Marianne Svensson

Valuing the Benefits of Reducing the Risk of Non-Fatal Road Injuries: The Swedish Experience

The Swedish National Road Administration’s (NRA’S) method for evaluating traffic safety effects of new roads and alternative safety improvements implies that an average casualty is set a certain cost or value. This average cost per casualty is divided into material costs and “human value”. The material costs consist of health-care costs, net lost production, costs of property damage and administration. The human value (including a value of lost consumption due to premature death) corresponds to the willingness to pay approach. This definition is considered to be theoretically consistent with the principles of cost-benefit analysis and comparable with methodology used in other European countries, e.g. in Great Britain (O’Reilly et al. 1994), see also a recent report published by the Commission of the European Communities (COST-313 1994).

Modelling the benefits of early diagnosis of pancreatic cancer using a biomarker signature.

Pancreatic cancer (PC) has a poor prognosis, with a 5‐year survival of 3–4%. This is mainly due to late diagnosis because of diffuse symptoms, where 80–85% of the patients are inoperable. Consequently, early diagnosis would be of significant benefit, resulting in a potential 5‐year survival of 30–40%. However, new technologies must be carefully evaluated concerning effectiveness and healthcare costs. We have developed a framework for modelling cost and health effects from early detection of PC, which for the first time allowed us to analyse its cost‐effectiveness. A probabilistic cohort model for estimating costs and quality adjusted life‐years (QALY) arising from screening for PC, compared to a “wait‐and‐see”‐approach, was designed. The test accuracy, Swedish survival and costs by tumour stage, expected life gain from early detection and pretest probabilities in risk groups, were retrieved from previous investigations. In a cohort of newly diagnosed diabetic patient (incidence 0.71%) the incremental cost per QALY gained (ICER) was €13,500, which is considered cost‐effective in Europe. Results were mainly sensitive to the incidence with the ICER ranging from €315 to €204,000 (familial PC 35% and general population 0.046%, respectively). This is the first study focusing on clinical implementation of advanced testing and what is required for novel technologies in cancer care to be cost‐effective. The model clearly demonstrated the potential of multiplexed proteomic‐testing of PC and also identified the requirements for test accuracy. Consequently, it can serve as a model for assessing the possibilities to introduce advanced test platforms also for other cancer indications.

The Swedish cost burden of overweight and obesity – evaluated with the PAR approach and a statistical modelling approach

The rising trend in the prevalence of obesity, which is a major risk factor for a number of diseases notably diabetes and cardiovascular diseases, has become a major public health concern in many countries during the past decades. This development has also led to an increased cost burden on the public health care delivery system that has been documented in many studies. The standard approach taken for estimating the cost burden attributed to a risk factor is the so-called PAR (Population Attributed Risk) approach; an approach that is based on cross-sectional data. In this paper, the methods and findings of two studies that have documented the cost burden attributed to overweight and obesity on the public health care delivery system in Sweden are contrasted: one using the PAR approach and one using a statistical modeling approach based on longitudinal hospital care data for 15 years for 33 000 individuals. The main motivation for this paper is that the study using the PAR approach is only available in the Swedish language. The PAR approach estimated a cost burden of 3 600 million SEK (390 million Euro), equavalent to 1.9% of national health care expenditure, out of which 1 800 million SEK (190 million Euro) were spent on hospital care. The statistical modeling approach estimated the corresponding cost burden for hospital care at 2 100 million SEK (230 million Euro). The statistical modeling approach presents no estimates of the total cost burden attributed to overweight and obesity.

Group living for elderly patients with dementia--a cost analysis.

The average labour cost of group living for elderly people suffering from senile dementia amounted to just over SEK 230,000 per patient and year, or SEK 639 per patient and day (24h), in 1992 prices. These figures emerge from our study of 106 group-living units in 46 municipalities in southern Sweden. The average staff density, that is the number of full-time employees on a yearly basis, was 1.06 per patient. The study also shows that the labour cost per patient decreases when the number of patients in a unit increases. Units that form part of other types of residence for the elderly have lower labour costs than detached group-living units (everything else being equal). If individual flats or apartments are large (at least two rooms), a higher staff density was observed. A high degree of functional disability in the individual entails higher staff density and consequently higher labour costs as well. However, in comparison with other forms of caring for the elderly, such disabilities have a less marked effect on labour costs. Everything else being equal, comparatively young residents entail higher labour costs than older ones. The average cost per patient in group-living units amounted to SEK 986 per day. This cost includes the cost of care (labour cost adjusted for flexible salary increments), as well as of capital, operation and maintenance, and food (raw materials). The cost of care amounts to approx. 80% of the estimated cost per patient. The average cost per patient is higher in group-living units than in old peoples homes; but as regards dementia sufferers with some degree of functional disability, the cost of care is probably about the same in both types of accommodation.

Home service costs: The Swedish experience

This article will show that the annual cost of service and care for a receiver of home service in Sweden ranges from SEK 5,000 to SEK 435,000 according to individual disability. In our sample, the average annual cost amounts to slightly less than SEK 100,000. Furthermore, the cost of service and care for pensioners of good mental health is about SEK 50,000 higher than for the group of mentally disabled (everything else being the same). Not quite unexpectedly, the annual cost of service and care decreases when assistance from relatives increases. Without help from relatives, the annual cost increases by approximately SEK 16,000 per individual. The average annual cost is higher for home service receivers who live at home and have an alarm telephone than for those who have not got an alarm telephone (everything else being the same). Alarm telephone systems which require staff for supervision and home visits account for half of the recorded difference in cost. Both living in ones own home with handicap adjustment and living in a service flat mean a lower cost of service and care than living in ones own home without handicap adjustment (everything else being the same). For persons who are in great need of daily help, living at home implies a cost that is slightly more than 20 per cent higher than the cost for living in a service flat.

Kundval för äldre och funktionshindrade i Norden. Konsumentperspektivet

Kundval for aldre och personer med funktionshinder diskuteras i de nor-diska landerna och i vissa fall har det ocksa inforts. Kundval i handikapp-omsorgen forekommer da personer med funktionshinder valjer sin per-sonliga assistent. I aldreomsorgen finns det system dar den aldre efter ett bistandsbeslut kan fa valja vem som ska utfora vissa insatser. Nagra svenska kommuner var pionjarer i borjan av 1990-talet nar de inforde kundval i aldreomsorgen. Langst har utvecklingen gatt i Danmark dar ett nationellt reglerat kundvalssystem infordes ar 2003. I Finland infordes ocksa nyligen en lag som reglerar kundvalssystemet i de fall kommuner beslutar att infora det. Denna studie har haft till uppgift att redovisa befintlig kunskap om ef-fekter av kundvalssystem i nordisk aldre- och handikappomsorg. Studien tar sin utgangspunkt i brukarnas perspektiv och ger en beskrivning av hur kundvalsmodellerna ar uppbyggda och vad vi idag vet om modellernas effekter. En central slutsats i studien ar att det hittills genomforts lite veten-skaplig forskning om kundval sett ur ett konsumentperspektiv i de nor-diska landerna. Forskningen karaktariseras av kommunvisa studier som gor det svart att generalisera resultaten – inte minst mot bakgrund av att kundvalet i sin utformning skiljer sig mellan olika kommuner och lander. Begreppet kundval ar mangfacetterat. Brukarens situation blir beroen-de av hur kundvalssystemet ar konstruerat; exempelvis om det for bruka-ren ar obligatoriskt eller frivilligt att valja utforare, vilka tjanster som brukaren kan valja mellan och hur manga utforare som kan vara aktuella. Det saknas kunskap om hur olika ”typmodeller” av kundval fungerar sett ur ett brukarperspektiv.