Professor Ulf-Göran Gerdtham, PhD - Department of Economics and Head of the Health Economics Unit, Medical Faculty, Lund University - (Full) Professor

Professor Ulf-Göran Gerdtham

PhD

Department of Economics and Head of the Health Economics Unit, Medical Faculty, Lund University

(Full) Professor

Lund | Sweden

Main Specialties: Epidemiology, Public Health

Additional Specialties: Health Economics

ORCID logohttps://orcid.org/0000-0002-0647-7817


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Professor Ulf-Göran Gerdtham, PhD - Department of Economics and Head of the Health Economics Unit, Medical Faculty, Lund University - (Full) Professor

Professor Ulf-Göran Gerdtham

PhD

Introduction

Ulf-Göran Gerdtham is a Professor in Health Economics at the Department of Economics and at the Department of Clinical Sciences at Lund University as well as a research director at the Swedish Institute for Health Economics in Lund. He is also an Adjunct Professor at the Centre for Health Economics at Monash University. Professor Gerdtham research focuses on exploring the relationship between economic factors and individuals' health-related behavior. He is particularly interested in measuring and explaining the sources of income-related inequality in health. He is also interested in the consequences of risky behavior and chronic diseases. His other research focus is on the economic evaluations of health interventions, health system effects on health care costs and productivity.

Primary Affiliation: Department of Economics and Head of the Health Economics Unit, Medical Faculty, Lund University - Lund , Sweden

Specialties:

Additional Specialties:

Research Interests:


View Professor Ulf-Göran Gerdtham’s Resume / CV

Education

Aug 1987 - Jun 1991
Linköping University
PhD
Department of Health and Society
Aug 1984 - Jun 1987
University of Örebro
BA in Public Administration (Advanced Economics and Statistics)
Economics

Experience

Aug 1991 - Aug 2001
Stockholm School of Economics
Associate Professor
Department of Economics
Jan 2010
Swedish Institute for Health Economics
Research Director
Aug 2001
Lunds Universitet Ekonomihogskolan
Professor
Department of Economics
Lund University

Publications

339Publications

1261Reads

262Profile Views

981PubMed Central Citations

The Impact of Grade Inflation on Higher Education Enrolment and Earnings

Working Papers

Although grade inflation is unfair and may imply inefficient allocation of human resources, current knowledge of grade inflation effects on individual outcomes is scarce. One explanation is probably the challenge of measuring and estimating causal grade inflation effects. This study examines the consequences of grade inflation at the upper secondary education level on enrolment in higher education and earnings for Sweden. Rigorous diagnostic testing supports our empirical approach. Grade inflation at the school level affects earnings mainly through choice of university and the chosen field of education, rather than through enrolment per se, because attending universities of higher quality and pursuing high-paying fields of education have a substantial impact on earnings. On the other hand, high-skilled students attending upper secondary schools without grade inflation and, unexpectedly, low-skilled women attending "lenient" schools are harmed by this. This causes extensive unfairness and, plausibly, detrimental welfare effects.

http://portal.research.lu.se/portal/en/publications/the-impact-of-grade-inflation-on-higher-education-enrolment-and-earnings(eb549083-0628-432f-8e2e-6f3fdc2026cd).html

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2019

What Kind of Inequality Do You Prefer? Evaluating Measures of Income and Health Inequality Using Choice Experiments

Working Papers

When measuring inequality using conventional inequality measures, ethical assumptions about distributional preferences are often implicitly made. In this paper, we ask whether the ethical assumptions underlying the concentration index for income-related inequality in health and the Gini index for income inequality are supported in a representative sample of the Swedish population using an internet-based survey. We find that the median subject has preferences regarding income-related inequality in health that are in line with the ethical assumptions implied by the concentration index, but put higher weight on the poor than what is implied by the Gini index of income inequality. We find that women and individuals with a poorer health status put higher weight on the poor than men and healthier individuals. Ethically flexible inequality measures, such as the s-Gini index and the extended concentration index, imply that researchers have to choose from a toolbox of infinitely many inequality indices. The results of this paper are indicative of which indices (i.e. which parameter values) reflect the views of the population regarding how inequality should be defined.

http://portal.research.lu.se/portal/en/publications/what-kind-of-inequality-do-you-prefer-evaluating-measures-of-income-and-health-inequality-using-choice-experiments(8cbc3f14-37a0-43cb-a05a-7cc250a2a21f).html

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2019

Economic Evaluation of Interventions in Parkinson’s Disease:

Movement Disorders Clinical Practice

Background

Parkinson's disease (PD) management comprises of drug treatments, surgery, and physical activity/occupational therapies to relieve PD's symptoms. The aim of this study is twofold; first, to appraise recent economic evaluation studies on PD management in order to update the existing knowledge; and second, to facilitate decision making on PD management by assessing the cost‐effectiveness of all types of PD interventions.
Methods

A systematic search for studies published between 2010 and 2018 was conducted. The inclusion and exclusion of the articles were based on criteria relevant to population, intervention, comparison, outcomes, and study design (PICO). The reporting quality of the articles was assessed according to Consolidated Health Economic Evaluation Reporting Standards.
Results

Twenty‐eight articles were included, 10 of which were evaluations of drug treatments, 10 deep brain stimulation (DBS), and eight physical/occupational therapies. Among early‐stage treatments, Ti Ji dominated all physical activity interventions; however, its cost‐effectiveness should be further explored in relation to its duration, intensity, and frequency. Multidisciplinary interventions of joint medical and nonmedical therapies provided slightly better health outcomes for the same costs. In advanced PD patients, adjunct drug treatments could become more cost‐effective if introduced during early PD and, although DBS was more cost‐effective than adjunct drug therapies, the results were time‐bound.
Conclusions

Conditionally, certain PD interventions are cost‐effective. However, PD progression differs in each patient; thus, the cost‐effectiveness of individually tailored combinations of interventions that could provide more time in less severe disease states and improve patients’ and caregivers’ quality of life, should be further explored.

http://portal.research.lu.se/portal/en/publications/economic-evaluation-of-interventions-in-parkinsons-disease(2bab2d2e-45bc-48d4-b5a1-9d056f799e66).html

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March 2019

Prevention of Cardiovascular Disease and Cancer Mortality by Achieving Healthy Dietary Goals for the Swedish Population

International Journal of Environmental Research and Public Health

The objective is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in Sweden if adults adhere to the official dietary recommendations. We used an age-group and sex-specific epidemiological macro-simulation model to estimate preventable deaths due to the discrepancies between actual intake and recommended intake of changes in food components. Data included in the model are a baseline scenario (actual dietary intake), a counterfactual scenario (recommended intake) and age- and sex-specific mortality for cardiovascular and diet-related cancer diseases together compared with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations was performed to produce the 95% uncertainty intervals (UI). The model predicts that 6405 (95% UI: 5086⁻7086) deaths could be prevented or delayed if the Swedish population could adhere to official dietary recommendations in a year. More deaths would be saved for men than women. The recommendations for fruits and vegetables could have saved 47% of the deaths, followed by fiber intake (32%). For men, fruits and vegetables could have saved more compared to other dietary components, while for women dietary fiber was the prominent factor. Public health policies should consider ensuring healthy eating practices for the Swedish population.

http://portal.research.lu.se/portal/en/publications/prevention-of-cardiovascular-disease-and-cancer-mortality-by-achieving-healthy-dietary-goals-for-the-swedish-population(dc9c3e9d-507f-4ac4-a5bf-2dc6861561e3).html

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March 2019

Debt and mental health

European Journal of Public Health

Background: Empirical research suggests that household debt and payment difficulties are detrimental to mental health. Despite well-known measurement problems that may contaminate analyses using subjective self-reported health measures, our knowledge is very limited concerning the effect of payment difficulties on 'objective' measures of mental health. Moreover, few studies use longitudinal data to examine the relationship. This study combines rich survey data and longitudinal data from administrative registers on a representative sample of the Swedish population to examine the relationship between payment difficulties and subjective and objective measures of mental health.

Methods: We use data from a large survey of Swedish inhabitants (The Swedish Living Conditions Surveys) combined with data from administrative registers. We investigate both directions of the relationship between mental ill health and payment difficulties, controlling for previous mental health status and previous experiences of payment difficulties. We compare the association between payment difficulties and a self-reported measure of anxiety with the associations between payment difficulties and objective measures of mental ill health from a register of psychopharmaceutical drug consumption.

Results: Payment difficulties associate with subjectively reported mental ill health, but less to psychopharmaca use. For objective measures, we find stronger evidence of a link running from mental ill health to later payment difficulties.

Conclusions: Self-reported and objective measures of mental problems may convey different messages regarding the impact of payment difficulties on mental health. Policy measures depend on whether the primary target group is individuals with severe mental problems or individuals with mild anxiety.

http://portal.research.lu.se/portal/en/publications/debt-and-mental-health(9e069f38-98fe-4f1f-bf5a-df353413b996).html

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February 2019

Patient-reported outcome and experience measures for diabetes

BMJ Open

PURPOSE: The Swedish National Diabetes Register (NDR) has developed a diabetes-specific questionnaire to collect information on individuals' management of their diabetes, collaboration with healthcare providers and the disease's impact on daily life. Our main objective was to develop measures of well-being, abilities to manage diabetes and judgements of diabetes care, and to detect and quantify differences using the NDR questionnaire.

DESIGN, SETTING AND PARTICIPANTS: The questionnaire was analysed with using responses from 3689 participants with type 1 and 2 diabetes, randomly sampled from the NDR population, combined with register data on patient characteristics and cardiovascular and diabetes complication risk factors.

METHODS: We used item response theory to develop scales for measuring well-being, abilities to manage diabetes and judgements of diabetes care (scores). Test-retest reliability on the scale level was analysed with intraclass correlation. Associations between scores and risk factor levels were investigated with subgroup analyses and correlations.

RESULTS: We obtained scales with satisfactory measurement properties, covering patient reported outcome measures such as general well-being and being free of worries, and patient reported experience measure, for example, access and continuity in diabetes care. All scales had acceptable test-retest reliability and could detect differences between diabetes types, age, gender and treatment subgroups. In several aspects, for example, freedom of worries, type 1 patients report lower than type 2, and younger patients lower than older. Associations were found between some scores and glycated haemoglobin, but none with systolic blood pressure or low-density lipoprotein cholesterol. Clinicians report positive experience of using scores, visually presented, in the patient dialogue.

CONCLUSIONS: The questionnaire measures and detects differences in patient well-being, abilities and judgements of diabetes care, and identifies areas for improvement. To further improve diabetes care, we conclude that patient-reported measures are important supplements to cardiovascular and diabetes complication risk factors, reflecting patient experiences of living with diabetes and diabetes care.

http://portal.research.lu.se/portal/en/publications/patientreported-outcome-and-experience-measures-for-diabetes(825cfdfe-c207-4174-bb36-431e61c9f8fa).html

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January 2019
1 Read

Do We Know What We Are Doing? An Exploratory Study on Swedish Health Economists and the EQ-5D

Working Papers

The UK tariff for quality of life associated with the health states in the EQ-5D is probably not consistent with the preferences of Swedish health economists. This is worrying in view of the widespread use of the tariff values and the fact that health economists likely are better able than ordinary citizens to report their preferences for health states in a valid and reliable manner. We suggest this result is taken into account when the EQ-5D instrument is used, and that researchers should be cautious in using the UK (or any other) value sets. Our results also indicate that the variation across citizens in preferences for health may be a more complex issue than previously observed and deserves further study. An intriguing question for the future is to what extent health economists use methods and instruments that they themselves do not believe in.

http://portal.research.lu.se/portal/en/publications/do-we-know-what-we-are-doing-an-exploratory-study-on-swedish-health-economists-and-the-eq5d(95bbf403-f547-426e-bb42-27285c3e3160).html

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2018
2 Reads

Economic Evaluation of Management of Dementia Patients - A Systematic Literature Review

Working Papers, Lund University

Objective: The objective is to systematically review the literature on economic evaluations of the interventions for the management of dementia and Alzheimer patients in home, hospital or institutional care. Methods: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results: Twelve studies were identified and there was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of interventions. Interventions for the management of dementia patients are in general, not cost-effective. Interventions at the community and home setting for managing both the dementia patients and caregivers on a large scale may have the potential to save societal resources. Conclusion: More effectiveness studies as well as good quality economic evaluations are required before implementation decisions on management strategies can be made based on cost-effectiveness.

http://portal.research.lu.se/portal/en/publications/economic-evaluation-of-management-of-dementia-patients--a-systematic-literature-review(4e712231-9bdc-4c90-a6af-20e2a060ff65).html

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2018
2 Reads

Economic Evaluation of Pharmacological Treatments in Dementia Disorders - A Systematic Literature Review

Working Papers

The objective is to systematically review the literature on economic evaluations of pharmacological treatments of dementia disorders. A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Fourteen studies were included in this review. There was a considerable heterogeneity in methodological approaches, use of simulation models, target populations, study time frames, and perspectives as well as comparators used. Keeping these issues in mind, we find that Cholinesterase Inhibitors (ChEIs), and especially donepezil, are dominating no treatment (i.e. less costly and more effective) for mild to moderate AD patients. For moderate to severe AD patients memantine is cost-effective compared to memantine or ChEIs alone. However, the effect of these drugs on survival is yet not established, which could have a major impact on the cost-effectiveness of these drugs. Conclusion: Pharmaceutical treatments are cost-effective comparing to no treatment for dementia patients. However, more research is required on the long-term effectiveness of these drugs, especially on the effects of drugs on survival.

http://portal.research.lu.se/portal/en/publications/economic-evaluation-of-pharmacological-treatments-in-dementia-disorders--a-systematic-literature-review(60a69245-4714-4bed-b095-40243b2bb3dc).html

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2018
2 Reads

Economic evaluation of mindfulness group therapy for patients with depression, anxiety, stress and adjustment disorders compared with treatment as usual

British Journal of Psychiatry

BACKGROUND: A randomised controlled trial found that a structured mindfulness group therapy (MGT) programme was as effective as treatment as usual (mostly cognitive-behavioural therapy) for patients with a diagnosis of depression, anxiety or stress and adjustment disorders in Sweden (ClinicalTrials.gov: NCT01476371).AimsTo perform a cost-effectiveness analysis of MGT compared with treatment as usual from both a healthcare and a societal perspective for the trial duration (8 weeks).

METHOD: The costs from a healthcare perspective included treatment as usual, medication and costs for providing MGT. The societal perspective included costs from the healthcare perspective plus savings from productivity gains for the trial duration. The effectiveness was measured as quality-adjusted life-years (QALY) using the EQ-5D-5L questionnaire and the UK value set. Uncertainty surrounding the incremental costs and effects were estimated using non-parametric bootstrapping with 5000 replications and presented with 95% confidence intervals and cost-effectiveness acceptability curves.

RESULTS: The MGT group had significantly lower healthcare and societal costs (mean differences -€115 (95% CI -193 to -36) and -€112 (95% CI -207 to -17), respectively) compared with the control group. In terms of effectiveness, there was no significant difference in QALY gain (mean difference -0.003, 95% CI -0.0076 to 0.0012) between the two groups.

CONCLUSIONS: MGT is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders in Sweden.Declaration of interestNone.

http://portal.research.lu.se/portal/en/publications/economic-evaluation-of-mindfulness-group-therapy-for-patients-with-depression-anxiety-stress-and-adjustment-disorders-compared-with-treatment-as-usual(f81119ae-39b4-4ef5-bf60-3fbe5548e450).html

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November 2018
2 Reads

Why childhood-onset type 1 diabetes impacts labour market outcomes

Diabetologia

Aims/hypothesis: Previous studies show a negative effect of type 1 diabetes on labour market outcomes such as employment and earnings later in life. However, little is known about the mechanisms underlying these effects. This study aims to analyse the mediating role of adult health, education, occupation and family formation. Methods: A total of 4179 individuals from the Swedish Childhood Diabetes Register and 16,983 individuals forming a population control group born between 1962 and 1979 were followed between 30 and 50 years of age. The total effect of having type 1 diabetes was broken down into a direct effect and an indirect (mediating) effect using statistical mediation analysis. We also analysed whether type 1 diabetes has different effects on labour market outcome between the sexes and across socioeconomic status. Results: Childhood-onset type 1 diabetes had a negative impact on employment (OR 0.68 [95% CI 0.62, 0.76] and OR 0.76 [95% CI 0.67, 0.86]) and earnings (−6%, p < 0.001 and −8%, p < 0.001) for women and men, respectively. Each of the mediators studied contributed to the total effect with adult health and occupational field accounting for the largest part. However, some of the effect could not be attributed to any of the mediators studied and was therefore likely related to other characteristics of the disease that hamper career opportunities. The effect of type 1 diabetes on employment and earnings did not vary significantly according to socioeconomic status of the family (parental education and earnings). Conclusions/interpretation: A large part of the effect of type 1 diabetes on the labour market is attributed to adult health but there are other important mediating factors that need to be considered to reduce this negative effect.

http://portal.research.lu.se/portal/en/publications/why-childhoodonset-type-1-diabetes-impacts-labour-market-outcomes(acb8494e-3a31-49c5-82b6-fdecf4926e41).html

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November 2018
7 Reads

What Do Demographics Have To Do With It? An Oaxaca-Blinder Decomposition of Changes over Time in Inequalities in Alcohol, Narcotics and Tobacco-Related Ill Health in Sweden

Working Papers

The purpose of this study was to document historical trends and socioeconomic inequalities in ill health outcomes related to alcohol consumption, narcotics use and tobacco smoking over the seventeen years prior to the implementation of the Swedish government’s first strategy for alcohol, narcotics, doping and tobacco (ANDT) in 2011. We also sought to explain the changes over time in terms of changes in the population distribution of selected demographic and socioeconomic characteristics. Our two key research questions, for each of alcohol, narcotics and smoking were: 1) How have trends in a) consumption, inpatient care and deaths, and b) income-related inequalities therein developed over time? 2) To what extent can demographic (gender, age, civil status, foreign background), socioeconomic (parental education, own education) and social characteristics (social isolation, proportion of welfare recipients in the municipality) explain the trends in a) levels of consumption, inpatient care and deaths, and b) income-related inequalities therein? For consumption, we investigated the prevalence of heavy drinking and smoking; data on narcotics use were not available. We used International Classification of Diseases (ICD) codes to identify inpatient care and deaths related to alcohol, narcotics and smoking. In our main analyses we used income as a measure of socioeconomic rank. We performed sensitivity analyses to investigate: i) the use of education as an alternative socioeconomic rank, ii) differences between measures of relative and absolute inequality, and iii) sex-differences in the trends over time. We document increasing pro-poor socioeconomic-related inequalities in all of our outcomes except heavy drinking (which was concentrated among higher income individuals, and did not change significantly) during the study period. This reflects an increasing concentration of smoking, and inpatient care and deaths related to alcohol, narcotics and smoking among low income individuals. We are able to explain some of the change over time by demographic and socioeconomic changes (i.e changes in the distribution of our sample by age, foreign background and educational attainment). However, our findings suggest that most of the change observed was due to external factors, such as changing norms and behaviours, and policy or macroeconomic conditions affecting certain groups more than others. In order to achieve the goal of equality in health, ANDT as a policy area must address the increasing concentration of alcohol-, narcotics- and smoking-related outcomes among the poorest and least educated in our society.

http://portal.research.lu.se/portal/en/publications/what-do-demographics-have-to-do-with-it-an-oaxacablinder-decomposition-of-changes-over-time-in-inequalities-in-alcohol-narcotics-and-tobaccorelated-ill-health-in-sweden(866e62cc-b5e3-4b4f-8d8d-a1d80346673d).html

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October 2018
3 Reads

Economic Evaluation of Interventions for Screening of Dementia

Working Papers

OBJECTIVE: The objective is to systematically review the literature on economic evaluations of screening interventions for early diagnosis of dementia disorders. METHODS: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: Fourteen studies were identified and broadly fell into two groups: screening without biomarkers and screening using biomarkers. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of biomarkers used. The sensitivity and specificity of screening instruments are one of the important aspects in estimating the cost-effectiveness of the interventions. Cost-effectiveness of non-biomarker based interventions cannot be judged due to lack of information. The biomarkers based screening have the potential to be cost-effective but their effectiveness has to be established first. CONCLUSION: More economic evaluations studies as well as good quality effectiveness studies are required in screening strategies before these can be implemented in the clinical practice.

http://portal.research.lu.se/portal/en/publications/economic-evaluation-of-interventions-for-screening-of-dementia(c599acbc-09f9-4086-9d3a-9a8fc189cacc).html

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September 2018
4 Reads

Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation

European Journal of Health Economics

A cluster-randomized controlled trial, WorkUp, was conducted for working-aged patients at risk of sick leave or on short-term sick leave due to acute/subacute neck and/or back pain in Sweden. The purpose of WorkUp was to facilitate participants to stay at work or in case of sick leave, return-to-work. The aim of this study was to study whether the WorkUp trial was cost-effective. Patients in the intervention and reference group received structured evidence-based physiotherapy, while patients in the intervention group also received a work place dialogue with the employer as an add-on. The participants, 352 in total, were recruited from 20 physiotherapeutic units in primary healthcare in southern Sweden. The economic evaluation was performed both from a healthcare and a societal perspective with a 12-month time frame with extensive univariate sensitivity analyses. Results were presented as incremental cost–effectiveness ratios (ICER) with outcomes measured as quality-adjusted life-years (QALY) and proportion working for at least 4 weeks in a row without reported sick leave at 12-month follow-up. From the healthcare perspective, the ICER was €23,606 (2013 price year) per QALY gain. From the societal perspective the intervention was dominating, i.e.. less costly and more effective than reference care. Bootstrap analysis showed that the probability of the intervention to be cost-effective at €50,000 willingness-to-pay per QALY was 85% from the societal perspective. Structured evidence-based physiotherapeutic care together with workplace dialogue is a cost-effective alternative from both a societal and a healthcare perspective for acute/subacute neck and/or back pain patients.

http://portal.research.lu.se/portal/en/publications/structured-physiotherapy-including-a-work-place-intervention-for-patients-with-neck-andor-back-pain-in-primary-care-an-economic-evaluation(a5f6d789-1b75-4d42-8135-443b89edccd3).html

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August 2018
4 Reads

Effects of Kidney Transplantation on Labor Market Outcomes in Sweden

Transplantation

Background: Kidney transplantation is considered a superior treatment for end-stage renal disease compared with dialysis although little is known about the wider effects, especially on labor market outcomes. The objective is to estimate the treatment effect of kidney transplantation compared with dialysis on labor market outcomes, controlling for the nonrandom selection into treatment. Methods: The average treatment effect is estimated using an inverse-probability weighting regression adjustment approach on all patients in renal replacement therapy 1995 to 2012. Results: Kidney transplantation is associated with a treatment advantage over dialysis on employment, labor force participation, early retirement, and labor income. The probability of being employed 1 year after treatment is 21 (95% confidence interval, 16-25) percentage points higher for transplantation. The positive effect increases to 38 (95% confidence interval, 30-46) percentage points after 5 years, mainly due to worsening outcomes on dialysis. The effect on labor income is mainly mediated through employment probability. The productivity gains of transplantation compared to dialysis amounts to €33 000 over 5 years. Conclusions: Transplantation is superior to dialysis in terms of potential to return to work as well as in terms of labor income and risk of early retirement, after controlling for treatment selection. This positive effect increases over time after transplantation.

http://portal.research.lu.se/portal/en/publications/effects-of-kidney-transplantation-on-labor-market-outcomes-in-sweden(332010d6-03b7-4dea-8033-c15f91ac327c).html

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August 2018
4 Reads

Measuring the end-of-life premium in cancer using individual ex ante willingness to pay.

Eur J Health Econ 2018 Jul 12;19(6):807-820. Epub 2017 Aug 12.

The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden.

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http://dx.doi.org/10.1007/s10198-017-0922-6DOI Listing
July 2018
24 Reads

Inequalities in labour market consequences of common mental disorders

Working Papers

The burden of mental disorders continues to grow and is now a leading cause of disability worldwide. The prevalence of mental disorders is unequal between population subgroups, and these disorders are associated with unfavourable consequences in social and economic conditions, health and survival. However, how the negative effects of mental disorders are distributed among population subgroups is less studied. Our aim is to investigate how labour market consequences of Common Mental Disorders (CMD) differ over gender, age, education, and country of birth. We use a population sample from southern Sweden of patients diagnosed with CMD 2009-2012 and a matched general population control group with linked register information on employment, long-term sick leave, and disability pension. Logistic regression with interaction effects between CMD and sociodemographic indicators are used to estimate labour market consequences of CMD in the different population subgroups. CMD have a negative impact on all labour market outcomes studied, reducing employment while increasing the risk of long term sick leave and disability pension. However, the associated effect is found to be stronger for men than women, except for disability pension where consequences are similar. Surprisingly, high educated individuals suffer worse labour market consequences than low educated. Consequences of CMD in labour market outcomes are not consistent across different age-groups and country of birth. Inequalities in the labour market consequences of common mental disorders sometimes contributes to, and sometimes mitigates, societal inequalities in employment, long term sick leave and disability pension. When developing new strategies to tackle mental ill health in the population, it may therefore be motivated to consider not only inequalities in the prevalence of mental disorders, but also inequalities in the consequences of these disorders.

http://portal.research.lu.se/portal/en/publications/inequalities-in-labour-market-consequences-of-common-mental-disorders(bda19b5d-cd26-48c0-b7a2-0e863d2d1bfc).html

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June 2018
7 Reads

Cost-effectiveness of supported employment adapted for people with affective disorders.

Nord J Psychiatry 2018 Apr 9;72(3):236-239. Epub 2018 Jan 9.

a Health Economics Unit, Department of Clinical Science (Malmö) , Lund University , Lund , Sweden.

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http://dx.doi.org/10.1080/08039488.2017.1422801DOI Listing
April 2018
15 Reads
1.500 Impact Factor

Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis

International Journal of Environmental Research and Public Health

This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.

http://portal.research.lu.se/portal/en/publications/measuring-quality-gaps-in-tb-screening-in-south-africa-using-standardised-patient-analysis(f13d3416-ce16-40fc-a825-aecc80e887a5).html

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April 2018
8 Reads

Could Easier Access to University Improve Health and Reduce Health Inequalities?

Working Papers

This paper estimates the impact of university education on medical care use and its income related inequality. We do this by exploiting an arbitrary university eligibility rule in Sweden combined with regression discontinuity design for the years 2003-2013 for students who graduated 2003-2005. We find a clear jump in university attendance due to university eligibility. This jump coincides with a positive jump in prescriptions for contraceptives for females but also a positive jump in mental health related hospital admissions for males. Analysis of the inequality impact of tertiary eligibility finds no clear impact on medical care use by socioeconomic status of the parents. The results imply that easing access to university for the lower ability student will lead to an increase in contraceptive use without increasing its socioeconomic related inequality. At the same time, the results highlight that universities may need to do more to take care of the mental health of their least able students.

http://portal.research.lu.se/portal/en/publications/could-easier-access-to-university-improve-health-and-reduce-health-inequalities(0d0d3f64-37b6-4964-a8ec-93b315d98bf5).html

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March 2018
7 Reads

Valuing a Lifestyle Intervention for Middle Eastern Immigrants at Risk of Diabetes

International Journal of Environmental Research and Public Health

Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for assessing the value of interventions. The objective of this study was to estimate WTP and its predictors in a randomized controlled trial of a lifestyle intervention exclusively targeting Middle Eastern immigrants living in Malmö, Sweden, who are at high risk of type 2 diabetes. We used the contingent valuation method to evaluate WTP. The questionnaire was designed following the payment-scale approach, and administered at the end of the trial, giving an ex-post perspective. We performed logistic regression and linear regression techniques to identify the factors associated
with zero WTP value and positive WTP values. The intervention group had significantly higher average WTP than the control group (216 SEK vs. 127 SEK; p= 0.035; 1 U.S.$ = 8.52 SEK, 2015 price year) per month. The regression models demonstrated that being in the intervention group, acculturation, and self-employment were significant factors associated with positive WTP values. Male participants and lower-educated participants had a significantly higher likelihood of zero WTP. In this era of increased
migration, our findings can help policy makers to take informed decisions to implement lifestyle interventions for immigrant populations.

http://portal.research.lu.se/portal/en/publications/valuing-a-lifestyle-intervention-for-middle-eastern-immigrants-at-risk-of-diabetes(a5ef8de3-7324-4270-b619-096e7782605b).html

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February 2018
7 Reads

Socioeconomic Inequalities in the Kidney Transplantation Process: A Registry-Based Study in Sweden.

Transplant Direct 2018 Feb 2;4(2):e346. Epub 2018 Feb 2.

Health Economics Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1097/TXD.0000000000000764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811275PMC
February 2018
21 Reads

Why childhood-onset type 1 diabetes impacts labour market outcomes: a mediation analysis.

Diabetologia 2018 02 23;61(2):342-353. Epub 2017 Nov 23.

Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Medicon Village, 223 81, Lund, Sweden.

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http://dx.doi.org/10.1007/s00125-017-4472-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448960PMC
February 2018
9 Reads
1 Citation
6.671 Impact Factor

Valuing a Lifestyle Intervention for Middle Eastern Immigrants at Risk of Diabetes.

Int J Environ Res Public Health 2018 02 27;15(3). Epub 2018 Feb 27.

Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Skåne University Hospital, SE-20502 Malmö, Sweden.

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http://dx.doi.org/10.3390/ijerph15030413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876958PMC
February 2018
22 Reads
2.063 Impact Factor

Socioeconomic inequalities in the kidney transplantation process

Transplant Direct

Background. Few studies have examined the association between individual-level socioeconomic status and access to kidney transplantation. This study aims to investigate the association between predialysis income and education, and access to (i) the kidney waitlist (first listing), and (ii) kidney transplantation conditional on waitlist placement. Adjustment will be made for a number of medical and nonmedical factors. Methods. The Swedish Renal Register was linked to national registers for adult patients in Sweden who started dialysis during 1995 to 2013. We employed Cox proportional hazards models. Results. Nineteen per cent of patients were placed on the waitlist. Once on the waitlist, 80% received kidney transplantation. After adjusting for covariates,patients in the highest income quintile were found to have higher access to both the waitlist (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.53-1.96) and kidney transplantation (HR, 1.33; 95% CI, 1.16-1.53) compared with patients in the lowest incomequintile. Patients with higher education also had better access to the waitlist and kidney transplantation (HR, 2.16; 95% CI, 1.94-2.40; and HR, 1.16; 95% CI, 1.03-1.30, respectively) compared with patients with mandatory education. Conclusions. Socioeconomic status-related inequalities exist with regard to both access to the waitlist, and kidney transplantation conditional on listing. However, the former inequality is substantially larger and is therefore expected to contribute more to societal inequalities. Further studies are needed to explore the potential mechanisms and strategies to reduce these inequalities.

http://portal.research.lu.se/portal/en/publications/socioeconomic-inequalities-in-the-kidney-transplantation-process(5cf553f9-a771-478b-8ca6-6988cf95cff9).html

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January 2018
7 Reads

Too Young to Die: Regression Discontinuity of a Two-Part Minimum Legal Drinking Age Policy and the Causal Effect of Alcohol on Health

Working Papers

This study examines the impact of Sweden’s unique two-part Minimum Legal Drinking Age (MLDA) policy on alcohol consumption and health using regression discontinuity design. In Sweden on-licence purchasing of alcohol is legalised at 18 and off-licence purchasing is legalised later at 20 years of age. We find an immediate and significant 6% jump in participation and a larger increase in number of days drinking at age 18 of about 16% but no large jumps at age 20. No discernible increases in mortality at age 18 or 20 are found but hospital visits due to external causes do see an increase at both 18 and 20 years. Compared to previous findings for single MLDAs the alcohol impacts we find are smaller and the health impacts less severe. The findings suggest that a two-part MLDA can help young adults in their transition to unrestricted alcohol and help contain the negative health impacts that have been observed elsewhere.

http://portal.research.lu.se/portal/en/publications/too-young-to-die-regression-discontinuity-of-a-twopart-minimum-legal-drinking-age-policy-and-the-causal-effect-of-alcohol-on-health(2693609a-fc13-4346-b239-f33aea3789c6).html

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January 2018
7 Reads

The Long-Term Impact of Education on Mortality and Health: Evidence from Sweden

Working Papers

There is a well-documented large positive correlation between education and health and yet it remains unclear as to whether this is a causal relationship. Potential reasons for this lack of clarity include estimation using different methods, analysis of different populations and school reforms that are different in design. In this paper we assess whether the type of school reform, the instrument and therefore subgroup identified and the modelling strategy impact the estimated health returns to education. To this end we use both Regression Discontinuity and Difference in Differences applied to two Swedish school reforms that are different in design but were implemented across overlapping cohorts born between 1938 and 1954 and follow them up until 2013. We find small and insignificant impacts on overall mortality and its common causes and the results are robust to regression method, identification strategy and type of school reform. Extending the analysis to hospitalisations or self-reported health and health behaviours, we find no clear evidence of health improvements due to increased education. Based on the results we find no support for a positive causal effect of education on health.

http://portal.research.lu.se/portal/en/publications/the-longterm-impact-of-education-on-mortality-and-health-evidence-from-sweden(09c611de-db66-4b75-b05a-0854c37fe706).html

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January 2018
7 Reads

Social Assistance and Mental Health: Evidence from Longitudinal Data on Pharmaceutical Consumption

Working Papers

This paper examines the short-term effect between take-up of Social Assistance Benefit (SAB) and mental health. Using a panel dataset including rich yearly register data on e.g. income, income sources, unemployment and types of pharmaceutical consumption for over 140,000 Swedes 2006-2012, we quantify the importance of the psychosocial dimensions (e.g. shame and guilt) of the socioeconomic status – mental health nexus. Our main independent variable is an indicator for SAB, which is the means-tested last-resort option for individuals with no other means to cover necessary living expenses, received by six per cent of all Swedish households annually. Mental ill-health is measured by data on prescribed antidepressants, anxiolytics, or hypnotics. While SAB strongly associates with psychopharmaca consumption in a cross-section of observations, the association largely disappear once we introduce individual fixed effects. These results indicate that other mechanisms than shame or guilt related to the SAB experience are more important for mental health in the short term.

http://portal.research.lu.se/portal/en/publications/social-assistance-and-mental-health-evidence-from-longitudinal-data-on-pharmaceutical-consumption(88936919-b53d-4443-aba0-3aa468dd6d35).html

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January 2018
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Mortality and the business cycle: Evidence from individual and aggregated data.

J Health Econ 2017 12 14;56:61-70. Epub 2017 Sep 14.

Faculty of Medicine, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1016/j.jhealeco.2017.09.005DOI Listing
December 2017
15 Reads
2.580 Impact Factor

Mortality and the business cycle

Working Papers

There has been much interest recently in the relationship between economic conditions and mortality, with some studies showing that mortality is pro-cyclical, while others find the opposite. Some suggest that the aggregation level of analysis (e.g. individual vs. regional) matters. We use both individual and aggregated data on a sample of 20-64 year-old Swedish men from 1993 to 2007. Our results show that the association between the business cycle and mortality does not depend on the level of analysis: the sign and magnitude of the parameter estimates are similar at the individual level and the aggregate (county) level; both showing pro-cyclical mortality.

http://portal.research.lu.se/portal/en/publications/mortality-and-the-business-cycle(ae94de2f-a12a-414a-a463-c3cf22dcba8c).html

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December 2017
8 Reads

Measuring the end-of-life premium in cancer using individual ex ante willingness to pay

European Journal of Health Economics

For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per quality-adjusted life-year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so-called end-of-life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20–80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4–10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. Order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity. Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies.

http://portal.research.lu.se/portal/en/publications/measuring-the-endoflife-premium-in-cancer-using-individual-ex-ante-willingness-to-pay(2c85eda1-5fa7-46c2-af57-5b365f5cc697).html

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August 2017
7 Reads

Frequency and intensity of alcohol consumption: new evidence from Sweden.

Eur J Health Econ 2017 May 9;18(4):495-517. Epub 2016 Jun 9.

Health Economics and Management, Institute of Economic Research, Lund University, Box 117, 22100, Lund, Sweden.

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http://dx.doi.org/10.1007/s10198-016-0805-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387029PMC
May 2017
16 Reads

Frequency and intensity of alcohol consumption: new evidence from Sweden.

Authors:

The European journal of health economics : HEPAC : health economics in prevention and care

http://europepmc.org/abstract/med/27282872

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May 2017
7 Reads

Economic Burden of Obesity: A Systematic Literature Review.

Int J Environ Res Public Health 2017 04 19;14(4). Epub 2017 Apr 19.

Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden.

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http://dx.doi.org/10.3390/ijerph14040435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409636PMC
April 2017
21 Reads
16 Citations
2.063 Impact Factor

Economic burden of obesity

International Journal of Environmental Research and Public Health

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.

http://portal.research.lu.se/portal/en/publications/economic-burden-of-obesity(7578ab72-485b-4d70-bb47-466a4382250f).html

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April 2017
7 Reads

Are there inequities in treatment of end-stage renal disease in Sweden? A longitudinal register-based study on socioeconomic status-related access to kidney transplantation

International Journal of Environmental Research and Public Health

Socioeconomic status-related factors have been associated with access to kidney transplantation, yet few studies have investigated both individual income and education as determinates of access to kidney transplantation. Therefore, this study aims to explore the effects of both individual income and education on access to kidney transplantation, controlling for both medical and non-medical factors. We linked the Swedish Renal Register to national registers for a sample of adult patients who started Renal Replacement Therapy (RRT) in Sweden between 1 January 1995, and 31 December 2013. Using uni- and multivariate logistic models, we studied the association between pre-RRT income and education and likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, we also used multivariate Cox proportional hazards regression analysis to assess the association between treatment and socioeconomic factors. Among the 16,215 patients in the sample, 27% had received kidney transplantation by the end of 2013. After adjusting for covariates, the highest income group had more than three times the chance of accessing kidney transplantation compared with patients in the lowest income group (odds ratio (OR): 3.22; 95% confidence interval (CI): 2.73–3.80). Patients with college education had more than three times higher chance of access to kidney transplantation compared with patients with mandatory education (OR: 3.18; 95% CI: 2.77–3.66). Neither living in the county of the transplantation center nor gender was shown to have any effect on the likelihood of receiving kidney transplantation. For non-pre-emptive transplantation patients, the results from Cox models were similar with what we got from logistic models. Sensitive analyses showed that results were not sensitive to different conditions. Overall, socioeconomic status-related inequities exist in access to kidney transplantation in Sweden. Additional studies are needed to explore the possible mechanisms and strategies to mitigate these inequities.

http://portal.research.lu.se/portal/en/publications/are-there-inequities-in-treatment-of-endstage-renal-disease-in-sweden-a-longitudinal-registerbased-study-on-socioeconomic-statusrelated-access-to-kidney-transplantation(f7b38627-a9b4-4b45-a958-39629375233e).html

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February 2017
7 Reads

Are There Inequities in Treatment of End-Stage Renal Disease in Sweden? A Longitudinal Register-Based Study on Socioeconomic Status-Related Access to Kidney Transplantation.

Int J Environ Res Public Health 2017 01 27;14(2). Epub 2017 Jan 27.

Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden.

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http://dx.doi.org/10.3390/ijerph14020119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5334673PMC
January 2017
20 Reads
1 Citation
2.063 Impact Factor

Impact of a Tertiary Eligibility Threshold on Tertiary Education and Earnings

Working Papers

This study evaluates the impact of achieving tertiary eligibility in upper-secondary education on tertiary education and earnings in Sweden. Using a regression discontinuity design, we estimate the impact of tertiary eligibility and show that it has a substantial impact on the probability of enrolling in tertiary education. For students who achieve tertiary eligibility, the probability of enrolling in tertiary education increases by around 15 and 7 percentage points for an academic and vocational track, respectively. This implies (before age 30) around 8 percent higher earnings (at the intensive margin) for men on an academic track, while for women on an academic track it increases the probability of having positive incomes (the extensive margin) by around 3 percent. Thus, we conclude that (academic) students at the margin of eligibility for enrolling in tertiary education receive a substantial tertiary education payoff.

http://portal.research.lu.se/portal/en/publications/impact-of-a-tertiary-eligibility-threshold-on-tertiary-education-and-earnings(2c24af79-54e5-4016-b234-9a765e4cc391).html

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January 2017
7 Reads

Socio-economic inequalities in health and health service use among older adults in India: results from the WHO Study on Global AGEing and adult health survey.

Public Health 2016 Dec 16;141:32-41. Epub 2016 Sep 16.

Section for Health Promotion and Health Services Research, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.

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http://dx.doi.org/10.1016/j.puhe.2016.08.005DOI Listing
December 2016
7 Reads
1.480 Impact Factor

Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries: World Health Organization Study on Global AGEing and Adult Health.

Am J Geriatr Psychiatry 2016 12 25;24(12):1196-1208. Epub 2016 Jul 25.

Department of Psychiatry, Christian Medical College, Vellore, India.

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http://dx.doi.org/10.1016/j.jagp.2016.07.016DOI Listing
December 2016
21 Reads
3 Citations
4.240 Impact Factor

Labor market consequences of childhood onset type 1 diabetes.

Econ Hum Biol 2016 12 14;23:180-192. Epub 2016 Sep 14.

Health Economics Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden; Health Economics Program, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1016/j.ehb.2016.09.003DOI Listing
December 2016
16 Reads
3 Citations
1.901 Impact Factor

Value of a QALY and VSI Estimated with the Chained Approach

Working Papers

The value of a Quality-Adjusted Life-Year (QALY) and the Value of a Statistical Injury (VSI) are important measures within health economics and transport economics. Several studies have therefore estimated people’s WTP for these estimates, but most results show problems with scale insensitivity. The Chained Approach (CA) is a method developed to reduce this problem. The objective of this study was to estimate the value of a QALY and VSI in the context of non-fatal road traffic accidents using CA. Data was collected from a total of 800 individuals in the Swedish adult general population using two web-based questionnaires. The result showed evidence of scale sensitivity both within and between samples. The value of a QALY based on trimmed individual estimates where close to constant at €300,000 irrespective of the type and size of the QALY gain. The study shows promising results for using the original CA to estimate the value of a QALY and VSI. It also supports the use of a constant value of a QALY, but at a higher level than what is currently applied by HTA’s.

http://portal.research.lu.se/portal/en/publications/value-of-a-qaly-and-vsi-estimated-with-the-chained-approach(f9f282d5-a9ba-47b6-89f5-36946962be6c).html

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December 2016
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Chained Approach vs Contingent Valuation for Estimating the Value of Risk Reduction

Working Papers

To decide how much resources to spend on reducing mortality risk, governmental agencies in several countries turn to the value of a statistical life (VSL). VSL has been shown to vary depending on the size of the risk reduction, which indicates that WTP does not increase near-proportional in relation to risk reduction as suggested by standard economic theory. Chained approach (CA) is a stated preference method that was designed to deal with this problem. The objective of this study was to compare CA to the more traditional approach contingent valuation (CV). Data was collected from 500 individuals in the Swedish adult general population using two web-based questionnaires, whereof one based on CA and the other on the CV method. Despite the two different ways of deriving the estimates, the methods showed similar results. The CV result showed scale insensitivity with respect to the size of the risk reduction and disease duration and resulted in more zero and protest response. The CA result did also vary depending on the procedure used, but not when chaining on individual estimates. The CA result was also found to be more sensitive to disease duration and severity. This study provides support for the validity of studies of the WTP for a risk reduction. It also shows that CA is associated with encouraging features for the valuation of non-fatal road traffic accidents, but the result does not support the use of one method over the other.

http://portal.research.lu.se/portal/en/publications/chained-approach-vs-contingent-valuation-for-estimating-the-value-of-risk-reduction(616b036e-f49f-4889-bfd3-67f1716702fe).html

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December 2016
7 Reads

Socio-economic inequalities in health and health service use among older adults in India

Public Health

Objective The objectives of this study were to measure socio-economic inequalities in self-reported health (SRH) and healthcare visits and to identify factors contributing to health inequalities among older people aged 50-plus years. Study design This study is based on a population-based, cross-sectional survey. Methods We accessed data of 7150 older adults from the World Health Organization's Study on Global AGEing and adult health Indian survey. We used multivariate logistic regression to assess the correlates of poor SRH. We estimated the concentration index to measure socio-economic inequalities in SRH and healthcare visits. Regression-based decomposition analysis was employed to explore the correlates contributing to poor SRH inequality. Results About 19% (95% CI: 18%, 20%) reported poor health (n = 1368) and these individuals were significantly less wealthy. In total, 5134 (71.8%) participants made at least one health service visit. Increasing age, female gender, low social caste, rural residence, multimorbidity, absence of pension support, and health insurance were significant correlates of poor SRH. The standardized concentration index of poor SRH –0.122 (95% CI: –0.102; –0.141) and healthcare visits 0.364 (95% CI: 0.324, 0.403) indicated pro-poor and pro-rich inequality, respectively. Economic status (62.3%), pension support (11.5%), health insurance coverage (11.5%), social caste (10.7%) and place of residence (4.1%) were important contributors to inequalities in poor health. Conclusion Socio-economic disparities in health and health care are major concerns in India. Achievement of health equity demand strategies beyond health policies, to include pro-poor, social welfare policies among older Indians.

http://portal.research.lu.se/portal/en/publications/socioeconomic-inequalities-in-health-and-health-service-use-among-older-adults-in-india(18945445-1d49-4495-b7b8-590290c0f5f7).html

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December 2016
7 Reads

Labor market consequences of childhood onset type 1 diabetes

Economics and Human Biology

This paper examines the effect of the onset of Type 1 Diabetes Mellitus (T1DM) before 15 years of age on labor market outcomes and contributes to the literature on effects of childhood health on adult socioeconomic status. Using national Swedish socioeconomic register data 1991–2010 for 2485 individuals born 1972–1978 with onset of T1DM in 1977–1993, we find that T1DM in childhood has a negative effect on labor market outcomes later in life. Part of the T1DM effect is channeled through occupational field which may be related to both choice and opportunities. Although the magnitude of the effect is only directly generalizable to illnesses with similar attributes as T1DM, the results suggest that causality in the often observed correlation between health and socioeconomic status, at least partly, is explained by an effect running from health to earnings. This has implications for research and policy on strategies to reduce socioeconomic-related health inequality. Our findings also shed light on productivity losses, measured by employment status and earnings due to childhood onset T1DM, which have implications for both the individual and society.

http://portal.research.lu.se/portal/en/publications/labor-market-consequences-of-childhood-onset-type-1-diabetes(c1ba7bda-da8e-4c8e-b74a-5c77d373bf9f).html

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December 2016
7 Reads

Health, Social, and Economic Variables Associated with Depression Among Older People in Low and Middle Income Countries

American Journal of Geriatric Psychiatry

Objective Although depression among older people is an important public health problem worldwide, systematic studies evaluating its prevalence and determinants in low and middle income countries (LMICs) are sparse. The biopsychosocial model of depression and prevailing socioeconomic hardships for older people in LMICs have provided the impetus to determine the prevalence of geriatric depression; to study its associations with health, social, and economic variables; and to investigate socioeconomic inequalities in depression prevalence in LMICs. Methods The authors accessed the World Health Organization Study on Global AGEing and Adult Health Wave 1 data that studied nationally representative samples from six large LMICs (N = 14,877). A computerized algorithm derived depression diagnoses. The authors assessed hypothesized associations using survey multivariate logistic regression models for each LMIC and pooled their risk estimates by meta-analyses and investigated related socioeconomic inequalities using concentration indices. Results Cross-national prevalence of geriatric depression was 4.7% (95% CI: 1.9%–11.9%). Female gender, illiteracy, poverty, indebtedness, past informal-sector occupation, bereavement, angina, and stroke had significant positive associations, whereas pension support and health insurance showed significant negative associations with geriatric depression. Pro-poor inequality of geriatric depression were documented in five LMICs. Conclusions Socioeconomic factors and related inequalities may predispose, precipitate, or perpetuate depression amongolder people in LMICs. Relative absence of health safety net places socioeconomically disadvantaged older people in LMICs at risk. The need for population-based public health interventions and policies to prevent and to manage geriatric depression effectively in LMICs cannot be overemphasized.

http://portal.research.lu.se/portal/en/publications/health-social-and-economic-variables-associated-with-depression-among-older-people-in-low-and-middle-income-countries(e8b546ed-e80a-4e2c-bbc6-05e20c539096).html

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December 2016
7 Reads

Effect of Type 1 Diabetes on School Performance in a Dynamic World

Working Papers

This paper investigates if the effect of type 1 diabetes mellitus (T1DM) on school performance has changed over time using national Swedish population register data. The issue is of interest because management and treatment of the disease have improved over the last decades and, furthermore, because of changes in the educational grading system. Despite these changes, data indicate a persistent negative effect of T1DM on compulsory and upper secondary school grades and the results appears similar to earlier findings on cohorts completing school under the previous grading system. Moreover, the results are robust to alternative model specifications and econometric estimation strategies. Whereas access to new treatment technologies and improved diabetes management strategies has reduced the burden of diabetes in daily life, the results from this study indicate that other trends have not implied a reduction, over time, in the impact of T1DM on school performance. This finding indicates that continued efforts are needed to improve the situation in school for children with T1DM to prevent potential long-term socioeconomic consequences.

http://portal.research.lu.se/portal/en/publications/effect-of-type-1-diabetes-on-school-performance-in-a-dynamic-world(2c58502d-f170-4b61-8124-e68b516e62dd).html

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October 2016
7 Reads

Socioeconomic inequalities in breast cancer incidence and mortality in Europe-a systematic review and meta-analysis.

Eur J Public Health 2016 10 23;26(5):804-813. Epub 2016 May 23.

IHE, The Swedish Institute for Health Economics, Lund, Sweden.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5054273PMC
http://dx.doi.org/10.1093/eurpub/ckw070DOI Listing
October 2016
12 Reads
7 Citations
2.591 Impact Factor

Socioeconomic inequalities in breast cancer incidence and mortality in Europe - A systematic review and meta-analysis

European Journal of Public Health

Background: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous. Methods: We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated. Results: The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17-1.32), a significantly decreased case fatality (SRR 0.72, 0.63-0.81) and a significantly increased mortality (SRR 1.16, 1.10-1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors. Conclusion: Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.

http://portal.research.lu.se/portal/en/publications/socioeconomic-inequalities-in-breast-cancer-incidence-and-mortality-in-europe--a-systematic-review-and-metaanalysis(88152fdc-cbd5-4164-84f0-d5eac5793157).html

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October 2016
7 Reads

The Dynamics of Income-Related Health Inequalities in Australia versus Great Britain

Working Papers

This study compares the evolution of income-related health inequality (IRHI) in Australia (2001–2006) and in Great Britain (1999–2004) by exploring patterns of morbidity- and mortality-related health changes across income groups. Using Australian longitudinal data, the change in health inequality is decomposed into those changes related to health changes (income-related health mobility) and income changes (health-related income mobility), and compared with recent results from Great Britain. Absolute IRHI increased for both sexes, indicating greater absolute health inequality in Australia over this period, similar to that seen in Great Britain. The income-related health mobility indicates that this was due to health losses over this period being concentrated in those initially poor who were significantly more likely to die. The health-related income mobility further indicates that those who moved up the income distribution during the period were more likely to be those who were healthy. Australian estimates of mobility measures are similar, if not greater, in magnitude than for Great Britain. While reducing health inequality remains high on the political agenda in Great Britain, it has received less attention in Australia even though the evidence provided here suggests it should receive more attention.

http://portal.research.lu.se/portal/en/publications/the-dynamics-of-incomerelated-health-inequalities-in-australia-versus-great-britain(ca1f7e1e-3385-4123-9b5f-646fe500a076).html

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September 2016
7 Reads

Day-to-Day Living Expenses and Mental Health

Working Papers

We use rich longitudinal survey and register data on Swedish individuals to examine the relationship between financial strain and mental health. Specifically, we consider the longitudinal relationships between payment difficulties and subjective (self-reported anxiety) as well as objective (psychiatric drug use) measures of mental ill-health. Among previously healthy individuals, payment difficulty experiences are strongly associated with self-reported mental ill-health. The association with later psychiatric drug use is weaker and differs by gender. Psychiatric drug users are on the other hand at high risk of later experiencing payment difficulties. This indicates that policy measures regarding the payment difficulties–health nexus ought to prioritize activities improving mental health.

http://portal.research.lu.se/portal/en/publications/daytoday-living-expenses-and-mental-health(1106a379-e192-4378-b63b-6d7a4493e0b8).html

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August 2016
7 Reads

A general method for decomposing the causes of socioeconomic inequality in health.

J Health Econ 2016 07 7;48:89-106. Epub 2016 Apr 7.

Department of Economics, University of Gothenburg, Gothenburg, Sweden; Centre of Health Economics at Gothenburg University (CHEGU), Gothenburg, Sweden.

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http://dx.doi.org/10.1016/j.jhealeco.2016.03.006DOI Listing
July 2016
15 Reads
6 Citations
2.580 Impact Factor

A general method for decomposing the causes of socioeconomic inequality in health

Journal of Health Economics

We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality.

http://portal.research.lu.se/portal/en/publications/a-general-method-for-decomposing-the-causes-of-socioeconomic-inequality-in-health(95f9b448-0444-447b-8390-4b26e835eb55).html

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July 2016
8 Reads

The Authors Respond.

Epidemiology 2016 May;27(3):e16-7

Department of Economics, University of Gothenburg, Centre for Health Economics at the University of Gothenburg (CHEGU), Gothenburg, Sweden, of Economics, Health Economics & Management, Institute of Economic Research, Lund University, Lund, SwedenCenter for Primary Health Care Research, Lund University/Region Skåne, Lund, SwedenCentre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1097/EDE.0000000000000441DOI Listing
May 2016
14 Reads
6.200 Impact Factor

The Authors Respond.

Authors:
May 2016
7 Reads

Measuring the End of Life Premium in Cancer using Individual ex ante Willingness to Pay

Working Papers

For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per Quality-Adjusted Life-Years (QALY) gained. Some HTAs accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so called End-Of-Life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20-80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The value of a QALY at EoL in cancer was between €275,000 and €440,000, which is higher than the thresholds applied by HTAs. When expected remaining life expectancy was 6 months, the value of a QALY was 10-20 % higher compared to when remaining life expectancy was 24 months. Order of scenarios did not have a significant impact on the result and the result showed scale sensitivity. Thus this study supports an EoL premium in cancer when expected remaining lifetime is short.

http://portal.research.lu.se/portal/en/publications/measuring-the-end-of-life-premium-in-cancer-using-individual-ex-ante-willingness-to-pay(58602f81-aef3-42b1-afa4-f49fea30779e).html

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January 2016
7 Reads

Health behavior in the Nordic countries

Nordic Journal of Health Economics

This paper provides a descriptive analysis of the level of and change in cigarette smoking, excessive alcohol consumption and body weight in Nordic countries and compares them with non-Nordic OECD countries. Our results show that the average prevalence of daily smokers is significantly lower for Nordic countries compared to non-Nordic countries. Four out of five Nordic countries are below the non-Nordic average. However, for alcohol consumption and obesity, it is more difficult to see a clear difference between Nordic countries and non-Nordic countries. Sweden ranks relatively low on all three health behaviors, while alcohol consumption is relatively high in Finland and Denmark. Smoking rates are relatively high in Norway, while the obesity rate is relatively high in Iceland. We conclude that although Nordic populations are often perceived as relatively homogeneous in terms of cultural and political aspects, there are interesting differences in health behaviors within these Nordic countries. These differences need more focus in health-economics research and may have a significant potential in light of the availability of health surveys and administrative register data that can sometimes be linked at the individual level. Such Nordic analyses may, in general, help to move the research front forward and can also be used to predict changes in population health and to study the effectiveness of health economic policies.

http://portal.research.lu.se/portal/en/publications/health-behavior-in-the-nordic-countries(51535155-0ae6-4678-9af6-3053c66a2859).html

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January 2016
7 Reads

Ekonomisk knapphet, skuldsättning och hälsa

Särtryck

Tillgången på kredit kan öka människors hälsa och välfärd, men mot bakgrund av att skulder så småningom måste betalas tillbaka är det samtidigt tänkbart att överskuldsättning kan ge upphov till försämrad hälsa. I denna rapport använder vi svenska enkät- och registerdata på individnivå för att närmare studera denna fråga. Särskilt undersöker vi sambandet mellan betalningssvårigheter och olika subjektiva och objektiva hälsomått. Vår empiriska analys ger att det inte verkar finnas särskilt starka samband mellan ekonomisk knapphet och hälsa när man tar hänsyn till initial hälsostatus och knapphet. Vi finner visserligen genomgående signifikanta samband mellan betalningssvårigheter och självrapporterad ohälsa, men när vi istället studerar objektiva hälsomått, i form av data från Läkemedelsregistret, noterar vi ingen överrisk för konsumtion av antidepressiva läkemedel, lugnande medel, hjärtmedicin eller blodtrycksmedicin. Däremot finns har individer med betalningssvårigheter en viss överrisk för användande av sömnmedel och magsårsmedel. I en fördjupande analys finner vi att sambandet mellan betalningssvårigheter och senare hälsoproblem till stor del förklaras av inneboende egenskaper, så som exempelvis stresstålighet.

http://portal.research.lu.se/portal/en/publications/ekonomisk-knapphet-skuldsattning-och-halsa(1ef6ea5d-adef-4fd3-a8bb-5e99c3bd413d).html

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January 2016
7 Reads

Dread and Risk Elimination Premium for the Value of a Statistical Life

Working Papers

The Value of a Statistical Life (VSL) is a widely used measure of the value of mortality risk reduction. Since VSL should reflect preferences and attitudes to risk, there are reasons to believe that it varies depending on the type of risk involved. It has been argued that cancer should be considered a “dread disease”, which supports the use of a “cancer premium”. The objective of this study is to elicit the existence and size of a cancer premium (for pancreatic cancer and multiple myeloma) in relation to road traffic accidents, sudden cardiac arrest and Amyotrophic Lateral Sclerosis (ALS). Data was collected from 500 individuals in the Swedish general population 50 -74 years old using a web-based questionnaire. Preferences were elicited using the Contingent Valuation method, and a split-sample design was applied to test for scale sensitivity. VSL differs significantly between contexts, being highest for ALS and lowest for road traffic accident. A premium (26-76 %) for cancer was found in relation to road traffic accidents, but not in relation to ALS and sudden cardiac arrest. The premium was higher for cancer with a shorter time from diagnosis to death. Eliminating risk was associated with a premium of around 17 %. Evidence of scale sensitivity was found when comparing WTP for all risks simultaneously. This study shows that there exist a dread premium and risk elimination premium. These factors should be considered when searching for an appropriate value for economic evaluation and health technology assessment.

http://portal.research.lu.se/portal/en/publications/dread-and-risk-elimination-premium-for-the-value-of-a-statistical-life(0a1332ef-8c9f-48d0-906e-c2d793ca825c).html

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January 2016
7 Reads

Misreporting and misclassification: implications for socioeconomic disparities in body-mass index and obesity.

Ljungvall A, Gerdtham UG, Lindblad U, The European journal of health economics : HEPAC : health economics in prevention and care, 2013

http://europepmc.org/abstract/med/24363175

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December 2015
7 Reads

Does the choice of EQ-5D tariff matter? A comparison of the Swedish EQ-5D-3L index score with UK, US, Germany and Denmark among type 2 diabetes patients.

Health Qual Life Outcomes 2015 Sep 15;13:145. Epub 2015 Sep 15.

Health Economics Unit, Department of Clinical Sciences-Malmö, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1186/s12955-015-0344-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572641PMC
September 2015
17 Reads
3 Citations
2.120 Impact Factor

Lies, Damned Lies, and Health Inequality Measurements: Understanding the Value Judgments.

Epidemiology 2015 Sep;26(5):673-80

From the aDepartment of Economics, University of Gothenburg, Gothenburg, Sweden; bDepartment of Economics, cHealth Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden; dCenter for Primary Health Care Research, Lund University/Region Skåne, Lund, Sweden; and eCentre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.

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http://dx.doi.org/10.1097/EDE.0000000000000319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521896PMC
September 2015
15 Reads
10 Citations
6.200 Impact Factor

Productivity or discrimination? An economic analysis of excess-weight penalty in the Swedish labor market.

Eur J Health Econ 2015 Jul 6;16(6):589-601. Epub 2014 Jun 6.

Department of Economics, Lund University, P.O. Box 7082, 220 07, Lund, Sweden,

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http://dx.doi.org/10.1007/s10198-014-0611-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464599PMC
July 2015
16 Reads

Productivity or discrimination? An economic analysis of excess-weight penalty in the Swedish labor market.

Dackehag M, Gerdtham UG, Nordin M, The European journal of health economics : HEPAC : health economics in prevention and care, 2014

http://europepmc.org/abstract/med/24903023

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June 2015
7 Reads

Are lifestyle interventions in primary care cost-effective?--An analysis based on a Markov model, differences-in-differences approach and the Swedish Björknäs study.

PLoS One 2013 14;8(11):e80672. Epub 2013 Nov 14.

Centre for Primary Healthcare Research, Skåne University Hospital, Malmö, Lund University/Region Skåne, Malmö, Sweden ; Health Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden.

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0080672PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828270PMC
February 2015
11 Reads
1 Citation
3.234 Impact Factor

Misreporting and misclassification: implications for socioeconomic disparities in body-mass index and obesity.

Eur J Health Econ 2015 Jan 21;16(1):5-20. Epub 2013 Dec 21.

Department of Economics, Lund University, P.O. Box 7082, 220 07, Lund, Sweden,

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http://dx.doi.org/10.1007/s10198-013-0545-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286627PMC
January 2015
18 Reads
4 Citations

The future of health economics: the potential of behavioral and experimental econmics

Nordic Journal of Health Economics

Health care systems around the globe are facing great challenges. The demand for health care is increasing due to the continuous development of new medical technologies, changing demographics, increasing income levels, and greater expectations from patients. The possibilities and willingness to expand health care resources, however, are limited. Consequently, health care organizations are increasingly required to take economic restrictions into account, and there is an urgent need for improved efficiency. It is reasonable to ask whether the health economics field of today is prepared and equipped to help us meet these challenges. Our aim with this article is twofold: to introduce the fields of behavioral and experimental economics and to then identify and characterize health economics areas where these two fields have a promising potential. We also discuss the advantages of a pluralistic view in health economics research, and we anticipate a dynamic future for health economics.

http://portal.research.lu.se/portal/en/publications/the-future-of-health-economics-the-potential-of-behavioral-and-experimental-econmics(1018357a-c9ac-40f9-9dc1-5cb6a0c75999).html

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January 2015
7 Reads

Cost-Effectiveness and Heterogeneity: Using Finite Mixtures of Disease Activity Models to Identify and Analyze Phenotypes

Working Paper / Department of Economics, School of Economics and Management, Lund University

Heterogeneity in patient populations is an important issue in health economic evaluations, as the cost-effectiveness of an intervention can vary between patient subgroups, and an intervention which is not cost-effective in the overall population may be cost-effective in particular subgroups. Identifying such subgroups is of interest in the allocation of healthcare resources. Our aim was to develop a method for cost-effectiveness analysis in heterogeneous chronic diseases, by identifying subgroups (phenotypes) directly relevant to the cost-effectiveness of an intervention, and by enabling cost-effectiveness analyses of the intervention in each of these phenotypes. We identified phenotypes based on healthcare resource utilization, using finite mixtures of underlying disease activity models: first, an explicit disease activity model, and secondly, a model of aggregated disease activity. They differed with regards to time-dependence, level of detail, and what interventions they could evaluate. We used them for cost-effectiveness analyses of two hypothetical interventions. Allowing for different phenotypes improved model fit, and was a key step towards dealing with heterogeneity. The cost-effectiveness of the interventions varied substantially between phenotypes. Using underlying disease activity models for identifying phenotypes as well as cost-effectiveness analysis appears both feasible and useful in that they guide the decision to introduce an intervention.

http://portal.research.lu.se/portal/en/publications/costeffectiveness-and-heterogeneity-using-finite-mixtures-of-disease-activity-models-to-identify-and-analyze-phenotypes(35786f95-426f-4019-bf87-98736c5008eb).html

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January 2015
7 Reads

Cost-utility analysis of glucagon-like Peptide-1 agonists compared with dipeptidyl peptidase-4 inhibitors or neutral protamine hagedorn Basal insulin as add-on to metformin in type 2 diabetes in sweden.

Diabetes Ther 2014 Dec 12;5(2):591-607. Epub 2014 Sep 12.

Health Economics Unit, Department of Clinical Sciences-Malmö, Lund University, Medicon Village, SE-223 81, Lund, Sweden,

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http://dx.doi.org/10.1007/s13300-014-0080-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269657PMC
December 2014
28 Reads
3 Citations

Patient-reported outcome measures and risk factors in a quality registry: a basis for more patient-centered diabetes care in Sweden.

Int J Environ Res Public Health 2014 Nov 26;11(12):12223-46. Epub 2014 Nov 26.

The National Diabetes Register, SE-413 45 Gothenburg, Sweden.

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http://dx.doi.org/10.3390/ijerph111212223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276611PMC
November 2014
17 Reads
2 Citations
2.063 Impact Factor

Predicting mortality in people with type 2 diabetes mellitus after major complications: a study using Swedish National Diabetes Register data.

Diabet Med 2014 Aug 8;31(8):954-62. Epub 2014 May 8.

Sydney School of Public Health, University of Sydney, Sydney, Australia.

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http://dx.doi.org/10.1111/dme.12468DOI Listing
August 2014
7 Reads
9 Citations
3.120 Impact Factor

Predicting mortality in people with Type 2 diabetes mellitus after major complications: a study using Swedish National Diabetes Register data.

Kelly PJ, Clarke PM, Hayes AJ, Gerdtham UG, Cederholm J, Nilsson P, Eliasson B, Gudbjornsdottir S, Diabetic medicine : a journal of the British Diabetic Association, 2014, vol. 31, no. 8, pp. 954-962

http://europepmc.org/abstract/med/24750341

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August 2014
7 Reads

Forgetting to remember or remembering to forget: a study of the recall period length in health care survey questions.

J Health Econ 2014 May 7;35:34-46. Epub 2014 Feb 7.

Department of Economics, Lund University, P.O. Box 7082, SE-220 07 Lund, Sweden; Health Economics & Management, Institute of Economic Research, Lund University, Sweden; Center for Primary Health Care Research, Lund University/Region Skåne, Sweden.

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http://dx.doi.org/10.1016/j.jhealeco.2014.01.007DOI Listing
May 2014
11 Reads
12 Citations
2.580 Impact Factor

Health utilities of type 2 diabetes-related complications: a cross-sectional study in Sweden.

Int J Environ Res Public Health 2014 May 7;11(5):4939-52. Epub 2014 May 7.

Health Economics Unit, Department of Clinical Sciences, Lund University, Lund 22381, Sweden.

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http://dx.doi.org/10.3390/ijerph110504939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4053909PMC
May 2014
18 Reads
9 Citations
2.063 Impact Factor

Health utilities of type 2 diabetes-related complications: a cross-sectional study in Sweden.

Kiadaliri AA, Gerdtham UG, Eliasson B, Gudbjörnsdottir S, Svensson AM, Carlsson KS, International journal of environmental research and public health, 2014, vol. 11, no. 5, pp. 4939-4952

http://europepmc.org/abstract/med/24810579

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May 2014
7 Reads

Swedish experience-based value sets for EQ-5D health states.

Qual Life Res 2014 Mar 22;23(2):431-42. Epub 2013 Aug 22.

Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden,

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http://dx.doi.org/10.1007/s11136-013-0496-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967073PMC
March 2014
14 Reads
42 Citations
2.490 Impact Factor

Swedish experience-based value sets for EQ-5D health states.

Burström K, Sun S, Gerdtham UG, Henriksson M, Johannesson M, Levin LÅ, Zethraeus N, Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2014, vol. 23, no. 2, pp. 431-442

http://europepmc.org/abstract/med/23975375

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March 2014
7 Reads

[What is the cost of health inequalities?].

Lakartidningen 2013 Nov 20-26;110(47):2124

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January 2014
9 Reads

Measuring health inequalities using the concentration index approach

Encyclopedia of Health Economics

This article briefly reviews the recent discussion on how to use different versions of the concentration index to measure socioeconomic health inequalities; the appropriateness of the different versions depends on the measurement properties of the health variable and the intended value judgment. Using the European Survey of Health, Ageing and Retirement, the article also empirically illustrates the guidelines for practitioners.

http://portal.research.lu.se/portal/en/publications/measuring-health-inequalities-using-the-concentration-index-approach(d31fb10a-85ad-4782-ac19-59fa82602b69).html

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January 2014
7 Reads

Frequency and Intensity of Alcohol Consumption: New Evidence from Sweden

Working Paper / Department of Economics, School of Economics and Management, Lund University

This paper provides an extensive analysis of the demand for alcohol in terms of total quantity and quantity subdivided into frequency and intensity demand. The analysis compares across alcohol types (beer, wine and spirits), alcohol drinking pattern (average drinker vs. binge drinkers) and also how these decisions differ across gender. The analysis is based on a large sample of cross-sectional data from Sweden 2004-11. The results show a positive socioeconomic (income and education) gradient in quantity. This gradient is generally positive in the frequency decision while negative in the intensity decision. Women predominantly choose to drink wine and show a strong positive socioeconomic gradient in both frequency and intensity demand for wine. Binge drinkers show less of a differentiation across alcohol types and this is true even of binge drinking women. Smoking is universally positively associated with quantity, frequency and intensity of alcohol demand with the exception of wine binge drinkers. The results highlight that while quantity consumed has a positive socioeconomic gradient, policies targeted at the less affluent and less educated are likely to have the greatest impact in reducing the social cost of alcohol and in reducing the socioeconomic gradient in health and socioeconomic related health inequality.

http://portal.research.lu.se/portal/en/publications/frequency-and-intensity-of-alcohol-consumption-new-evidence-from-sweden(8604d59c-2e2a-4c64-bda7-b059462899a1).html

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January 2014
7 Reads

Childhood Health and Labor Market Outcomes in the Case of Type 1 Diabetes

Working Paper / Department of Economics, School of Economics and Management, Lund University

This study investigates the impact of childhood health on labor market outcomes. We used type 1 diabetes as an instrument of health because its cause is multifactorial and it is triggered by a complex combination of genetic and environmental components; its incidence is low and unforeseeable for the individual; and its onset may be considered an exogenous health shock. Using data from the Swedish Childhood Diabetes Register and national registers on education, employment, and earnings for 2,485 individuals born in 1972–1978 and diagnosed with type 1 diabetes at <15 years old, we found that childhood health impacts on labor market outcomes. The results also imply that causality in the often observed correlation between health and socioeconomic status is partly explained by a gradient that runs from health to earnings, rather than the other way around, which has important implications for policy to reduce socioeconomic-related health inequality.

http://portal.research.lu.se/portal/en/publications/childhood-health-and-labor-market-outcomes-in-the-case-of-type-1-diabetes(25b2f302-e9ed-4058-8264-97463ee39927).html

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January 2014
7 Reads

A New Approach to Decomposition of a Bivariate Rank Dependent Index Using Recentered Influence Function Regression

Working Paper / Department of Economics, School of Economics and Management, Lund University

Socioeconomic related health inequality as measured by a bivariate rank dependent index, of which the concentration index is a leading example, is well documented across a wide number of countries and measures. To decompose an inequality index is to ascertain the potential causes of this measured inequality. Current available regression based decomposition methods applicable to bivariate rank dependent indices impose stringent conditions in order for them to recover the parameters of interest. In this paper we suggest an alternative and less demanding technique based on a recentered influence function (RIF) regression. Because of the less stringent conditions this method imposes, it is more likely to yield the parameters of interest and is therefore preferred over current best practice. The RIF regression approach is also simple to estimate and interpret: the regression yields average marginal effects of covariates on the rank dependent index and interpretation resembles that of standard conditional mean analysis and has strong links to the treatment effects literature. Interpretation of the RIF regression method applied to a bivariate rank dependent index is illustrated by way of an empirical example of income related health utility inequality.

http://portal.research.lu.se/portal/en/publications/a-new-approach-to-decomposition-of-a-bivariate-rank-dependent-index-using-recentered-influence-function-regression(3574b8d0-d63a-47a7-bfd8-953ce97f7c0c).html

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January 2014
7 Reads

Towards renewed health economic simulation of type 2 diabetes: risk equations for first and second cardiovascular events from Swedish register data.

PLoS One 2013 9;8(5):e62650. Epub 2013 May 9.

Division of Health Economics, Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmö, Sweden.

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062650PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3650043PMC
December 2013
22 Reads
7 Citations
3.234 Impact Factor

Cost of illness studies on reproductive, maternal, newborn, and child health: a systematic literature review.

Health Econ Rev 2013 Nov 11;3(1):24. Epub 2013 Nov 11.

Center for Primary Healthcare Research, Sk?ne University Hospital, Lund University/Region Sk?ne,, Jan Waldenstr?ms gata 35, Malm? SE-205 02, Sweden.

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http://dx.doi.org/10.1186/2191-1991-3-24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177189PMC
November 2013
12 Reads
5 Citations

A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmö): study protocol for a randomized controlled trial.

Trials 2013 Sep 3;14:279. Epub 2013 Sep 3.

Department of Clinical Sciences, Center for Primary Health Care Research, Lund University/Region Skåne, Skåne University Hospital, Building 60, floor 12 Jan Waldenströms gata 37, 205 02 Malmö, Sweden.

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http://dx.doi.org/10.1186/1745-6215-14-279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3844588PMC
September 2013
12 Reads
6 Citations
2.120 Impact Factor

Frontier-based techniques in measuring hospital efficiency in Iran: a systematic review and meta-regression analysis.

BMC Health Serv Res 2013 Aug 15;13:312. Epub 2013 Aug 15.

Division of Health Economics, Department of Clinical Sciences-Malmö, Lund University, Malmö University Hospital, CRC, Entrance 72, House 28, Plan 10, Room 027, 20502 Malmö, Sweden.

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http://dx.doi.org/10.1186/1472-6963-13-312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751475PMC
August 2013
16 Reads
10 Citations
1.660 Impact Factor

Alcohol drinking cessation and the risk of laryngeal and pharyngeal cancers: a systematic review and meta-analysis.

PLoS One 2013 1;8(3):e58158. Epub 2013 Mar 1.

Division of Health Economics, Department of Clinical Sciences, Malmö University Hospital, Lund University, Malmö, Sweden.

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0058158PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585880PMC
August 2013
10 Reads
5 Citations
3.234 Impact Factor

Impact of childhood-onset type 1 diabetes on schooling: a population-based register study.

Diabetologia 2013 Jun 24;56(6):1254-62. Epub 2013 Feb 24.

Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, 205 02 Malmö, Sweden.

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http://dx.doi.org/10.1007/s00125-013-2870-8DOI Listing
June 2013
7 Reads
10 Citations
6.671 Impact Factor

Time characteristics of the effect of alcohol cessation on the risk of stomach cancer--a meta-analysis.

BMC Public Health 2013 Jun 20;13:600. Epub 2013 Jun 20.

Health Economics & Management, Institute of Economic Research, Lund University, Box 117, Lund 22100, Sweden.

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http://dx.doi.org/10.1186/1471-2458-13-600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695890PMC
June 2013
35 Reads
2 Citations
2.264 Impact Factor

Impact of childhood-onset type 1 diabetes on schooling: a population-based register study.

Persson S, Dahlquist G, Gerdtham UG, Steen Carlsson K, Diabetologia, 2013, vol. 56, no. 6, pp. 1254-1262

http://europepmc.org/abstract/med/23435847

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June 2013
7 Reads

Computer modeling of diabetes and its complications: a report on the Fifth Mount Hood challenge meeting.

Palmer AJ, Mount Hood 5 Modeling Group, Clarke P, Gray A, Leal J, Lloyd A, Grant D, Palmer J, Foos V, Lamotte M, Hermann W, Barhak J, Willis M, Coleman R, Zhang P, McEwan P, Betz Brown J, Gerdtham U, Huang E, Briggs A, Carlsson KS, Valentine W, Value in health : the journal of the International Soci

http://europepmc.org/abstract/med/23796302

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June 2013
7 Reads

Predicting Changes in Cardiovascular Risk Factors in Type 2 Diabetes in the Post-UKPDS Era: Longitudinal Analysis of the Swedish National Diabetes Register.

J Diabetes Res 2013 28;2013:241347. Epub 2013 Feb 28.

Division of Health Economics, Department of Clinical Sciences, Malmö University Hospital, Lund University, 20502 Malmö, Sweden ; Health Economics & Management, Institute of Economic Research, Lund University, 22007 Lund, Sweden ; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran 141556447, Iran.

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http://dx.doi.org/10.1155/2013/241347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647571PMC
May 2013
27 Reads
4 Citations

On correcting the concentration index for binary variables.

J Health Econ 2013 May 8;32(3):659-70. Epub 2012 Nov 8.

Department of Economics, Lund University, P.O. Box 7082, SE-220 07 Lund, Sweden.

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http://dx.doi.org/10.1016/j.jhealeco.2012.10.012DOI Listing
May 2013
9 Reads
23 Citations
2.580 Impact Factor

Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran.

Int J Environ Res Public Health 2013 May 6;10(5):1882-94. Epub 2013 May 6.

Division of Health Economics, Department of Clinical Sciences-Malmö, Lund University, Malmö 20502, Sweden.

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http://dx.doi.org/10.3390/ijerph10051882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709354PMC
May 2013
29 Reads
6 Citations
2.063 Impact Factor

Heterogeneity in self-assessed health status among the elderly in India.

Asia Pac J Public Health 2013 May 13;25(3):271-83. Epub 2011 Sep 13.

Future Health Systems RPC, Kolkata, India.

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http://dx.doi.org/10.1177/1010539511416109DOI Listing
May 2013
8 Reads
1.111 Impact Factor

Pure and social disparities in distribution of dentists: a cross-sectional province-based study in Iran.

Kiadaliri AA, Hosseinpour R, Haghparast-Bidgoli H, Gerdtham UG, International journal of environmental research and public health, 2013, vol. 10, no. 5, pp. 1882-1894

http://europepmc.org/abstract/med/23648443

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May 2013
7 Reads

On correcting the concentration index for binary variables.

Kjellsson G, Gerdtham UG, Journal of health economics, 2013, vol. 32, no. 3, pp. 659-670

http://europepmc.org/abstract/med/23522656

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May 2013
7 Reads

Heterogeneity in self-assessed health status among the elderly in India.

Mazumdar S, Gerdtham UG, Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health, 2013, vol. 25, no. 3, pp. 271-283

http://europepmc.org/abstract/med/21914712

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May 2013
7 Reads

Time characteristics of the effect of alcohol cessation on the risk of stomach cancer a meta-analysis

BMC Public Health

Background: In the Bagnardi et al. (2001) meta-analysis, it was found that alcohol consumption increases the risk of stomach cancer (OR = 1.32 for heavy drinkers). However, it is unknown if drinking cessation reverses this alcohol-elevated risk. Methods: A systematic literature review was performed to provide the information for a meta-analysis where the dose-risk trend was estimated for years since drinking cessation and the risk of stomach cancer. A random effect generalised least squares model for trend estimation was used, employing study characteristics to control for heterogeneity. Results: Nineteen observational studies were identified in the literature review, of which five studies quantified duration of cessation and risk of stomach cancer, giving a total of 1947 cancer cases. No significant effect of drinking cessation on the risk of stomach cancer could be found (OR = 0.99 CI: 0.97-1.02). Conclusions: This result should be interpreted with caution due to the limited number of studies in this area. Recent findings suggest a link between heavy drinking and stomach cancer, especially gastric noncardia, but not for moderate drinking. Since all but one of the included studies in this meta-analysis failed to control for consumption level, the current study could not test if the risk decline following drinking cessation differs between moderate and high consumers.

http://portal.research.lu.se/portal/en/publications/time-characteristics-of-the-effect-of-alcohol-cessation-on-the-risk-of-stomach-cancer-a-metaanalysis(d2521de9-655f-467e-97f9-768a9f4ae17d).html

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January 2013
7 Reads

Explaining socioeconomic inequalities in drug utilization for Sweden 2005-2006: Evidence from linked survey and register data

Social Science and Medicine

This study uses the Swedish register of prescribed drugs, merged with the Survey of Living Conditions (the ULF), to analyze the socioeconomic gradient in drug utilization. It finds a significant education gradient (but no income gradient) in individual drug utilization. Whereas the education gradient for men is quantitative in its orientation (education affects number of drugs used), the gradient for women is both quantitative and qualitative (education affects mean cost of drugs). For males, but not as clearly for females, the study finds that the education gradient is weaker for more health-related drugs but stronger for more expensive drugs. Our results indicate that the main reason for the education gradient in drug utilization is doctors’ behaviour rather than compliance with medication and affordability of drugs.

http://portal.research.lu.se/portal/en/publications/explaining-socioeconomic-inequalities-in-drug-utilization-for-sweden-20052006-evidence-from-linked-survey-and-register-data(da2fd77e-afaa-4cd3-9dc6-bcb478f7f871).html

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January 2013
7 Reads

Are lifestyle interventions in primary care cost-effective? - an analysis based on a markov model, differences-in-differences approach and the Swedish björknäs study.

PLoS ONE

Lifestyle interventions affect patients' risk factors for metabolic syndrome (MeSy), a pre-stage to cardiovascular diseases, diabetes and related complications. An effective lifestyle intervention is the Swedish Björknäs intervention, a 3-year randomized controlled trial in primary care for MeSy patients. To include future disease-related cost and health consequences in a cost-effectiveness analysis, a simulation model was used to estimate the short-term (3-year) and long-term (lifelong) cost-effectiveness of the Björknäs study.

http://portal.research.lu.se/portal/en/publications/are-lifestyle-interventions-in-primary-care-costeffective--an-analysis-based-on-a-markov-model-differencesindifferences-approach-and-the-swedish-bjoerknas-study(f437a9e2-05da-449e-b595-a82b8bd06234).html

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January 2013
7 Reads

A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmo): study protocol for a randomized controlled trial

Trials

Background: Studies have shown that lifestyle interventions are effective in preventing or delaying the onset of type 2 diabetes in high-risk patients. However, research on the effectiveness of lifestyle interventions in high-risk immigrant populations with different cultural and socioeconomic backgrounds is scarce. The aim was to design a culturally adapted lifestyle intervention for an immigrant population and to evaluate its effectiveness and cost-effectiveness. Methods/design: In this randomized controlled trial, 308 participants (born in Iraq, living in Malmo, Sweden and at high risk of type 2 diabetes) will be allocated to either a culturally adapted intervention or a control group. The intervention will consist of 10 group counseling sessions focusing on diet, physical activity and behavioral change over 6 months, and the offer of exercise sessions. Cultural adaptation includes gender-specific exercise sessions, and counseling by a health coach community member. The control group will receive the information about healthy lifestyle habits provided by the primary health care center. The primary outcome is change in fasting glucose level. Secondary outcomes are changes in body mass index, insulin sensitivity, physical activity, food habits and health-related quality of life. Measurements will be taken at baseline, after 3 and 6 months. Data will be analyzed by the intention-to-treat approach. The cost-effectiveness during the trial period and over the longer term will be assessed by simulation modeling from patient, health care and societal perspectives. Discussion: This study will provide a basis to measure the effectiveness of a lifestyle intervention designed for immigrants from the Middle East in terms of improvement in glucose metabolism, and will also assess its cost-effectiveness. Results from this trial may help health care providers and policy makers to adapt and implement lifestyle interventions suitable for this population group that can be conducted in the community.

http://portal.research.lu.se/portal/en/publications/a-culturally-adapted-lifestyle-intervention-addressing-a-middle-eastern-immigrant-population-at-risk-of-diabetes-the-medim-impact-of-migration-and-ethnicity-on-diabetes-in-malmo-study-protocol-for-a-(51bc92ca-dc0d-4846-b3d7-c53a76848e3e).html

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January 2013
7 Reads

Socioeconomic inequalities in drug utilization for Sweden: evidence from linked survey and register data.

Nordin M, Dackehag M, Gerdtham UG, Social science & medicine (1982), 2013, vol. 77, pp. 106-117

http://europepmc.org/abstract/med/23219166

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January 2013
7 Reads

Inequalities in reproductive, maternal, newborn and child health in Vietnam: a retrospective study of survey data for 1997-2006.

BMC Health Serv Res 2012 Dec 13;12:456. Epub 2012 Dec 13.

The Partnership for Maternal, Newborn & Child Health (PMNCH), hosted by the World Health Organization, Avenue Appia 20, Geneva 27, 1211, Switzerland.

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http://dx.doi.org/10.1186/1472-6963-12-456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529685PMC
December 2012
22 Reads
7 Citations
1.660 Impact Factor

Societal costs of hearing disorders: a systematic and critical review of literature.

Int J Audiol 2012 Sep 26;51(9):655-62. Epub 2012 Jun 26.

The Swedish Institute for Health Economics, Lund, Sweden.

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http://dx.doi.org/10.3109/14992027.2012.690077DOI Listing
September 2012
14 Reads
6 Citations
1.430 Impact Factor

Societal costs of hearing disorders: a systematic and critical review of literature.

Hjalte F, Brännström J, Gerdtham UG, International journal of audiology, 2012, vol. 51, no. 9, pp. 655-662

http://europepmc.org/abstract/med/22731920

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September 2012
7 Reads

Commentary on Jarl & Gerdtham (2012): further evidence of the reversal of alcohol-related risk of oesophageal cancer after alcohol cessation.

Addiction 2012 Jul;107(7):1244-5

Centre for Addiction and Mental Health-Social and Epidemiological Research Department, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1111/j.1360-0443.2012.03864.xDOI Listing
July 2012
8 Reads
4.740 Impact Factor

Time pattern of reduction in risk of oesophageal cancer following alcohol cessation--a meta-analysis.

Addiction 2012 Jul 28;107(7):1234-43. Epub 2012 Feb 28.

Health Economics and Management, Institute of Economic Research, Lund University, Malmö, Sweden.

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http://dx.doi.org/10.1111/j.1360-0443.2011.03772.xDOI Listing
July 2012
9 Reads
8 Citations
4.740 Impact Factor

Time pattern of reduction in risk of oesophageal cancer following alcohol cessation--a meta-analysis.

Jarl J, Gerdtham UG, Addiction (Abingdon, England), 2012, vol. 107, no. 7, pp. 1234-1243

http://europepmc.org/abstract/med/22175692

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July 2012
7 Reads

HIV/AIDS-GDP Nexus?

Economics Bulletin

To test potential bilateral causalities relation between HIV-AIDS mortality and GDP, we propose a simple Granger noncausality test for heterogeneous panel data models. 44 African countries are selected for annual pooled data from 1990 to 2009. Results are presented for the heterogeneous noncausality hypothesis (HENC), which tests, for each cross-section unit, the nullity of all the coefficients of the lagged explanatory variable. Bilateral causality relation is observed for 5 countries out of 44 (11% of the countries in our data set). We have 18 countries of unidirectional causality, which 14 are from HIV mortality rate to GDP (43% from total), and 4 are from GDP to HIV mortality rate (9% from total). These results alert for the risk of epidemic trap, initiated first by the deleterious effect of HIV-Aids on countries income.

http://portal.research.lu.se/portal/en/publications/hivaidsgdp-nexus(0a7b4740-76ca-4d36-a3f9-c6cca20404d3).html

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March 2012
7 Reads

Health care utilisation and attitudes towards health care in subjects reporting environmental annoyance from electricity and chemicals.

J Environ Public Health 2009 14;2009:106389. Epub 2009 Apr 14.

Department of Occupational and Environmental Medicine, Lund University, SE 221 85 Lund, Sweden.

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http://dx.doi.org/10.1155/2009/106389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2778839PMC
February 2012
9 Reads

Inequalities in reproductive, maternal, newborn and child health in Vietnam: a retrospective study of survey data for 1997-2006

BMC Health Services Research

Background: Vietnam has achieved considerable success in economic development, poverty reduction, and health over a relatively short period of time. However, there is concern that inequalities in health outcomes and intervention coverage are widening. This study explores if inequalities in reproductive, maternal, newborn and child health and nutrition changed over time in Vietnam in 1997-2006, and if inequalities were different depending on the type of stratifying variable used to measure inequalities and on the type of outcome studied. Methods: Using data from four nationally representative household surveys conducted in 1997-2006, we study inequalities in reproductive, maternal, newborn and child health and nutrition outcomes and intervention coverage by computing concentration indices by living standards, maternal education, ethnicity, region, urban/rural residence, and sex of child. Results: Inequalities in maternal, newborn and child health persisted in 1997-2006. Inequalities were largest by living standards, but not trivial by the other stratifying variables. Inequalities in health outcomes generally increased over time, while inequalities in intervention coverage generally declined. The most equitably distributed interventions were family planning, exclusive breastfeeding, and immunizations. The most inequitably distributed interventions were those requiring multiple service contacts, such as four or more antenatal care visits, and those requiring significant support from the health system, such as skilled birth attendance. Conclusions: Three main policy implications emerge. First, persistent inequalities suggest the need to address financial and other access barriers, for example by subsidizing health care for the poor and ethnic minorities and by support from other sectors, for example in strengthening transportation networks. This should be complemented by careful monitoring and evaluation of current program design and implementation to ensure effective and efficient use of resources. Second, greater inequalities for interventions that require multiple service contacts imply that inequalities could be reduced by strengthening information and service provision by community and village health workers to promote and sustain timely care-seeking. Finally, larger inequalities for interventions that require a fully functioning health system suggest that investments in health facilities and human resources, particularly in areas that are disproportionately inhabited by the poor and ethnic minorities, may contribute to reducing inequalities.

http://portal.research.lu.se/portal/en/publications/inequalities-in-reproductive-maternal-newborn-and-child-health-in-vietnam-a-retrospective-study-of-survey-data-for-19972006(c72e1482-0aa9-4ada-ad36-8a43c76ba4cc).html

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January 2012
7 Reads

Economic Evaluations of Organ Transplantations

Nordic Journal of Health Economics

The purpose of this study is threefold; 1) to establish the current level of knowledge regarding cost-effectiveness of organ transplantation, 2) to identify knowledge gaps, and 3) to suggest a framework for future studies. A systematic literature review of economic evaluations of transplantations of solid organs was conducted in October 2010. Economic evaluations published since 2000 and reviews published since 1987 for kidney, liver, lung, heart, pancreas, and small bowel transplantations were collected. The studies were analysed regarding results and study characteristics. The review demonstrates a lack of economic evaluations for all included organ transplantations. The cost-effectiveness of kidney transplantation, and to some extent liver transplantation, compared to a non-transplant alternative appears to be established. However, cost-effectiveness for transplantation of lung, heart, pancreas, and small bowel can neither be established nor rejected based on earlier studies. Many of the included studies were limited in a number of ways; e.g. using short follow-up period, failing to account for sample selection in treatment groups, comparing to unrealistic alternatives, lacking important cost categories, and using a limiting perspective. Recommendation for future studies are, besides accounting for the above, to conduct sub-group analyses as patient and disease characteristics, among other things, has been shown to affect the cost-effectiveness of organ transplantation.

http://portal.research.lu.se/portal/en/publications/economic-evaluations-of-organ-transplantations(6b22be43-63ae-45f7-99cd-6e1028080329).html

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January 2012
7 Reads

Accounting for the dead in the longitudinal analysis of income-related health inequalities.

J Health Econ 2011 Sep 18;30(5):1113-23. Epub 2011 Jul 18.

Economics Studies, School of Business, University of Dundee, Perth Road, Dundee DD1 4HN, Scotland, UK.

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http://dx.doi.org/10.1016/j.jhealeco.2011.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181404PMC
September 2011
17 Reads
8 Citations
2.580 Impact Factor

Accounting for the dead in the longitudinal analysis of income-related health inequalities.

Petrie D, Allanson P, Gerdtham UG, Journal of health economics, 2011, vol. 30, no. 5, pp. 1113-1123

http://europepmc.org/abstract/med/21820193

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September 2011
6 Reads

Breaking bad habits by education - smoking dynamics among Swedish women.

Health Econ 2011 Jul 29;20(7):876-81. Epub 2010 Sep 29.

Department of Economics, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1002/hec.1669DOI Listing
July 2011
10 Reads
1 Citation
2.140 Impact Factor

Breaking bad habits by education - smoking dynamics among Swedish women.

Kjellsson G, Gerdtham UG, Lyttkens CH, Health economics, 2011, vol. 20, no. 7, pp. 876-881

http://europepmc.org/abstract/med/20882575

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July 2011
6 Reads

Värdet av nya läkemedel: en förstudie

Denna rapport redovisar en förstudie till SNS fleråriga forskningsprojekt som undersöker hur värdet av nya läkemedel kan bedömas ur ett brett samhällsperspektiv. En slutsats av förstudien är att det finns goda möjligheter att få bättre svar på många av de policyfrågor som ställs i läkemedelspolitiken, t ex om förskrivning och offentlig subventionering av nya läkemedel. De omfattande svenska patientregistren erbjuder unika möjligheter att studera det faktiska, realiserade värdet av läkemedel.

http://portal.research.lu.se/portal/en/publications/vardet-av-nya-lakemedel-en-foerstudie(be5e862a-6521-4592-866e-4f7e7b825ca4).html

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June 2011
6 Reads

Equalisation of alcohol participation among socioeconomic groups over time: an analysis based on the total differential approach and longitudinal data from Sweden.

Int J Equity Health 2011 Feb 10;10:10. Epub 2011 Feb 10.

Health Economics Research Unit (HERU), University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.

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http://dx.doi.org/10.1186/1475-9276-10-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042406PMC
February 2011
9 Reads
9 Citations

Equalisation of alcohol participation among socioeconomic groups over time: an analysis based on the total differential approach and longitudinal data from Sweden

International Journal for Equity in Health

Background: Health inequality and its social determinants are well-studied, but the determinants of inequality of alcohol consumption are less well-investigated. Methods: The total differential approach of decomposition of changes in the concentration index of the probability of participation in alcohol consumption was applied to 8-year longitudinal data for Swedish women aged 28-76 in 1988/89. Results: Alcohol consumption showed a pro-rich inequality, with income being a strong contributor. Overall participation remained fairly constant, but the inequality decreased over time as abstinence became less common among the poor and more common among the rich. This was mainly due to changes in the relative weights of certain population groups, such as a decrease in the proportional size of the oldest cohorts. Conclusions: Inequality in participation in alcohol consumption is pro-rich in Sweden. This inequality has tended to decrease over time, due to changes in population composition rather than to policy intervention.

http://portal.research.lu.se/portal/en/publications/equalisation-of-alcohol-participation-among-socioeconomic-groups-over-time-an-analysis-based-on-the-total-differential-approach-and-longitudinal-data-from-sweden(348b761b-10e1-4708-82e5-4631896f69f2).html

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January 2011
6 Reads

Ekonomiska utvärderingar av organtransplantationer: En systematisk litteraturöversikt

IHE Rapport

Organtransplantation har under de senaste decennierna utvecklats från att vara en experimentell behandling till att bli huvudbehandling för en rad sjukdomar. Förbättringar i immundämpande behandlingar anses generellt vara en av huvudorsakerna till denna utveckling, som också har medfört bättre utfall i form av överlevnad och livskvalitet. Under samma tidsperiod har kostnaden per transplantation minskat, vilket också pekar på en förbättrad kostnadseffektivitet. Det är därför angeläget att analysera kostnadseffektiviteten så att samhällets begränsade resurser kan användas effektivt och därigenom maximera utfallen i förhållande till utnyttjade resurser.

Syftet med denna studie är tredelat: att sammanställa kunskapsläget om organtransplantationers kostnadseffektivitet, identifiera viktiga kunskapsluckor och föreslå en plan för framtida forskning.

http://portal.research.lu.se/portal/en/publications/ekonomiska-utvarderingar-av-organtransplantationer-en-systematisk-litteraturoeversikt(b39b6d9f-22d6-4d4e-8cd2-faca5f91d67c).html

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January 2011
6 Reads

Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases.

Int J Environ Res Public Health 2010 08 9;7(8):3150-95. Epub 2010 Aug 9.

Centre for Primary Health Care Research, Lund University, Lund, Sweden.

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http://dx.doi.org/10.3390/ijerph7083150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954575PMC
August 2010
9 Reads
26 Citations
2.063 Impact Factor

Economic evaluation of lifestyle interventions for preventing diabetes and cardiovascular diseases.

Saha S, Gerdtham UG, Johansson P, International journal of environmental research and public health, 2010, vol. 7, no. 8, pp. 3150-3195

http://europepmc.org/abstract/med/20948954

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August 2010
6 Reads

On measurement of avoidable and unavoidable cost of alcohol: an application of method for estimating costs due to prior consumption.

Int J Environ Res Public Health 2010 07 16;7(7):2881-95. Epub 2010 Jul 16.

Health Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden.

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http://dx.doi.org/10.3390/ijerph7072881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922734PMC
July 2010
15 Reads
3 Citations
2.063 Impact Factor

On measurement of avoidable and unavoidable cost of alcohol: an application of method for estimating costs due to prior consumption.

Jarl J, Gerdtham UG, Ludbrook A, Petrie D, International journal of environmental research and public health, 2010, vol. 7, no. 7, pp. 2881-2895

http://europepmc.org/abstract/med/20717547

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July 2010
6 Reads

Does income-related health inequality change as the population ages? Evidence from Swedish panel data.

Health Econ 2010 Mar;19(3):334-49

Department of Economics, University of Bergen, Bergen, Norway.

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http://dx.doi.org/10.1002/hec.1479DOI Listing
March 2010
7 Reads
10 Citations
2.140 Impact Factor

Does income-related health inequality change as the population ages? Evidence from Swedish panel data.

Islam MK, Gerdtham UG, Clarke P, Burström K, Health economics, 2010, vol. 19, no. 3, pp. 334-349

http://europepmc.org/abstract/med/19370697

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March 2010
6 Reads

Longitudinal analysis of income-related health inequality.

J Health Econ 2010 Jan 10;29(1):78-86. Epub 2009 Nov 10.

Economics Studies, School of Social and Environmental Sciences, University of Dundee, 3 Perth Road, Dundee DD1 4HN, Scotland, United Kingdom.

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http://dx.doi.org/10.1016/j.jhealeco.2009.10.005DOI Listing
January 2010
6 Reads
7 Citations
2.580 Impact Factor

More equal but heavier: a longitudinal analysis of income-related obesity inequalities in an adult Swedish cohort.

Soc Sci Med 2010 Jan 2;70(2):221-31. Epub 2009 Nov 2.

Department of Economics, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1016/j.socscimed.2009.10.014DOI Listing
January 2010
10 Reads
7 Citations
2.890 Impact Factor

Wage penalty of abstinence and wage premium of drinking-A misclassification bias due to pooling of drinking groups?

Addiction Research & Theory

Several studies have found protective effects of low/moderate (hereafter 'light') alcohol consumption compared with 'abstinence' on mortality, health and wage. Some of these studies have been criticised because former drinkers have been included among the abstainers, which may overstate the protective effect of light alcohol consumption. It has also been proposed, but not shown, that the commonly pooled group of light drinkers and former heavy drinkers would understate the protective effect of light drinking. We also suggest that former abstainers might cause the same effect when pooled with light drinkers. The aim of this article is to study whether the pooling of consumption groups creates bias in the form of misclassification and confounding. The analysis focuses on: 'former drinker error' (pooling of lifelong abstainers and former drinkers); 'former abstainer error' (pooling of former abstainers and lifelong light drinkers) and 'former heavy drinker error' (pooling of light drinkers with and without a history of heavy drinking). Swedish panel data were used in a multinomial logit model, presenting odds ratios when comparing the subgroups. The results demonstrate that commonly pooled groups are heterogeneous with respect to a number of variables, which may implicate confounding. Given appropriate controls, misclassification bias is likely in the pooled group of light drinkers. The direction of the misclassification bias, however, is to underestimate the beneficial effect of light alcohol consumption on wage and therefore cannot explain the wage penalty of abstinence compared to light drinking.</.

http://portal.research.lu.se/portal/en/publications/wage-penalty-of-abstinence-and-wage-premium-of-drinkinga-misclassification-bias-due-to-pooling-of-drinking-groups(896550e0-25c2-4433-a44d-e8b0cb6701c3).html

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January 2010
5 Reads

Longitudinal analysis of income-related health inequality.

Allanson P, Gerdtham UG, Petrie D, Journal of health economics, 2010, vol. 29, no. 1, pp. 78-86

http://europepmc.org/abstract/med/19954852

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January 2010
5 Reads

Medical net cost of low alcohol consumption - a cause to reconsider improved health as the link between alcohol and wage?

Cost Eff Resour Alloc 2009 Oct 23;7:17. Epub 2009 Oct 23.

Health Economics & Management, Institute of Economic Research, Lund University, Lund, Sweden.

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http://dx.doi.org/10.1186/1478-7547-7-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770988PMC
October 2009
7 Reads

Estimating the cost of diabetes mellitus-related events from inpatient admissions in Sweden using administrative hospitalization data.

Pharmacoeconomics 2009 ;27(1):81-90

Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland.

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http://dx.doi.org/10.2165/00019053-200927010-00008DOI Listing
May 2009
13 Reads
4 Citations
2.450 Impact Factor

Factors affecting chronic obstructive pulmonary disease (COPD)-related costs: a multivariate analysis of a Swedish COPD cohort.

Eur J Health Econ 2009 May 14;10(2):217-26. Epub 2008 Oct 14.

Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.

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http://dx.doi.org/10.1007/s10198-008-0121-6DOI Listing
May 2009
8 Reads
5 Citations

Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam.

Int J Equity Health 2009 May 27;8:20. Epub 2009 May 27.

Health Economics and Management, Institute of Economic Research, Lund University, Sweden.

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http://dx.doi.org/10.1186/1475-9276-8-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694203PMC
May 2009
7 Reads
19 Citations

Factors affecting chronic obstructive pulmonary disease (COPD)-related costs: a multivariate analysis of a Swedish COPD cohort.

Gerdtham UG, Andersson LF, Ericsson A, Borg S, Jansson SA, Rönmark E, Lundbäck B, The European journal of health economics : HEPAC : health economics in prevention and care, 2009, vol. 10, no. 2, pp. 217-226

http://europepmc.org/abstract/med/18853206

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May 2009
5 Reads

Medical net cost of low alcohol consumption - a cause to reconsider improved health as the link between alcohol and wage?

Jarl J, Gerdtham UG, Selin KH, Cost effectiveness and resource allocation : C/E, 2009, vol. 7, pp. 17

http://europepmc.org/abstract/med/19852776

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January 2009
5 Reads

Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam

International Journal for Equity in Health

Background: Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. Method: Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). Results: We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. Conclusion: The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and evaluation mechanisms.

http://portal.research.lu.se/portal/en/publications/health-financing-for-the-poor-produces-promising-shortterm-effects-on-utilization-and-outofpocket-expenditure-evidence-from-vietnam(9ad47af1-67dd-4774-ab81-66dc946a2e81).html

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January 2009
5 Reads

Estimating the Cost of Diabetes Mellitus-Related Events from Inpatient Admissions in Sweden Using Administrative Hospitalization Data

PharmacoEconomics

Background and aims: To estimate short- and long-term costs of inpatient hospitalization in Sweden for major diabetes mellitus-related events. Materials and methods: Costs were estimated using administrative hospital data from the Swedish National Board of Health and Welfare, which is linked to the Swedish National Diabetes Register. Data were available for 179 749 patients with diabetes in Sweden from 1998 to 2003 (mean and median duration of 6 years' follow-up). Costing of inpatient admissions was based on Nordic diagnosis-related groups (NordDRG). Multiple regression analysis (linear and generalizing estimating equation models) was used to estimate inpatient care costs controlling for age, sex and co-morbidities. The data on hospitalizations were converted to costs (E) using 2003 exchange rates. Results: The average annual costs (linear model) associated with inpatient admissions for a 60-year-old male in the year the first event first occurred were as follows: (sic)6488 (95% CI 5034, 8354) for diabetic coma; (sic)6850 (95% CI 6514, 7204) for heart failure; (sic)7853 (95% CI 7559, 8144) for non-fatal stroke; (sic)8121 (95% CI 7104, 9128) for peripheral circulatory complications; (sic)8736 (95% CI 8474, 9001) for non-fatal myocardial infarction (MI); (sic) 10 360 (95% CI 10 085, 10 643) for ischaemic heart disease; (sic) 11411 (95% CI 10 298, 12 654) for renal failure; and (sic)14 949 (95% CI 13 849, 16 551) for amputation. On average, the costs were higher when co-morbidity was accounted for (e.g. MI with co-morbidity was twice as costly as MI alone). Conclusions: Average hospital inpatient costs associated with common diabetes-related events can be estimated using panel data regression methods. These could assist in modelling of long-term costs of diabetes and in evaluating the cost effectiveness of improving care.

http://portal.research.lu.se/portal/en/publications/estimating-the-cost-of-diabetes-mellitusrelated-events-from-inpatient-admissions-in-sweden-using-administrative-hospitalization-data(f97ce583-62ce-4101-8f2e-5f91557532ef).html

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January 2009
6 Reads

The societal cost of alcohol consumption: an estimation of the economic and human cost including health effects in Sweden, 2002.

Eur J Health Econ 2008 Nov 28;9(4):351-60. Epub 2007 Nov 28.

Health Economic Program, Department of Clinical Sciences, Lund University, S-205 02 Malmo, Sweden.

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http://dx.doi.org/10.1007/s10198-007-0082-1DOI Listing
November 2008
18 Reads
15 Citations

The societal cost of alcohol consumption: an estimation of the economic and human cost including health effects in Sweden, 2002.

Jarl J, Johansson P, Eriksson A, Eriksson M, Gerdtham UG, Hemström O, Selin KH, Lenke L, Ramstedt M, Room R, The European journal of health economics : HEPAC : health economics in prevention and care, 2008, vol. 9, no. 4, pp. 351-360

http://europepmc.org/abstract/med/18043953

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November 2008
5 Reads

Societal costs of air pollution-related health hazards: A review of methods and results.

Cost Eff Resour Alloc 2008 Sep 11;6:19. Epub 2008 Sep 11.

Health Economics Program (HEP), Department of Clinical Sciences, Malmö, Lund University SE-205 02 Malmö, Sweden.

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http://dx.doi.org/10.1186/1478-7547-6-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553058PMC
September 2008
7 Reads
2 Citations

Optimal recall length in survey design.

J Health Econ 2008 Sep 26;27(5):1275-84. Epub 2008 Jun 26.

School of Public Health, The University of Sydney, NSW 2006, Australia.

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http://dx.doi.org/10.1016/j.jhealeco.2008.05.012DOI Listing
September 2008
13 Reads
18 Citations
2.580 Impact Factor

Optimal recall length in survey design.

Clarke PM, Fiebig DG, Gerdtham UG, Journal of health economics, 2008, vol. 27, no. 5, pp. 1275-1284

http://europepmc.org/abstract/med/18667254

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September 2008
4 Reads

Social capital externalities and mortality in Sweden.

Econ Hum Biol 2008 Mar 22;6(1):19-42. Epub 2007 Oct 22.

Department of Clinical Sciences, Malmö, Lund University, Sweden.

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http://dx.doi.org/10.1016/j.ehb.2007.09.004DOI Listing
March 2008
7 Reads
6 Citations
1.901 Impact Factor

Social capital externalities and mortality in Sweden.

Islam MK, Gerdtham UG, Gullberg B, Lindström M, Merlo J, Economics and human biology, 2008, vol. 6, no. 1, pp. 19-42

http://europepmc.org/abstract/med/18280227

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March 2008
4 Reads

Societal costs of air pollution-related health hazards: A review of methods and results.

Pervin T, Gerdtham UG, Lyttkens CH, Cost effectiveness and resource allocation : C/E, 2008, vol. 6, pp. 19

http://europepmc.org/abstract/med/18786247

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January 2008
4 Reads

[Is Denmark a Swedish health risk? Analysis of alcohol-related hospitalization in Scania].

Lakartidningen 2007 Jun 4-11;104(23):1783-6

Institutionen för kliniska vetenskaper, Malmö, Lunds universitet.

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July 2007
7 Reads

Sweden

DEVELOPMENT OF SCENARIOS FOR HEALTH AND LONG-TERM CARE EXPENDITURE IN THE EUROPEAN UNION MEMBER STATES

http://portal.research.lu.se/portal/en/publications/sweden(569767b2-3482-49c4-ac57-6deced6fd845).html

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January 2007
4 Reads

More detailed data does not always raise the costs

Contemporary Drug Problems

The aim is to investigate the effect of availability and level of detail of data on cost estimates of alcohol consumption. Using the recent Swedish cost of alcohol study as baseline, limitations on data are applied, forming two models. The costs of alcohol in Sweden are re-estimated in the two models and compared to the baseline, to establish the magnitude and direction of the bias resulting from limited data, and which results are the most sensitive to variations in data availability and level of detail. Almost all differences between the baseline and the two limited models stem from reduced availability and not the level of detail of data. However, the level of detail plays an important role for the prevalence of consumption and the alcohol-attributable fractions (AAFs) for injuries. The conclusion is that it is more important to estimate more cost components than to improve existing estimates, as differences between cost estimates are mainly driven by the availability rather than the level of detail of data. However, the level of detail in the prevalence rates of consumption and in the AAFs for injuries is likely to considerably affect the cost estimates and obtaining the best possible data in these areas should therefore be prioritized.

http://portal.research.lu.se/portal/en/publications/more-detailed-data-does-not-always-raise-the-costs(5cadb812-7435-424b-80d1-59397e3afaf7).html

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January 2007
4 Reads

Deaths rise in good economic times: evidence from the OECD.

Econ Hum Biol 2006 Dec 18;4(3):298-316. Epub 2006 May 18.

Health Economics Program, Department of Clinical Sciences, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden.

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http://dx.doi.org/10.1016/j.ehb.2006.04.001DOI Listing
December 2006
12 Reads
49 Citations
1.901 Impact Factor

Deaths rise in good economic times: evidence from the OECD.

Gerdtham UG, Ruhm CJ, Economics and human biology, 2006, vol. 4, no. 3, pp. 298-316

http://europepmc.org/abstract/med/16713407

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December 2006
3 Reads

Social capital and health: does egalitarianism matter? A literature review.

Int J Equity Health 2006 Apr 5;5. Epub 2006 Apr 5.

Department of Clinical Sciences, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden.

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http://dx.doi.org/10.1186/1475-9276-5-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1524772PMC
April 2006
7 Reads
71 Citations

The Danish effect on Swedish alcohol costs. An analysis based on hospitalization data from southern Sweden.

Eur J Health Econ 2006 Mar;7(1):46-54

Department of Clinical Science, Malmö, Lund University, Sweden.

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http://dx.doi.org/10.1007/s10198-005-0329-7DOI Listing
March 2006
6 Reads

The Danish effect on Swedish alcohol costs. An analysis based on hospitalization data from southern Sweden.

Jarl J, Gerdtham UG, Lyttkens CH, Lithman T, Merlo J, The European journal of health economics : HEPAC : health economics in prevention and care, 2006, vol. 7, no. 1, pp. 46-54

http://europepmc.org/abstract/med/16341738

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March 2006
3 Reads

The Cost of Maternal-Newborn Illness and Mortality

Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty

The aim of this paper is to provide a systematic review of the estimation of the cost of illness (COI) related to maternal-newborn ill-health (MNIH). The methodology used for the review includes a systematic search on electronic databases for published literature and manual searches for the identification of grey (unpublished) literature. Searches are based on the major electronic databases and also on the home pages of some major international organizations. While the problems of MNIH are well known and the importance of conducting COI studies is understood, knowledge is still lacking about the magnitude of the costs of MNIH at the societal level. After a search of the existing electronic databases, only one published paper was found to be relevant for the review; four grey studies (using REDUCE Safe Motherhood model) were also directly relevant. The published study estimates most of the cost components associated with a particular complication of MNIH -- emergency obstetric care (EmOC) -- and reports a total average cost per user of EmOC in the range of US$ 177-369 in Bangladesh. The unpublished studies based on the REDUCE model illustrate the MNIH issue more directly and elaborately; however, they estimate merely the productivity cost for four African countries. The model estimates a huge amount of productivity losses associated with MNIH: an annual total of about US$ 95 million for Ethiopia and about US$ 85 million for Uganda. To formulate an idea of issues related to data, measurement and methodology the present study also reviews COI studies on other related diseases that are similar to those on MNIH. The review reveals some difficulties in measurement and proposes to incorporate some relevant cost components that MNIH cause society and also suggests probable data sources for COI studies of MNIH. Although it is evident that MNIH results in suffering for women and children and hinders economic development through its huge burden for society, in order to stimulate further policy debate regarding its significance future research efforts should be directed towards theoretically sound and comprehensive COI studies with use of longitudinal and experimental data.

http://portal.research.lu.se/portal/en/publications/the-cost-of-maternalnewborn-illness-and-mortality(6bf2f9bf-032b-49c9-a284-f6a4e02cb733).html

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January 2006
3 Reads

Social capital and health: does egalitarianism matter? A literature review

International Journal for Equity in Health

The aim of the paper is to critically review the notion of social capital and review empirical literature on the association between social capital and health across countries. The methodology used for the review includes a systematic search on electronic databases for peer-reviewed published literature. We categorize studies according to level of analysis (single and multilevel) and examine whether studies reveal a significant health impact of individual and area level social capital. We compare the study conclusions according to the country's degrees of economic egalitarianism. Regardless of study design, our findings indicate that a positive association (fixed effect) exists between social capital and better health irrespective of countries degree of egalitarianism. However, we find that the between-area variance (random effect) in health tends to be lower in more egalitarian countries than in less egalitarian countries. Our tentative conclusion is that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country. Area level or contextual social capital may be less salient in egalitarian countries in explaining health differences across places.

http://portal.research.lu.se/portal/en/publications/social-capital-and-health-does-egalitarianism-matter-a-literature-review(de1b0306-0091-40d1-8c3a-68cd563161e5).html

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January 2006
3 Reads

Impact on Economic Growth of Investing in Maternal-Newborn Health

Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty

The aim of this paper is to provide a systematic review of the evidence of the impact on economic growth of investments in maternal--newborn health (MNH). The methodology used for the review includes a systematic search for published literature in relevant electronic databases. In the paper, we review five studies: four empirical and one theoretical. One of the empirical papers measures health by infant mortality. The study finds that a 1/1000-point reduction in the infant mortality rate leads to an increase in the level of State Domestic Product by Indian Rs 2.70 and an increase in the average growth rate per year of 0.145%. Similar results are reported for other health measures in other studies. Our main conclusion, however, is that the area lacks research and that considerably more is needed before any advice can be provided to policy-makers about the contribution to growth of investments in MNH. Specifically, first and foremost, studies are needed that explicitly analyse the impact of MNH on level and growth of output. Second, we suggest the use of more comprehensive MNH measures that consider the health of both mothers and newborns and aspects of ill-health other than death, such as measures of quality of life, functional limitations, mental health and sickness absenteeism. Third, estimates of the effects of MNH on growth need to be controlled for other health dimensions, i.e. aspects that may confound the impact of MNH. Fourth, studies are needed of the effects on determinants of growth in order to understand better the links between MNH and growth. Fifth, studies based on smaller geographical areas within countries and longer time series are needed, in order to obtain more precise estimates and also better estimates of the long-term growth paths. Finally, we suggest compilation of other data sets on microeconomic data, for example, to study effects at firm level of MNH on labour productivity through inability to work, disability, sick days, etc.

http://portal.research.lu.se/portal/en/publications/impact-on-economic-growth-of-investing-in-maternalnewborn-health(2be1ce50-10c3-4d04-b0ca-626cd70dd280).html

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January 2006
3 Reads

Hospital level of care and neonatal mortality in low- and high-risk deliveries: reassessing the question in Sweden by multilevel analysis.

Med Care 2005 Nov;43(11):1092-100

Community Medicine, Department of Clinical Science, Malmö University Hospital, Faculty of Medicine, Lund University, Malmö, Sweden.

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November 2005
7 Reads
9 Citations
3.232 Impact Factor

Understanding adherence to official guidelines on statin prescribing in primary health care--a multi-level methodological approach.

Eur J Clin Pharmacol 2005 Oct 19;61(9):657-65. Epub 2005 Oct 19.

Drug Utilization Unit, Scania Region, Regionhuset, Box 1, 22100 Lund, Sweden.

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http://dx.doi.org/10.1007/s00228-005-0975-9DOI Listing
October 2005
6 Reads
4 Citations
2.970 Impact Factor

Understanding adherence to official guidelines on statin prescribing in primary health care--a multi-level methodological approach.

Ohlsson H, Lindblad U, Lithman T, Ericsson B, Gerdtham UG, Melander A, Råstam L, Merlo J, European journal of clinical pharmacology, 2005, vol. 61, no. 9, pp. 657-665

http://europepmc.org/abstract/med/16133551

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October 2005
3 Reads

[Geographical differences in mortality after myocardial infarction? Coincidence claims many victims--small hospitals suffer most of all!].

Lakartidningen 2005 Jan 17-23;102(3):150-1

Samhällsmedicinska institutionen, Lunds universitet, Universitetssjukhuset MAS, Malmö.

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February 2005
8 Reads

[Equally good care of myocardial infarction in Sweden today. Geographic differences in mortality are without significance for the individual patient].

Lakartidningen 2005 Jan 3-16;102(1-2):20-3

Samhällsmedicinska institutionen, Universitetssjukhuset MAS, Malmö.

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February 2005
10 Reads

Business cycles and mortality: results from Swedish microdata.

Soc Sci Med 2005 Jan;60(1):205-18

Department of Community Medicine, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden.

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http://dx.doi.org/10.1016/j.socscimed.2004.05.004DOI Listing
January 2005
14 Reads
20 Citations
2.890 Impact Factor

Kritisk analys av skattningar av samhällets kostnader för alkoholkonsumtion – en diskussion om fem studiers metodval och resultat

Gränslös utmaning : alkoholpolitik i ny tid : slutbetänkande

The consumption of alcohol imposes costs on the society and several cost-of-illness studies have been conducted to estimate these costs. This essay presents the results from five cost-of-illness studies and examines the methodology used. The differences in results are discussed in reference to the differences in the applied methods.
The results differ immensely from US$ 91 to US$ 2,433 per capita. These differences could partly be explained by six factors; 1) differences in the costs included; 2) attributable fraction of alcohol consumption in different diseases and phenomena; 3) methods used (in particular for indirect costs); 4) level of discount rate; 5) definitions including area of estimation and 6) institutional dissimilarities.
A discussion about costs to the Swedish society when the consumption increases to the level of the European Union estimates this to at least US$ 435 per capita, i.e. an increase by 40–50 percent.
The results of this essay stress the importance of similar methods and definitions in order to be able to compare international studies and evaluate national policies.

http://portal.research.lu.se/portal/en/publications/kritisk-analys-av-skattningar-av-samhallets-kostnader-foer-alkoholkonsumtion--en-diskussion-om-fem-studiers-metodval-och-resultat(42260552-1b11-4cd4-8ff7-8d1dad935c0c).html

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January 2005
3 Reads

God vård på lika villkor vid hjärtinfarkt i dagens Sverige. Geografiska skillnader i dödlighet utan betyd [Equally good care of myocardial infarction in Sweden today. Geographic differences in mortality are without significance for the individual patient]

Läkartidningen

It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR=1.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women - an issue that deserves further analysis.

http://portal.research.lu.se/portal/en/publications/god-vaard-paa-lika-villkor-vid-hjartinfarkt-i-dagens-sverige-geografiska-skillnader-i-doedlighet-utan-betyd-equally-good-care-of-myocardial-infarction-in-sweden-today-geographic-differences-in-mortal(aabc5459-9185-49c2-b9e6-9df2530e04ba).html

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January 2005
3 Reads

Business cycles and mortality: results from Swedish microdata.

Gerdtham UG, Johannesson M, Social science & medicine (1982), 2005, vol. 60, no. 1, pp. 205-218

http://europepmc.org/abstract/med/15482879

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January 2005
3 Reads

Effects of macroeconomic trends on social security spending due to sickness and disability.

Am J Public Health 2004 Nov;94(11):2004-9

Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Norrbacka, 2nd floor, 171 76 Stockholm, Sweden.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448576PMC
http://dx.doi.org/10.2105/ajph.94.11.2004DOI Listing
November 2004
8 Reads
3 Citations
4.552 Impact Factor

Effects of macroeconomic trends on social security spending due to sickness and disability.

Khan J, Gerdtham UG, Jansson B, American journal of public health, 2004, vol. 94, no. 11, pp. 2004-2009

http://europepmc.org/abstract/med/15514244

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November 2004
3 Reads

Changes in drug spending for different age groups during the 1990s? Evidence from Sweden.

Expert Rev Pharmacoecon Outcomes Res 2004 Jun;4(3):343-51

Malmo University Hospital, Department of Community Medicine, S 205 02 Malmo, Sweden.

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http://dx.doi.org/10.1586/14737167.4.3.343DOI Listing
June 2004
5 Reads
2 Citations
1.870 Impact Factor

Changes in drug spending for different age groups during the 1990s? Evidence from Sweden.

Gerdtham UG, Lundin D, Expert review of pharmacoeconomics & outcomes research, 2004, vol. 4, no. 3, pp. 343-351

http://europepmc.org/abstract/med/19807316

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June 2004
3 Reads

Why did drug spending increase during the 1990s? A decomposition based on Swedish data.

Pharmacoeconomics 2004 ;22(1):29-42

Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.

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http://dx.doi.org/10.2165/00019053-200422010-00003DOI Listing
March 2004
6 Reads
5 Citations
2.450 Impact Factor

Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmö, Sweden.

J Epidemiol Community Health 2004 Feb;58(2):145-9

Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732676PMC
http://dx.doi.org/10.1136/jech.58.2.145DOI Listing
February 2004
3 Reads
15 Citations
3.501 Impact Factor

Country of birth, socioeconomic position, and healthcare expenditure: a multilevel analysis of Malmo, Sweden.

Beckman A, Merlo J, Lynch JW, Gerdtham UG, Lindström M, Lithman T, Journal of epidemiology and community health, 2004, vol. 58, no. 2, pp. 145-149

http://europepmc.org/abstract/med/14729898

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February 2004
3 Reads

Effects of macroeconomic trends on social security spending due to sickness and disability

American Journal of Public Health

Objectives. We analyzed the relationship between macroeconomic conditions, measured as unemployment rate and social security spending, from 4 social security schemes and total spending due to sickness and disability. Methods. We obtained aggregated panel data from 13 Organization for Economic Cooperation and Development member countries for 1980-1996. We used regression analysis and fixed effect models to examine spending on sickness benefits, disability pensions, occupational-injury benefits, survivor's pensions, and total spending. Results. A decline in unemployment increased sickness benefits spending and reduced disability pension spending. These effects reversed direction after 4 years of unemployment. Inclusion of mortality rate as an additional variable in the analysis did not affect the findings. Conclusions. Macroeconomic conditions influence some reimbursements from social security schemes but not total spending.

http://portal.research.lu.se/portal/en/publications/effects-of-macroeconomic-trends-on-social-security-spending-due-to-sickness-and-disability(16d6da34-fc5a-47dc-bba0-143bda3b7050).html

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January 2004
3 Reads

Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data.

Soc Sci Med 2003 Nov;57(9):1621-9

Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, Netherlands.

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November 2003
9 Reads
33 Citations
2.890 Impact Factor

Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data.

van Doorslaer E, Gerdtham UG, Social science & medicine (1982), 2003, vol. 57, no. 9, pp. 1621-1629

http://europepmc.org/abstract/med/12948571

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November 2003
3 Reads

Predicting survival in cost-effectiveness analyses based on clinical trials.

Int J Technol Assess Health Care 2003 ;19(3):507-12

Department of Community Medicine, Malmö University Hospital, Sweden.

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October 2003
7 Reads
2 Citations
1.560 Impact Factor

A note on the decomposition of the health concentration index.

Health Econ 2003 Jun;12(6):511-6

Health Economics Research Centre, University of Oxford, UK.

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http://dx.doi.org/10.1002/hec.767DOI Listing
June 2003
8 Reads
8 Citations
2.140 Impact Factor

A note on the decomposition of the health concentration index.

Clarke PM, Gerdtham UG, Connelly LB, Health economics, 2003, vol. 12, no. 6, pp. 511-516

http://europepmc.org/abstract/med/12759920

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June 2003
3 Reads

A note on the effect of unemployment on mortality.

J Health Econ 2003 May;22(3):505-18

Department of Community Medicine, Malmö University Hospital, Lund University, SE-205 02 Malmö, Sweden.

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http://dx.doi.org/10.1016/S0167-6296(03)00004-3DOI Listing
May 2003
11 Reads
12 Citations
2.580 Impact Factor

A note on the effect of unemployment on mortality.

Gerdtham UG, Johannesson M, Journal of health economics, 2003, vol. 22, no. 3, pp. 505-518

http://europepmc.org/abstract/med/12683964

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May 2003
3 Reads

Social inequalities in health- do they diminish with age? Revisiting the question in Sweden 1999.

Int J Equity Health 2003 Mar 11;2(1). Epub 2003 Mar 11.

Department of Community Medicine, Malmö University Hospital, Lund University, Malmö, Sweden.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC153479PMC
March 2003
5 Reads
7 Citations

Social inequalities in health- do they diminish with age? Revisiting the question in Sweden 1999.

Merlo J, Gerdtham UG, Lynch J, Beckman A, Norlund A, Lithman T, International journal for equity in health, 2003, vol. 2, no. 1, pp. 2

http://europepmc.org/abstract/med/12685938

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March 2003
3 Reads

Redistributive effects of the Swedish social insurance system.

Eur J Public Health 2002 Dec;12(4):273-8

Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Norrbacka, 2nd Floor, S-171 76 Stockholm, Sweden.

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http://dx.doi.org/10.1093/eurpub/12.4.273DOI Listing
December 2002
5 Reads
2.591 Impact Factor

On the measurement of relative and absolute income-related health inequality.

Soc Sci Med 2002 Dec;55(11):1923-8

Health Economics Research Centre, University of Oxford, Oxford, UK.

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December 2002
6 Reads
17 Citations
2.890 Impact Factor

Redistributive effects of the Swedish social insurance system.

Khan J, Gerdtham UG, Jansson B, European journal of public health, 2002, vol. 12, no. 4, pp. 273-278

http://europepmc.org/abstract/med/12506502

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December 2002
3 Reads

On the measurement of relative and absolute income-related health inequality.

Clarke PM, Gerdtham UG, Johannesson M, Bingefors K, Smith L, Social science & medicine (1982), 2002, vol. 55, no. 11, pp. 1923-1928

http://europepmc.org/abstract/med/12406461

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December 2002
3 Reads

The Determinants of Health in Sweden

Individual Decisions for Health

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January 2002
3 Reads

Rise in Good Economic Times: Evidence from OECD

NBER Working Paper

This study uses aggregate data for 23 OECD countries over the 1960-1997 period to examine the relationship between macroeconomic conditions and fatalities. The main finding is that total mortality and deaths from several common causes increase when labor markets strengthen. For instance, controlling for year effects, location fixed effects, country-specific time trends and demographic characteristics, a one percentage point decrease in the national unemployment rate is associated with a 0.4 percent rise in total mortality and 0.4, 1.1, 1.8, 2.1 and 0.8 percent increases in deaths from cardiovascular disease, influenza/pneumonia, liver disease, motor vehicle fatalities and other accidents. These results are consistent with the findings of other recent research and cast doubt on the hypothesis that economic downturns have negative effects on physical health.

http://portal.research.lu.se/portal/en/publications/rise-in-good-economic-times-evidence-from-oecd(1e3d8910-bdf7-4fd2-aa5f-0f36b0ae3d6e).html

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January 2002
3 Reads

Do life-saving regulations save lives ?

Journal of Risk and Uncertainty

Life-saving regulations may be counter-productive since they have an indirect mortality effect through the reduction in disposable income. This paper estimates the effect of income on mortality, controlling for the initial health status and a host of personal characteristics. The analysis is based on a random sample of the adult Swedish population of over 40,000 individuals followed up for 10-17 years. The income loss that will induce an expected fatality is estimated to be $6.8 million when the costs are borne equally among all adults, $8.4 million when the costs are borne proportionally to income and $9.8 million when the costs are borne progressively to income.

http://portal.research.lu.se/portal/en/publications/do-lifesaving-regulations-save-lives-(1b45d3c8-84bb-4b6f-8126-b32081bb3f75).html

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January 2002
3 Reads

Equity in Swedish health care reconsidered: new results based on the finite mixture model.

Health Econ 2001 Sep;10(6):565-72

Stockholm School of Economics, Stockholm, Sweden.

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September 2001
4 Reads
2 Citations
2.140 Impact Factor

Equity in Swedish health care reconsidered: new results based on the finite mixture model.

Gerdtham UG, Trivedi PK, Health economics, 2001, vol. 10, no. 6, pp. 565-572

http://europepmc.org/abstract/med/11550296

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September 2001
3 Reads

Income-related inequality in life-years and quality-adjusted life-years.

J Health Econ 2000 Nov;19(6):1007-26

Department of Economics, Stockholm School of Economics, Sweden.

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November 2000
6 Reads
3 Citations
2.580 Impact Factor

Income-related inequality in life-years and quality-adjusted life-years.

Gerdtham UG, Johannesson M, Journal of health economics, 2000, vol. 19, no. 6, pp. 1007-1026

http://europepmc.org/abstract/med/11186842

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November 2000
3 Reads

Equity in the delivery of health care in Europe and the US.

J Health Econ 2000 Sep;19(5):553-83

Department of Health Policy, Erasmus University, Rotterdam, Netherlands.

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September 2000
3 Reads
71 Citations
2.580 Impact Factor

Equity in the delivery of health care in Europe and the US.

van Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, De Graeve D, Duchesne I, Gerdtham UG, Gerfin M, Geurts J, Gross L, Häkkinen U, John J, Klavus J, Leu RE, Nolan B, O'Donnell O, Propper C, Puffer F, Schellhorn M, Sundberg G, Winkelhake O, Journal of health economics, 2000, vol. 19, no. 5,

http://europepmc.org/abstract/med/11184794

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September 2000
3 Reads

On stationarity and cointegration of international health expenditure and GDP.

J Health Econ 2000 Jul;19(4):461-75

Centre for Health Economics, Stockholm School of Economics, Sweden.

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July 2000
6 Reads
7 Citations
2.580 Impact Factor

On stationarity and cointegration of international health expenditure and GDP.

Gerdtham UG, Löthgren M, Journal of health economics, 2000, vol. 19, no. 4, pp. 461-475

http://europepmc.org/abstract/med/11010235

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July 2000
3 Reads

The determinants of health expenditure in the OECD countries: a pooled data analysis.

Dev Health Econ Public Policy 1998 ;6:113-34

Stockholm School of Economics, Sweden.

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January 2000
3 Reads
5 Citations

Estimating the effect of cesarean section rate on health outcome

International Journal of Technology Assessment in Health Care

This paper tests the null hypothesis of a zero effect of cesarean section rate on health outcome against the alternative of a positive effect. Using data from 59 hospitals in Sweden from 1988-92, we specify two separate linear regression models for health outcome, one with perinatal mortality, and the other with rate of asphyxia, as dependent variable. We estimate the models by single-year cross-section regressions and as pooled data systems. The null hypothesis cannot be rejected, i.e., we do not find any significant positive effect of cesarean section rate on health outcome. Thus, we conclude that an increase in cesarean section rate does not imply lower perinatal mortality or lower rate of asphyxia. This in turn indicates that the minimum cesarean section rate is optimal.

http://portal.research.lu.se/portal/en/publications/estimating-the-effect-of-cesarean-section-rate-on-health-outcome(ad371844-38d8-493a-bbae-e164fe4c387b).html

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December 1999
1 Read

New estimates of the demand for health: results based on a categorical health measure and Swedish micro data.

Soc Sci Med 1999 Nov;49(10):1325-32

Department of Economics, Stockholm School of Economics, Sweden.

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November 1999
3 Reads
3 Citations
2.890 Impact Factor

New estimates of the demand for health: results based on a categorical health measure and Swedish micro data.

Gerdtham UG, Johannesson M, Social science & medicine (1982), 1999, vol. 49, no. 10, pp. 1325-1332

http://europepmc.org/abstract/med/10509823

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November 1999
4 Reads

Estimating the effect of cesarean section rate on health outcome. Evidence from Swedish hospital data.

Int J Technol Assess Health Care 1999 ;15(1):123-35

Stockholm School of Economics.

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August 1999
3 Reads
1 Citation
1.560 Impact Factor

The redistributive effect of health care finance in twelve OECD countries.

J Health Econ 1999 Jun;18(3):291-313

Department of Health Policy, Erasmus University, Rotterdam, Netherlands.

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June 1999
7 Reads
11 Citations
2.580 Impact Factor

The redistributive effect of health care finance in twelve OECD countries.

van Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, Citoni G, Di Biase R, Gerdtham UG, Gerfin M, Gross L, Häkinnen U, John J, Johnson P, Klavus J, Lachaud C, Lauritsen J, Leu R, Nolan B, Pereira J, Propper C, Puffer F, Rochaix L, Schellhorn M, Sundberg G, Winkelhake O, Journal of health eco

http://europepmc.org/abstract/med/10537897

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June 1999
3 Reads

Equity in the finance of health care: some further international comparisons.

Wagstaff A, van Doorslaer E, van der Burg H, Calonge S, Christiansen T, Citoni G, Gerdtham UG, Gerfin M, Gross L, Häkinnen U, Johnson P, John J, Klavus J, Lachaud C, Lauritsen J, Leu R, Nolan B, Perán E, Pereira J, Propper C, Puffer F, Rochaix L, Rodríguez M, Schellhorn M, Winkelhake O, Journal of h

http://europepmc.org/abstract/med/10537896

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June 1999
3 Reads

Redistributive effects of Swedish health care finance.

Int J Health Plann Manage 1998 Oct-Dec;13(4):289-306

Centre for Health Economics, Stockholm School of Economics, Sweden.

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http://dx.doi.org/10.1002/(SICI)1099-1751(199810/12)13:4<289::AID-HPM524>3.0.CO;2-NDOI Listing
April 1999
4 Reads
2 Citations

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

Health Econ 1999 Mar;8(2):151-64

Centre for Health Economics, Stockholm School of Economics, Sweden.

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March 1999
3 Reads
4 Citations
2.140 Impact Factor

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

Gerdtham UG, Löthgren M, Tambour M, Rehnberg C, Health economics, 1999, vol. 8, no. 2, pp. 151-164

http://europepmc.org/abstract/med/10342728

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March 1999
3 Reads

A note on validating Wagstaff and van Doorslaer's health measure in the analysis of inequalities in health.

J Health Econ 1999 Jan;18(1):117-24

Department of Economics, Stockholm School of Economics, Sweden.

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January 1999
3 Reads
6 Citations
2.580 Impact Factor

Econometric analysis of variation in cesarean section rates. A cross-sectional study of 59 obstetrical departments in Sweden.

Int J Technol Assess Health Care 1998 ;14(4):774-87

Stockholm School of Economics.

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January 1999
3 Reads
2 Citations
1.560 Impact Factor

A note on validating Wagstaft and van Doorslaer's health measure in the analysis of inequalities in health

Journal of Health Economics

The aim of this note is to validate Wagstaff and van Doorslaer's approach of constructing a continuous health measure to be used in the analysis of inequalities in health. We calculate health concentration indices for Uppsala County in Sweden based on three different health status measures: health measured according to the WvD approach based on a self-assessed categorical health measure, health measured by the rating scale method, and health measured by the time trade-off method. The concentration index does not differ significantly for the three health status measures, and our results thus support the validity of the WvD method.

http://portal.research.lu.se/portal/en/publications/a-note-on-validating-wagstaft-and-van-doorslaers-health-measure-in-the-analysis-of-inequalities-in-health(4dad9cc7-0074-47ea-a9e5-0ae72a43a36b).html

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January 1999
1 Read

Equity in the delivery of health care in Sweden.

Scand J Soc Med 1998 Dec;26(4):259-64

Centre for Health Economics, Stockholm School of Economics, Uppsala, Sweden.

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December 1998
4 Reads
4 Citations

Equity in the delivery of health care in Sweden.

Gerdtham UG, Sundberg G, Scandinavian journal of social medicine, 1998, vol. 26, no. 4, pp. 259-264

http://europepmc.org/abstract/med/9868749

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December 1998
1 Read

The effect of changes in treatment patterns on drug expenditure

PharmacoEconomics

This paper investigates the effects of changes in drug therapy on drug expenditure in Sweden between 1990 and 1995. Analyses have been carried out for both the aggregate drug expenditure and for drug expenditure according to the main groups of the Anatomical Therapeutic Chemical (ATC) classification system. Changes in expenditure can be divided into 3 components: the price of drugs, the quantity of drugs consumed and a residual. The size of the residual is a measure of the effect of changes in drug treatment patterns on drug expenditure. The aggregate real drug expenditure increased by 50% between 1990 and 1995. The relative retail price index of drugs decreased by 9% and the quantity index measured in terms of defined daily doses increased by 27%. The remaining residual increased by 30%. This implies that, if the residual had been unchanged during the study period, the aggregate expenditure would have increased by only 15%. The results also show that the size of the residual varies substantially across different ATC groups. The increase in the residual was largest for drugs that affect the nervous system (ATC group N); the residual increased by 86%. From the observed changes in residual values, it can be concluded that the underlying factor responsible for the increase in drug expenditure in Sweden is changes in drug therapy from less expensive to more expensive drugs.

http://portal.research.lu.se/portal/en/publications/the-effect-of-changes-in-treatment-patterns-on-drug-expenditure(91678171-7780-4105-84bb-dc3d8ca1b66b).html

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December 1998
1 Read

Redistributive effects of Swedish health care finance

The International Journal of Health Planning and Management

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December 1998
1 Read

Price indices of drugs and the switching to new drugs two empirical examples

PharmacoEconomics

Standard price indices may not account for the price decrease that results when patients switch to pharmaceutical products for which their demand-reservation price exceeds the price of the new product. In a similar way, standard price indices may not account for the price increase that results when patients switch to pharmaceuticals for which the reservation price is below the price of the new drug. This study was designed to assess whether standard pharmaceutical price indices under- or overestimate the real price development resulting from new drug introductions. We illustrate that both situations may occur. In our first example, the switch from a branded to a generic drug, we showed that standard price indices recorded a price increase of about 16%, although the price actually decreased by about 5%. In our second example, the introduction of new formulation of a currently marketed drug, we showed that standard price indices recorded a price increase of about 6%, when the actual price increased by more than 65%.

http://portal.research.lu.se/portal/en/publications/price-indices-of-drugs-and-the-switching-to-new-drugs-two-empirical-examples(573bd3a1-b86c-4446-8f18-9582f38cc9f3).html

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December 1998

Direct costs of glaucoma management following initiation of medical therapy. A simulation model based on an observational study of glaucoma treatment in Germany.

Graefes Arch Clin Exp Ophthalmol 1998 Nov;236(11):811-21

Health Dynamics International Ltd., France.

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November 1998
3 Reads
2 Citations
1.910 Impact Factor

Direct costs of glaucoma management following initiation of medical therapy. A simulation model based on an observational study of glaucoma treatment in Germany

Graefe's Archive for Clinical and Experimental Ophthalmology

Background: Economic evaluation of new treatments in the field of glaucoma represents a challenge. In the absence of a clear epidemiological link between intra-ocular pressure (IOP) and disease progression to blindness, the economic impact of treatments that lower IOP on long-term outcome cannot be estimated. As an alternative, effectiveness may be expressed as the ability to control IOP over time, making it possible to estimate the cost-effectiveness of therapies. The objective of this study was to investigate treatment strategies for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) in Germany and to estimate the impact of new topical therapies on the total cost of treatment. Methods: We performed a retrospective analysis of 200 randomly selected patient charts in 50 ophthalmology practices. Demographics, diagnoses, IOP and detailed resource utilization over 2 years were collected. Resources were valued independently from the quantitative data collection, and a standard charge from the perspective of the third party payer, as well as a cost from the societal viewpoint, was determined for each item. A Markov model was created to calculate total treatment costs with the new therapy. Result: During the 2 years, 54% of patients had their therapy changed at least once. Mean total charge and cost per patient were DM 815 and DM 1274, respectively. Mean IOP at baseline was 31.2 mm at baseline and 18.8 mm after 2 years. IOP at baseline was positively correlated with costs, while IOP reduction after treatment initiation was negatively correlated with costs. Simulations of the effect of new topical therapies on treatment costs to third party payers and to society indicate that a potential reduction or delay of surgical interventions may partly offset the extra cost of the new drugs. Conclusion: Observational data for glaucoma treatment indicate a high frequency of treatment changes that are associated with higher costs. New treatments that control IOP effectively over time may thus reduce the cost of patient management. Their cost-effectiveness for managing IOP will depend on both, their price and their effectiveness.

http://portal.research.lu.se/portal/en/publications/direct-costs-of-glaucoma-management-following-initiation-of-medical-therapy-a-simulation-model-based-on-an-observational-study-of-glaucoma-treatment-in-germany(65578b7e-98fa-4b7d-a33f-df08b54102ad).html

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November 1998
1 Read

Estimating the costs of hip fracture and potential savings.

Int J Technol Assess Health Care 1998 ;14(2):255-67

Stockholm School of Economics.

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July 1998
3 Reads
1 Citation
1.560 Impact Factor

Costs of treating primary open-angle glaucoma and ocular hypertension: a retrospective, observational two-year chart review of newly diagnosed patients in Sweden and the United States.

J Glaucoma 1998 Apr;7(2):95-104

Health Dynamics International, London, United Kingdom.

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April 1998
3 Reads
13 Citations
2.430 Impact Factor

Costs of treating primary open-angle glaucoma and ocular hypertension

Journal of Glaucoma

Purpose: The objective of this study was to investigate what treatment strategies prevail in different countries for patients newly diagnosed with primary open-angle glaucoma (POAG) or ocular hypertension (OH) only and initiated on treatment with beta-blockers, and to estimate the total direct cost of treatment for two years. In addition, differences in costs between and within the countries and the determinants of variations in costs across patients were examined. Materials and Methods: The authors performed a retrospective medical record analysis in several academic and office-based study centers in Sweden and the United States. Standard costs for each resource item were determined and applied to all centers within the country. Differences in treatment costs within the countries are thus the effect of differences in treatment strategies, not of differences in prices. Results: There was considerable variation between the centers of each country. Sweden had a higher number of surgical interventions, which may be explained by the fact that the Swedish cohort had a higher mean intraocular pressure (IOP) at baseline and a higher proportion of patients with definite POAG and exfoliation glaucoma. However, in both countries the mean IOP at study end was approximately 18 mm HE. Total direct costs for two years were 15,119 SEK (US$ 2160; $ 1US = 7 SEK) and $ 2109, respectively. In a multiple regression analysis, the estimated effects of baseline IOP and of IOP change after treatment initiation on treatment costs were positively and negatively significant, respectively, in both countries. Conclusion: Despite differences in baseline diagnosis and in treatment strategies, mean IOP was decreased to 18 mm Hg in both countries. Baseline IOP was positively correlated with treatment costs, while the initial IOP-lowering effect of treatment was negatively correlated with two-year costs.

http://portal.research.lu.se/portal/en/publications/costs-of-treating-primary-openangle-glaucoma-and-ocular-hypertension(99a29ad4-cd1f-43f1-9a01-22e0a7585827).html

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April 1998
1 Read

Estimating the Costs of Hip Fracture and Potential Savings

International Journal of Technology Assessment in Health Care

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March 1998
1 Read

Price indices of drugs and the switching to new drugs. Two empirical examples.

Pharmacoeconomics 1998 Jan;13(1 Pt 1):71-80

Centre for Health Economics, Stockholm School of Economics, Sweden.

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http://dx.doi.org/10.2165/00019053-199813010-00007DOI Listing
January 1998
3 Reads
2.450 Impact Factor

The effect of changes in treatment patterns on drug expenditure.

Pharmacoeconomics 1998 Jan;13(1 Pt 2):127-34

Centre for Health Economics, Stockholm School of Economics, Sweden.

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http://dx.doi.org/10.2165/00019053-199813010-00012DOI Listing
January 1998
3 Reads
2 Citations
2.450 Impact Factor

The determinants of health expenditure in the OECD countries

Developments in health economics and public policy

This paper uses international health expenditure and the latest OECD data to investigate the determinants of aggregate health expenditure. The study differs from most previous studies in two principal ways. First, it uses a somewhat larger sample for estimation, with pooled time-series, cross-section data for 22 OECD countries for a 20-year period. Most previous work has used a purely cross-section approach: in this case, the small sample size reduced the statistical reliability of results and limited the number of hypotheses that can be tested simultaneously. Second, and following from this, a more extensive range of hypotheses is tested, with particular emphasis on those relating to the contractual relations between payers, providers and patients. The findings show, for example, that the use of primary care "gatekeepers" seems to result in lower health expenditure and also that the way of remunerating physicians in the ambulatory care sector appears to influence health expenditure; capitation systems tend to lead to lower expenditure than fee-for-service systems.

http://portal.research.lu.se/portal/en/publications/the-determinants-of-health-expenditure-in-the-oecd-countries(ba032312-d830-4418-9c1e-81170783471e).html

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January 1998

Econometric analysis of variation in cesarean section rates

International Journal of Technology Assessment in Health Care

The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as supply-related. A general model including all these regressors was species. After reducing this model, we were able to explain about one-quarter of the variation. We conclude that the large variation in cesarean section rates indicates inefficiency, due mainly to overutilization, but perhaps also underutilization. It is difficult to calculate the economic consequences or the welfare loss to society. We estimated an additional cost for unnecessary cesarean sections of 13-16 million Swedish crowns (SEK) per year.

http://portal.research.lu.se/portal/en/publications/econometric-analysis-of-variation-in-cesarean-section-rates(6ddc330d-7369-4152-afa1-5e867b9a42c3).html

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January 1998
1 Read

Equity in health care utilization: further tests based on hurdle models and Swedish micro data.

Authors:
U G Gerdtham

Health Econ 1997 May-Jun;6(3):303-19

Centre for Health Economics, Stockholm School of Economics, Sweden.

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September 1997
3 Reads
17 Citations
2.140 Impact Factor

Equity in health care utilization

Health Economics

This paper tests the null hypothesis of no horizontal inequity in delivery of health care by use of count data hurdle models and Swedish micro data. It differs from most earlier work in three principal ways: First, the tests are carried out separately for physician and hospital care; second, the tests are carried out separately for the probability of seeking care and the amount of care received (given any use); and third, the tests are based on a model that includes several socioeconomic variables, e.g. income, education and size of community of residence. The paper rejects the hypothesis of no inequity because socioeconomic factors also have significant effects on utilization, e.g. income and size of community of residence. Size of community of residence has a positive significant effect on the frequency of physician visits but not on the probability of visiting a physician.

http://portal.research.lu.se/portal/en/publications/equity-in-health-care-utilization(4092ffcb-1b1d-4be8-bed0-6271ebea89a9).html

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May 1997

Income-related inequalities in health: some international comparisons.

J Health Econ 1997 Feb;16(1):93-112

Department of Health Policy and Management, Erasmus University, Rotterdam, Netherlands.

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February 1997
3 Reads
79 Citations
2.580 Impact Factor

Income-related inequalities in health

Journal of Health Economics

This paper presents evidence on income-related inequalities in self- assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.

http://portal.research.lu.se/portal/en/publications/incomerelated-inequalities-in-health(442c5920-6d2f-4981-ba0a-13272de0fc4e).html

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February 1997
1 Read

Impact of inhaled corticosteroids on acute asthma hospitalization in Sweden 1978 to 1991.

Med Care 1996 Dec;34(12):1188-98

Centre for Health Economics, Stockholm School of Economics, Sweden.

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December 1996
5 Reads
3 Citations
3.230 Impact Factor

Impact of inhaled corticosteroids on acute asthma hospitalization in Sweden 1978 to 1991.

Gerdtham UG, Hertzman P, Jönsson B, Boman G, Medical care, 1996, vol. 34, no. 12, pp. 1188-1198

http://europepmc.org/abstract/med/8962585

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December 1996
1 Read

The impact of user charges on the consumption of drugs. Empirical evidence and economic implications.

Pharmacoeconomics 1996 Jun;9(6):478-83

Centre for Health Economics, Stockholm School of Economics, Sweden.

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http://dx.doi.org/10.2165/00019053-199609060-00002DOI Listing
June 1996
1 Read
1 Citation
2.450 Impact Factor

A note on the estimation of the equity-efficiency trade-off for QALYs.

J Health Econ 1996 Jun;15(3):359-68

Centre for Health Economics, Stockholm School of Economics, Sweden.

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June 1996
3 Reads
6 Citations
2.580 Impact Factor

A note on the estimation of the equity-efficiency trade-off for QALYs.

Johannesson M, Gerdtham U, Journal of health economics, 1996, vol. 15, no. 3, pp. 359-368

http://europepmc.org/abstract/med/10159446

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June 1996

A pooled cross-section analysis of the health care expenditures of the OECD countries.

Dev Health Econ Public Policy 1992 ;1:287-310

Department of Economics, Stockholm School of Economics, Sweden.

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December 1995
10 Reads
3 Citations

Health care expenditure in the Nordic countries.

Health Policy 1994 Jan;26(3):207-20

Centre for Health Economics, Stockholm School of Economics, Sweden.

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January 1994
3 Reads
1.730 Impact Factor

Drug expenditure and new drug introductions: the Swedish experience.

Pharmacoeconomics 1993 Sep;4(3):215-25

Centre for Health Economics, Stockholm School of Economics, Sweden.

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http://dx.doi.org/10.2165/00019053-199304030-00006DOI Listing
September 1993
3 Reads
2.450 Impact Factor

Drug expenditure and new drug introductions: the Swedish experience.

Gerdtham UG, Johannesson M, Jönsson B, PharmacoEconomics, 1993, vol. 4, no. 3, pp. 215-225

http://europepmc.org/abstract/med/10146924

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September 1993

Willingness to pay for antihypertensive therapy--further results.

J Health Econ 1993 Apr;12(1):95-108

Centre for Health Economics, Stockholm School of Economics, Sweden.

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April 1993
3 Reads
3 Citations
2.580 Impact Factor

The impact of aging on health care expenditure in Sweden.

Authors:
U G Gerdtham

Health Policy 1993 Apr;24(1):1-8

Centre for Health Economics, Stockholm School of Economics, Sweden.

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April 1993
3 Reads
3 Citations
1.730 Impact Factor

Willingness to pay for antihypertensive therapy--further results.

Johannesson M, Johansson PO, Kriström B, Gerdtham UG, Journal of health economics, 1993, vol. 12, no. 1, pp. 95-108

http://europepmc.org/abstract/med/10126492

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April 1993

The impact of aging on health care expenditure in Sweden.

Authors:
Gerdtham UG

Gerdtham UG, Health policy (Amsterdam, Netherlands), 1993, vol. 24, no. 1, pp. 1-8

http://europepmc.org/abstract/med/10125808

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April 1993

Pooling international health care expenditure data.

Authors:
U G Gerdtham

Health Econ 1992 Dec;1(4):217-31

Centre for Health Economics, Stockholm School of Economics, Sweden.

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December 1992
8 Reads
2 Citations
2.140 Impact Factor

Pooling international health care expenditure data.

Authors:
Gerdtham UG

Gerdtham UG, Health economics, 1992, vol. 1, no. 4, pp. 217-231

http://europepmc.org/abstract/med/1341938

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December 1992
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An econometric analysis of health care expenditure: a cross-section study of the OECD countries.

J Health Econ 1992 May;11(1):63-84

Centre for Health Economics, Stockholm School of Economics, Sweden.

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May 1992
7 Reads
19 Citations
2.580 Impact Factor

An econometric analysis of health care expenditure: a cross-section study of the OECD countries.

Gerdtham UG, Søgaard J, Andersson F, Jönsson B, Journal of health economics, 1992, vol. 11, no. 1, pp. 63-84

http://europepmc.org/abstract/med/10119757

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May 1992

Health care expenditure in Sweden--an international comparison.

Health Policy 1991 ;19(2-3):211-28

Centre for Health Economics, Stockholm School of Economics, Sweden.

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March 1992
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1.730 Impact Factor

Conversion factor instability in international comparisons of health care expenditure.

J Health Econ 1991 Jul;10(2):227-34

University of Linköping, Sweden.

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July 1991
3 Reads
5 Citations
2.580 Impact Factor

Conversion factor instability in international comparisons of health care expenditure.

Gerdtham UG, Jönsson B, Journal of health economics, 1991, vol. 10, no. 2, pp. 227-234

http://europepmc.org/abstract/med/10113711

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July 1991

Economic Evaluation of Nonpharmacological Interventions for Dementia Patients and their Caregivers - A Systematic Literature Review

Working Papers

Background: The rising prevalence of dementia represents an important public health issue. There is currently no available cure for dementia disorders, only symptom-relieving therapies which can be either pharmacological or non-pharmacological. The number of non-pharmacological interventions for patients with dementia disorders and their caregivers have been increasing in recent years without much knowledge on their cost-effectiveness. The objective is to review the existing evidence on cost-effectiveness of non-pharmacological interventions targeting patients with dementia disorders, their caregivers, and the patient-caregiver dyad. 
Method: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, ICER) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. 
Results: We included seventeen studies in this review categorised into three groups: physical exercise, occupational therapy, and psychological/psychosocial treatment. In almost all the studies (except one), economic evaluation was performed for a randomised controlled trial alongside the non-pharmacological intervention or retrospectively. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of intervention. This prevents an informative comparison between most of the studies. However, we found that physical exercise was the most-effective non-pharmacological interventions for patients with dementia. For occupational therapy and psychological/psychosocial interventions we found mixed results although the majority was not cost-effective. 
Conclusion: More economic evaluations studies are required in non-pharmacological interventions. However, the interventions need to have a strong study design with the intention to perform economic evaluation in parallel.

http://portal.research.lu.se/portal/en/publications/economic-evaluation-of-nonpharmacological-interventions-for-dementia-patients-and-their-caregivers--a-systematic-literature-review(b598a352-cac2-471c-8925-6aa2dc9d8879).html

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