Clas Rehnberg

Health related quality of life in different states of breast cancer

ObjectivesThe aim of this study was to describe the health related quality of life (HRQoL) in different breast cancer disease states using preference-based measures.Material and MethodsA total of 361 consecutive breast cancer patients attending the breast cancer outpatient clinic at Karolinska University hospital Solna for outpatient visits between April and May 2005 were included in the study. The EQ-5D self classifier and a direct Time Trade Off (TTO) question were used to estimate the HRQoL in different breast cancer disease states.ResultsPatients in their first year after a primary breast cancer had a mean EQ-5D index value of 0.696 (95% confidence interval (CI): 0.634–0.747)). Patients in their first year after a recurrence had a mean EQ-5D index value of 0.779 (CI: 0.700–0.849). Patients who had not had a primary breast cancer diagnosis or a recurrence during the previous year had a mean EQ-5D index value of 0.779 (CI: 0.745–0.811). Patients with metastatic disease reported the lowest HRQoL values, and had a mean EQ-5D index value of 0.685 (CI: 0.620–0.735). The main driver behind the reduction in HRQoL was pain and discomfort as well as anxiety and depression. TTO values were higher for all diseases states compared to the EQ-5D index values.ConclusionThis study shows that breast cancer is associated with a reduction in HRQoL. This effect is most pronounced for patients with metastatic disease.

Internal markets and health care efficiency: a multiple-output stochastic frontier analysis

This paper has two purposes. The first purpose is methodological and aims to extend previous work on efficiency analysis by implementing a multiple-output stochastic ray frontier production function model. This model generalizes the single-output stochastic frontier model to multiple-input, multiple-output technologies and allows simultaneous estimation of technical efficiency and analysis of influential variables on efficiency. The second, empirical, purpose is to test for existence and magnitude of the effect of purchaser/provider split combined with new reimbursement schemes on technical efficiency in the Swedish public hospital system. The analysis is carried out with a panel data set covering the total population of 26 Swedish County Councils from 1989 to 1995. Our empirical results support the frontier model specification and indicate that output-based reimbursement improves technical efficiency. The potential saving in costs due to a switch from budget-based allocation to output-based allocation is estimated to be almost 10%.

The impact of internal markets on health care efficiency: evidence from health care reforms in Sweden

A purchaser/provider split together with output-based reimbursement were recently introduced by several Swedish county councils. These changes have been motivated by arguments of efficiency and consumer choice. This paper tests the null hypothesis that hospital services are provided as efficiently by county councils with internal markets and output-based reimbursement as by county councils with budget reimbursement. We first estimate technical efficiency using data envelopment analysis and then we regress the efficiency scores as the dependent variable on new internal organizations in a multiple regression by use of pooled cross-section data for the 26 county councils for two years (1993 and 1994). The results reject our null hypothesis and we conclude that the organizational changes in the county councils improve health care efficiency. Our results further indicate that the potential savings in costs due to a hypothetical switch from budget based allocation to an output based allocation is about 13%. We also found some evidence indicating that county councils with a nonsocialist political majority are relatively more efficient than those with a socialist regime and that large county councils are more efficient than small county councils.

Resource use and costs associated with different states of breast cancer

OBJECTIVES This study investigated the direct medical resource use and cost, informal care cost, and indirect cost associated with breast cancer in different states of the disease in normal clinical practice. METHODS A retrospective database analysis was used to estimate direct medical resource use and cost, and a patient questionnaire was used to evaluate informal care and work capacity in different states of breast cancer. RESULTS For patients younger than 65 years of age, the first year after a primary diagnosis total cost amounted to 280,000 SEK (

How are individual-level social capital and poverty associated with health equity? A study from two Chinese cities

39,000) and the first year after a local or contralateral recurrence total cost was 351,000 SEK (

Cost-effectiveness of HER2 testing and trastuzumab therapy for metastatic breast cancer.

48,900). The second and following years after primary breast cancer or recurrence had substantially lower total cost, amounting to 94,000 SEK (

Drug policy in China: pharmaceutical distribution in rural areas.

13,000). For patients with metastatic disease, the annual total cost was estimated to 334,000 SEK (

Association between health insurance and antibiotics prescribing in four counties in rural China

46,500). For patients older than 65 years of age, the total cost for the first year after a primary diagnosis amounted to 80,000 SEK (

Health care performance comparison using a disease-based approach: The EuroHOPE project

11,200) and the total cost for the first year after a local or contralateral recurrence was 92,000 SEK (

Measuring cost efficiency in the Nordic Hospitals—a cross-sectional comparison of public hospitals in 2002

12,900). The total cost for the second and following years after primary breast cancer or recurrence was estimated to 18,000 SEK (