Biomedical subjects
Publications and source records attributed to B Lindgren.
This study describes the operation of an in-home alarm system in seven Swedish municipalities. Statistics on the diffusion of this technology, its costs, and the characteristics of its use are reported. Alarms were triggered by 60% of the users. Mean annual costs per recipient varied from SEK 1,985 to SEK 8,215, mainly reflecting different patterns of use.
The quantitative capabilities of Western "ligand" blot analysis (LBA) of insulin-like growth factor binding protein have been evaluated using iodine-labeled insulin-like growth factor-II (125I-IGF-II), purified amniotic fluid insulin-like growth factor binding protein-1 (IGFBP-1), and IGFBP-1 in conditioned medium (CM) from Hep-G2 cells. Optimal conditions were evaluated for analysis of IGFBP-1 using IGF-2-II as the ligand. IGFBP-1 ligand blot quantities were measured after autoradiography by one- (1D) and two (2D)-dimensional densitometry. The 2D method was found to exhibit higher linearity (IGF-I, r = 0.993; IGF-II, r = 0.984) over a wider range than the 1D method. Displacement curves for IGF-II against membrane-bound IGFBP-1 measured by LBA were similar to those obtained with IGFBP-1 solutions using antibody precipitation of IGFBP-1. Transfer of IGFBP-1 from sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels to nitrocellulose membranes was linear across the range 3.1-400 ng with both the 0.45- and the 0.2-micron pore sizes tested. The 0.2-micron size, however, showed nearly quantitative binding of IGFBP-1 trapping 20% more of this binding protein than the larger pore size. LBA was used to measure IGFBP-1 in CM from control and des1-3IGF-I (trIGF-I)-treated Hep-G2 cells and the results were compared with those obtained by a specific IGFBP-1 radioimmunoassay. IGFBP-1 concentrations measured by both assays were similar and both demonstrated nearly identical sensitivities. Each assay confirmed the previously noted trIGF-I suppression of IGFBP-1 secretion by Hep-G2 cells.
OBJECTIVES: to compare possible outcomes of the non-operative treatment for intermittent claudication with that of surgery. DESIGN: decision tree approach using published and vascular registry data. The valuation of clinical outcomes was estimated by index weights using the Rosser index and the Quality of Well-Being scale. SETTING: routine health care in Sweden. MATERIALS: published data on 224 non-operatively treated claudicants and data from 805 claudicants treated with surgery or angioplasty from the Swedvasc registry. No diabetics were included. Chief outcome measure: expected utility value at one year after decision on treatment given the clinical data and the estimated health status valuations. MAIN RESULTS: it was possible to identify a success rate for surgery above which it was the better alternative. However, depending on which of two health indices that was used, and if reconstruction was supra- or infrainguinal, this threshold value varied from 0-81%. CONCLUSIONS: reliable measures of the value of outcomes have to be developed and, in addition, long-term data on outcome and costs in routine care have to be collected before a comprehensive economic assessment based on the decision tree approach can be made to support decisions on treatment for intermittent claudication.
BACKGROUND: Beginning in 1970, a series of patients with Hodgkin disease were treated at the University of Minnesota, after staging laparotomy, with radiation therapy (RT) for Stage I, II, and IIIA Hodgkin disease. This report is an analysis of the results of the treatment and of treatment modifications. METHODS: From 1970 to 1974, all patients were treated with standard RT. In 1975, an analysis of these patients indicated that patients with large mediastinal mass (LMM) and patients with Stage IIIA spleen-positive (IIIAS+) disease had a higher recurrence rates than patients without these factors. Subsequently, a schema of radical radiation therapy (RRT) was devised, which included low-dose lung RT for patients with LMM and low-dose liver RT for patients with IIIAS+ disease. RESULTS: Analysis of the results of the two treatments indicates that the use of low-dose lung RT in patients with LMM and low-dose liver RT in patients with IIIAS+ Hodgkin disease produced survival and recurrence-free survival results equivalent to those achieved by use of combined modality treatment (CMT) or chemotherapy (CT) alone. CONCLUSIONS: The use of RT with whole lung and liver irradiation for patients with LMM and IIIAS+ Hodgkin disease, respectively, produces results that are equivalent to those of CMT or CT alone with the advantage of a decreased incidence of second malignant neoplasms. In addition, patients who do not respond to initial RT have a greater chance of being saved with chemotherapy than do patients initially treated with CMT of being saved with RT. The authors suggest that radical RT is the treatment of choice for patients with LMM and/or IIIAS+ Hodgkin disease.
Cost-effectiveness ratios were estimated for each of 2 plasma cholesterol-lowering drug therapies, the HMG-CoA reductase inhibitor simvastatin and the well established cholestyramine, in comparison with a nonpreventive drug treatment alternative. The study was confined to Swedish men (aged 37 to 64 years at start of therapy) with total serum cholesterol levels above 6.2 mmol/L who were free of coronary artery disease (CAD). Costs included expected direct costs of plasma cholesterol-lowering treatment less expected savings resulting from preventing CAD. Effects were defined as changes in life expectancy. A discount rate of 5% and Swedish kronor (SEK) 1988 prices were used. The impact on CAD risks was calculated using multivariate logistic risk estimates from the Framingham Heart Study; Swedish estimates were used to calculate intervention costs and changes in healthcare costs. Over the range of cholesterol levels examined (6.2 to 9.8 mmol/L), simvastatin was consistently more cost-effective than cholestyramine.
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Clinical outcome and health care costs related to investigation, treatment with either percutaneous transluminal renal angioplasty (PTRA) or reconstructive surgery, and follow-up of patients with renovascular hypertension with or without uraemia were analysed in 21 PTRA-treated and 16 operated patients. Most renal artery stenoses were atherosclerotic. Nineteen PTRAs were successful or partly successful and two failed; the patients were operated on without delay. All surgical reconstructions were successful. In the PTRA group six restenoses occurred after 4-24 months. Four were treated with re-PTRA and two were operated on. No recurrence occurred in the operated group. At the end of follow-up (median 48, range 9-84 months) primary patency in the PTRA group was 69 per cent and in the operated group 100 per cent. Secondary patency in the PTRA group was 100 per cent. With regard to hypertension, including primary and secondary results, 19 out of 21 (90 per cent) patients were improved in the PTRA group and 13 out of 16 (81 per cent) in the operated group. The diagnostic and preprocedure costs were the same in both groups, whereas the procedure and postprocedure costs were lower in the PTRA group. However, the follow-up costs were considerably higher because of recurrences and their treatment in the PTRA group. The total median cost of reconstructive surgery was 12 per cent higher than for PTRA, a non-significant difference.
The EuroQol Group, which currently comprises 7 centres in 5 countries, has been testing the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. The instrument employs a visual analogue scale of the 'thermometer' type to allow respondents to rank a number of health states. As part of the Swedish IHE's contribution to the EuroQol Group's work, questionnaires were sent to 1000 people randomly selected to provide a representative sample of the Swedish population aged 16-84 years. 349 persons responded and 208 provided sufficient information for detailed analysis. From these 208 it proved possible to derive health status information in a quantitative form. The most interesting result was that the health state valuations from this survey indicated a striking similarity with those of EuroQol studies in Frome (England) and Bergen op Zoom (The Netherlands). The lessons learned from undertaking the survey are briefly discussed. The Swedish IHE is encouraged by the exercise to continue to play its part in the continuing developments of the EuroQol methodology.
This double blind, placebo-controlled trial was designed to determine whether intervention with a stepped regimen of trimethoprim-sulfamethoxazole (TMP-SMX) and prednisone would prevent high risk children from developing chronic otitis media with effusion (OME) and recurrent acute otitis media. Forty-two children were enrolled, assigned to treatment with active drug or placebo and then examined at 2-week intervals. They received TMP-SMX (or placebo) during the first 2 weeks, TMP-SMX and prednisone (or placebo) during Weeks 3 and 4 for persistent OME and TMP-SMX (or placebo) for Weeks 5 and 6 if OME was still unresolved. After treatment 48% of active drug and 14% of placebo subjects resolved OME bilaterally (P less than 0.05). Active drug subjects also had fewer acute otitis media episodes than placebo subjects while receiving study treatment (P less than 0.01). Although this treatment regimen produced short term OME resolution, long term benefits were not demonstrated.
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The economic evaluation of pharmaceuticals is becoming increasingly important. This article presents an illustrative example of how the cost-benefit approach can be used in the pricing of a new pharmaceutical product. Doxazosin, a new selective alpha 1-inhibitor used in the treatment of hypertension, is compared with the established beta-blocker, atenolol. Cost-effectiveness ratios are calculated for both, and from the analysis it emerges that doxazosin is the more cost-effective agent. This is largely the result of the favorable high-density lipoprotein/total cholesterol changes that doxazosin produces. Even when doxazosin is priced 30% higher than atenolol, doxazosin is more cost-effective. It is concluded that in the future economic evaluations will have significant impacts on research and development within the pharmaceutical industry. However, a number of issues still must be addressed, and economic evaluation should be subject to continuous review.
Direct costs were estimated for the treatment, rehabilitation, and nursing of 125 patients with first stroke in the Lund and Orup health districts (population of 200,191). Patients were followed from the onset of stroke in 1983 until October 31, 1985. The data were used to calculate the present value of the expected lifetime direct costs for an individual contracting his or her first stroke at various ages. For example, at the age of 72, these costs were estimated at SEK 283,000 for a man and SEK 561,000 for a woman. Hospital care was the major cost component (75% for males and 89% for females) at this age of onset. The results could be used to estimate the economic benefits of preventing new strokes, hence, forming part of a cost-effectiveness or cost-utility analysis. Together with prognoses of the expected developments in the incidence of stroke, they could also serve as the basis of forecasts of future costs of the health care and social service sectors.
The cost-effectiveness of three different screening methods was studied: the no specific screening, the conventional clinical screening, and the combined clinical moiré screening alternative. A multistage model of the treatment process was developed. Data from retrospective studies in Malmo were used. The costs for health care and production loss were calculated and applied to the time profiles of the three screening alternatives. Health care costs as well as costs in loss of production increased with the introduction of the conventional clinical screening program. However, when the clinical screening was combined with the moiré technique, the costs were markedly reduced. Thus, the combined clinical moiré screening would be the cost-effective way of using resources to prevent scolioses from developing into a more severe deformity.
Diazepam and pro-diazepam (2-benzoyl-4-chloro-N-methyl-N-lysylglycin anilide) have been used as adjunct antidotes to pyridostigmine and atropine against the organophosphate, soman, in the guinea-pig. Both added significant protection to the pyridostigmine/atropine treatment. Animals pretreated with diazepam, 60 min before soman, were "better" protected than animals given an equimolar dose of pro-diazepam therapeutically 1 min after soman. A pretreatment with diazepam for three days further increased the protection. A therapeutic dose of pro-diazepam, 1 min after soman, gave no further protection, to the three day diazepam pretreatment. The serum concentrations of diazepam (given i.p.) and desmethyldiazepam (given i.m.) were determined by GLC after diazepam (i.p.) and pro-diazepam (i.m.) were given. The protection, relative to the control, provided by the diazepam pretreatment (60 min before and for three days before soman) correlated linearly, r = 0.9898, with the serum values of diazepam achieved at these times. Our data suggest that diazepam as adjunct to pyridostigmine and atropine administered as pretreatment gives a "safer" protection, than an equimolar dose of pro-diazepam given therapeutically.
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In recent years, value for money in health care has become of increasing concern. There are various ways to perform an economic evaluation, the most simple being a cost-effectiveness analysis, where differences in costs will influence the choice between methods. Cost-utility and cost-benefit analyses represent more advanced forms of economic evaluations. In this cost-effectiveness analysis, the following three strategies aimed at solving the problem of post-operative thromboembolic complications were compared: (a) no prophylaxis but treatment of occurring complications, (b) general prophylaxis with low-dose heparin for patients over 40 years of age and (c) selective treatment based on post-operative surveillance with a fibrinogen uptake test. Moreover, these alternatives were evaluated for three types of surgery: general abdominal surgery, cholecystectomy and elective hip surgery. Costs for thromboembolic and haemorrhagic complications were estimated from data available for patients hospitalized in Malmö. A sensitivity analysis was made with regard to the frequency of thrombosis, prophylactic effect and treatment costs. Health care costs would be minimized with general prophylaxis in hip and general surgery, whereas no prophylaxis is the most cost-effective alternative in cholecystectomy patients, i.e. with a frequency of thrombosis below 8%. General prophylaxis minimized the duration of patients' health losses due to thromboembolic disease in general, as well as in elective hip surgery. After cholecystectomy, no difference in health loss for the individual was found between the alternative of no prophylaxis and general prophylaxis. Selective treatment was always the least satisfactory alternative in all categories and always the most expensive.
The incidence of spontaneous pneumothorax has increased during the last fifty years, and recent studies indicate that tobacco smoking increases the incidence approximately tenfold among women and twentyfold among men. Total direct and indirect costs for the community due to smoking-induced spontaneous pneumothorax in Sweden amount to roughly 70 million SEK annually. Were smokers to give up smoking, 70 to 90 per cent of the cases could be avoided. These figures, and the fact that other smoking-induced diseases annually cause at least 10,000 deaths, 1,000 permanent disabilities, and 450,000 days of hospital care in Sweden, constitute formidable arguments in favour of efforts to prevent smoking.