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M Johannesson

Publications and source records attributed to M Johannesson.

At least 91 records · Page 5Linked to original sources
PubMed1996

The impact of user charges on the consumption of drugs. Empirical evidence and economic implications.

Expenditure on drugs is increasing rapidly in many countries, and this has led to increased interest in measures to contain drug expenditure. One measure that has been discussed is to increase user charges for prescription drug. In this article, we consider whether or not raising user charges decreases the consumption of drugs. We also discuss how to judge if increased user charges for drugs are desirable from an economic viewpoint. We conclude that the decision to increase user charges for prescription drugs should not be viewed as an issue of cost containment, but as a matter of balancing the societal costs against the societal benefits of increased user charges.

Drug Utilization↗
PubMed1996

Economic evaluation in healthcare. A brief history and future directions.

Over the last decade there has been tremendous interest in economic evaluations of healthcare programmes, especially in the pharmaceutical field. Economic evaluations started about 30 years ago as rather crude analyses, in which the value of improved health was measured in terms of increased labour production. Now, more refined methods are available to measure health changes in terms of quality-adjusted life-years gained or willingness to pay. It is important to continue this development, and major fields for future work include the incorporation of quality-of-life measurements into economic evaluations and the linking of cost-effectiveness and cost-benefit analyses into a unified framework of economic evaluation. How to incorporate distributional issues is another important area. Finally, it seems crucial to further explore the link between economic evaluation and decision making, since the purpose of economic evaluations is to affect decision making.

Animals↗
PubMed1996

The cost-effectiveness of hypertension treatment in Sweden: an analysis of the criteria for intervention and the choice of drug treatment.

Results of an analysis of the cost-effectiveness of hypertension treatment in Sweden are presented. The cost per life-year gained decreases with age for both men and women and is relatively low for middle-aged and older men and women even in the blood pressure range 90-94 mmHg. The results indicate that it is in general cost-effective to treat middle-aged and older men and women in Sweden with a diastolic blood pressure > or = 90 mmHg, but that it is questionable whether it is in general cost-effective to treat younger men and women with mild hypertension. It is furthermore shown that ACE-inhibitors and calcium-antagonists may be cost-effective in some patient groups at a high risk of coronary heart disease, if they achieve the epidemiologically expected risk reduction for coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials ACE-inhibitors and calcium-antagonists cannot, however, at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.

Adrenergic beta-Antagonists↗
PubMed1996

How to assess the economics of hypertension control programmes.

In this paper we summarise the discussion in the session about how to assess the economics of hypertension control programmes. The paper is structured around the four main themes discussed in the session: the methods of economic evaluation, the estimation of costs in an economic evaluation, the estimation of effects in an economic evaluation, and the relationship between economic evaluation and policy-making.

Cost of Illness↗
PubMed1995

A note on the depreciation of the societal perspective in economic evaluation of health care.

It is common in cost-effectiveness analyses of health care to only include health care costs, with the argument that some fictive 'health care budget' should be used to maximize the health effects. This paper provides a criticism of the 'health care budget' approach to cost-effectiveness analysis of health care. It is argued that the approach is ad hoc and lacks theoretical foundation. The approach is also inconsistent with using a fixed budget as the decision rule for cost-effectiveness analysis. That is the case unless only costs that fall into a single annual actual budget are included in the analysis, which would mean that any cost paid by the patients should be excluded as well as any future cost changes and all costs that fall on other budgets. Furthermore the prices facing the budget holder should be used, rather than opportunity costs. It is concluded that the 'health care budget' perspective should be abandoned and the societal perspective reinstated in economic evaluation of health care.

Budgets↗
PubMed1995

Economic evaluation of health care and policymaking.

The interest in economic evaluation of health care programmes is steadily increasing, but the impact of economic evaluations on decisions concerning the allocation of resources to health care programmes is unclear. In this paper we examine different decision and policy situations where economic evaluation of health care programmes could potentially be used. Economic evaluation as an aid to: the development of treatment guidelines, decisions within health care organizations, introduction of new medical technologies, reimbursement decisions, and pricing decisions are examined. It is concluded that economic evaluation seems to be most useful in the development of treatment guidelines and as an aid to reimbursement decisions. The importance of the incentives to use economic evaluation embodied in the health care system is also stressed. It is argued that it is too early to introduce regulations that require the use of economic evaluation in for instance reimbursement decisions. A more cautious approach may be preferred with economic evaluation used more selectively until the methods and the field have developed further.

Decision Making, Organizational↗
PubMed1995

Value for money? A contingent valuation study of the optimal size of the Swedish health care budget.

The contingent valuation method has been developed in the environmental field to measure the willingness to pay for environmental changes using survey methods. In this exploratory study the contingent valuation method was used to analyse how much individuals are willing to spend in total in the form of taxes for health care in Sweden, i.e. to analyse the optimal size of the 'health care budget' in Sweden. A binary contingent valuation question was included in a telephone survey of a random sample of 1260 households in Sweden. With a conservative interpretation of the data the result shows that 50% of the respondents would accept an increased tax payment to health care of about SEK 60 per month ($1 = SEK 8). It is concluded that the results indicate that the population overall thinks that the current spending on health care in Sweden is on a reasonable level. There seems to be a willingness to increase the tax payments somewhat, but major increases does not seem acceptable to a majority of the population.

Attitude to Health↗
PubMed1995

On the estimation of cost-effectiveness ratios.

In a recent paper Birch and Gafni criticised the use of cost-effectiveness ratios in decisions about the allocation of health care resources. To support their claim that the use of cost-effectiveness ratios will not lead to the maximization of health effects for a given budget they used an example. In this paper it is pointed out that the example used contains two basic errors. The first error is the failure to exclude dominated programmes in the estimation of incremental cost-effectiveness ratios. The second error is the failure to distinguish between independent and mutually exclusive programmes. It is concluded that to get a more sober discussion about the use and interpretation of cost-effectiveness analysis it is important that the technique is used correctly.

Cost-Benefit Analysis↗
PubMed1995

The relationship between cost-effectiveness analysis and cost-benefit analysis.

This paper examines the relationship between cost-effectiveness analysis and cost-benefit analysis. Provided that a cost-effectiveness analysis includes all the relevant societal costs, it is shown that a cost-effectiveness analysis can be interpreted as a cost-benefit analysis where the willingness to pay per effectiveness unit is assumed to be constant and the same for everyone. To relax this assumption the willingness to pay per effectiveness unit can be allowed to vary depending on for instance the size of the health effects and the target population. It is argued that cost-effectiveness analysis is best viewed as a subset of cost-benefit analysis, where the aim of the analysis is to estimate the cost function of producing health effects. It is also concluded that to interpret and use cost-effectiveness analysis as a tool to maximize the health effects for one specified real-world budget, will be inconsistent with a societal perspective and is likely to lead to major problems of suboptimization.

Cost-Benefit Analysis↗
PubMed1995

The ranking properties of healthy-years equivalents and quality-adjusted life-years under certainty and uncertainty.

This paper investigates the theoretical properties of healthy-years equivalents (HYEs) and quality-adjusted life-years (QALYs). A distinction is made between ex ante HYEs (EA-HYEs) and expected HYEs (EXP-HYEs) and between risk-neutral quality-adjusted life-years (RN-QALYs) and risk-adjusted quality adjusted life-years (RA-QALYs). In the case of certainty, HYEs always rank health profiles according to individual preferences, whereas QALYs only rank health profiles according to individual preferences if constant proportional trade-off holds for all health states and if additive independence of quality in different periods holds. In the case of uncertainty, EA-HYEs always rank risky health profiles the same way as expected utility. The assumptions needed for the other measures to rank risky health profiles the same way as expected utility are: risk neutrality with respect to healthy time for EXP-HYEs; risk neutrality with respect to time in all health states and additive independence of quality in different periods for RN-HYEs; and constant proportional risk posture with respect to time in all health states and additive independence of quality in different periods for RA-QALYs.

Cost-Benefit Analysis↗
PubMed1995

The costs and effects of two different lipid intervention programmes in primary health care.

OBJECTIVE: To compare the costs and effects of two different intervention strategies for the nonpharmacological treatment of hypercholesterolaemia. DESIGN: Randomized, controlled trial. Subjects were randomly allocated to one of two intervention models and followed up for 1 year. SETTING: Vårby Health Centre, a primary care practice located in a suburb of Stockholm. SUBJECTS: Subjects with a total serum cholesterol in the range 7.0-7.8 mmol L-1 and no signs of ischaemic heart disease or diabetes mellitus, randomized to a low-intensity (n = 35) or medium-intensity (n = 41) intervention. INTERVENTION: Two strategies were used, one labelled medium-intensity strategy which followed national current guidelines for nonpharmacological treatment of hypercholesterolaemia, the other was a low-intensity strategy. MAIN OUTCOME MEASURES: Total serum cholesterol and intervention costs. RESULTS: Both intervention strategies resulted in small (mean 3.5%) decreases in total cholesterol with no significant difference between the groups. The cost per subject in the low-intensity group was SEK 753 and in the medium-intensity group SEK 3614. CONCLUSIONS: Because the effect of the two intervention programmes did not differ, the low-intensity programme is to be preferred from a cost-effectiveness point of view. If only one-third of the population in Stockholm county with cholesterol levels > or = 6.5 mmol L-1 are discovered by the primary health care system, and follow the treatment advice, the net savings in the low-intensity model compared to the current guidelines here presented as the moderate-intensity model, would be SEK 93 million.

Adult↗
PubMed1995

The cost-effectiveness of a cardiovascular multiple-risk-factor intervention programme in treated hypertensive men.

OBJECTIVES: The aim of this study was to carry out a cost-effectiveness analysis of a multifactorial intervention programme in treated hypertensive patients. DESIGN: A cost-effectiveness analysis based on 3 years of follow-up in an open, randomized, parallel-group study with allocation either to a comprehensive, multiple-risk factor modification programme or to conventional treatment. SETTING: An outpatient clinic of a city hospital. SUBJECTS: Inclusion criteria were: male sex, age 50-72 (mean 66.4) years, treated hypertension and at least one of the following: serum cholesterol > or = 6.5 mmol L-1, and/or smoking and/or diabetes mellitus. A total of 508 patients were included in the study. INTERVENTIONS: Advice given to individuals, and group meetings based on nutritional advice and behavioural treatment principles. If necessary, drug therapy could be instituted to achieve the treatment goals in the intervention group: serum total cholesterol of < 6.0 mmol L-1, no smoking, HbAlc < 6.0% and diastolic blood pressure < 90 mmHg in both groups. MAIN OUTCOME MEASURE: Incremental cost per life-year gained of the intervention programme. RESULTS: The cost per life-year gained was SEK 4000 in an estimation based on the observed risk reduction and ranged between SEK 62,000 and SEK 163,000 in three estimations based on the risk factor changes. CONCLUSIONS: The analysis indicates that the intervention programme is cost-effective in the studied patient population.

Aged↗
PubMed1995

The cost effectiveness of hypertension treatment in Sweden.

The aim of this study was to carry out an analysis of the cost effectiveness of antihypertensive drug treatment in different patient groups in Sweden. The cost-effectiveness ratios were estimated as net costs (treatment costs minus reduced costs of cardiovascular morbidity) divided by the number of life-years gained (the increase in life expectancy). The analysis was based on the reduction of coronary heart disease and stroke in the most recent meta-analysis of antihypertensive treatment, to which Swedish cost data were applied. We found that the cost per life-year gained decreases with age for both men and women, and is relatively low for middle-aged and older patients, even when the diastolic blood pressure (DBP) range is 90 to 94mm Hg. In conclusion, the results indicate that, in Sweden, antihypertensive treatment is generally cost effective in middle-aged and older patients with a DBP of > or = 90 mm Hg. However, it is questionable whether it is generally cost effective to treat younger patients with mild hypertension.

Adult↗
PubMed1995

Economic evaluation of drugs and its potential uses in policy making.

Interest in the economic evaluation of drug treatments is steadily increasing, but the impact of such evaluations on decisions concerning the use of drugs is unclear. In this article I examine different decision and policy situations where economic evaluations of drug treatments could potentially be used. Economic evaluations may be used as an aid to the development of treatment guidelines, decisions within healthcare organisations, and decisions relating to approval, reimbursement and pricing. Economic evaluations appear to be most useful in the development of treatment guidelines and as an aid to reimbursement decisions. The incentive to use economic evaluations embodied in the healthcare system is also important. It is argued that it is too early to introduce regulations that require the use economic evaluations in, for example, reimbursement decisions. A more cautious approach might be preferred, where economic evaluations are used more selectively until the methodology and the field have developed further.

Decision Making, Organizational↗
PubMed1995

Cost-benefit aspects of treatment of hypertension in the elderly.

Treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective according to the analyses of the results of the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). The cost-effectiveness ratios are low and of the same magnitude for both men and women. The results with respect to reduced risk of cardiovascular disease in STOP Hypertension are also supported by several other studies using the same groups of drugs. The more modern drugs (calcium antagonists, alpha 1 blockers, and ACE inhibitors) have not proven their efficacy in the reduction of cardiovascular events in prospective studies of primary hypertension. It has, however, been shown that they lower blood pressure well also in the elderly and that they are cost-effective among the elderly if treatment with beta-receptor blockers and/or diuretics is contraindicated, provided that they lower the incidence of cardiovascular disease to the same extent as do beta-receptor blockers and diuretics. Studies tackling this latter question are under way, also in the elderly.

Aged↗