PubMed Health⌕ Search

Biomedical subjects

F Andersson

Publications and source records attributed to F Andersson.

35 records · Page 2Linked to original sources
PubMed1997

Cost effectiveness in the treatment of heart failure with ramipril. A Swedish substudy of the AIRE study. Acute Infarction Ramipril Efficacy.

We estimated the cost effectiveness of adding the ACE inhibitor ramipril to conventional treatment in patients with heart failure after acute myocardial infarction. These estimates were based on the Acute Infarction Ramipril Efficacy (AIRE) study and on complementary Swedish healthcare resource use data for a subset of patients. The average follow-up period was 15 months (minimum 6 months, maximum 3.8 years). The perspective of the analysis was that of the county councils (third-party payers), and we focused on the cost of drugs and hospitalisation. The marginal cost effectiveness of the treatment was estimated over 3 treatment periods: 1, 2 and 3.8 years. The cost-effectiveness ratios varied between SEK14,148 and SEK33,033 per life-year gained ($US1 = SEK7.70. Pounds 1 = SEK12.40) for the 3 treatment periods. Adding ramipril to conventional treatment for heart failure after acute myocardial infarction is therefore cost effective, and compares favourably with the cost effectiveness of other common medical therapies in the cardiovascular field.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1995

The cost of angina pectoris in Sweden.

A survey of 402 Swedish patients with angina pectoris was performed to estimate the annual direct medical costs, and nonmedical costs, of a typical Swedish angina pectoris patient, and to identify those variables having the greatest impact on the direct medical costs. Data regarding the consumption of healthcare services over a 3-month period were collected through telephone interviews conducted by trained nurses at a medical marketing agency. The data were multiplied by 4 to obtain an estimate of the annual resource consumption. The annual direct medical cost of angina pectoris was estimated at 40,052 Swedish krona (SEK; $US1 approximately SEK7.20, March 1995) per patient, comparable with the cost of a myocardial infarction. As expected, however, the severity of angina pectoris was important in determining the direct medical cost. The significant variables explaining variations in direct costs were (in order of importance): (i) whether the patient had undergone cardiovascular surgery; (ii) whether the patient was treated by a general practitioner or an internist; (iii) the number of years since first diagnosis of angina pectoris; and (iv) whether the patient's angina pectoris was characterised as stable or unstable. The annual nonmedical cost of angina pectoris per patient was estimated at SEK38,225. The relatively high costs of angina pectoris underline the importance of health economic evaluations of various diseases and medical interventions.

Aged↗
PubMed1994

The distribution of pharmaceuticals in Europe--current and future trends in wholesaling.

As of January 1, 1993 a huge market, encompassing more than 325 million people, has been established with the unification of the 12 member states in the European Community. During the last 10 years, the pharmaceutical wholesaling sector has therefore been involved in an intense restructuring process. But, there is a considerable scientific gap in the knowledge of pharmaceutical wholesaling. In view of the uncertain situation and the scarcity of structured information, the purpose of this article is to examine current and future trends in the European pharmaceutical wholesaling sector. We reviewed the literature and identified three major areas of interest; general threats to traditional full-line wholesaling, wholesalers' response to these threats, and the new Glaxo distribution scheme. The current and expected importance of these areas were assessed with the help of a survey, encompassing 20 experts in this field. Based on the review and the survey, we conclude that there are many serious threats to traditional wholesaling, the major ones being governmental pressures to lower the already relatively low gross margins, manufacturers contemplating taking over the drug distribution process themselves and increasing international competition. The major responses to these threats are to become a truly international player (via mergers, acquisitions and joint ventures), or being able to provide the customers with detailed management information through computerised networks. In order to survive the next 5-10 years, companies have to be very alert to the changing competitive situation.

Drug Industry↗
PubMed1994

Cost effectiveness of antiviral treatment with zalcitabine plus zidovudine for AIDS patients with CD4+ counts less than 300/microliters in 5 European countries.

A cost-effectiveness model was developed on the basis of early clinical trial results from the US reporting sustained CD4+ cell response in patients receiving zalcitabine in addition to zidovudine. This model was then adapted and applied to 5 European countries to assess the comparative cost effectiveness of adding zalcitabine to antiviral treatment for AIDS patients. The countries included in the modelling effort were Switzerland, France, Italy, Germany and the UK. The model used a Markov state-transition process to estimate the rate of acute opportunistic disease episodes, lifetime medical treatment costs, and survival for populations of AIDS patients with baseline CD4+ counts of less than 300/microliters. Physician panels in each country developed standard treatment algorithms and adjusted the epidemiological data to reflect the AIDS profile of each country. Economic consultants provided cost data. Results from this exploratory data analysis show that if CD4+ counts correlate with the incidence of opportunistic disease episodes as expected, the combined use of zalcitabine and zidovudine for a 1-year period should be cost effective.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Methodological aspects of international drug price comparisons.

Drug prices have become an important issue in the last few years as concerns about constrained healthcare resources have increased. Healthcare authorities in all industrialised countries are questioning whether their country is carrying a heavier burden than others in paying for drugs. In view of this discussion, several price comparison studies have been conducted. However, there is no generally accepted methodology on how to conduct price comparisons, and many methodological issues remain unresolved. The results of most published studies are affected by moderately serious methodological flaws, which are never properly addressed. The purpose of this study is to discuss the methodological issue of international drug price comparison, in terms of 6 points that appear to this author to be necessary to conduct a methodologically sound study. A previous review of a large number of drug price comparisons revealed that they all fail to take into account some or all of these 6 basic methodological points. Studies that fulfil the methodological criteria outlined in this paper are therefore urgently needed before drug pricing studies can be fully utilised as a basis for important policy decisions in the healthcare arena.

Drug Costs↗
PubMed1992

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

This paper has two purposes. The first, empirical purpose is to estimate and evaluate the effects of aggregate income, institutional and socio-demographic factors on health care expenditures in the OECD countries. The second purpose is methodological, and comprises assessment of temporal instability, the choice of functional form, and misspecification of the estimated relationships. Data compiled over three years (1974, 1980 and 1987) from 19 OECD countries are used in a pooled cross-section regression analysis. Like previous studies, this one concludes that aggregate income measured by Gross Domestic Product per capita is the statistically most important factor in cross-national variation in health care expenditures, and that the aggregate income elasticity exceeds one. However, the data analyzed in this study also show some evidence that public financing of health care services is associated with lower expenditures per capita, and that countries with fee for service as the dominant form of remuneration have higher expenditures. The examined relationships appear to be temporally stable over the three years except for upward shifts, and there is no indication of statistical misspecification. This does not necessarily imply a correct specification, and we do note the presence of measurement errors in some of the variables. Moreover, the selected log-linear functional form appears to be non-optimal according to a likelihood criterion, and is rejected against a quadratic form. Based on the analyses from this study the results do not appear to be sensitive to use of the quadratic form specification.

Europe↗
PubMed1992

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

This paper is an empirical examination of the determinants of aggregate health care expenditure. The paper presents a systematic analysis of relationships across 19 OECD countries, showing the effects of aggregate income, institutional and socio-demographic factors on health care expenditure. The results indicate that institutional factors of the health systems, in addition to per capita Gross Domestic Product (GDP), contribute significantly to the explanation of the health care expenditure variation between countries; for example the way physicians in outpatient care are paid, and the mixture of public/private funding and inpatient/outpatient care.

Ambulatory Care↗
PubMed1992

Norway's pivotal role in regulatory health economics and pharmaceutical cost containment--what can other countries learn?

With an increasing trend in health care consumption--together with the introduction of an increasing number of new medical technologies-- governments, insurance companies and other third party payers seek new ways of limiting increases in consumption, as well as limiting the use of new medical technologies to the most efficient ones (clinically, economically). One particular area of focus in this context is the pharmaceutical sector, where the innovational rate of new technologies (drugs) has been high. One of the forerunners in the areas of health care cost containment and regulatory health economics is Norway. This country has succeeded in keeping drug prices and drug consumption at moderate levels, as well as keeping the number of new drugs to a relatively modest level. This study describes the Norwegian drug regulatory process, the Norwegian drug market, the Norwegian cost-containment policies and future regulatory perspectives. For many European countries and in North America, where stricter price and reimbursement regulations are considered, the Norwegian drug regulatory process presents an interesting example of how a strict regulatory environment may affect the availability of drugs, as well as drug prices, drug reimbursement and drug consumption.

Cost Control↗
PubMed1992

The costs and benefits of switching a drug from prescription-only to over-the-counter status: a review of methodological issues and current evidence.

In recent years various governments, pharmacy associations, consumer groups and the pharmaceutical industry have suggested that more drugs should be switched from prescription-only (Rx) to over-the-counter (OTC) status. Many rationales have been offered, including lowering healthcare costs, taking advantage of pharmacists' training and knowledge, promoting the concept of prevention and self-care, and increasing sales of pharmaceuticals. The purpose of this article is to examine the current state of knowledge on assessing the effects of such a change. First, the paper discusses the methodology and data necessary for conducting an assessment of the costs and benefits of switching a drug from Rx to OTC status. Basically two methods, the economic theory of consumers' surplus and the epidemiological approach, are available; the choice of method depends on the drug examined and the data available. Secondly, the article discusses existing evidence pertaining to the costs and benefits of these switches. Based on our review of the literature, we conclude that the benefits, to individual consumers and to society as a whole, resulting from a change in prescription status outweigh the costs. The extent of the benefits depends on the type of drug and the size of the market.

Cost-Benefit Analysis↗
PubMed1992

The drug lag issue: the debate seen from an international perspective.

This article reviews the literature related to the "drug lag" issue, i.e., the issue of whether important new drugs are introduced relatively late, or, in certain cases, are introduced at all, in a particular country. The literature can be divided into two main parts: studies primarily related to the delay in introduction of new drugs and studies primarily related to the number of introduced new drugs. Most studies have found the United States, Sweden, and Norway to have a long delay in the introduction of new drugs. The United Kingdom and (West) Germany in general have the shortest delay. There are also large differences in the number of introduced new drugs. In most studies, the United States and Norway have introduced far fewer new drugs than any other industrialized country. In general (West) Germany, France, the United Kingdom, and Italy have introduced the largest number of new drugs. One of the reviewed studies presented a relationship between regulatory processing time and delay in introduction. Another study found an increasing influence of regulatory stringency on the number of introduced new drugs in a country. If a country's aim is to decrease the delay in introduction and/or to increase the introduction of important new drugs, a review of the local regulatory agencies and the regulations seems worthwhile.

Diffusion of Innovation↗
PubMed1991

Student impressions of problem-based learning.

The student impressions of problem-based learning of the first term's study are described. The students worry about their ability to determine what to know and to what depth.

Education, Dental↗
PubMedDate not supplied

Health economic guidelines--similarities, differences and some implications.

OBJECTIVE: To classify, summarize, and compare the health economic guidelines (HE) issued in Europe, North America, and Australia to clarify similarities and differences between them. MATERIALS AND METHODS: In a literature review HE guidelines were classified according to whether they were 1) formalized, 2) informal, or 3) guidelines for health economic methods. All the guidelines were summarized in a table format according to 15 important methodological aspects. The aspects were compared both within and between the three groups. RESULTS: A total of 25 guidelines were identified, seven formalized, eight informal, and 10 guidelines for HE methods. The levels of agreement for methodological aspects within groups were 40% to 100%, 25% to 100% and 30% to 100% for the formalized, informal, and HE guidelines, respectively. The formal guidelines were slightly more homogenous than the other groups. The between-group comparison showed that the guidelines were in agreement for about 75% of methodological aspects. Disagreement between guidelines was found in choice of perspective, resources, and costs that should be included in the analysis, and in methods of evaluating resources used. CONCLUSION: A harmonization of methodological requirements and recommendations exists both within and between the guideline groups. This review provides information concerning the core of agreements that have been reached. A number of policy implications for various parties, mainly the pharmaceutical industry, were identified.

Australia↗
PubMedDate not supplied

Willingness to pay for reductions in angina pectoris attacks.

To compare the costs of health care programs, with the benefits, the values of changes in health status must be expressed in monetary terms. The development of methods to estimate willingness to pay for changes in health status is therefore of interest. This paper reports the results of a contingent valuation study measuring willingness to pay for reductions in angina pectoris attacks. An innovative study design allowed analysis on the data on willingness to pay using two approaches, a binary question and a bidding-game technique. Percentage reductions in anginal attacks were varied randomly in different subsamples, and data were collected about angina pectoris status, attack rate, and income to test the internal validity of the contingent valuation method. Willingness to pay for a 50% reduction in the attack rate for three months was estimated to be about SEK 2,500 ($345) with the binary approach, and about SEK 2,100 ($290) using the bidding-game technique. Regression analyses showed that income, angina pectoris status, attack rate, and percentage reduction in attack rate were all related to willingness to pay, in agreement with the authors' hypothesis.

Aged↗