Swedish Institute

About: Swedish Institute is a government organization based out in Stockholm, Sweden. It is known for research contribution in the topics: Population & Health care. The organization has 1657 authors who have published 2301 publications receiving 103682 citations. The organization is also known as: Svenska Institutet.

Cost-effectiveness of Evolocumab Therapy for Reducing Cardiovascular Events in Patients With Atherosclerotic Cardiovascular Disease.

Abstract: Importance The proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab has been demonstrated to reduce the composite of myocardial infarction, stroke, or cardiovascular death in patients with established atherosclerotic cardiovascular disease. To our knowledge, long-term cost-effectiveness of this therapy has not been evaluated using clinical trial efficacy data. Objective To evaluate the cost-effectiveness of evolocumab in patients with atherosclerotic cardiovascular disease when added to standard background therapy. Design, Setting, and Participants A Markov cohort state-transition model was used, integrating US population-specific demographics, risk factors, background therapy, and event rates along with trial-based event risk reduction. Costs, including price of drug, utilities, and transitional probabilities, were included from published sources. Exposures Addition of evolocumab to standard background therapy including statins. Main Outcomes and Measures Cardiovascular events including myocardial infarction, ischemic stroke and cardiovascular death, quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER), and net value-based price. Results In the base case, using US clinical practice patients with atherosclerotic cardiovascular disease with low-density lipoprotein cholesterol levels of at least 70 mg/dL (to convert to millimoles per liter, multiply by 0.0259) and an annual events rate of 6.4 per 100 patient-years, evolocumab was associated with increased cost and improved QALY: incremental cost, $105 398; incremental QALY, 0.39, with an ICER of $268 637 per QALY gained ($165 689 with discounted price of $10 311 based on mean rebate of 29% for branded pharmaceuticals). Sensitivity and scenario analyses demonstrated ICERs ranging from $100 193 to $488 642 per QALY, with ICER of $413 579 per QALY for trial patient characteristics and event rate of 4.2 per 100 patient-years ($270 192 with discounted price of $10 311) and $483 800 if no cardiovascular mortality reduction emerges. Evolocumab treatment exceeded $150 000 per QALY in most scenarios but would meet this threshold at an annual net price of $9669 ($6780 for the trial participants) or with the discounted net price of $10 311 in patients with low-density lipoprotein cholesterol levels of at least 80 mg/dL. Conclusions and Relevance At its current list price of $14 523, the addition of evolocumab to standard background therapy in patients with atherosclerotic cardiovascular disease exceeds generally accepted cost-effectiveness thresholds. To achieve an ICER of $150 000 per QALY, the annual net price would need to be substantially lower ($9669 for US clinical practice and $6780 for trial participants), or a higher-risk population would need to be treated.

COPD and the risk of tuberculosis--a population-based cohort study.

Abstract: BACKGROUND: Both chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD and TB have common risk factors such as smoking, low socioeconomic status and dysregulation of host defence functions. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality. METHODS AND FINDINGS: All individuals > or = 40 years of age, discharged with a diagnosis of COPD from Swedish hospitals 1987-2003 were identified in the Swedish Inpatient Register (n = 115,867). Records were linked to the Swedish Tuberculosis Register 1989-2007 and the relative risk of active TB in patients with COPD compared to control subjects randomly selected from the general population (matched for sex, year of birth and county of residence) was estimated using Cox regression. The analyses were stratified by year of birth, sex and county of residence and adjusted for immigration status, socioeconomic status (SES) and inpatient co-morbidities previously known to increase the risk of TB. COPD patients had a three-fold increased hazard ratio (HR) of developing active TB (HR 3.0 (95% confidence interval 2.4 to 4.0)) that was mainly dependent on an increased risk of pulmonary TB. In addition, logistic regression estimates showed that COPD patients who developed active TB had a two-fold increased risk of death from all causes within first year after the TB diagnosis compared to the general population control subjects with TB (OR 2.2, 95% confidence interval 1.2 to 4.1). CONCLUSIONS: This population-based study comprised of a large number of COPD patients shows that these patients have an increased risk of developing active TB compared to the general population. The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB. The underlying contributory factors need to be disentangled in further studies. (Less)

Using motion interactive games to promote physical activity and enhance motor performance in children with cerebral palsy

Abstract: Objective: To explore the feasibility of using low-cost motion interactive games as a home-based intervention for children with cerebral palsy (CP).Methods: Fourteen children with CP, 6–16 years ol ...

Annual costs of treatment for venous leg ulcers in Sweden and the United Kingdom.

Abstract: The aim of this study was to estimate costs of treating venous leg ulcers in Sweden and the United Kingdom during 1 year and to quantify costs in different health states The costs of treating four different types of venous leg ulcers were estimated for 52 weeks by a stochastic health economic model, which simulated resource use data obtained from prospectively collected patient data, expert panels in the two countries, and published scientific literature The average cost of treating an ulcer varied between 1332 Euro and 2585 Euro in Sweden and from 814 Euro to 1994 Euro in the United Kingdom Cost of treating large ulcers (>/= 10 cm(2)) of long duration (>/= 6 months) was highest in both countries Frequency of dressing changes and duration of time for each dressing change were higher in Sweden than in the United Kingdom, resulting in higher total cost per patient in Sweden An important factor for the total costs was time to heal Other important variables influencing treatment costs were frequency and duration of dressing changes Actions to reduce time used for dressing changes and the total time to healing are thus very important in reducing costs spent on treatment of venous leg ulcers in both countries

Life cycle assessment (LCA) of food products and production systems

Abstract: Life Cycle Assessment (LCA), which is a method for analysis and assessment of the environmental impact caused by product systems, and its application to food products and production systems have been studied. For foods, the complete product system includes: production of inputs to agriculture, agricultural production, industrial refining, storage and distribution, packaging, the household phase and waste management. The overall objectives were to learn more about the feasibility and limitations of LCAs of food systems and to generate information on the environmental impact of such systems. Case studies of tomato ketchup and white bread were carried out. Ketchup was chosen because its life cycle represents a rather common food-product system: it includes a harvest, a preservation process (seasonal production), storage, transportation and, finally, further processing into a consumer product. Bread was chosen because it is an important staple food. For ketchup, a screening LCA and, later, an analysis of options for environmental improvements were carried out. For bread, different scales of production and their potential environmental effects were compared; systems for home baking, a local bakery and two industrial bakeries with distribution areas of different sizes were studied. Energy use and emissions were quantified and the potential contributions to global warming, acidification, eutrophication and photo-oxidant formation were assessed. In the screening of ketchup, the impact categories of human toxicity and ecotoxicity were also included; for bread, land use for cultivation and the use of water for food processing were included. The great scarcity of environmental data was one of the major problems encountered when applying the LCA methodology to food systems. Hence, the data collection and modelling were time consuming and the uncertainties of the results were relatively large. Each individual LCA study contributes to the generation of new data as well as the identification of data gaps. Further research and development are required to improve both data bases and models so that the uncertainties can be reduced. Until high quality environmental data are accessible, there is a need for simplified methods which can be used as a compass to show the direction towards sustainability. Accordingly, the feasibility of combining the concept of sustainability and LCA for product development was examined and discussed. The main conclusion is that LCA is very valuable for incorporating environmental aspects in the evolution of more sustainable systems for production and consumption of foods. For ketchup it was found that the packaging and processing in food industries are significant in the total environmental impact made by ketchup. From the improvement analysis, it was concluded that, in particular, the contribution to acidification can be reduced significantly. For bread, it was concluded that the specific systems for home baking, the local bakery and the small industrial bakery show similar environmental performance. The large industrial bakery was found to require more energy and to contribute more to global warming, acidification, eutrophication and photo-oxidant formation. The combination of the concept of sustainability principles and the methodology of LCA was found to yield a simplified method well suited for screening analysis and product development aiming towards sustainability. The semi-quantitative approach eases the inclusion of information and aspects not usually included because they are difficult to quantify; for foods such information and aspects are often of major significance.