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Stubhaug A, Hansen JL, Hallberg S, Gustavsson A, Eggen AE, Nielsen CS. The costs of chronic pain-Long-term estimates. Eur J Pain 2024. [PMID: 38214661 DOI: 10.1002/ejp.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Chronic pain is a condition with severe impact on many aspects of life, including work, functional ability and quality of life, thereby reducing physical, mental and social well-being. Despite the high prevalence and burden of chronic pain, it has received disproportionally little attention in research and public policy and the societal costs of chronic pain remain largely unknown. This study aimed to describe the long-term healthcare and work absence costs of individuals with and without self-identified chronic pain. METHODS The study population were participants in two Norwegian population health studies (HUNT3 and Tromsø6). Participants were defined as having chronic pain based on a self-reported answer to a question on chronic pain in the health studies in 2008. Individuals in the study population were linked to four national register databases on healthcare resource use and work absence. RESULTS In our study, 36% (n = 63,782) self-reported to have chronic pain and the average years of age was 56.6. The accumulated difference in costs between those with and without chronic pain from 2010 to 2016 was €55,003 (CI: 54,414-55,592) per individual. Extrapolating this to the entire population suggests that chronic pain imposes a yearly burden of 4% of GDP. Eighty per cent of the costs were estimated to be productivity loss. CONCLUSION Insights from this study can provide a greater understanding of the extent of healthcare use and productivity loss by those with chronic pain and serve as an important basis for improvements in rehabilitation and quality of care, and the education of the public on the burden of chronic pain. SIGNIFICANCE This was the first study to estimate the economic burden associated with chronic pain in the general population using linked individual-level administrative data and self-reported survey answers. We provide calculations showing that annual costs of chronic pain may be as high as €12 billion or 4% of GDP. Findings from this study highlight the need for a greater understanding of the substantial healthcare use and productivity losses among individuals with chronic pain.
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Affiliation(s)
- Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Liseth Hansen
- Quantify Research, Stockholm, Sweden
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anders Gustavsson
- Quantify Research, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Hallberg S, Rolfson O, Karppinen J, Schiøttz-Christensen B, Stubhaug A, Toresson Grip E, Robinson RL, De Geer A, Schepman P. Economic burden of osteoarthritis - multi-country estimates of direct and indirect costs from the BISCUITS study. Scand J Pain 2023; 23:694-704. [PMID: 37381657 DOI: 10.1515/sjpain-2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
Data from 'BISCUITS', a large Nordic cohort study linking several registries, were used to estimate differences in average direct and indirect costs between patients with osteoarthritis and controls (matched 1:1 based on birth year and sex) from the general population in Sweden, Norway, Finland and Denmark for 2017. Patients ≥18 years with ≥1 diagnosis of osteoarthritis (ICD-10: M15-M19) recorded in specialty or primary care (the latter available for a subset of patients in Sweden and for all patients in Finland) during 2011-2017 were included. Patients with a cancer diagnosis (ICD-10: C00-C43/C45-C97) were excluded. Productivity loss (sick leave and disability pension) and associated indirect costs were estimated among working-age adults (18-66 years). In 2017, average annual incremental direct costs among adults with osteoarthritis (n=1,157,236) in specialty care relative to controls ranged between €1,259 and €1,693 (p<0.001) per patient across all countries. Total average annual incremental costs were €3,224-€4,969 (p<0.001) per patient. Healthcare cost differences were mainly explained by osteoarthritis patients having more surgeries. However, among patients with both primary and secondary care data, primary care costs exceeded the costs of surgery. Primary care constituted 41 and 29 % of the difference in direct costs in Sweden and Finland, respectively. From a societal perspective, the total economic burden of osteoarthritis is substantial, and the incremental cost was estimated to €1.1-€1.3 billion yearly for patients in specialty care across the Nordic countries. When including patients in primary care, incremental costs rose to €3 billion in Sweden and €1.8 billion in Finland. Given the large economic impact, finding cost-effective and safe therapeutic strategies for these patients will be important.
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Affiliation(s)
| | - Ola Rolfson
- University of Gothenburg, Gothenburg, Sweden
| | | | | | - Audun Stubhaug
- Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
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Hallberg S, Rolfson O, Karppinen J, Schiøttz-Christensen B, Stubhaug A, Rivano Fischer M, Gerdle B, Toresson Grip E, Gustavsson A, Robinson RL, Varenhorst C, Schepman P. Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study. Scand J Pain 2023; 23:126-138. [PMID: 35858277 DOI: 10.1515/sjpain-2021-0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/28/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Osteoarthritis (OA) and chronic low back pain (CLBP) are common musculoskeletal disorders with substantial patient and societal burden. Nordic administrative registers offer a unique opportunity to study the impact of these conditions in the real-world setting. The Burden of Disease and Management of Osteoarthritis and Chronic Low Back Pain: Health Care Utilization and Sick Leave in Sweden, Norway, Finland and Denmark (BISCUITS) study was designed to study disease prevalence and the societal and economic burden in broad OA and CLBP populations. METHODS Patients in Sweden, Norway, Finland and Denmark with diagnoses of OA or CLBP (low back pain record plus ≥2 pain relief prescriptions to indicate chronicity) were identified in specialty care, in primary care (Sweden and Finland) and in a quality-of-care register (Sweden). Matched controls were identified for the specialty care cohort. Longitudinal data were extracted on prevalence, treatment patterns, patient-reported outcomes, social and economic burden. RESULTS Almost 1.4 million patients with OA and 0.4 million with CLBP were identified in specialty care, corresponding to a prevalence in the Nordic countries of 6.3 and 1.9%, respectively. The prevalence increased to 11-14% for OA and almost 6% for CLBP when adding patients identified in primary care. OA patients had a higher Elixhauser comorbidity index (0.66 vs. 0.46) and were using opioids (44.7 vs. 10.2%) or long-term nonsteroidal anti-inflammatory drug (NSAIDs) (20.9 vs. 4.5%) more than four times as often as compared to controls. The differences were even larger for CLBP patients compared to their controls (comorbidity index 0.89 vs. 0.39, opioid use 77.7 vs. 9.4%, and long-term NSAID use 37.2 vs. 4.8%). CONCLUSIONS The BISCUITS study offers an unprecedented, longitudinal healthcare data source to quantify the real-world burden of more than 1.8 million patients with OA or CLBP across four countries. In subsequent papers we aim to explore among others additional outcomes and subgroups of patients, primarily those patients who may benefit most from better healthcare management.
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Affiliation(s)
| | - Ola Rolfson
- University of Gothenburg, Gothenburg, Sweden
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | | | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marcelo Rivano Fischer
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Anders Gustavsson
- Quantify Research, Stockholm, Sweden
- Karolinska Institute, Stockholm, Sweden
| | | | - Christoph Varenhorst
- Pfizer AB, Sollentuna, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Schepman P, Robinson R, Blakeman KH, Wilhelm S, Beck C, Hallberg S, Liseth-Hansen J, De Geer A, Rolfson O, Arendt-Nielsen L. Factors influencing quality of life in patients with osteoarthritis: analyses from the BISCUITS study. Scand J Pain 2023; 23:139-148. [PMID: 35787832 DOI: 10.1515/sjpain-2021-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/14/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Osteoarthritis can have a profound effect on patients' quality of life. The Burden of Disease and Management of Osteoarthritis and Chronic Low Back Pain: Health Care Utilization and Sick Leave in Sweden, Norway, Finland and Denmark (BISCUITS) study aimed to describe the impact of osteoarthritis on quality of life and determine the association with factors such as pain severity and pharmacological treatment. METHODS An observational study was performed with a cross-sectional design including patients with a confirmed osteoarthritis diagnosis enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2016 and 2017 in Sweden. Patient-reported information from BOA was linked to administrative data from three national health registers. The impact of osteoarthritis on quality of life was estimated using the EQ-5D-5L and the first developed experienced-based time-trade-off value set for Sweden to calculate the EQ-5D-5L index scores. EQ-5D-3L index scores were also estimated based on a UK hypothetical value set via a crosswalk method. Ordinary least squares regression models were used to analyse the association between quality of life and potential influencing factors. RESULTS For the 34,254 patients evaluated, mean EQ-5D-5L index score was 0.792 (SD 0.126). Stratifications showed that the index score varied across different levels of pain severity. Increased pain severity and use of pain-relieving medications remained significantly associated with a lower quality of life index score when controlled for potential confounders. The mean EQ-5D-3L index score was 0.605 (SD 0.192). CONCLUSIONS This large population-based study from Sweden highlights the substantial impact of osteoarthritis on quality of life amongst different patient groups and that currently available treatment options for osteoarthritis pain do not appropriately address the needs for many osteoarthritis patients.
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Affiliation(s)
| | | | | | - Stefan Wilhelm
- Eli Lilly International Medical Affairs, Bad Homburg, Germany
| | | | | | | | | | - Ola Rolfson
- University of Gothenburg, Gothenburg, Sweden
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology (Mech-Sense), Aalborg University Hospital, Aalborg, Denmark
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Hagström E, Sorio Vilela F, Svensson MK, Hallberg S, Söreskog E, Villa G. Cardiovascular Event Rates After Myocardial Infarction or Ischaemic Stroke in Patients with Additional Risk Factors: A Retrospective Population-Based Cohort Study. Adv Ther 2021; 38:4695-4708. [PMID: 34312813 PMCID: PMC8408079 DOI: 10.1007/s12325-021-01852-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Abstract
Introduction The impact of additional risk factors on major cardiovascular event (MACE) rates in patients with a history of myocardial infarction (MI) or ischaemic stroke (IS) treated with statins is not well defined. Methods In this retrospective population-based cohort study, patients with a history of MI or IS treated with moderate- or high-intensity statins were identified using Swedish national register data. Patients were incident (index event between July 2006 and December 2014 and followed from diagnosis) or prevalent (MI or IS before July 2006 and followed thereafter). Four subgroups were defined on the basis of additional risk factors associated with increased cardiovascular risk: diabetes mellitus with target organ damage; chronic kidney disease stages 3–4; index event within 2 years after prior MI or IS; and polyvascular disease. First and total MACE rates (i.e. MI, IS, or cardiovascular death) were calculated, and first MACE 10-year risks (prevalent cohort only) were predicted. Results Numerically, MACE rates in subgroups were 1.5–3 times higher than in overall populations, and were highest in the 2 years after the index event. First MACE rates in the additional risk factor subgroups were 17.2–33.5 per 100 person-years for the incident cohorts and 9.9–13.2 per 100 person-years for the prevalent cohorts. Total MACE rates per 100 person-years were 20.1–39.8 per 100 person-years and 12.4–17.6 per 100 person-years, respectively. Conclusion Despite previous use of moderate- or high-intensity statins, patients with a history of MI or IS, and additional risk factors remain at very high cardiovascular risk. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01852-1.
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Affiliation(s)
- Emil Hagström
- Uppsala University Hospital, UCR-Uppsala Clinical Research Center, 751 85, Uppsala, Sweden.
- Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden.
| | | | - Maria K Svensson
- Department of Medical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Amgen AB, Gustav III:s Boulevard 54, 169 74, Solna Municipality, Sweden
| | - Sara Hallberg
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
| | - Emma Söreskog
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
| | - Guillermo Villa
- Amgen (Europe) GmbH, Suurstoffi 22, 6343, Risch-Rotkreuz, Switzerland
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Hagström E, Vilela FS, Svensson ME, Hallberg S, Söreskog E, Villa G. Rates of major cardiovascular events in patients with a history of myocardial infarction and additional risk factors: Evidence from a Swedish nationwide register-based study. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lindh M, Banefelt J, Fox KM, Hallberg S, Tai MH, Eriksson M, Villa G, Svensson MK, Qian Y. Cardiovascular event rates in a high atherosclerotic cardiovascular disease risk population: estimates from Swedish population-based register data. Eur Heart J Qual Care Clin Outcomes 2020; 5:225-232. [PMID: 30649251 PMCID: PMC6613595 DOI: 10.1093/ehjqcco/qcy058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 12/27/2022]
Abstract
Aims This study aimed to estimate the rate of cardiovascular (CV) events in the real world in patients at high risk of recurrent CV events similar to the FOURIER trial population. Methods and results A retrospective population-based cohort study was conducted using Swedish national registers from 1 July 2001 to 31 December 2015. Patients in the atherosclerotic cardiovascular disease (ASCVD) prevalent cohort met the FOURIER-like inclusion criteria, including treatment with high/moderate-intensity statins, on 1 July 2006. Additionally, two cohorts defined by diagnosis of incident ischaemic stroke (IS) and incident myocardial infarction (MI), meeting the FOURIER-like inclusion criteria were followed from date of diagnosis. Event rates were calculated for the hard major adverse cardiovascular events (MACE) composite: MI, IS, and CV death; and the ASCVD composite: MI, IS, unstable angina, coronary revascularization, and CV death. Approximately half of patients experienced a CV event (ASCVD composite) during follow-up. The MACE composite rates/100 person-years were 6.3, 11.9, and 12.3 in the ASCVD prevalent (n = 54 992), MI incident (n = 45 895), and IS incident (n = 36 134) cohorts, respectively. The ASCVD composite rates/100 person-years were 7.0, 21.7, and 12.9 in the ASCVD prevalent, MI incident, and IS incident cohorts, respectively. The multiple-event MACE composite rates/100 person-years were 8.5 (ASCVD prevalent cohort), 15.4 (MI incident cohort), and 14.4 (IS incident cohort). Conclusion In this real-world setting, CV event rates were high in all studied cohorts. In particular, the MACE composite rates were two to three times higher than in the FOURIER clinical trial, indicating a substantial disease burden despite treatment with moderate or high-intensity statins.
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Affiliation(s)
- Maria Lindh
- Quantify Research, Hantverkargatan 8, Stockholm, Sweden
| | | | - Kathleen M Fox
- Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane, Aiken, SC, USA
| | - Sara Hallberg
- Quantify Research, Hantverkargatan 8, Stockholm, Sweden
| | - Ming-Hui Tai
- Department of Global Health Economics, One Amgen center dr. Thousand Oaks, CA, USA
| | - Mats Eriksson
- Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset Huddinge, Stockholm, Sweden
| | - Guillermo Villa
- Department of Global Health Economics, AMGEN Europe GmbH, Suurstoffi 22, Rotkreuz, Switzerland
| | - Maria K Svensson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Yi Qian
- Department of Global Health Economics, One Amgen center dr. Thousand Oaks, CA, USA
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson C. Simulating the Radiation Therapy Process: An Analytical Approach to Enable Quantification of Patient Inflows. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson C. Healthcare Professionals’ Views on Work Related Issues at Swedish Radiotherapy Departments. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lindberg J, Holmström P, Hallberg S, Björk-Eriksson T, Olsson C. PO-1129 An analytical approach to aggregate patient workflows for system dynamics modelling of radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Banefelt J, Hallberg S, Fox KM, Mesterton J, Paoli CJ, Johansson G, Levin LÅ, Sobocki P, Gandra SR. Work productivity loss and indirect costs associated with new cardiovascular events in high-risk patients with hyperlipidemia: estimates from population-based register data in Sweden. Eur J Health Econ 2016; 17:1117-1124. [PMID: 26607457 PMCID: PMC5080301 DOI: 10.1007/s10198-015-0749-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To estimate productivity loss and associated indirect costs in high-risk patients treated for hyperlipidemia who experience cardiovascular (CV) events. METHODS Retrospective population-based cohort study conducted using Swedish medical records linked to national registers. Patients were included based on prescriptions of lipid-lowering therapy between 1 January 2006 and 31 December 2011 and followed until 31 December 2012 for identification of CV events and estimation of work productivity loss (sick leave and disability pension) and indirect costs. Patients were stratified into two cohorts based on CV risk level: history of major cardiovascular disease (CVD) and coronary heart disease (CHD) risk equivalent. Propensity score matching was applied to compare patients with new events (cases) to patients without new events (controls). The incremental effect of CV events was estimated using a difference-in-differences design, comparing productivity loss among cases and controls during the year before and the year after the cases' event. RESULTS The incremental effect on indirect costs was largest in the CHD risk equivalent cohort (n = 2946) at €3119 (P value <0.01). The corresponding figure in the major CVD history cohort (n = 4508) was €2210 (P value <0.01). There was substantial variation in productivity loss depending on the type of event. Transient ischemic attack and revascularization had no significant effect on indirect costs. Myocardial infarction (€3465), unstable angina (€2733) and, most notably, ischemic stroke (€6784) yielded substantial incremental cost estimates (P values <0.01). CONCLUSIONS Indirect costs related to work productivity losses of CV events are substantial in Swedish high-risk patients treated for hyperlipidemia and vary considerably by type of event.
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Affiliation(s)
- J Banefelt
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden.
| | - S Hallberg
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
| | - K M Fox
- Strategic Healthcare Solutions, LLC, Baltimore, MD, USA
| | - J Mesterton
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | | | - G Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - L-Å Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - P Sobocki
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- IMS Health, Stockholm, Sweden
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Hallberg S, Gandra SR, Fox KM, Mesterton J, Banefelt J, Johansson G, Levin LÅ, Sobocki P. Healthcare costs associated with cardiovascular events in patients with hyperlipidemia or prior cardiovascular events: estimates from Swedish population-based register data. Eur J Health Econ 2016; 17:591-601. [PMID: 26077550 PMCID: PMC4869759 DOI: 10.1007/s10198-015-0702-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/27/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To estimate healthcare costs of new cardiovascular (CV) events (myocardial infarction, unstable angina, revascularization, ischemic stroke, transient ischemic attack, heart failure) in patients with hyperlipidemia or prior CV events. METHODS A retrospective population-based cohort study was conducted using Swedish national registers and electronic medical records. Patients with hyperlipidemia or prior CV events were stratified into three cohorts based on CV risk level: history of major cardiovascular disease (CVD), coronary heart disease (CHD) risk-equivalent, and low/unknown risk. Propensity score matching was applied to compare patients with new events to patients without new events for estimation of incremental costs of any event and by event type. RESULTS A CV event resulted in increased costs over 3 years of follow-up, with the majority of costs occurring in the 1st year following the event. The mean incremental cost of patients with a history of major CVD (n = 6881) was €8588 during the 1st year following the event. This was similar to that of CHD risk-equivalent patients (n = 3226; €6663) and patients at low/unknown risk (n = 2497; €8346). Ischemic stroke resulted in the highest 1st-year cost for patients with a history of major CVD and CHD risk-equivalent patients (€10,194 and €9823, respectively); transient ischemic attack in the lowest (€3917 and €4140). Incremental costs remained elevated in all cohorts during all three follow-up years, with costs being highest in the major CVD history cohort. CONCLUSIONS Healthcare costs of CV events are substantial and vary considerably by event type. Incremental costs remain elevated for several years after an event.
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Affiliation(s)
- S Hallberg
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden.
| | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Baltimore, MD, USA
| | - J Mesterton
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - J Banefelt
- Quantify Research, Hantverkargatan 8, 112 21, Stockholm, Sweden
| | - G Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - L-Å Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - P Sobocki
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- IMS Health, Stockholm, Sweden
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Hallberg S, Banefelt J, Fox KM, Mesterton J, Johansson G, Levin LÅ, Sobocki P, Gandra SR. Lipid-lowering treatment patterns in patients with new cardiovascular events - estimates from population-based register data in Sweden. Int J Clin Pract 2016; 70:222-8. [PMID: 26799539 PMCID: PMC4819716 DOI: 10.1111/ijcp.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess treatment patterns of lipid-lowering therapy (LLT) in patients with hyperlipidaemia or prior cardiovascular (CV) events who experience new CV events. METHODS A retrospective population-based cohort study was conducted using Swedish medical records and registers. Patients were included in the study based on a prescription of LLT or CV event history and followed up for up to 7 years for identification of new CV events and assessment of LLT treatment patterns. Patients were stratified into three cohorts based on CV risk level. All outcomes were assessed during the year following index (the date of first new CV event). Adherence was defined as medication possession ratio (MPR) > 0.80. Persistence was defined as no gaps > 60 days in supply of drug used at index. RESULTS Of patients with major cardiovascular disease (CVD) history (n = 6881), 49% were not on LLT at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n = 3226) and 38% (n = 2497) respectively. MPR for patients on LLT at index was similar across cohorts (0.74-0.75). The proportions of adherent (60-63%) and persistent patients (56-57%) were also similar across cohorts. Dose escalation from dose at index was seen within all cohorts and 2-3% of patients switched to a different LLT after index while 5-6% of patients augmented treatment by adding another LLT. CONCLUSIONS Almost 50% of patients with major CVD history were not on any LLT, indicating a potential therapeutic gap. Medication adherence and persistence among patients on LLT were suboptimal.
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Affiliation(s)
| | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Baltimore, MD, USA
| | - J Mesterton
- Quantify Research, Stockholm, Sweden
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
| | - G Johansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - L-Å Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - P Sobocki
- LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- IMS Health, Stockholm, Sweden
| | - S R Gandra
- Amgen Inc., Thousand Oaks, CA, United States
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Hallberg S, Banefelt J, Mesterton J, Gandra SR, Fox KM, Johansson G, Levin LÅ, Sobocki P. Health Care Costs Associated With Cardiovascular Events In Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden. Value Health 2014; 17:A492. [PMID: 27201468 DOI: 10.1016/j.jval.2014.08.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Monkton, MD, USA
| | | | - L Å Levin
- Linköping University, Linköping, Sweden
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Hallberg S, Banefelt J, Fox KM, Mesterton J, Johansson G, Levin LÅ, Sobocki P, Gandra SR. Treatment Patterns in Hyperlipidemia Patients With New Cardiovascular Events - Estimates From Population-Based Register Data in Sweden. Value Health 2014; 17:A501. [PMID: 27201519 DOI: 10.1016/j.jval.2014.08.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Monkton, MD, USA
| | | | | | - L Å Levin
- Linköping University, Linköping, Sweden
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Banefelt J, Hallberg S, Fox KM, Mesterton J, Paoli CJ, Johansson G, Levin LÅ, Sobocki P, Gandra SR. Work Productivity Loss and Indirect Costs Associated with New Cardiovascular Events in High-Risk Patients with Hyperlipidemia - Estimates from Population-Based Register Data in Sweden. Value Health 2014; 17:A327-A328. [PMID: 27200553 DOI: 10.1016/j.jval.2014.08.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Monkton, MD, USA
| | | | | | | | - L Å Levin
- Linköping University, Linköping, Sweden
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Banefelt J, Hallberg S, Gandra SR, Mesterton J, Fox KM, Paoli CJ, Johansson G, Levin LÅ, Sobocki P. Burden Of Hyperlipidemia Resulting From Productivity Loss - Estimates From Population-Based Register Data In Sweden. Value Health 2014; 17:A491-A492. [PMID: 27201458 DOI: 10.1016/j.jval.2014.08.1454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Monkton, MD, USA
| | | | | | - L Å Levin
- Linköping University, Linköping, Sweden
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Mesterton J, Hallberg S, Gandra SR, Banefelt J, Fox KM, Johansson G, Levin LÅ, Sobocki P. Ldl-C Goal Attainment In Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden. Value Health 2014; 17:A497. [PMID: 27201495 DOI: 10.1016/j.jval.2014.08.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | | | | | - K M Fox
- Strategic Healthcare Solutions, LLC, Monkton, MD, USA
| | | | - L Å Levin
- Linköping University, Linköping, Sweden
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Abstract
In a controlled study a single segment combined spinal epidural (CSE) block was compared with spinal or epidural block for major orthopaedic surgery. Seventy-five patients, age 52-86 yr, were randomly assigned to receive one of the three blocks. Bupivacaine 0.5% was used for surgical analgesia. The postoperative pain relief after 4.0 mg epidural morphine was compared with the analgesic effect of 0.2 or 0.4 mg morphine administered intrathecally. With the spinal technique good or excellent surgical analgesia and muscle relaxation were achieved rapidly (11.8 +/- 1.1 min). The time taken to provide an equally effective and reliable block with the CSE technique was no longer (14.9 +/- 2.2 min). For epidural block with the catheter technique more time was required (35.9 +/- 3.9 min) to provide acceptable surgical conditions (P < 0.05). Perioperative sedatives and concomitant analgesics were required more frequently and in larger doses by the patients undergoing surgery with epidural block (P < 0.05) than with CSE or spinal block. Our study demonstrated that the analgesia after surgery provided by 0.2 and 0.4 mg morphine administered intrathecally was comparable to that provided by 4.0 mg of epidural morphine. It is concluded that the analgesia and surgical conditions provided by the spinal and CSE blocks were similar and were superior to those provided by an epidural block.
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Affiliation(s)
- B Holmström
- Department of Anaesthesiology and Intensive Care, Lindesbergs Hospital, Sweden
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