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D Gyrd-Hansen

Publications and source records attributed to D Gyrd-Hansen.

15 recordsLinked to original sources
PubMed2005

Influence of number needed to treat, costs and outcome on preferences for a preventive drug.

BACKGROUND: The number needed to treat (NNT) has been widely recommended for communicating benefits from risk reductions. It has been claimed that NNT is easily understood and that it has intuitive meaning. There are, however, only few studies of lay people's understanding of NNT. OBJECTIVE: The objective of this study was to explore whether lay people are sensitive to the magnitude of treatment effectiveness as expressed in terms of NNT, and whether the sensitivity is influenced by variation in the type of health outcome, variation in patients' payment for the treatment or variation in the type of side effects. METHODS: In total, 2326 non-institutionalized Danes aged 18-91 years were interviewed face to face and asked whether they would consent to a treatment against a somewhat increased risk of death or heart attack. The respondents were allocated to different levels of effectiveness of treatment expressed as NNT of 10, 100, 200 or 400, different costs and different descriptions of adverse effects. RESULTS: The odds for consenting to therapy were little influenced by the magnitude of NNT, but were greater among married respondents and among those who had side effects presented in terms of headache and constipation. CONCLUSION: In this study, the respondents' choice of treatment was largely insensitive to the magnitude of NNT independently of variations in type of health outcome and costs. NNT may not be easily understood by lay people.

Adult↗
PubMed2001

Analysing public preferences for cancer screening programmes.

Economic evaluations generally fail to incorporate elements of intangible costs and benefits, such as anxiety and discomfort associated with the screening test and diagnostic test, as well as the magnitude of utility associated with a reduction in the risk of dying from cancer. In the present analysis, 750 respondents were interviewed and asked to rank, according to priority, a number of alternative screening programme set-ups. Focus was on colorectal cancer screening and breast cancer screening. The alternative programmes varied with respect to number of tests performed, risk reduction obtained, probability of a false positive outcome and extent of co-payment. Stated preferences were analysed using discrete ranking modelling and the relative weighting of the programme attributes identified. Applying discrete choice methods to elicit preferences within this area of health care seems justified by the face validity of the results. The signs of the coefficients are in accordance with a priori hypotheses. This paper suggests that large-scale surveys focusing on individuals' preferences for cancer screening programmes may contribute significantly to the quality of economic evaluations within this field of health care.

Breast Neoplasms↗
PubMed2000

Cost implications of routine mammography screening of women 50-69 years in the county of Funen, Denmark.

In order to estimate the net costs of introducing mammography screening to women 50-69 years of age, unit costs of all relevant activities related to detection and treatment of breast cancer were estimated using activity based costing methods. In order to determine the overall impact of mammography screening, activity data collected from the second screening round (1996-1997) were compared with expected activity levels in the case no screening had taken place in this time period. The direct health care costs associated with the screening activity, excluding effects on treatment and diagnostics but including women's transport and time costs, were estimated at DKK 305 per attendee. The cost of clinical mammography decreases with the introduction of screening due to a decrease in the total number of women undergoing this introductory diagnostic activity, while surgery costs increases, whereas cost incurred by adjuvant treatment and treatment of recurrences will be significantly reduced. Overall, inclusion of effects on course of treatment decreases the net cost of screening by 30-40% to DKK 208 and DKK 128 including and excluding the women's time and transport costs, respectively.

Aged↗
PubMed2000

Cost-benefit analysis of mammography screening in Denmark based on discrete ranking data.

OBJECTIVE: Economic evaluations such as cost-effectiveness and cost-utility analyses generally fail to incorporate elements of intangible costs and benefits, such as anxiety and discomfort associated with the screening test and diagnostic test, as well as the magnitude of utility associated with a reduction in the risk of dying from cancer. This paper seeks to include all costs and effects incurred by introducing mammography screening through the application of discrete ranking modeling. METHODS: In the present analysis, 207 women were interviewed and asked to rank, according to priority, a number of alternative breast cancer screening setups. The alternative programs varied with respect to number of tests performed, risk reduction obtained, probability of a false-positive outcome, and extent of copayment. Using discrete ranking modeling, the stated preferences were analyzed and the relative weighting of the program attributes identified. For a range of hypothetical breast cancer programs, relative utilities and corresponding willingness-to-pay estimates were derived. RESULTS: A comparison of cost and willingness to pay for each of the programs suggested that net benefits are maximized when screening person aged 50-74 years biennially. More intensive screening produces lower or similar levels of utility at a higher cost. CONCLUSION: Discrete ranking modeling can aid decision making by identifying inferior healthcare programs, i.e., programs that are more costly but less beneficial.

Aged↗
PubMed1998

Colorectal cancer screening: efficiency and effectiveness.

The cost-effectiveness of a series of mutually exclusive colorectal cancer screening programmes with varying screening interval and target group are analysed. Costs and effects for 60 possible screening programmes are simulated on the basis of data collected from a randomized trial initiated in 1985 in Funen County, Denmark. The screening test applied is the unhydrated Hemoccult-II. The analysis identifies six efficient programmes with cost-effectiveness estimates ranging from 17000 to 42500 Danish kroner (DKK) per life-year.

Aged↗
PubMed1998

Discounting life-years: whither time preference?

If elicited time preferences are to be incorporated into economic evaluations, not only social but also individual preferences may be included. The view of this paper is that social intertemporal preferences should govern social intertemporal choices when prioritising between the saving of lives now or in the future. However, the present value of an individual's stream of future health benefits is a matter of private consumption and hence either individual time preferences or social interpersonal preferences could be applied when evaluating the value of extended life or improved quality of life. This paper shows that it is possible to incorporate both types of time preferences in an economic evaluation; using the individual time preference or the social interpersonal preference when discounting the remaining life expectancy and the social intertemporal time preference for discounting the health benefits from the time of the risk reduction to present time. Such a scenario could solve potential problems such as double discounting of QALYs, the paradox of intertemporal equity versus interpersonal equity, as well as include elements of quantity, risk and uncertainty which are otherwise ignored in evaluations of life-saving therapies.

Attitude to Health↗
PubMed1998

Counting and discounting gained life-years.

The life expectancy gain produced by a reduction in mortality can be determined by three different methods with respect to the timing of the gained life-years. One method adds the life expectancy gain to the expected end of life. Another method places the gain at the time of occurrence of the mortality reduction. A third method distributes the gained life-years over the maximum lifespan according to the differences in survival probabilities after and before the reduction in mortality. The three methods are all used in the literature together with a quasi-deterministic and a probabilistic approach to the notion of life expectancy. The counted numbers of gained life-years are the same, but due to different timing of life expectancy gains the discounted numbers are different. Several discounting models are identified when combining the three methods of counting with the deterministic and the probabilistic approaches to life expectancy. Some are symmetrical, some are not. However, most importantly, they come out with potentially very large differences in the discounted number of gained life-years. They differ by a factor of approximately (1 + r)e(a)-1, where r is a constant discount rate and e(a) is remaining life expectancy at age a, when the reduction of mortality occurs. For a new-born, discounting at 7% p.a., one discounting model provides a present value that is 150 times larger than another discounting model, the other models being in between. The various counting and discounting models for life expectancy gains are presented formally, graphically, and with numerical examples using Danish male mortality data. We show how three different discounting models provide large differences in discounted life expectancy gains and hence cost-effectiveness ratios in an economic evaluation of a colorectal cancer screening programme in Denmark. These different discounting models co-exist in the evaluation literature. Choice of method is rarely made explicit. Sensitivity analysis with respect to this choice is even rarer. We argue that one counting-discounting model is sufficient and that this should be to discount the differences between the two survival probability curves.

Adult↗
PubMed1998

Fecal occult blood tests. A cost-effectiveness analysis.

A range of fecal occult blood tests are presently on the market and could potentially be used in population screening programs for the detection of colorectal neoplasms. This paper estimates the relative cost-effectiveness of alternative tests and concludes that the unhydrated Hemoccult II is the most cost-effective. However, the incremental costs per life-year of the HemeSelect test and the rehydrated Hemoccult II test are in line with incremental costs observed in breast cancer and cervical cancer programs.

Aged↗
PubMed1997

Is it cost effective to introduce screening programmes for colorectal cancer? Illustrating the principles of optimal resource allocation.

This paper seeks to shed light on the relative cost effectiveness of colorectal cancer by comparing the cost effectiveness of this programme with the economics of another screening programme which is widely implemented: cervical cancer screening. The paper illustrates the principles of optimal resource allocation, and discusses the limitations and strengths of the analysis presented. The paper concludes that colorectal cancer is a cost effective option relative to cervical cancer screening when health is seen as the only outcome of the screening programmes. However, further insight into consumer preferences and inclusion of intangible costs and benefits is necessary in order to guarantee optimal resource allocation.

Adult↗
PubMed1997

Analysis of screening data: colorectal cancer.

BACKGROUND: This paper illustrates how data gathered from an existing screening programme against colorectal cancer can be used to produce new information on the natural history of colorectal cancer as well as the characteristics of the unhydrated Hemoccult II screening test. METHODS: A mathematical model is used, which on the basis of prevalence and interval incidence data from a randomized screening project initiated in Funen County, Denmark, estimates the sensitivity of the screening test and the sojourn time of the disease. RESULTS: The sensitivity of the Hemoccult is estimated at 62.1% and the mean sojourn time is estimated to be 2.1 years. CONCLUSIONS: The short sojourn time indicates that overall effectiveness of a Hemoccult II screening programme can be improved significantly by more frequent screening.

Aged↗
PubMed1996

[Costs and effects of alternative screening programs against cervical cancer].

This paper presents a framework for comparison of screening programme designs, based on efficiency and cost effectiveness criteria. Design parameters such as choice of screening interval and which population segments to screen are varied simultaneously. The costs and effects for a range of existing and hypothetical screening programmes for cervical cancer are estimated, using a mathematical simulation model. On the basis of these estimations incremental costs per life year are calculated for a range of programmes. Efficiency and cost effectiveness criteria indicate that extending screening programmes for cervical cancer beyond screening women in the age group 25-59 years every four years may not be optimal.

Adult↗
PubMed1995

A cost-effectiveness analysis of cervical cancer screening: health policy implications.

This paper presents a framework for comparison of screening programme designs, based on efficiency and cost effectiveness criteria. The design parameters, such as choice of screening interval, which population segments to screen and expected participation rates in the selected population segments, are varied simultaneously. The costs and effects for a range of existing and hypothetical screening programmes against cervical cancer are estimated, using a mathematical simulation model. On the basis of these estimates average costs per life year and marginal costs per life year are calculated for a range of programmes. These calculations result in the definition of a range of inefficient programmes. Moreover, it is illustrated that the cost effectiveness of the efficient screening programmes decreases at an increasing rate as programmes are intensified either by way of shortening the screening interval or extending the target population segment to encompass the very young and/or the very old. The conclusion of this paper is that one should probably not extend screening programmes against cervical cancer beyond screening women in the age group 25-59 years every 4 years. In addition, increasing the participation rate of this group is a more cost effective way of increasing the number of life years gained, rather than extending the target group or decreasing the screening interval.

Adult↗
PubMedDate not supplied

Health-economic analyses of subcutaneous specific immunotherapy for grass pollen and mite allergy.

OBJECTIVE: To investigate the health and monetary consequences of treating allergy with specific immunotherapy (SIT) compared with symptomatic treatment/standard care among patients with grass pollen or mite allergy. METHODS: We performed an economic analysis based on 253 grass- and/or mite allergic patients who started SIT from 1.1.1996 to 1.1.2002 at the Allergy Unit, Aarhus University Hospital and at a specialist practice in Aarhus. Relevant data were collected before, during and after SIT treatment from the national health service based on each patient's personal identification number and medical records and from a specifically designed questionnaire. A cost-benefit analysis including direct and indirect costs before, during and after SIT was performed. In addition direct costs were related to the clinical effect (improvement in well-being) in the form of a cost-effectiveness analysis. RESULTS: The direct cost per patient/year before SIT (equivalent to standard care) was DKK 2,580. The investment in SIT was DKK 27,545 (in present values) per patient over a 4-year period. After SIT the cost was reduced to DKK 1,072 per patient/year. In the long term, prospective introduction of SIT incurred additional present-value direct costs of DKK 13,676 per patient treated and DKK 2,784 per patient/year of improved well-being. However, when indirect costs were included in the economic evaluation SIT was shown to be net beneficial. CONCLUSION: This study reveals that SIT is associated with initial resource investments and subsequent resource savings in the long term compared with standard care. When all consequences are measured in monetary terms, and assuming that sick days are associated with a loss of productivity, this analysis suggests that SIT increases societal welfare. This conclusion also holds if there is no loss of productivity.

Absenteeism↗
PubMedDate not supplied

Clinical and patient based evaluation of immunotherapy for grass pollen and mite allergy.

BACKGROUND: Treatment of allergic disease can be done by pharmacological intervention by allergen avoidance--in the following called standard care (SC), or by specific treatment with allergy vaccination; Specific Immunotherapy (SIT). The aim of this study were to evaluate the effects of subcutaneously administrated SIT compared to SC by objective (clinical/medical records) and subjective parameters (patient's opinion) in a before/after SIT study. METHODS: The study included retrospectively all grass- and mite allergic 16-60 year old patients (N = 253) who had started SIT for grass pollen or mite allergy during the period 1.1.1996-1.1.2002 at The Allergy Unit, Aarhus University Hospital, or at a specialist practice in Aarhus. Relevant data were collected before/after treatment from medical records and from a specific designed questionnaire. The following indicators for effect were applied: Success of immunotherapy expressed as completion of up dosing phase, change in symptoms, a comparison of overall rhinoconjunctivitis symptoms, number of symptom free days per year, effect of pharmaceuticals, change in physical and psychological wellbeing and number of lost days from work/education and leisure activities. RESULTS: Compliance for completed up dosing for SIT was 94 % (95 % CI 90-97). The questionnaire revealed that after SIT there were a significant reduction in degree of symptoms, 84 % (95 % CI 79-89) of the respondents achieved a reduction in over all rhinoconjunctivitis score, there were an increase in symptom free days per year, a decrease in days off/incapacity from work/education and leisure activities, an improved effect of the pharmaceuticals used for allergic symptoms and an improvement in physical and psychological wellbeing. The study also showed that SIT was more effective treating rhinoconjunctivitis symptoms than lung symptoms. CONCLUSION: The study revealed great advantages of SIT compared to SC and a high compliance for SIT during the up dosing period.

Adolescent↗