en lika stor ålders- och könsmatchad kontrollgrupp utan sjukdomen KOL. Dessa individer har sedan 2005 intervjuats årligen om deras resurskonsumtion i sjukvårdssektorn samt genomgått en klinisk undersökning. Deltagandegraden har årligen varit cirka 90 %.

    Resultat

    Individer med KOL hade fler sjukhusinläggningar, både till följd av KOL och på grund av andra sjukdomar, jämfört med individer utan KOL (0.8 dagar respektive 1,1 dagar per individ och år). Trots att mer än 90% av individerna med KOL hade en mild eller medelsvår sjukdom visade studien att individer med KOL hade 25% fler dagar på sjukhus både för KOL och för andra sjukdomar jämfört med kontrollgruppen. Detta var oberoende av kön, men skillnaden var större bland män jämfört med kvinnor (0,4 dagar respektive 0,2 dagar per individ och år). Resultaten tyder på att komorbiditeten vid KOL är betydande.

    Sammanfattning

    Kostnader för KOL blir kraftigt underskattade om man inte tar hänsyn till kostnader för komorbiditiet. Beräkningar och analyser av resurskonsumtion och kostnader för komorbiditet måste därför genomföras för att erhålla den verkliga kostnaden för KOL.

  • 8.
    Jansson, Sven-Arne
    et al.
    Sunderby Sjukhus, Luleå .
    Stenling, Anna
    AstraZeneca Nordic.
    Backman, Helena
    Sunderbyns sjukhus .
    Rönmark, Eva
    Sunderbyns sjukhus .
    Lindberg, Anne
    Lung- och Allergimottagningen, Sunderby Sjukhus .
    Lundbäck, Bo
    Sjukvårdskostnader och läkemedelsanvändning hos individer med KOL i Sverige2010In: Svenska läkaresällskapets handlingar: Hygiea, ISSN 0349-1722, Vol. 119, no 1, p. 92-92Article in journal (Other academic)
    Abstract [sv]

    Bakgrund Kroniskt obstruktiv lungsjukdom (KOL) är en av de vanligast förekommande sjukdomarna i Sverige och medför stort lidande för de drabbade. De samhällsekonomiska kostnaderna till följd av sjukdomen är höga. Syftet var att studera sjukvårdskostnader (sjukhusinläggningar och öppenvårdsbesök) och läkemedelsanvändning hos individer med respektive utan KOL.

    Metod Studiepopulationen är identifierad sedan tidigare i kliniska undersökningar av populationsbaserade kohorter inom OLIN-studierna (Obstruktiv Lungsjukdom i Norrbotten). Kohorten innehöll ursprungligen 993 individer, vilka alla uppfyllde kriterierna (GOLD) för KOL; samt en lika stor ålders- och könsmatchad kontrollgrupp utan sjukdomen. Dessa individer har sedan 2005 kallats till årliga intervjuer och kliniska undersökningar. Deltagandegraden har varit >85% varje år. Analysen är baserad på data om resurskonsumtion insamlade år 2006 (n=772 KOL, n=802 icke-KOL). Enhetskostnader från Norra Sjukvårdsregionens prislista 2010 har använts.

    Resultat Bland individer med KOL uppgick genomsnittliga sjukvårdskostnaden för alla sjukdomar till 14 299 kr per individ och år jämfört med 11 312 kr för individer utan KOL (p=0,16). Uppdelat i svårighetsgrad var motsvarande kostnader: stadium 1 – 11 657 kr (p=0,92), 2 – 17 552 kr (p=0,12), 3+4 – 22 226 kr (p<0,01). En mindre del av kostnaderna hänfördes till luftvägssjukdomar; 10,5% bland individer med KOL och 6,2% bland individer utan KOL. Kostnader för luftvägssjukdomar var signifikant högre bland individer med KOL och ökade med sjukdomens svårighetsgrad. Individer med KOL uppvisade 20% högre kostnader för andra sjukdomar jämfört med individer utan KOL. Andelen individer med KOL som använde luftvägsmediciner ökade med sjukdomens svårighetsgrad (stadium 1 - 29,6%, 2 - 51,5% respektive 3+4 - 84,8%). Andelen individer som använde läkemedel mot andra sjukdomar än luftvägssjukdomar tenderade att vara högre bland individer med KOL jämfört med individer utan KOL, framförallt i svårare grader av sjukdomen.

    Sammanfattning Sjukvårdskostnader och andelen individer som använde läkemedel var högre bland individer med KOL och ökade med sjukdomens svårighetsgrad. Resultaten tyder på att utöver sjukdomen i sig, är även komorbiditet en bidragande orsak till de högre kostnaderna. Det är av stor vikt, både samhällsekonomiskt och för patientens bästa, att upptäcka och diagnostisera KOL i ett tidigt stadium för att förhindra att sjukdomen fortskrider till allvarligare stadier.

  • 9. Kjellander, Christian
    et al.
    Hernlund, Emma
    Ivergård, Moa
    Svedbom, Axel
    Dibbern, Therese
    Stenling, Anna
    Novartis Sverige AB, Stockholm, Sweden.
    Sjöö, Fredrik
    Vertuani, Simona
    Glenthøj, Andreas
    Cherif, Honar
    Costs of Hospital Care and Productivity Loss Due to Sickle Cell Disease in Sweden: A Retrospective Study2022In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 25, no 1, p. S248-S248, article id POSA386Article in journal (Refereed)
    Abstract [en]

    Objectives: Sickle cell disease (SCD) is an inherited disorder of hemoglobin, associated with significant morbidity and mortality. Although the disease is most prevalent in Africa, it has been increasingly common in Western countries due to migration. The number of SCD patients in Sweden is unknown and the comprehensive national registries in Sweden provide a unique opportunity to address the objective to assess the burden of SCD.

    Methods: Using Sweden’s national patient registry, the 1-year prevalence of SCD with crisis (at least one registration of ICD-10 code D57.0 during the identification period, 2001-2018) was estimated during a 13-year follow-up period (2006-2018). Costs for hospital care of SCD (any ICD-10 D57) were estimated through hospital remuneration amounts based on diagnosis-related group. Productivity losses due to sick leave or disability for SCD, from the Swedish Social Insurance Agency, were assessed for working-age patients (18-65 years) and costed with Swedish mean salary, plus social security contributions.

    Results: The 1-year prevalence of SCD with crisis increased during the follow-up period from 139 patients in year 2006 to 260 in 2018. A total of 2,427 inpatients stays were recorded with SCD (ICD-10 D57) as main reason for stay (observed in 2,632 SCD patient years) over the study period. In addition, 7,213 outpatient visits due to SCD were recorded. These stays and visits were estimated to cost 76.4 million (M) Swedish Krona (SEK) and 31.0 M SEK, respectively. Productivity losses due to sick leaves and disability pension amounted to 14.8 M SEK and 68.3 M SEK, respectively.

    Conclusions: This study demonstrates that SCD with crisis is associated with economic burden to society, health care and patients in Sweden and increasing prevalence and costs over the years of follow up. In total, for the years 2006-2018, the cost of hospital care and productivity losses for SCD amounted to 190.6 M SEK.

  • 10. Kjellander, Christian
    et al.
    Hernlund, Emma
    Ivergård, Moa
    Svedbom, Axel
    Dibbern, Therese
    Stenling, Anna
    Novartis Sverige AB, Stockholm, Sweden.
    Sjöö, Fredrik
    Vertuani, Simona
    Glenthøj, Andreas
    Cherif, Honar
    Economic burden of sickle cell disease in Sweden: a population-based national register study with 13 years follow up2023In: Frontiers in Hematology, E-ISSN 2813-3935, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Introduction: Sickle cell disease (SCD) describes a group of inherited disorders of hemoglobin. Globally, SCD occurs in approximately 300,000-400,000 births annually and is most prevalent in malaria-endemic countries. However, migration has impacted the epidemiology of SCD but data on the matter are scarce. The objective of this study was to describe the epidemiology, treatment uptake, and economic burden of SCD in Sweden, a country with substantial immigration over the last decades.

    Methods: This nationwide retrospective observational registry cohort study identified patients with SCD from 2001 to 2018 and followed them from 2006 to 2018. Using data from high-quality population-based Swedish registers, we estimated prevalence, treatment uptake, and SCD-related health care resource use, sick leave and disability pension.

    Results: Between 2006 and 2018 the number of patients with SCD increased from 504 to 670; inpatient hospital stays and outpatient visits increased by 200% and 300%, respectively. Patients with pain crises had approximately twice the number of inpatient episodes and outpatient visit per year, and had higher productivity losses compared to patients without crises.

    Conclusion: In an era of emerging treatments for SCD, we have, to the best of our knowledge, for the first time comprehensively described epidemiological and economic aspects of SCD in a country where the disease is still rare and not well recognized by the healthcare system.

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  • 11.
    Kjellander, Christian
    et al.
    Department of Internal Medicine, St Göran Hospital, Stockholm, Sweden.
    Hernlund, Emma
    ICON plc, Stockholm, Sweden.
    Ivergård, Moa
    ICON plc, Stockholm, Sweden.
    Svedbom, Axel
    ICON plc, Stockholm, Sweden.
    Dibbern, Therese
    Novartis Sverige AB, Kista, Sweden.
    Stenling, Anna
    Novartis, Kista, Sweden.
    Sjöö, Fredrik
    Novartis Sverige AB, Kista, Sweden.
    Vertuani, Simona
    Novartis Sverige AB, Kista, Sweden.
    Glenthøj, Andreas
    Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
    Cherif, Honar
    Uppsala University Hospital, Uppsala, Sweden.
    Sickle Cell Disease in Sweden - Prevalence and Resource Use Estimated through Population-Based National Registers2021In: Blood, ISSN 0006-4971, E-ISSN 1528-0020, Vol. 138, no Suppl 1, p. 2040-, article id 2040Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin. SCD causes hemolytic anemia, vaso-occlusion leading to vaso-occlusive crises (VOC) and contributing to organ damage and early death. SCD is most prevalent in sub-Saharan Africa and the Middle East, but also countries such as Brazil, India and US, have comparatively high frequencies of SCD. Global migration has contributed to a greater geographical spread. The prevalence of SCD in Sweden is unknown.

    OBJECTIVE: The primary objectives of this study were to estimate the 1-year prevalence of SCD and SCD-associated resource use in Sweden. Secondary objectives were to estimate birth incidence, treatment patterns and survival.

    PATIENTS: Patients with an ICD-10 diagnosis code for SCD (any D57 [excluding D57.3, sickle cell trait]) were identified from the Swedish Patient Registry (between January 1 st 2001 and June 30 th 2018). Patients were assessed for 1-year prevalence and resource use per calendar year for a follow-up period of 13 years (2006-2018).

    METHODS: Patients were considered prevalent from birth or immigration to death or emigration. Resource use from specialized care, including all events recorded in the registry with any D57 as the main diagnosis was assessed in the follow up period 2006-2018 as number of outpatient visits and inpatient stays. Costs for this hospital resource use were estimated through remuneration amounts based on diagnosis related groups. Data on sick leave days and days with disability pension due to SCD in patients in working age (18-65 years) were retrieved from the Swedish Social Security Agency and costed with the mean salary in Sweden, plus social security contributions. Costs are reported in 2019 Swedish Krona (SEK, ≈$ 0.1).

    RESULTS: One-year prevalence of all SCD diagnosis increased from 504 patients (5.53 per 100,000 population) in 2006 to 670 patients (6.55 per 100,000 population) in 2018. The 1-year prevalence of SCD patients ever recorded with an ICD-10 code for SCD with VOC (D57.0) increased from 139 patients (1.53 per 100,000 population) in 2006 to 260 patients (2.54 per 100,000 population) in 2018. The proportion of prevalent patients that were born in Sweden decreased over the years, from approximately 55% in the beginning of the study period to 45% in the end of the study period. The mean and median age of the SCD population decreased over the study period. Individuals with SCD and VOC were, on average younger than the other SCD (D57) subgroups.

    Birth incidence was captured by calendar year 2006-2018 and was highest in 2007 with 15 children born with SCD. For Swedish-born children with SCD during the patient identification time (n=123), the mean time to identification in the registers was 2.6 years (SD 2.7, range 0-16 years).

    Hospital outpatient visits and inpatient stays with SCD (all events with D57 recorded) as main diagnosis increased from 57 to 189, and 250 to 1,003, respectively, over the years 2006-2018. This corresponded to costs of inpatient care increasing from 1.4 million (M) SEK in 2006 to 7.3 M SEK in 2018 and costs of outpatient visits increasing from 0.9 M SEK in 2006 to 4.6 M SEK in 2018. The vast majority of costs were incurred in individuals ever recorded with a SCD with VOC diagnosis (D57.0). The most frequent hospital treatment was blood transfusion, with 8-11% of patients receiving transfusion in each year studied, especially common in SCD and VOC diagnosis. The prescribed treatment with the highest increase of uptake over the study period were hydroxyurea, vitamins and paracetamol in all SCD.

    Individuals in working age had on average 2.3 days of sick leave per patient-year due to SCD (D57), and approximately 4% of these patients received disability benefits because of their SCD.

    During the follow-up period, the median age at death was 74 years for all SCD and 69 years for SCD with crisis, this is 7-10 years and 12-15 years less compared to the Swedish general population respectively.

    CONCLUSION: This study demonstrates that the prevalence, hospital resource use and associated costs have increased substantially in Sweden. In an era of emerging treatments for SCD we have for the first time comprehensively described epidemiological-, disease-related and economical aspects of SCD in Sweden.

  • 12.
    Lindholm, Lars
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenling, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort2018In: BMC Public Health, E-ISSN 1471-2458, Vol. 18, article id 452Article in journal (Refereed)
    Abstract [en]

    Background: Several large scale community-based cardiovascular disease prevention programs were initiated in the 80s, and one was the Västerbotten Intervention Programme, Sweden. As an initial step in 1985, a pilot study was introduced in the Norsjö municipality that combined individual disease prevention efforts among the middle-aged population with community-oriented health promotion activities. All citizens at 30, 40, 50, and 60 years of age were invited to a physical examination combined with a healthy dialogue at the local primary health care centre. Västerbotten Intervention Program is still running following the same lines and is now a part of the ordinary public health in the county. The purpose of this study is to estimate the costs of running Västerbotten Intervention Programme from 1990 to 2006, versus the health gains and savings reasonably attributable to the program during the same time period. Methods: A previous study estimated the number of prevented deaths during the period 1990-2006 which can be attributed to the programme. We used this estimate and calculated the number of QALYs gained, as well as savings in resources due to prevented non-fatal cases during the time period 1990 to 2006. Costs for the programmes were based on previously published scientific articles as well as current cost data from the county council, who is responsible for the programme. Result: The cost per QALY gained from a societal perspective is SEK 650 (Euro 68). From a health care sector perspective, the savings attributable to the VIP exceeded its costs. Conclusion: Our analysis shows that Västerbotten Intervention Programme is extremely cost-effective in relation to the Swedish threshold value (SEK 500000 per QALY gained or Euro 53,000 per QALY gained). Other research has also shown a favorable effect of Västerbotten Intervention Programme on population health and the health gap. We therefore argue that all health care organizations, acting in settings reasonably similar to Sweden, have good incentive to implement programs like Västerbotten Intervention Programme.

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  • 13. Nielsen, Rune
    et al.
    Kankaanranta, Hannu
    Bjermer, Leif
    Lange, Peter
    Arnetorp, Sofie
    Hedegaard, Morten
    Stenling, Anna
    AstraZeneca Nordic-Baltic, Department of Health Economics, Södertälje, Sweden.
    Mittmann, Nicole
    Cost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries2013In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 107, no 11, p. 1709-1721Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler(®)+tiotropium (TIO) HandiHaler(®) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA).

    METHODS: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.

    RESULTS: From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust.

    CONCLUSION: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. (ClinicalTrials.gov Identifier: NCT00496470).

  • 14. Nielsen, Rune
    et al.
    Kankaanranta, Hannu
    Bjermer, Leif
    Lange, Peter
    Arnetorp, Sofie
    Hedegaard, Morten
    Stenling, Anna
    AstraZeneca Nordic.
    Mittmann, Nicole
    Cost-effectiveness of adding budesonide/formoterol to tiotropium in severe COPD patients in four Nordic countries2012In: European Respiratory Journal, Vol. 40, no Suppl 56Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the cost-effectiveness of budesonide/formoterol (B/F)+tiotropium (TIO) versus placebo (PBO)+TIO for the treatment of chronic obstructive pulmonary disease (COPD) patients eligible for inhaled corticosteroid/ long-acting β2-agonist from societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.Method: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial (NCT00496470) of 659 COPD patients with pre-bronchodilator FEV1 ≤50%, and at least one severe exacerbation (hospitalisation, emergency room visit or systemic glucocorticosteroids) the preceding year. Subjects were treated with B/F 320/9µg bid+TIO 18µg qd or PBO bid+TIO 18µg qd. Effectiveness was defined as the number of exacerbations avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from the trial was combined with 2010 Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs. The incremental cost-effectiveness ratios (ICERs) were estimated by bootstrapping.Results: From a societal perspective, the ICER was estimated at €174 per exacerbation avoided (pEA) in Finland while B/F+TIO was dominant in the other countries. From a healthcare perspective, B/F+TIO was dominant in Norway and the ICERs were estimated at DKK 1,580 (€212), €307, SEK 1,573 (€165) pEA for Denmark, Finland and Sweden, respectively. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust.Conclusion: The results indicate that B/F+TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries.

  • 15. Olofsson, Peter
    et al.
    Nerstedt, Annika
    Hultqvist, Malin
    Nilsson, Elisabeth C
    Andersson, Sofia
    Bergelin, Anna
    Biovitrum AB, Göteborg, Sweden.
    Holmdahl, Rikard
    Arthritis suppression by NADPH activation operates through an interferon-beta pathway2007In: BMC Biology, E-ISSN 1741-7007, Vol. 5, p. 19-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A polymorphism in the activating component of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex, neutrophil cytosolic factor 1 (NCF1), has previously been identified as a regulator of arthritis severity in mice and rats. This discovery resulted in a search for NADPH oxidase-activating substances as a potential new approach to treat autoimmune disorders such as rheumatoid arthritis (RA). We have recently shown that compounds inducing NCF1-dependent oxidative burst, e.g. phytol, have a strong ameliorating effect on arthritis in rats. However, the underlying molecular mechanism is still not clearly understood. The aim of this study was to use gene-expression profiling to understand the protective effect against arthritis of activation of NADPH oxidase in the immune system.

    RESULTS: Subcutaneous administration of phytol leads to an accumulation of the compound in the inguinal lymph nodes, with peak levels being reached approximately 10 days after administration. Hence, global gene-expression profiling on inguinal lymph nodes was performed 10 days after the induction of pristane-induced arthritis (PIA) and phytol administration. The differentially expressed genes could be divided into two pathways, consisting of genes regulated by different interferons. IFN-gamma regulated the pathway associated with arthritis development, whereas IFN-beta regulated the pathway associated with disease protection through phytol. Importantly, these two molecular pathways were also confirmed to differentiate between the arthritis-susceptible dark agouti (DA) rat, (with an Ncf-1DA allele that allows only low oxidative burst), and the arthritis-protected DA.Ncf-1E3 rat (with an Ncf1E3 allele that allows a stronger oxidative burst).

    CONCLUSION: Naturally occurring genetic polymorphisms in the Ncf-1 gene modulate the activity of the NADPH oxidase complex, which strongly regulates the severity of arthritis. We now show that the Ncf-1 allele that enhances oxidative burst and protects against arthritis is operating through an IFN-beta-associated pathway, whereas the arthritis-driving allele operates through an IFN-gamma-associated pathway. Treatment of arthritis-susceptible rats with an NADPH oxidase-activating substance, phytol, protects against arthritis. Interestingly, the treatment led to a restoration of the oxidative-burst effect and induction of a strikingly similar IFN-beta-dependent pathway, as seen with the disease-protective Ncf1 polymorphism.

  • 16.
    Skovgaard Svingel, Lise
    et al.
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark.
    Friis Christensen, Sarah
    Department of Hematology, Zealand University Hospital, Denmark.
    Kjærsgaard, Anders
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark.
    Stenling, Anna
    Novartis Sverige AB, Sweden.
    Paulsson, Björn
    Novartis Sverige AB, Sweden.
    Andersen, Christen Lykkegaard
    Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.
    Christiansen, Christian Fynbo
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark.
    Stentoft, Jesper
    Department of Hematology, Aarhus University Hospital, Denmark.
    Starklint, Jørn
    Department of Medicine, Goedstrup Hospital, Denmark.
    Severinsen, Marianne Tang
    Department of Hematology, Aalborg University Hospital, Denmark.
    Borg Clausen, Mette
    Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.
    Hagemann Hilsøe, Morten
    Department of Hematology, Hospital of South West Jutland, Denmark.
    Hasselbalch, Hans Carl
    Department of Hematology, Zealand University Hospital, Denmark.
    Frederiksen, Henrik
    Department of Hematology, Odense University Hospital, Denmark.
    Bak, Marie
    Department of Hematology, Zealand University Hospital, Denmark.
    Mikkelsen, Ellen Margrethe
    Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark.
    Labor market affiliation of patients with myeloproliferative neoplasms: a population-based matched cohort study2023In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226XArticle in journal (Refereed)
    Abstract [en]

    Background: Patients with myeloproliferative neoplasms (MPNs) suffer from substantial symptoms and risk of debilitating complications, yet observational data on their labor market affiliation are scarce.

    Material and methods: We conducted a descriptive cohort study using data from Danish nationwide registries, including patients diagnosed with MPN in 2010-2016. Each patient was matched with up to ten comparators without MPN on age, sex, level of education, and region of residence. We assessed pre- and post-diagnosis labor market affiliation, defined as working, unemployed, or receiving sickness benefit, disability pension, retirement pension, or other health-related benefits. Labor market affiliation was assessed weekly from two years pre-diagnosis until death, emigration, or 31 December 2018. For patients and comparators, we reported percentage point (pp) changes in labor market affiliation cross-sectionally from week −104 pre-diagnosis to week 104 post-diagnosis.

    Results: The study included 3,342 patients with MPN and 32,737 comparators. From two years pre-diagnosis until two years post-diagnosis, a larger reduction in the proportion working was observed among patients than comparators (essential thrombocythemia: 10.2 [95% CI: 6.3–14.1] vs. 6.8 [95% CI: 5.5–8.0] pp; polycythemia vera: 9.6 [95% CI: 5.9–13.2] vs. 7.4 [95% CI: 6.2–8.7] pp; myelofibrosis: 8.1 [95% CI: 3.0–13.2] vs. 5.8 [95% CI: 4.2–7.5] pp; and unclassifiable MPN: 8.0 [95% CI: 3.0–13.0] vs. 7.4 [95% CI: 5.7–9.1] pp). Correspondingly, an increase in the proportion of patients receiving sickness benefits including other health-related benefits was evident around the time of diagnosis.

    Conclusion: Overall, we found that Danish patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN had slightly impaired labor market affiliation compared with a population of the same age and sex. From two years pre-diagnosis to two years post-diagnosis, we observed a larger reduction in the proportion of patients with MPN working and a greater proportion receiving sickness benefits compared with matched individuals.

  • 17.
    Stenling, Anna
    et al.
    Novartis Sverige AB, Kista, Sweden.
    Friis Christensen, Sarah
    Skovgaard Svingel, Lise
    Kjærsgaard, Anders
    Paulsson, Björn
    Lykkegaard Andersen, Christen
    Fynbo Christiansen, Christian
    Stentoft, Jesper
    Starklint, Jørn
    Tang Severinsen, Marianne
    Borg Clausen, Mette
    Hagemann Hilsøe, Morten
    Hasselbalch, Hans Carl
    Mikkelsen, Ellen Margrethe
    Bak, Marie
    EE215 Estimation of 10-Year healthcare costs of patients diagnosed with Myeloproliferative Neoplasms in Denmark2023In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 26, no 12 Suppl., p. S92-S92Article in journal (Refereed)
  • 18.
    Stenling, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lifetime risk predictions for cardiovascular diseases: competing risks analyses on a population-based cohort in Sweden2020In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 312, p. 90-98Article in journal (Refereed)
    Abstract [en]

    Background and aims: There are guideline discussions on a lifetime approach to cardiovascular risk. Many of the available risk models estimate the short-term, usually 10-year risk of non-fatal and fatal cardiovascular diseases (CVD) grouped together. We aimed to develop lifetime risk models for non-fatal coronary heart disease, stroke, heart failure and death from CVD and non-CVD.

    Methods: We included 92,915 individuals who had participated in a community-based lifestyle intervention programme at 40, 50 and/or 60 years of age. Their collected data on selected risk factors were linked to register data on hospitalizations and death. Parametric multivariable survival regression with a competing risks approach was employed to model cause-specific hazards, which were translated into cumulative incidence functions to provide the risk of experiencing each event separately. All analyses were performed gender-age wise. For illustrative purposes, "better" and "worse" risk profiles were created by setting three modifiable risk factors to the best and worst levels, respectively.

    Results: Most of the risk factors qualified for inclusion in the regressions. Men had a higher risk of cardiovascular events and the events occurred at a younger age than women. In the created risk profiles, where serum total cholesterol, smoking status and blood pressure were modified, an excessive number of CVD events were observed in the worse profiles.

    Conclusions: Using these models, the lifetime risk of each of the first CVD events can be estimated for different risk factor profiles. Since the predictions are diagnosis specific, the estimates are more accurate.

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  • 19. Thorn, J.
    et al.
    Tilling, B.
    Lisspers, K.
    Jorgensen, L.
    AstraZeneca Nordic MC.
    Stenling, Anna
    AstraZeneca Nordic MC.
    Stratelis, G.
    AstraZeneca Nordic MC.
    Improved prediction of finding COPD patients by lung function pre-screening in primary care2010In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 13, no 7, p. A324-A325Article in journal (Other academic)
  • 20. Thorn, Jörgen
    et al.
    Tilling, Björn
    Lisspers, Karin
    Jörgensen, Leif
    Stenling, Anna
    Stratelis, Georgios
    Improved prediction of COPD in at-risk patients using lung function pre-screening in primary care: a real-life study and cost-effectiveness analysis.2012In: Primary Care Respiratory Journal, ISSN 1471-4418, E-ISSN 1475-1534, Vol. 21, no 2, p. 159-66Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The importance of identifying chronic obstructive pulmonary disease (COPD) at an early stage is recognised. Improved and easily accessible identification of individuals at risk of COPD in primary care is needed to select patients for spirometry more accurately.

    AIMS: To explore whether use of a mini-spirometer can predict a diagnosis of COPD in patients at risk of COPD in primary care, and to assess its cost-effectiveness in detecting patients with COPD.

    METHODS: Primary care patients aged 45-85 years with a smoking history of >15 pack-years were selected. Data were collected on the Clinical COPD Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and smoking habits. Lung function (forced expiratory volume in 1 and 6 s; FEV1 and FEV6, respectively) was measured by mini-spirometer (copd-6), followed by diagnostic standard spirometry (COPD diagnosis post-bronchodilation ratio of FEV1 to forced vital capacity (FVC) <0.7). Time consumed was recorded. Univariate logistic regression and receiver operating characteristic (ROC) curves were used.

    RESULTS: A total of 305 patients (57% females) of mean (SD) age 61.2 (8.4) years, mean (SD) total CCQ 1.0 (0.8) and mean (SD) MRC 0.8 (0.8) were recruited from 21 centres. COPD was diagnosed in 77 patients (25.2%) by standard diagnostic spirometry. Using the copd-6 device, mean (SD) FEV1/FEV6 was 68 (8)% in patients with COPD and 78 (10)% in patients without COPD. Sensitivity and specificity at a FEV1/FEV6 cut-off of 73% were 79.2% and 80.3%, respectively. The area under the ROC curve was 0.84. Screening with the copd-6 device significantly predicted COPD. Gender, CCQ, and MRC were not found to predict COPD.

    CONCLUSIONS: Using the copd-6 as a pre-screening device, the rate of COPD diagnoses by standard diagnostic spirometry increased from 25.2% to 79.2%. Although the sensitivity and specificity of the copd-6 could be improved, it might be an important device for prescreening of COPD in primary care and may reduce the number of unnecessary spirometric tests performed.

  • 21. Thorn, Jörgen
    et al.
    Tilling, Björn
    Lisspers, Karin
    Jörgensen, Leif
    AstraZeneca Nordic.
    Stenling, Anna
    AstraZeneca Nordic.
    Stratelis, Georgios
    AstraZeneca Nordic.
    Pre-screening av rökare med mini-spirometer leder till förbättrad prediktion av KOL2010In: Svenska läkaresällskapets handlingar: Hygiea, ISSN 0349-1722, Vol. 119, no 1, p. 78-78Article in journal (Other academic)
    Abstract [sv]

    Bakgrund

    Tidig diagnos av kroniskt obstruktiv lungsjukdom (KOL), i kombination med rökstopp är viktigt för att förhindra vidare sjukdomsprogress. I primärvården är det önskvärt med lättillgänglig diagnostik för att om möjligt selektera patienter för spirometri. I denna studie undersöks värdet av pre-screening av lungfunktion av patienter i riskzonen för KOL (NCT01013922).

    Metod

    Patienter 45 år och äldre, med rökhistorik ≥ 15 paketår inkluderades. Uppgifter kring bl. a. rökvanor och medicinsk historik samlades in. Hälsorelaterad livskvalitet och grad av dyspné undersöktes med frågeformulär (CCQ och MRC-skalan). Lungfunktion (FEV1 och FEV6) mättes initialt med en mini-spirometer, (copd-6, Vitalograph), följt av fullständig standardspirometri inklusive reversibilitetstest (KOL diagnos = FEV1/FVC post-bronkdilatation < 70). Tidsåtgång för spirometri noterades; kostnader beräknas baserat på genomsnittlig sjuksköterskelön. Univariat logistisk regression och ROC (receiver operating characteristic curves) användes.

    Resultat

    Total inkluderades 305 patienter från 21 primärvårdsenheter; 57 % kvinnor, medelålder (standardavvikelse, SD) 61,2 (8,4) år, FEV1/FVC 75,3 (10,2), paketår 30,2 (11,5). KOL diagnostiserades hos 83 patienter (27,2 %). Patienter med KOL hade en genomsnittlig FEV1/FEV6 kvot på 69,0 (9,1), rökare utan KOL 77,7 (9,6). Copd-6 (FEV1/FEV6) kunde med statistisk signifikans prediktera KOL. Sensitivitet och specificitet vid en FEV1/FEV6 cut off på 73,0 var 73,5 % respektive 79,7 %; arean under ROC kurvan var 0,80. Kostnaderna för en copd-6 mätning (tidsåtgång 4,2 minuter) var SEK 19,41, respektive SEK 147 (32,3 minuter) för en standardspirometri. Kostnaden för att detektera en KOL patient, med urval för spirometri baserat endast på ålder och antal paketår, var SEK 542. Genom att pre-selektera individer för spirometri med hjälp av copd-6 kunde kostnaden reduceras till SEK 283. Detta sker dock till priset av att 8,4 % lägre total detektion av KOL patienter till följd av begränsningar vad gäller sensitiviteten hos copd-6. Kön, CCQ eller MRC hade inget prediktivt värde.

    Sammanfattning

    Pre-screening med copd-6 för att selektera patienter med risk för KOL (≥ 45 år; ≥ 15 paketår) före utförande av standardspirometri kunde signifikant prediktera KOL. Användning av copd-6 kan minska kostnaden för att identifiera KOL patienter inom primärvården, men sensitiviteten och specificiteten är i denna studie begränsad.

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