Denne rap p ort citeres så ledes: B ech M et al. Medicinsk teknologivurdering af screening for ab... more Denne rap p ort citeres så ledes: B ech M et al. Medicinsk teknologivurdering af screening for abdominalt aortaaneurisme MTV og Sundhedstjenesteforskning Center for Folkesundhed Region Midtjylland 2008 Tryk: WE RK S Grafiske Hus as 827 0 Hø jbjerg Rap p orten kan downloades fra www.mtv.rm.dk For yderligere op lysninger rettes henvendelse til:
Budgetrammestyring: Finansieringssystem hvor hospitalerne tildeles et årligt budget. Casestudie: ... more Budgetrammestyring: Finansieringssystem hvor hospitalerne tildeles et årligt budget. Casestudie: En strategi til empirisk udforskning af et udvalgt nutidigt faenomen i sin naturlige sammenhaeng ved anvendelse af forskellige datakilder, der kan anvendes i en bevisførelse. Context-aware computing: Inden for computervidenskaben refererer contextaware computing til idéen om, at computere både kan fornemme og reagere på baggrund af det miljø, de befinder sig i. DRG: Forkortelse for "diagnosisrelated grouping", dansk: diagnoserelateret gruppering. Dummy-variabel: Variabel i en regressionsanalyse, der kan antage vaerdien 0 eller 1. Benyttes f.eks. til at belyse betyd ningen af kategoriske variable (f.eks. ja/nej spørgsmål). Knivtid: Den del af operationsstuernes åbningstid, hvor der opereres. Det vil sige fratrukket klargøring af stuerne, rengøring af stuerne, tid til anaestesi og generel ventetid på patienter, udstyr og medarbejdere. Komparativ analyse: Analyse, hvor man sammenligner forskellige cases. Kronevaerdien: Vaerdien af ressourceforbrug omregnet til kroner. Lean: Grundidéen bag Lean er at sikre, at alle aktiviteter tilfører vaerdi til organisationen med et minimum af organi satorisk spild og det mest optimale flow i arbejdsgangene. Odds ratio: Forholdet mellem odds (sandsynligheden for et bestemt udfald) i to grupper. Pervasive/ubiquitous computing: Computer teknologi som giver mulighed for interaktion flere steder end blot ved en enkelt arbejdsplads. Dette inkluderer håndholdte eller baerbare enheder, store interaktive skaerme, trådløs infra struktur til netvaerk og stemme og synsstyret teknologi. Begrebet daekker over teknologi, der ideelt set eksisterer eller er til stede alle steder på samme tid på et konstant niveau. Pervasive healthcare: Pervasive healthcare daekker over anvendelsen af pervasive computing (se ovenfor) inden for sundhedssektoren og en vision om at gøre sundhedssektoren tilgaengelig alle steder, til enhver tid og for alle. Produktivitet: Forholdet mellem output og input, f.eks. udtrykt ved antal operationer (output) divideret med lønom kostninger (input). Proof of concept: Beviser som demonstrerer, at en model eller en ny tilgang er funktionsdygtig, en mulig løsning og er i stand til at løse eller formindske et bestemt problem. Reliabilitet: Pålidelighed. Metoden skal måde det samme hver gang. Ordliste 18 Medicinsk teknologivurdering af Det Interaktive Hospital (iHospital) Skabelon Signifikant: Refererer til en statistisk beregning af sandsynligheden for at have observeret de pågaeldende data, hvis der ikke var nogen effekt. Et empirisk resultat kaldes ofte for signifikant, hvis denne sandsynlighed er mindre end 5% (95% signifikansniveau). Skiftetid: Den tid det tager, fra en operation er afsluttet, til den naeste operation saettes i gang. Takststyringsmodel: Finansieringssystem hvor hospitalerne afregnes ud fra takster og antal producerede ydelser.
The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis ... more The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging. A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature. The calculated cost-effectiveness ratio after the first year was $55,591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment g...
International Journal of Technology Assessment in Health Care, 2006
Objectives:The purpose of this project was to evaluate local decision support tools used in the D... more Objectives:The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view.Methods:The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support.Results:The response rate was high (87 percent, 94 percent, 85 percent, res...
Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in a... more Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in any country although the treatment is both effective and cost-effective in selected patients within a 3-h window after acute ischaemic stroke. The purpose of the present study was to describe the organisational barriers to delivery of thrombolysis for acute ischaemic stroke with special regard to the Danish healthcare system. Systematic and unsystematic searches of medical, economic and grey literature on organisational barriers to thrombolysis treatment were performed in Cochrane, PubMed, EMBASE, Cinahl, Econlit, NHS EED, SvedMed+ and the Health Technology Assessment (HTA) database. The search periods were 1996-2006. Three main types of literature on organisational barriers were found: medical literature including HTA reports on barriers related to the 3-h window, economic literature on barriers related to the lack of capacity to provide the treatment on a 24-h basis, and grey literature/policy papers on standards and demands to the hospitals and healthcare systems who implements the treatment. Information on organisational barriers can be extracted from different types of literature (medical, economic and grey literature/policy papers), but organisational barriers are most often not the primary study objective in the relevant literature. This review showed a broad spectrum of possible organisational barriers to the delivery of thrombolysis treatment of acute ischaemic stroke.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm... more Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm. Design Cost effectiveness analysis based on a probabilistic, enhanced economic decision analytical model from screening to death. Population and setting Hypothetical population of men aged 65 invited (or not invited) for ultrasound screening in the Danish healthcare system. Data sources Published results from randomised trials and observational epidemiological studies retrieved from electronic bibliographic databases, and supplementary data obtained from the Danish Vascular Registry. Data synthesis A hybrid decision tree and Markov model was developed to simulate the short term and long term effects of screening for abdominal aortic aneurysm compared with no systematic screening on clinical and cost effectiveness outcomes. Probabilistic sensitivity analyses using Monte Carlo simulation were carried out. Results were presented in a cost effectiveness acceptability curve, an expected value of perfect information curve, and a curve showing the expected (net) number of avoided deaths from abdominal aortic aneurysm over time after the introduction of screening. The model was validated by calibrating base case health outcomes and expected activity levels against evidence from the recent Cochrane review of screening for abdominal aortic aneurysm. Results The estimated costs per quality adjusted life year (QALY) gained discounted at 3% per year over a lifetime for costs and QALYs was £43 485 (€54 852; $71 160). At a willingness to pay threshold of £30 000 the probability of screening for abdominal aortic aneurysm being cost effective was less than 30%. One way sensitivity analyses showed the incremental cost effectiveness ratio varying from £32 640 to £66 001 per QALY. Conclusion Screening for abdominal aortic aneurysm does not seem to be cost effective. Further research is needed on long term quality of life outcomes and costs.
Background: Ruptured abdominal aortic aneurysm (AAA) is responsible for 1-2% of all male deaths o... more Background: Ruptured abdominal aortic aneurysm (AAA) is responsible for 1-2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA. Methods: We performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU). All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care. Results: The search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions. Conclusion: Further analyses of cost-effectiveness of AAA screening are recommended.
Denne rap p ort citeres så ledes: B ech M et al. Medicinsk teknologivurdering af screening for ab... more Denne rap p ort citeres så ledes: B ech M et al. Medicinsk teknologivurdering af screening for abdominalt aortaaneurisme MTV og Sundhedstjenesteforskning Center for Folkesundhed Region Midtjylland 2008 Tryk: WE RK S Grafiske Hus as 827 0 Hø jbjerg Rap p orten kan downloades fra www.mtv.rm.dk For yderligere op lysninger rettes henvendelse til:
Budgetrammestyring: Finansieringssystem hvor hospitalerne tildeles et årligt budget. Casestudie: ... more Budgetrammestyring: Finansieringssystem hvor hospitalerne tildeles et årligt budget. Casestudie: En strategi til empirisk udforskning af et udvalgt nutidigt faenomen i sin naturlige sammenhaeng ved anvendelse af forskellige datakilder, der kan anvendes i en bevisførelse. Context-aware computing: Inden for computervidenskaben refererer contextaware computing til idéen om, at computere både kan fornemme og reagere på baggrund af det miljø, de befinder sig i. DRG: Forkortelse for "diagnosisrelated grouping", dansk: diagnoserelateret gruppering. Dummy-variabel: Variabel i en regressionsanalyse, der kan antage vaerdien 0 eller 1. Benyttes f.eks. til at belyse betyd ningen af kategoriske variable (f.eks. ja/nej spørgsmål). Knivtid: Den del af operationsstuernes åbningstid, hvor der opereres. Det vil sige fratrukket klargøring af stuerne, rengøring af stuerne, tid til anaestesi og generel ventetid på patienter, udstyr og medarbejdere. Komparativ analyse: Analyse, hvor man sammenligner forskellige cases. Kronevaerdien: Vaerdien af ressourceforbrug omregnet til kroner. Lean: Grundidéen bag Lean er at sikre, at alle aktiviteter tilfører vaerdi til organisationen med et minimum af organi satorisk spild og det mest optimale flow i arbejdsgangene. Odds ratio: Forholdet mellem odds (sandsynligheden for et bestemt udfald) i to grupper. Pervasive/ubiquitous computing: Computer teknologi som giver mulighed for interaktion flere steder end blot ved en enkelt arbejdsplads. Dette inkluderer håndholdte eller baerbare enheder, store interaktive skaerme, trådløs infra struktur til netvaerk og stemme og synsstyret teknologi. Begrebet daekker over teknologi, der ideelt set eksisterer eller er til stede alle steder på samme tid på et konstant niveau. Pervasive healthcare: Pervasive healthcare daekker over anvendelsen af pervasive computing (se ovenfor) inden for sundhedssektoren og en vision om at gøre sundhedssektoren tilgaengelig alle steder, til enhver tid og for alle. Produktivitet: Forholdet mellem output og input, f.eks. udtrykt ved antal operationer (output) divideret med lønom kostninger (input). Proof of concept: Beviser som demonstrerer, at en model eller en ny tilgang er funktionsdygtig, en mulig løsning og er i stand til at løse eller formindske et bestemt problem. Reliabilitet: Pålidelighed. Metoden skal måde det samme hver gang. Ordliste 18 Medicinsk teknologivurdering af Det Interaktive Hospital (iHospital) Skabelon Signifikant: Refererer til en statistisk beregning af sandsynligheden for at have observeret de pågaeldende data, hvis der ikke var nogen effekt. Et empirisk resultat kaldes ofte for signifikant, hvis denne sandsynlighed er mindre end 5% (95% signifikansniveau). Skiftetid: Den tid det tager, fra en operation er afsluttet, til den naeste operation saettes i gang. Takststyringsmodel: Finansieringssystem hvor hospitalerne afregnes ud fra takster og antal producerede ydelser.
The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis ... more The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging. A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature. The calculated cost-effectiveness ratio after the first year was $55,591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment g...
International Journal of Technology Assessment in Health Care, 2006
Objectives:The purpose of this project was to evaluate local decision support tools used in the D... more Objectives:The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view.Methods:The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support.Results:The response rate was high (87 percent, 94 percent, 85 percent, res...
Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in a... more Intravenous thrombolysis with fibrinolytic drugs such as alteplase is not implemented widely in any country although the treatment is both effective and cost-effective in selected patients within a 3-h window after acute ischaemic stroke. The purpose of the present study was to describe the organisational barriers to delivery of thrombolysis for acute ischaemic stroke with special regard to the Danish healthcare system. Systematic and unsystematic searches of medical, economic and grey literature on organisational barriers to thrombolysis treatment were performed in Cochrane, PubMed, EMBASE, Cinahl, Econlit, NHS EED, SvedMed+ and the Health Technology Assessment (HTA) database. The search periods were 1996-2006. Three main types of literature on organisational barriers were found: medical literature including HTA reports on barriers related to the 3-h window, economic literature on barriers related to the lack of capacity to provide the treatment on a 24-h basis, and grey literature/policy papers on standards and demands to the hospitals and healthcare systems who implements the treatment. Information on organisational barriers can be extracted from different types of literature (medical, economic and grey literature/policy papers), but organisational barriers are most often not the primary study objective in the relevant literature. This review showed a broad spectrum of possible organisational barriers to the delivery of thrombolysis treatment of acute ischaemic stroke.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm... more Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm. Design Cost effectiveness analysis based on a probabilistic, enhanced economic decision analytical model from screening to death. Population and setting Hypothetical population of men aged 65 invited (or not invited) for ultrasound screening in the Danish healthcare system. Data sources Published results from randomised trials and observational epidemiological studies retrieved from electronic bibliographic databases, and supplementary data obtained from the Danish Vascular Registry. Data synthesis A hybrid decision tree and Markov model was developed to simulate the short term and long term effects of screening for abdominal aortic aneurysm compared with no systematic screening on clinical and cost effectiveness outcomes. Probabilistic sensitivity analyses using Monte Carlo simulation were carried out. Results were presented in a cost effectiveness acceptability curve, an expected value of perfect information curve, and a curve showing the expected (net) number of avoided deaths from abdominal aortic aneurysm over time after the introduction of screening. The model was validated by calibrating base case health outcomes and expected activity levels against evidence from the recent Cochrane review of screening for abdominal aortic aneurysm. Results The estimated costs per quality adjusted life year (QALY) gained discounted at 3% per year over a lifetime for costs and QALYs was £43 485 (€54 852; $71 160). At a willingness to pay threshold of £30 000 the probability of screening for abdominal aortic aneurysm being cost effective was less than 30%. One way sensitivity analyses showed the incremental cost effectiveness ratio varying from £32 640 to £66 001 per QALY. Conclusion Screening for abdominal aortic aneurysm does not seem to be cost effective. Further research is needed on long term quality of life outcomes and costs.
Background: Ruptured abdominal aortic aneurysm (AAA) is responsible for 1-2% of all male deaths o... more Background: Ruptured abdominal aortic aneurysm (AAA) is responsible for 1-2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA. Methods: We performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU). All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care. Results: The search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions. Conclusion: Further analyses of cost-effectiveness of AAA screening are recommended.
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Papers by Mette Kjølby