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Biomedical subjects

J A Olsen

Publications and source records attributed to J A Olsen.

At least 19 recordsLinked to original sources
PubMed2005

A monoclonal antibody against HER-2 (trastuzumab) for metastatic breast cancer: a model-based cost-effectiveness analysis.

BACKGROUND: The aim of this study was to evaluate the cost-effectiveness of trastuzumab in patients with metastatic breast cancer (MBC) in a model-based cost-effectiveness analysis (CEA). Trastuzumab has shown considerable activity in patients with MBC that overexpress HER2. However, significant resources have been allocated to finance this new therapy. Due to ever increasing pressures on health care budgets, economic evaluations are requested in order to compare health effects with costs. METHODS: All available data on trastuzumab in MBC presented at the San Antonio breast cancer conference in late 2003 and all data on Medline in December 2003 were analysed for life years (LY) gained and quality of life (QoL) with regard to the use of this new monoclonal antibody. Randomised studies comparing standard chemotherapy, with or without trastuzumab, were focused. The costs were calculated according to Norwegian prices as of January 2003. RESULTS: The LY gained ranged between 0.3 and 0.7 years. The median cost per patient treated was 44 196 yielding costs per life year saved in the range 63 137-162 417 depending on survival gain and discount rate employed. A sensitivity analysis documented the price of trastuzumab and the survival benefit the two major factors influencing the cost-effectiveness ratio. CONCLUSION: The economic evaluation indicates that trastuzumab is not cost effective in metastatic breast cancer. Reduced drug costs and/or improved survival may alter the conclusion.

Antibodies, Monoclonal↗
PubMed2002

Synthesis of new 3- and 4-substituted analogues of acyl homoserine lactone quorum sensing autoinducers.

The quorum sensing mechanism in Gram-negative bacteria uses small intercellular signal molecules, N-acyl-homoserine lactones (AHLs), to control transcription of specific genes in relation to population density. In this communication, we describe the parallel synthesis of new AHL analogues, in which substituents have been introduced into the 3- and 4-positions of the lactone ring. These analogues have been screened for their ability to activate and inhibit a Vibrio fischeri LuxI/LuxR-derived quorum sensing reporter system.

4-Butyrolactone↗
PubMed2001

Theory versus practice: a review of 'willingness-to-pay' in health and health care.

This paper is based upon an extensive review of 71 willingness-to-pay (WTP) surveys of health and health care published in English during the period 1985--1998. The aim of the paper is to outline the arguments advanced for the superiority of WTP over quality-adjusted-life-years (QALYs) as a measure of benefit of health care programmes, and to review how empirical WTP studies adhere to their implications. An important argument is that WTP enables a more comprehensive valuation of benefits than QALYs. Our main focus is therefore to provide a careful review of the scenario descriptions used in the surveys, according to which types of benefits are being valued, and how comprehensively the descriptions are presented. Furthermore, the 'cost-benefit argument', that WTP can assist in improving social efficiency, is discussed before we inquire into the extent to which the studies actually compare WTP with social costs.

Attitude to Health↗
PubMed2001

Equity in health: the importance of different health streams.

This paper develops a conceptual framework in which preferences about the distribution of future health gains depend on differences in four 'health streams'. These are as follows: (1) the amount of health to be gained; (2) the no-treatment profiles; (3) the amount of health experienced thus far: and (4) the amount of health gained previously as a result of public health interventions. This classification puts the well-established concerns for severity (stream 2) and age weights (stream 3) into a more complete analytical framework. Stream 4 has not been discussed to date and the paper suggests some moral arguments about the distributive relevance of this stream of health.

Health Services Research↗
PubMed2000

[How much money are we willing to spend on health services?].

BACKGROUND: Like most other countries, Norway spends increasing sums of money on health care. The purpose of this study is to elicit people's views on whether society should spend more, and if so, their willingness to contribute to the financing of an expanded health service. MATERIAL AND METHODS: A random sample of the Norwegian population (2,089) were approached regarding a questionnaire study. 716 returned completed questionnaires (34%). Different versions of a questionnaire were used on three sub-samples in order to analyze the extent to which the distribution of answers depends on the wording of the questions. Variation in answers are sought explained by sociodemographic variables and political preferences. RESULTS: 70-80% held that society should spend more on health care. Their willingness to pay more in terms of "earmarked health care taxes" varied between the sub-samples. The mean annual figures were between NOK 1,314 and NOK 1,972. The proportions not willing to pay more varied between 39% and 46%. INTERPRETATION: It appears to be wide support for the idea that society should spend more on health care, but limited support for the idea of having to finance the desired expansion. One should be very cautious to generalize from preference surveys of this kind, because answers depend on the wording of the questions.

Adult↗
PubMed2000

A note on eliciting distributive preferences for health.

While in theory the strength of preferences for equity in health can be expressed in an 'inequality aversion parameter', in practice, analysts would have to obtain them from people's choices. We are faced with a number of methodological problems when turning to this type of empirical research. This note investigates which types of preference could explain the choices people make when responding to equity-efficiency questions of this kind. Respondents may be heavily influenced by concerns that are not related to their equity preferences, something which may lead them to choose distributions that are not consistent with models on the equity-efficiency trade-off. Specifically, a threshold effect is identified, which could explain why some people would rather prefer to concentrate than to diffuse health gains. The second aim of this note is to offer some lessons from a survey which was designed for eliciting people's distributive preferences for health gains.

Choice Behavior↗
PubMed1999

Production gains from health care: what should be included in cost-effectiveness analyses?

Recent literature has been concerned with the correct measurement of the 'indirect costs and benefits' of health care as well as the issue of including these items in economic evaluations. This article considers the question of which 'indirect benefits' to include in cost effectiveness analysis and cost utility analysis. Within the context of a collectively financed health scheme the relevant issues include not only the size of the net resource costs of providing health care but also which costs and benefits the society is prepared to consider in its assessment of health services. The strong preference for 'equal access for equal need' implies that some production gains may have to be disregarded in the social welfare function. We introduce the notion of socially relevant and socially irrelevant production gains. The analysis suggests that the magnitude of the socially relevant part of the production gains may vary between countries as it depends, first, upon differences in patients' potential contributions to the rest of society (tax rates), and second, the strength of preferences for equity.

Cost of Illness↗
PubMed1999

Influence of cuff size on blood pressure among schoolchildren.

In 236 schoolchildren aged 7-15 years arm blood pressure was measured using a semiautomatic technique. Three different cuffs were chosen among four cuffs with bladder sizes of either 6 x 20 cm, 9 x 27 cm, 12 x 35 cm or 15 x 43 cm. Ideal cuff size in each pupil was defined as the one in which the width of the bladder was closest to 40% of arm circumference. In all subjects ideal cuffs were tested along with two cuffs bigger or smaller than the ideal one. The study showed that "normal blood pressure" in relation to age depended on the cuff used. Using the ideal one, systolic blood pressure increased from 105 mmHg at 7 years of age to 117-119 mmHg at age 11, with no further increase at higher ages, while diastolic blood pressure was almost unchanged in the different age groups. Normal blood pressure curves constructed using the same cuff in all children showed a steeper increase in both systolic and diastolic blood pressure in relation to age compared to the curve based on the ideal cuff in all children. It is strongly recommended that future studies should take the best-suited cuff problem into consideration when planning studies among children. Some of the differences between previous published studies may be explained by the differences introduced by different cuff sizes.

Adolescent↗
PubMed1998

Helicopters, hearts and hips: using willingness to pay to set priorities for public sector health care programmes.

The paper reports from a study that asked 150 interviewees their willingness to pay (WTP) in increased earmarked taxation for three different health care programmes: a helicopter ambulance service, more heart operations and more hip replacements. Reasons behind the stated WTP were asked for. Ordinary least squares regression analyses were used to analyse factors associated with WTP for each of the three programmes, and factors associated with the relative WTP for one programme compared with the total of the three. Comparisons were made of WTP for these programmes and the health outcome in terms of quality adjusted life years.

Adult↗
PubMed1997

Theories of justice and their implications for priority setting in health care.

The paper aims to show how three theories of distributive justice; utilitarianism, egalitarianism and maximum, can provide a clearer understanding of the normative basis of different priority setting regimes in the health service. The paper starts with a brief presentation of the theories, followed by their prescriptions for distribution, as illustrated with their respective preferred points on a utility possibility frontier. After this general discussion, attention is shifted from utils to health. The paper discusses how the recent Norwegian guidelines for priority setting can be understood in the light of the theories.

Efficiency, Organizational↗
PubMed1997

Lumpectomy or mastectomy? Is breast conserving surgery too expensive?

In the last decade, breast cancer patients have enjoyed an increase in breast conserving surgery (BCS). At present, modified radical mastectomy (MRM) and BCS offers equal expectations of survival. During the last few years, however, a drop in the frequency of BCS has been reported by several authors. Is this new trend due to economic concerns? To clarify the costs of breast cancer therapy (stage I and II), we review the literature and include a cost-utility and a cost-minimisation analysis comparing MRM and BCS. The treatment cost (per patient) of BCS and MRM in Norway was calculated at $9,564 and $5,596, respectively. Employing a quality of life gain in BCS of 0.03 (0-1 scale) and a 5% discount rate, the cost per QALY in BCS compared to MRM was $20,508. In cost-minimising analysis, BCS and mastectomy followed by reconstructive surgery had a cost of $10,748 and $8,538, respectively. This indicates that BCS remains within reasonable cost and should not be displaced by mastectomy on economic grounds.

Breast Neoplasms↗
PubMed1997

A cost-effectiveness approach to the Norwegian follow-up programme in colorectal cancer.

BACKGROUND: Today, continued periodic follow-up of patients treated for colorectal cancer (CRC) seems often to be routine because of tradition, rather than its demonstrated value. Recently, the Norwegian Gastrointestinal Cancer Group (NGICG) has recommended a standard surveillance programme in this malignancy. In this protocol patients are suggested followed for four years with CEA monitoring, ultrasound of the liver, chest radiograph and colonoscopy at regular intervals. MATERIALS AND METHODS: In this study, the cost-effectiveness of this programme was addressed employing Norwegian cost data and data from the Cancer Registry of Norway. Clinical data from the existing English language literature was used in the analysis. RESULTS: The basic cost of the NGICG recommended programme was 1,232 Pounds per patient. Including extended investigation due to suspected relapse in 45% of cases, the figure raised to 1,943 Pounds per patient. The cost per life year saved was indicated to 9,525 Pounds-16,192 Pounds. The corresponding cost per quality adjusted life year (QALY) was indicated to 11,476 Pounds-19,508 Pounds. CONCLUSION: We conclude the NGICG recommended follow-up programme in CRC cost-effective. Excluding CEA monitoring may improve the cost-effectiveness.

Carcinoembryonic Antigen↗
PubMed1997

Adjuvant chemotherapy (5-fluorouracil and levamisole) in Dukes' B and C colorectal carcinoma. A cost-effectiveness analysis.

BACKGROUND: Adjuvant chemotherapy (5-fluorouracil, levamisole) is now standard practice in the treatment of Dukes' B and C coloretal carcinoma (CRC), and this has increased the financial burden on health care systems world-wide. PATIENTS AND METHODS: Between 1993 and 1996, 95 patients in northern Norway were included in a national randomised CRC study, and assigned to surgery plus adjuvant chemotherapy or surgery alone. In April 1996, 94 of the patients were evaluable and 82 were still alive. The total treatment costs (hospital stay, surgery, chemotherapy, administrative and travelling costs) were calculated. A questionnaire was mailed to all survivors for assessment of the quality of their lives (QoL) (EuroQol questionnaire, a simple QoL-scale, global QoL-measure of the EORTC QLQ-C30), and 62 of them (76%) responded. RESULTS: Adjuvant chemotherapy in Dukes' B and C CRC raised the total treatment costs by 3,369 pounds. The median QoL was 0.83 (0-1 scale) in both arms. Employing a 5% discount rate and an improved survival of adjuvant therapy ranging from 5% to 15%, we calculated the cost of one gained quality-adjusted life-year (QALY) to be between 4,800 pounds and 16,800 pounds. CONCLUSION: Using a cut-off point level of 20,000 pounds per QALY, adjuvant chemotherapy in CRC appears to be cost-effective only when the improvement in 5-year survival is > or = 5%. Adjuvant chemotherapy does not affect short-term QoL.

Adult↗
PubMed1996

Treatment costs in Hodgkin's disease: a cost-utility analysis.

The aim of this study was to estimate costs of treatment for Hodgkin's disease (HD) and the outcome in health in terms of quality-adjusted life-years (QALYs), and compare these to a constructed nontreatment alternative. All 55 patients treated for HD at the oncological unit of the University Hospital of Tromsø between 1985 and 1993 were included. The total treatment costs (medication, hospital stay, hospital hotel stay, radiotherapy, travelling, loss in production, i.e. work) were retrospectively estimated for all patients. In December 1994, the 49 survivors were sent a EuroQol questionnaire recording quality of life: 42 responded. The mean quality of life score was 0.78 on a 0-1 scale, and the mean total cost of treatment was pounds 12512. The total treatment costs were significantly higher in patients with advanced clinical stages of the disease (P = 0.0006), B-symptoms (fever, sweats, weight loss) (P = 0.0027) and relapse (P < 0.0001). The costs of one QALY (with production gains included and using a 10% discount rate) were estimated at pounds 1651. When excluding production gains and using a 5% discount rate, the figures became pounds 1327. This makes HD one of the most cost-effective malignancies to treat.

Adolescent↗
PubMed1994

Agency in health care with an endogenous budget constraint.

In this paper a doctor acts as a perfect agent for a group of patients in an environment where the health service is funded by a group of contributors. The contributor group donates resources to the health sector in accordance with its split preferences about the health care services which they would like for themselves and those which they would like for others. We show that the size of the health budget is endogenous and depends on the choices made by the doctor. The focus is on the division of the budget between health enhancing and non-health enhancing health care.

Budgets↗
PubMed1993

Time preferences for health gains: an empirical investigation.

The purpose of this study was to elicit the implied discount rates to be used in economic evaluations of health care programmes. The paper presents results from two Norwegian surveys in which a random sample of the population and a sample of health planners were asked to prioritise between alternative health care programmes, and make trade-offs between future health gains and more immediate gains. The questionnaire had four hypothetical choice situations; two for life saving and two for health improvement.

Adult↗
PubMed1993

On what basis should health be discounted?

The discount rate to be applied in health care programmes should be based on the time preference rate for health, and this same rate should be applied to costs as well. Due to the limited tradeability of health, when eliciting its time preference rate, the intertemporal choices must be framed in such a way as to resemble as closely as possible those facing health planners and decision makers.

Data Collection↗