Dick Jonsson

Socioeconomic costs of rheumatic diseases. Implications for technology assessment.

OBJECTIVES To study the socioeconomic impact of rheumatic illness in Sweden and to discuss the consequences for technology assessment studies. METHODS A cost-of-illness study based on data from official statistics and treatment studies. RESULTS The total socioeconomic cost was 52 billion Swedish kronor (SEK) in 1994. The imbalance between direct (10% of total) and indirect costs (90 effectiveness of the healthcare sector, the need for new treatment methods, appropriate information systems, and technology assessment studies as well as the institutional arrangements for rehabilitation and basic medical research. CONCLUSIONS A discussion of solutions for financial cooperation between county councils and regional social insurance offices should be considered. The new biotechnological pharmaceuticals will increase the cost for drugs in health care about 20 times, but the total socioeconomic cost for society may remain at the same level due to a decrease of inpatient costs and indirect costs for loss of production as well as a decrease of transfer payments from social insurance. It is unavoidable that the new pharmaceuticals require priority discussions and active resource allocation in health care and in other sectors of society.

Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia

The costs and effects of clozapine treatment of refractory schizophrenic patients have been discussed recently. This study shows that 18 months of clozapine treatment results in an improvement of symptoms and social functioning in approximately 70% of treatment‐refractory schizophrenic patients, compared with treatment with conventional neuroleptics during a similar period of time. Treatment with clozapine reduces the cost of inpatient care but places increased demands on active rehabilitation resources in outpatient care. This leads to increased total costs in a short‐term perspective, but clozapine treatment is cost‐saving for annual maintenance therapy. These costs must be weighed against the positive effects on psychotic symptoms and social functioning.

The costs of early inflammatory joint disease: a population-based study in southern Sweden.

Objective: To study the costs and use of healthcare for patients during the first months with early joint inflammation, in a population‐based prospective referral study in Southern Sweden. Methods: Adult patients with arthritis for <3 months and with onset of symptoms between 1 May 1999 and 1 May 2000 were referred from primary health centres to rheumatologists. Four clinical assessments were performed during a 6‐month follow‐up period. The direct medical costs for inpatient stays, outpatient visits, visits to general practitioners, and visits to health professionals, as well as costs for medication, radiographs, and laboratory tests were recorded from the onset of the disease up to 6 months of follow‐up. Indirect costs for sick leave were also recorded. Results: Fifty‐six of 71 referred patients agreed to participate. Thirteen (23%) had RA, 21 (38%) had reactive arthritis (ReA), 14 (25%) had undifferentiated arthritis, and eight (14%) had other arthritides. The median cost per patient in the entire group was USD 3362. The median cost per patient in the RA group was USD 4385, and USD 4085 in the ReA group. There was no statistically significant difference in the median costs per patient in the different diagnostic groups. Sick leave accounted for 44% of the total costs in the entire group, and 46% and 47%, respectively, in the RA and ReA groups. Conclusion: The costs of early arthritis are already considerable during the first months of the disease following the onset of the symptoms. The indirect costs due to sick leave accounted for nearly half of the costs.

The cost of the Swedish handicap service system. Implications for technology assessment.

The total cost of the Swedish handicap system is estimated at US

The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden

10.7 billion for 1989. The cost is distributed across different authorities with separate legal and financial responsibility. The concept of technology must be extended to include consideration of both the resources spent and benefits gained in the public sector and the magnitude and distribution of transfer payments from social insurance to fulfill its function in handicap policy decision making.

Cost-utility analysis of the rehabilitation of patients with musculoskeletal problems

The aim of the study is to examine the socioeconomic costs of treatment of therapy-refractory schizophrenic patients. The patients usually have a great need for health care and remain in institutions for long periods of time. The method is retrospective, and the data refer to patients who received treatment at the Department of Psychiatry, University Hospital in Linkoping, Sweden in 1990. The total annual health care cost for treatment of therapy-refractory schizophrenia is estimated to be SEK 4.8 million (USD 1 = SEK 7.7). Inpatient care amounts to 93% of the total cost, and the cost of outpatient care to 6%. The cost of drugs and laboratory services corresponds to 1 % of the total cost. The high cost of inpatient care and the low cost of outpatient care may indicate that a redistribution of resources from inpatient to outpatient care is necessary. A generalization of the results indicates that the total annual cost of treating all therapy-refractory schizophrenic patients in Sweden is approximately SEK ...

Socio-economic evaluation of mental health as a basis for financing health care in Sweden

The objective of this study is to discuss the rehabilitation of patients in primary health care with problems in the musculoskeletal system from a socioeconomic perspective. A trial with coordinated rehabilitation in primary health care is compared with traditional rehabilitation. This trial, performed in Sweden in 1994, was a two-year prospective and comparative study of consecutively included patients with long-term illnesses due musculoskeletal problems (810 observations). A cost-utility analysis shows that the new rehabilitation program in primary health care is a cost-minimization program for society. There is no significant difference in the quality of life between the trial and control groups. The total cost is lower for rehabilitation in primary health care than for traditional rehabilitation (6 percent). The indirect costs are higher than the direct health care costs (60 percent), and payments from social insurance increased by 8 percent. The health economic results support rehabilitation in primary health care but also points out that this type of rehabilitation can be further improved.

Rheumatoid arthritis is already expensive during the first year of the disease (the Swedish TIRA project)

The objective of this paper is to examine hypotheses about the relationships between socio-economic factors, risk factors in working life, and the occurrence of mental illness, together with the degree of quality of life and consumption of health care, costs for health care, and costs for social insurance. This is a prospective and longitudinal study of 1,347 individuals of an active working age, 18–64 years, who have been on sick leave for more than 30 days. The group is characterized by the prevalence of risk factors in their work environment and welfare losses, such as multiple health problems, poor quality of life, inability to work, and dependency on societys support from health care and social insurance. The costs for health care were just over 2.8 million SEK, or 30 percent higher for those with psychological distress as compared to the group without. The payments from social insurance also increased by approximately 15 percent. The relatively greater weighting of health care costs and sickness cash benefits were motivating factors to study whether this group had an optimal amount and quality of health care, or if the resources available for health care should be distributed in another way that better satisfies the needs of the group.