Search PubMed⌕ Search

Biomedical subjects

M Johannesson

Publications and source records attributed to M Johannesson.

At least 127 records · Page 7Linked to original sources
PubMed1992

A review of cost-effectiveness analyses of hypertension treatment.

In this paper cost-effectiveness analyses of hypertension treatment are reviewed. Nine studies using life-years gained or quality-adjusted life-years gained as outcome measure are identified, summarised, and their results analysed. It is noted that there is a lack of methodological conformity between the studies, which makes comparisons difficult. The only consistent finding among the studies is that the cost-effectiveness increased with higher pretreatment blood pressure. The studies also indicated that treatment of hypertension is more cost-effective in younger men than in younger women, and that cost-effectiveness increases with age for both men and women. It is impossible at present to draw any policy conclusions from the cost-effectiveness analyses comparing different drugs, owing to poor methodology and insufficient data. For the future it is important to upgrade the quality of the cost-effectiveness analyses in this area by improving both the data and the methodology used. There is also a need to complement cost-effectiveness analysis with other approaches, for example willingness to pay.

Age Factors↗
PubMed1992

Economic evaluation of drug therapy: a review of the contingent valuation method.

The aim of this paper is to review the use of the contingent valuation (CV) method in economic evaluation of drug therapy. With the CV method, willingness to pay for a project 'treatment' is measured with survey methods, which makes it possible to carry out traditional cost-benefit analysis. The CV method has been developed in environmental economics and is now the most commonly used method of measuring environmental benefits. Due to the limitations of existing methods, empirical applications are starting to appear in the health field as well. From the empirical applications with respect to drug treatment it is evident that it is possible to achieve acceptable response rates. The methodological problems encountered when measuring willingness to pay with survey methods are similar to the problems encountered when measuring utility and quality of life in cost-utility analysis. It is concluded that further studies with the CV method are necessary to further explore questions concerning the reliability and validity of the method in this field.

Angina Pectoris↗
PubMed1992

A health-economic comparison of diet and drug treatment in obese men with mild hypertension.

OBJECTIVE: To compare dietary and antihypertensive drug treatment in obese men with mild hypertension in economic terms. DESIGN: A 6-week run-in period followed by randomization to either diet or drug treatment, lasting for 1 year. Blood pressure was measured blindly and serum lipid concentrations assessed at run-in and after 1 year. A computer-based model was used in five cost-effectiveness simulations with different assumptions as to the effect upon coronary heart disease risk from the changes in diastolic blood pressure and cholesterol, both total and high-density lipoprotein. A cost-benefit analysis was also performed, calculated as willingness to pay for treatment, as assessed by questionnaire, minus total cost. SETTING: Outpatient clinic in city hospital. PATIENTS: Sixty-four men aged 40-69 years with body mass index > or = 26 kg/m2 and a diastolic blood pressure 90-104 mmHg when untreated were recruited (screening after advertisement in newspaper). Exclusion criteria were diabetes mellitus, organ damage secondary to hypertension, and diseases that might have interfered with compliance and the interpretation of results. Sixty-one patients completed the study. INTERVENTIONS: Dietary treatment was based upon weight reduction and sodium restriction. Drug treatment used a stepped-care approach, with atenolol as the drug of first choice. MAIN OUTCOME MEASURES: Life years gained and willingness to pay. RESULTS: Drug treatment was the preferred option in three of the five cost-effectiveness simulations. The cost-benefit analysis did not show any difference between the two groups. CONCLUSIONS: Non-pharmacological treatment seemed to be less cost-effective than drug treatment. However, more studies and further methodological development are needed to verify this finding.

Adult↗
PubMed1991

Willingness to pay for antihypertensive therapy--results of a Swedish pilot study.

In this methodological study the results of a Swedish pilot study about willingness to pay for antihypertensive therapy are presented. The aim of the study was to test the feasibility of the contingent valuation (CV) method in this area. Open-ended and discrete CV questions were compared in a mail questionnaire. The open-ended CV question did not work well. The answers to the discrete question, analysed by logistic regression analysis, indicated a willingness to pay in the range SEK 2500-5000 per year for antihypertensive therapy. Further studies should be undertaken to explore the reliability and the validity of the CV method.

Attitude to Health↗
PubMed1991

Cost-effectiveness analysis of hypertension treatment--a review of methodological issues.

There is a lack of methodological conformity in cost-effectiveness analyses of hypertension treatment. They differ with respect to assumptions about the effectiveness of treatment, the outcome measure chosen, the cost-concept, the discounting of effects and the duration of therapy. The aim of this paper is to review these issues and estimate the importance of different assumptions for the cost per life-year gained. To analyse these assumptions a computer simulation model was constructed based on the Framingham logistic risk equations and Swedish cost data. It is shown that the cost per life-year gained is highly sensitive towards many of these assumptions. It is also shown that the average cost-effectiveness ratios calculated in previous studies and the relevant marginal cost-effectiveness ratios can differ by several hundred per cent. The results of cost-effectiveness analyses in the hypertension field have to be interpreted with caution. Due to the lack of standardized methodology, the comparability between studies is limited. There is also a need to complement cost-effectiveness analysis in this area with other approaches, for example based on WTP.

Adult↗
PubMed1991

The costs of treating hypertension--an analysis of different cut-off points.

In this article the effects of different cut-off points for hypertension treatment are analysed, with respect to treatment costs. A theoretical blood pressure distribution is used to calculate the potential annual cost of treating all persons in Sweden above certain cut-off points for drug treatment. A lowering of the cut-off point from 105 mm Hg to 100 mm Hg diastolic blood pressure could potentially lead to an increase in annual costs of approximately 80m pounds. Further lowering from 100 to 95 mm Hg in turn could increase annual costs by about 110m pounds. The potential annual cost of treating all persons (roughly 1.6 million) with a diastolic blood pressure of greater than or equal to 95 mm Hg with drugs is calculated as being roughly 40 pounds per inhabitant in Sweden. The Swedish cut-off point for treatment (95 mm Hg) can be expected to lead to roughly 50 per cent higher treatment costs than the British cut-off point (100 mm Hg).

Adult↗
PubMed1991

Economic evaluation in health care: is there a role for cost-benefit analysis?

This paper is devoted to the contingent valuation (CV) method and its possible area of application in health economics. With the CV method willingness to pay or willingness to accept is measured with survey methods. The CV method has been developed in environmental economics and is now the most commonly used method of measuring environmental benefits. The method has, however, seldom been used in economic evaluations of health care. The development of economic evaluation in the health care area is reviewed, and the existing methods (the human capital approach, cost-effectiveness analysis and cost-utility analysis) are compared with cost-benefit analysis using the CV method. It is shown that existing methods have several weak points, this makes the CV method an appealing alternative and/or complement to existing methods. From the empirical applications of the CV method in economic evaluations of health care it is evident that it is possible to achieve acceptable response rates. The methodological problems encountered when measuring willingness to pay with survey methods are shown to be similar to the problems encountered when measuring utility and quality of life in cost-utility analysis. Further studies with the CV method are necessary to further explore questions concerning the reliability and validity of the method.

Consumer Behavior↗
PubMed1991

Cost-benefit analysis of non-pharmacological treatment of hypertension.

In this study a non-pharmacological treatment (NPT) programme and conventional drug treatment of hypertension was compared in a cost-benefit analysis. The NPT programme involved 400 patients and was conducted at 8 health centres during the period 1984-1986. It consisted of monthly visits by a nurse, visits by a doctor every 6 months, home blood pressure (BP) measurements, dietary advice, relaxation, physical activity, etc. The patients were also followed up for 2 years after the study to assess whether the programme still worked, and whether future treatment costs were affected. The treatment costs were about SEK 5300 higher per patient for the NPT programme. The benefits, in the form of reduced treatment costs for the period 1986-1988 and willingness to pay (WTP) for the NPT programme, were about SEK 3200. Thus the NPT programme resulted in a loss of about SEK 2100 per patient. However, a longer follow-up period is needed for any specific conclusions to be drawn about the costs and benefits of the NPT programme, as compared with conventional drug treatment.

Adult↗
PubMed1991

The costs of treating hypertension in Sweden. An empirical investigation in primary health care.

The treatment costs of hypertension in Sweden were calculated both at the individual and at the national level after an empirical investigation in primary health care. The average drug cost per patient and year was calculated as c. SEK 1220, the annual consultation cost as c. SEK 620, and the annual travel and time cost as c. SEK 230. About 500,000 people are treated pharmacologically for hypertension in Sweden, and about 25,000 non-pharmacologically. The total annual treatment cost for these patients was calculated as c. SEK 1100 million. The drug cost accounts for c. SEK 650 million, the consultation cost for c. SEK 330 million, and the travel and time cost for c. SEK 120 million. The drug reimbursement scheme pays almost half these costs, while the county councils and the patients pay approximately a quarter each.

Adult↗
PubMedDate not supplied

The discounting of lives saved in future generations--some empirical results.

The aim of this note is to estimate the discount rates that individuals in the present generation in Sweden use to discount lives saved in future generations at different points in time. A binary survey question, where individuals choose between saving lives in their own generation versus saving lives in future generations, was administered in a general population sample of 850 individuals. Three time horizons of 20, 50 and 100 years were used in three different subsamples. Logistic regression analysis was used to estimate the discount rate. The estimated annual discount rate is 25% for the 20 year time horizon, 12% for the 50 year time horizon and 8% for the 100 year time horizon.

Adolescent↗
PubMedDate not supplied

Valuation of health changes with the contingent valuation method: a test of scope and question order effects.

In recent years, there has been a growing interest in the contingent valuation method for measurement of monetary values of various commodities. However, the validity and reliability of the method need to be examined thoroughly. This paper reports results of a test of scope and question order effects in a contingent valuation experiment in the health care field. Using three binary valuation questions, data were collected on willingness to pay for superior treatment of reflux oesophagitis. To test for scope effects, different probabilities of successful short- and long-term treatments were evaluated using a split sample approach. The presence of question order effects was tested by assigning respondents to different question orders. The contingent valuation method proved sensitive to changes in scope in that the willingness to pay increased with the probability of being free from symptoms and with a reduced risk of having a relapse once recovered. Also, regression analysis indicate that people who suffer from severe reflux oesophagitis are more willing to pay for more effective treatment. No question order effects were detected in the data.

Aged↗
PubMedDate not supplied

Contingent valuation with an open-ended follow-up question: a test of scope effects.

It has been suggested that an open-ended follow-up question should be added to the binary contingent valuation question. Before this is generally recommended, it is important to evaluate the properties of such follow-up questions. Using a split sample approach, we test whether the open-ended follow-up is sensitive to the scope of the commodity being valued. No significant scope effects were detected. It is concluded that the results obtained do not support the use of an open-ended follow-up in contingent valuation applications.

Esophagitis, Peptic↗