Biomedical subjects

B Jönsson

Publications and source records attributed to B Jönsson.

At least 19 recordsLinked to original sources

PubMed2007

Resource use and costs associated with patients treated for depression in primary care.

We investigated medical resource consumption, productivity loss and costs associated with patients treated with antidepressants for depression in primary care in Sweden. Patients on treatment for depression were followed naturalistically for six-months, and data on patients' characteristics, daily activity and resource-use were collected. The total cost per patient was estimated at euro 5,500 (95%CI euro 5,000-6,100) over six months in 2005 prices. Direct costs were estimated at euro 1,900 (euro 1,700-2,200), 35% of total costs, and indirect costs at euro 3,600 (euro 3,100-4,100), 65% of total costs. The cost for antidepressants represented only 4% of the total costs. We conclude that the burden of depression is high, both to the individual as well as to wider society, and there seems to be a particular need for therapies that have the potential to improve productivity in depressed patients.

Adolescent↗

PubMed2006

Cost-effectiveness of the treatment and prevention of osteoporosis--a review of the literature and a reference model.

OBJECTIVE: The purpose of the paper is to update and review the latest developments related to modelling and economic evaluation of osteoporosis in the period 2002-2005 and further to present a reference model for the assessment of the cost-effectiveness of the prevention and treatment of osteoporosis. DISCUSSION: The reference model is intended to be used for fracture specific interventions affecting the risk of fracture. An interface version and an extensive description of the model is available on the internet ( http://www.healtheconomics.se ) and also accessible via the International Osteoporosis Foundation ( http://www.osteofound.org ). The purpose of the reference model is to improve the quality and comparability of cost-effectiveness analysis in the osteoporosis field and to serve as a tool for validation of present and future cost-effectiveness models. The reference model allows the cost-effectiveness analysis to be carried out from a societal perspective including intervention, morbidity and mortality costs. The model has been extensively tested and calibrated, and meets the properties of good decision analytic modelling. The model is a state transition Markov cohort model, which is characterised by a 50-year time horizon divided into one year cycle lengths. The following health states are included: "healthy", "hip fracture", "spine fracture", "wrist fracture", "other fracture", and "dead". CONCLUSION: The model is flexible and allows for the estimation of the cost-effectiveness over different ranges for a selected number of variables (e.g., age, fracture risk, cost of intervention).

Aged↗

PubMed2006

An economic evaluation of strontium ranelate in the treatment of osteoporosis in a Swedish setting: based on the results of the SOTI and TROPOS trials.

INTRODUCTION: Strontium ranelate is a new therapy for the treatment and prevention of osteoporosis that has been shown in two phase III clinical trials (the Spinal Osteoporosis Therapeutic Intervention [SOTI] and the Treatment Of Peripheral OSteoporosis Study [TROPOS] trials) to reduce the risk of osteoporotic fractures at the vertebral, non-vertebral and hip level in postmenopausal women. The aim of this study was to estimate the potential cost-effectiveness of strontium ranelate in the treatment of osteoporosis in postmenopausal Swedish patients. METHODS: A Markov cohort model was adapted to fit patients corresponding to the patients in the SOTI and TROPOS clinical trials. The model was populated with Swedish cost and epidemiological data. In the base case, the cost-effectiveness was estimated for 69-year old women with low bone mineral density (BMD) and prevalent vertebral fractures (SOTI) and for 77-year old women with low BMD (TROPOS). The cost-effectiveness analysis had a societal perspective. RESULTS: In the base case analysis, the cost per quality-adjusted life years (QALY) gained of strontium ranelate patients compared to no treatment patients was estimated at SEK 472,586 and SEK 259,643, including costs in added life years, based on the SOTI and the TROPOS trials, respectively. Excluding cost in added life years, the cost per QALY gained was estimated at SEK 336,420 (SOTI) and SEK 165,680 (TROPOS). In subgroup analyses, in patients 74 years and older with a T-score lower than -2.4 and patients older than 80 years of age, strontium ranelate was found to be cost saving compared to no treatment. CONCLUSIONS: The results in the base case analyses and the sensitivity analyses of this study indicate that, compared to no treatment, strontium ranelate is cost-effective in the treatment of postmenopausal women with low BMD.

Aged↗

PubMed2006

A concentration polarization model for the ultrafiltration of nonionic surfactants.

A theoretical model has been developed that describes ultrafiltration of nonionic surfactants. The model takes into account the fact that surfactants start to aggregate and form micelles at the critical micelle concentration. The model can be used to predict the performance of the membrane if the transport properties inside and at the membrane surface as well as the surfactant association behavior, are known. Three hydrophilic ultrafiltration membranes, made of regenerated cellulose, were used in the investigation. The cut-offs of the membranes were 10,000, 20,000, and 30,000 Da. The surfactant used in the investigation was the nonionic surfactant Triton X-100. The influence of the concentration of surfactant, transmembrane pressure and pure water flux were studied theoretically and experimentally. From the results presented in this work it can be concluded that the calculated values are in good agreement with experimental data.

Journal Article↗

PubMed2006

At what hip fracture risk is it cost-effective to treat? International intervention thresholds for the treatment of osteoporosis.

INTRODUCTION: Intervention thresholds (ITs), the 10-year hip fracture risk at which treatment can be considered to be cost-effective, have previously been estimated for Sweden and the UK. OBJECTIVE: The aim of this study was to provide a Markov cohort model platform for a multinational estimation of thresholds at which intervention becomes cost-effective and to investigate and determine the main factors behind differences in these thresholds between countries. RESULTS AND DISCUSSION: Intervention thresholds were estimated for Australia, Germany, Japan, Sweden, Spain, the UK and USA using a societal perspective. The model was populated with as much relevant country-specific data as possible. Intervention was assumed to be given for 5 years and to decrease the risk of all osteoporotic fractures by 35%. The societal willingness to pay (WTP) for a quality-adjusted life-year (QALY) gained was set to the gross domestic product (GDP) per capita multiplied by two. In the base case analysis, the 10-year hip fracture probability at which intervention became cost-effective varied across ages and countries. For women starting therapy at an age of 70 years, the IT varied from a hip fracture probability of 5.6% in Japan to 14.7% in Spain. The main factors explaining differences in the IT between countries were the WTP for a QALY gained, fracture-related costs and intervention costs. CONCLUSION: The ITs presented in this paper are appropriate for use in treatment guidelines that consider health economic aspects, and they can be used in combination with fracture risk prediction algorithms to improve the selection of patients who are suitable for osteoporotic intervention.

Age Factors↗

PubMed2006

Costs and quality of life of patients with multiple sclerosis in Europe.

OBJECTIVE: To assess overall resource consumption, work capacity and quality of life of patients with multiple sclerosis in nine European countries. METHODS: Information on resource consumption related to multiple sclerosis, informal care by relatives, productivity losses and overall quality of life (utility) was collected with a standardised pre-tested questionnaire from 13,186 patients enrolled in national multiple sclerosis societies or followed up in neurology clinics. Information on disease included disease duration, self-assessed disease severity and relapses. Mean annual costs per patient (Euro, 2005) were estimated from the societal perspective. RESULTS: The mean age ranged from 45.1 to 53.4 years, and all levels of disease severity were represented. Between 16% and 29% of patients reported experiencing a relapse in the 3 months preceding data collection. The proportion of patients in early retirement because of multiple sclerosis ranged from 33% to 45%. The use of direct medical resources (eg, hospitalisation, consultations and drugs) varied considerably across countries, whereas the use of non-medical resources (eg, walking sticks, wheel chairs, modifications to house and car) and services (eg, home care and transportation) was comparable. Informal care use was highly correlated with disease severity, but was further influenced by healthcare systems and family structure. All types of costs increased with worsening disease. The total mean annual costs per patient (adjusted for gross domestic product purchasing power) were estimated at Euro 18,000 for mild disease (Expanded Disability Status Scale (EDSS) <4.0), Euro 36,500 for moderate disease (EDSS 4.0-6.5) and Euro 62,000 for severe disease (EDSS >7.0). Utility was similar across countries at around 0.70 for a patient with an EDSS of 2.0 and around 0.45 for a patient with an EDSS of 6.5. Intangible costs were estimated at around Euro 13,000 per patient.

Adult↗

PubMed2006

The cost-effectiveness of risedronate in the treatment of osteoporosis: an international perspective.

INTRODUCTION: Risedronate, a bisphosphonate for treatment and prevention of osteoporosis, has been shown in several clinical trials to reduce the risk of fractures in postmenopausal women with osteoporosis. The cost-effectiveness of risedronate treatment has previously been evaluated within different country settings using different model and analysis approaches. The objective of this study was to assess the cost-effectiveness of risedronate in postmenopausal women in four European countries -- Sweden, Finland, Spain, and Belgium -- by making use of the same modelling framework and analysis setup. METHODS: A previously developed Markov cohort model for the evaluation of osteoporosis treatments was used to estimate the cost-effectiveness of risedronate treatment. For each country, the model was populated with local mortality, fracture incidence, and cost data. Hip fractures, clinical vertebral fractures, and wrist fractures were included in the model. RESULTS: The incremental cost per quality-adjusted life years (QALY) gained from a 5-year intervention with risedronate compared to "no intervention" in 70-year-old women at the threshold of osteoporosis [T-score = -2.5 based on National Health and Nutrition Examination Survey (NHANES) III data] and previous vertebral fracture was estimated to be euro 860, euro 19,532, euro 11,782, and euro 32,515 in Sweden, Finland, Belgium, and Spain, respectively. Among 70-year-old women at the threshold of osteoporosis without previous fracture the estimated cost per QALY gained ranged from euro 21,148 (Sweden) to euro 80,100 (Spain). The differences in cost-effectiveness between countries are mainly explained by different costs (fracture and treatment costs), fracture risks, and discount rates. Based on cost per QALY gained threshold values found in the literature, the study results indicated risedronate to be cost effective in the treatment of elderly women with established osteoporosis in all the included countries. CONCLUSIONS: At a hypothetical threshold value of euro 40,000 per QALY gained, the results in this study indicate that risedronate is a cost-effective treatment in elderly women at the threshold of osteoporosis (i.e., a T-score of -2.5) with prevalent vertebral fractures in Sweden, Finland, Belgium, and Spain.

Age Factors↗

PubMed2006

Resource allocation to brain research in Europe (RABRE).

This article is a markedly condensed summary of a longer report [Resource allocation to brain research in Europe (RABRE), part 2] that is simultaneously published on line: (i) as supplementary material linked to this European Journal of Neuroscience article (http://www.blackwell-synergy.com/loi/ejn) and (ii) on the website of the European Brain Council (http://www.europeanbraincouncil.org/publications). We have recently shown that brain diseases account for 35% of the overall disease burden and cost European society almost euro 400 billion per year (a billion is understood to mean one thousand million throughout this report). The aim of the present study was to estimate funding for brain research in Europe and the cost-benefit of further investments in this area of research. The assessment of funding included public sources (governmental agencies plus charities) and industry funding. The assessment of publicly financed research support for brain research was based on a comprehensive survey, and industry investment in brain research was assessed based on published data on pharmaceutical development. The total funding of brain research in Europe was estimated at euro 4.1 billion in 2005, of which public grants amounted to < euro 900 million. Thus, industry funding accounted for 79%. Although cancer only incurred 50% of the cost of brain diseases in 2005, public grants for cancer research were almost twice as high as the public financial support of brain research. US-based funding of brain research was almost four times higher than European funding. We assessed the cost-benefit of further investment in brain research using different methods. They all showed that increased investment in brain research is likely to be highly cost-effective. We conclude that European spending on brain research, particularly public spending, is low compared to other fields of research and to the US, and that increased investment in brain research seems warranted.

Animals↗

PubMed2006

Improved compliance and self-care in patients with periodontitis--a randomized control trial.

UNLABELLED: The present study was a randomized control trial to test an intervention emanating from the Client Self-care Commitment Model (CSCCM), to encourage patients to increase their responsibility for their oral self-care. MATERIALS AND METHODS: A total of 75 individuals were re-examined 1-2 years after their initial therapy at the Department of Periodontology, Uppsala County Council, Sweden. Patients who exhibited insufficient compliance, 37 individuals, were included in a randomized single-blind control trial to test an intervention based on the CSCCM. Patients were examined at baseline and 3 months after hygiene treatment. RESULTS: The results demonstrated that patients in the intervention (IV) group increased their interdental cleaning and reduced their plaque index significantly compared with the control group. The former also reduced the number of periodontal pockets >4 mm significantly from baseline until after the hygiene treatment. The majority of the individuals in the IV group reported that the written commitment had influenced on their oral self-care habits in a positive direction. CONCLUSIONS: The CSCCM enhanced the client participation in the treatment process and improved the compliance and oral self-care behaviours. In addition, the model contributed to a reduction in periodontal pockets.

Adult↗

PubMed2006

The mission is remission: health economic consequences of achieving full remission with antidepressant treatment for depression.

The aim of the present study was to determine the magnitude of the impact of treating depression to full remission on cost and health-related quality of life. In a naturalistic longitudinal survey recordings of resource use and quality of life were carried out among depressed patients treated with antidepressant therapy in 56 Swedish primary care clinics. We found that a total of 52% of the patients achieved full remission during the study period. Remitting patients had, on average, three outpatient visits less than non-remitting patients (p < 0.01), 22 fewer sick leave days (p = 0.01), which translated into a significantly lower total cost (Euro 2700) compared with non-remitting patients (p < 0.01). Health-related quality-of-life scores improved by 40% for remitting patients when compared with non-remitting ones (p < 0.01). We conclude that remission has a substantial health economic impact on patients treated for depression, which further strengthens the importance of aiming for full remission in the treatment of depression.

Adult↗

PubMed2005

Non-invasive measurement of systolic blood pressure on the arm utilising photoplethysmography: development of the methodology.

Photoplethysmography (PPG) can be used to measure systolic blood pressure at the brachial artery. With a specially designed probe, positioned in the most distal position beneath a pressure cuff on the upper arm, this is possible. The distance between the light source (880 nm) and the photodetector was 20 mm. A test was performed on neuro-intensive care patients by determining blood pressure from the PPG curves, and, when it was compared with systolic blood pressure obtained from inserted indwelling arterial catheters, a correlation factor of r = 0.95 was achieved. The difference between blood pressure obtained using PPG and invasive blood pressure measurement was 3.9 +/- 9.1 mmHg (mean +/- SD), n = 19. The depth to the brachial artery was 13.9 +/- 4.1 mm (mean +/- SD), n = 18. A digital PPG system utilising pulsating light was also developed.

Arm↗

PubMed2005

A new probe for ankle systolic pressure measurement using photoplethysmography (PPG).

An automated method for ankle systolic pressure measurement, less operator dependent than the standard continuous wave (CW) Doppler technique, would imply an advantage both in patient measurements and in epidemiological studies. We present a new photoplethysmographic (PPG) probe that uses near-infrared light (880 nm) to detect pulsatory blood flow underneath the distal end of a standard pneumatic cuff. The probe is adapted to the anatomical conditions at the ankle, permitting recording of pressures in both ankle arteries separately. The validity of the equipment was tested with CW Doppler-derived systolic pressures and invasive blood pressure measurements for reference. In 20 healthy subjects, visual analysis of the PPG curves revealed a mean difference between CW Doppler and PPG measurements of -0.5 mmHg (SD 6.9). Corresponding results for the anterior and posterior tibial arteries separately were -1.8 mmHg (SD 6.2) and 0.9 mmHg (SD 7.3), respectively. A correct probe position was essential for the results. In direct recordings from the dorsalis pedis artery in 10 intensive care patients, PPG underestimated systolic pressure in the anterior tibial artery by 4.5 mmHg (SD 12.1). With further development, the PPG probe, integrated in the pneumatic cuff, may simplify measurements of ankle systolic pressures.

Adolescent↗

PubMed2005

Automatic ankle pressure measurements using PPG in ankle-brachial pressure index determination.

OBJECTIVE: To evaluate a new technique using a photoplethysmographic (PPG) probe for automatic ankle pressure measurements. DESIGN: Comparative study on two techniques for ankle pressure measurement. SETTING: University hospital. MATERIAL: Thirty-five patients with leg arterial disease and eight healthy volunteers. Ankle-brachial indices (ABPI) were measured using conventional CW Doppler technique and PPG-based prototype equipment for the ankle pressure recordings. CHIEF OUTCOME MEASURES: ABPIs calculated from CW Doppler and PPG ankle pressure measurements. The PPG signals were analysed both by visual judgement and by a software based, automatic algorithm. MAIN RESULTS: The mean difference between ABPIs calculated from CW Doppler recordings and PPG (visual analysis) was -0.01 (limits of agreement (+/-two standard deviations) +0.16 to -0.19). The correlation coefficient was 0.93. When the algorithm was used, the mean difference (CW Doppler-PPG) was 0.05 (limits of agreement 0.28 to -0.18, r=0.89). CONCLUSIONS: The PPG method is a promising technique with an inherent potential for automatisation of the ankle pressure measurements, thereby reducing the observer-dependency in ABPI recordings.

Adult↗

PubMed2005

Health-related quality of life in patients before and after surgery for a herniated lumbar disc.

We investigated the pre-operative and one-year post-operative health-related quality of life (HRQOL) outcome by using a Euroqol (EQ-5D) questionnaire in 263 patients who had undergone surgery for herniation of a lumbar disc. Data from the National Swedish Register for lumbar spinal surgery between 2001 and 2002 were used and, in addition, a comparison between our cohort and a Swedish EQ-5D population survey was performed. We analysed the pre- and post-operative quality of life data, age, gender, smoking habits, pain and walking capacity. The mean age of the patients was 42 years (20 to 66); 155 (59%) were men and 69 (26%) smoked. Pre-operatively, 72 (17%) could walk at least 1 km compared with 200 (76%) postoperatively. The mean EQ-5D score improved from 0.29 to 0.70, and the HRQOL improved in 195 (74%) of the patients. The pre-operative score did not influence the post-operative score. In most patients, all five EQ-5D dimensions improved, but did not reach the level reported by an age- and gender-matched population sample (mean difference 0.17). Predictors for poor outcome were smoking, a short pre-operative walking distance, and a long history of back pain.

Adult↗

PubMed2004

Onset of cohesion in cement paste.

It is generally agreed that the cohesion of cement paste occurs through the formation of a network of nanoparticles of a calcium-silicate-hydrate ("C-S-H"). However, the mechanism by which these particles develop this cohesion has not been established. Here we propose a dielectric continuum model which includes all ionic interactions within a dispersion of C-S-H particles. It takes into account all co-ions and counterions explicitly (with pure Coulomb interactions between ions and between ions and the surfaces) and makes no further assumptions concerning their hydration or their interactions with the surface sites. At high surface charge densities, the model shows that the surface charge of C-S-H particles is overcompensated by Ca2+ ions, giving a reversal of the apparent particle charge. Also, at high surface charge densities, the model predicts that the correlations of ions located around neighboring particles causes an attraction between the particle surfaces. This attraction has a range of approximately 3 nm and a magnitude of 1 nN, values that are in good agreement with recent AFM experiments. These predictions are stable with respect to small changes in surface-surface separation, hydrated ion radius, and dielectric constant of the solution. The model also describes the effect of changes in cement composition through the introduction of other ions, either monovalent (Na) or multivalent (aluminum or iron hydroxide).

Journal Article↗

PubMed2004

Cost-effectiveness of raloxifene in the UK: an economic evaluation based on the MORE study.

Raloxifene treatment has been shown to reduce the risk of vertebral fractures and breast cancer in postmenopausal women. The long-term economic implications of treatment with raloxifene have not yet been investigated. The aim of this study was to assess the cost-effectiveness of treating postmenopausal women in the UK with raloxifene. A previously developed computer simulation model was used to estimate the cost-effectiveness of osteoporotic treatments with extra skeletal benefits. The model was populated with epidemiological data and cost data relevant for a UK female population. Data on the effect of treatment were taken from the Multiple Outcomes of Raloxifene (MORE) study, which recruited women with low bone mineral density or with a prior vertebral fracture. Cost-effectiveness was estimated using Quality Adjusted Life Years (QALYs) and life years gained as primary outcome measures. The cost per QALY gained of treating postmenopausal women without prior vertebral fractures was 18,000 pounds, 23,000 pounds , 18,000 pounds and 21,000 pounds at 50, 60, 70 and 80 years of age. Corresponding estimates for women with prior vertebral fractures were 10,000 pounds, 24,000 pounds, 18,000 pounds and 20,000 pounds. In relation to threshold values that are recommended in the UK, the analysis suggests that raloxifene is cost-effective in the treatment of postmenopausal women at an increased risk of vertebral fractures.

Adult↗

PubMed2004

Cost-effectiveness of clopidogrel in acute coronary syndromes in Sweden: a long-term model based on the CURE trial.

OBJECTIVES: The purpose of this study was to evaluate the long-term cost-effectiveness of clopidogrel on top of standard therapy (including ASA) in patients with acute coronary syndromes without ST-segment elevation in Sweden. METHODS AND RESULTS: Incremental cost-effectiveness ratios (ICER) were assessed using a Markov model with transition probabilities estimated from the Swedish hospital discharge and cause of death registers. Patients were assumed to be treated for 1 year, with treatment effects (RR = 0.8) and costs taken from the Clopidogrel in Unstable Angina to prevent Recurrent ischaemic Events Trial. Two scenarios were analysed: with patients similar to those in the trial and with patients similar to those from the register. In the first scenario, the predicted net direct cost was 160 euro and the net total cost -54 euro, which with an incremental survival of 0.12 years give the ICER of 1365 euro per life-year gained from the health care payer perspective (including direct costs) and cost savings from the societal perspective (also including indirect costs). The net costs in the second scenario were 149 euro, giving an ICER of 1009 euro for both perspectives. CONCLUSIONS: Adding clopidogrel to standard therapy including ASA is cost-effective in the studied setting and compares favourably with other cardiovascular treatment and prevention strategies.

Acute Disease↗

PubMed2003

Fracture risk following an osteoporotic fracture.

The aim of this study was to examine the pattern of fracture risk following a prior fracture at the spine, shoulder or hip. We studied 1918 patients with fractures at these sites identified from the Department of Radiology in Malmo who were followed for 5 years. Poisson regression was used to compute fracture rates immediately after the initial fracture and at 5 years thereafter in men and women aged 60 or 80 years. Immediate fracture risk was higher than that of the general population, more markedly so at the age of 60 than at 80 years. At the age of 60 years, the risk of hip, forearm and spine fractures were significantly increased following a prior spine, hip or shoulder fracture in men. A similar pattern was seen in women, except that the increase in risk of forearm fracture following a spine or hip fracture was not statistically significant. The incidence of further fractures at the shoulder, spine or hip fell with time after the first fracture, a fall that was significant for all fractures after a shoulder fracture, hip fracture after a spine fracture, and hip and spine fractures after a hip fracture. We conclude that the risk of a subsequent fracture immediately after an osteoporotic fracture is highest immediately after the event. This provides a rationale for very early intervention immediately after fractures to avoid recurrent fractures.

Age Factors↗