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Background: Limited studies have directly compared health-related quality of life (HRQoL) in different countries during the COVID-19 global pandemic. The objective of this study was to evaluate the HRQoL outcomes in the US, Sweden, and Norway during the first year under the pandemic. Methods: In April 2020, during early phase of the pandemic, separately in the US, Sweden, and Norway, we surveyed 2,734, 1,003 and 1,020 respondents, then again in January 2021, we collected 2,252, 1,013 and 1,011 respondents. The survey was first developed in English and translated into Swedish and Norwegian. Selected variables were used for the current study. We collected respondents’ HRQoL using the EQ-5D-5L. Respondents’ background information included their sociodemographic data, medical history, and COVID-19 status. We reported the EQ-5D-5L utility, EQ-VAS, and the proportion of problems with each of the EQ-5D-5L health subdomains. Population quality-adjusted life year (QALY) changes based on EQ-5D-5L utility scores were also calculated. Outcomes were stratified by age. One-way ANOVA test was used to detect significant differences between countries and Student’s t-tests were used to assess the differences between waves. Results: Respectively for the US, Sweden, and Norway, mean EQ-5D-5L utilities were 0.822, 0.768, and 0.808 in April 2020 (p< 0.001); 0.823, 0.783, and 0.777 in January 2021 (p< 0.001); mean EQ-VAS scores were 0.746, 0.687, and 0.692 in April 2020 (p< 0.001), 0.764, 0.682, and 0.678 in January 2021 (p< 0.001). For both waves, EQ-5D-5L utilities and EQ-VAS scores in the US remained higher than both Sweden and Norway (p< 0.001). Norwegians reported considerably lowered HRQoL over time (p< 0.01). Self-reported problems with anxiety/depression were highest for the US and Sweden, while Norwegians reported most problems with pain/discomfort, followed by anxiety/depression. The population QALYs increased in the US and Sweden, but decreased in Norway. Conclusions: In the first year of the pandemic, a rebound in HRQoL was observed in the US, but not in Sweden or Norway. Mental health issues during the pandemic warrant a major public health concern across all 3 countries.

Background: Physiotherapy is usually the first line of treatment for musculoskeletal disorders. If pain persists, an appointment with an orthopaedic surgeon is indicated, but many disorders for which patients are placed on orthopaedic waiting lists cannot be treated in an orthopaedic clinic. Specialised manual therapy, although not mainstream, can be an effective alternative to orthopaedic care, although its cost-effectiveness beyond 12 months is unknown.Objectives: To perform an 8-year follow-up of the quality of life and costs of specialised manual therapy versus standard orthopaedic care for working-age patients with common nonsurgical musculoskeletal disorders referred to orthopaedic surgeons and to develop a health economic model.Design: Cost-effectiveness study using Markov modelling.Methods: The index group of a previously published pragmatic randomised controlled trial received a maximum of five treatment sessions of specialised manual therapy, while the control group received orthopaedic ‘care as usual’. At 3, 6, 12 and 96 months, Health-Related Quality of Life and costs were measured with Short Form Health Survey 36, Short Form Health Survey 6D and Diagnostic Related Groups. An incremental cost-effectiveness ratio was calculated, a Markov model was developed and a sensitivity analysis was performed.Results: Overall, 95% (n= 75) of the participants completed the 8-year follow-up. Recovery rates during the first 3 months (‘per protocol’) in the index and control group were 69% and 58%, respectively. The index group had 0.159 more gains in quality-adjusted life years and cost 40,270 SEK (€4027) less per patient over 8 years. The sensitivity analysis results were consistent with the main results.Conclusion: Specialised manual therapy dominated standard care after 8 years. The results of this small but very first study are promising; therefore, further exploration within other health care professions, clinics and/or countries is required. Our study raises questions about the triaging of orthopaedic outpatients, cost-effectiveness and resource allocation.Registration: Not applicable per the information provided by ClinicalTrials.gov.Plain Language Summary Specialised manual therapy is more cost-effective than ‘care as usual’ for working-age patients referred to an orthopaedist. This study provides an 8-year follow-up of the cost effects and quality of life of a previously published trial. Why was this study conducted? The standard care for musculoskeletal pain consists of exercises with a physiotherapist in primary care. If the pain persists, a referral to an orthopaedic clinic is often made. Many of these referrals are inappropriate because they concern pain from muscles and joints that do not benefit from surgery or the resources available in an orthopaedic clinic. There is a gap in competence and treatment between primary and specialised care that is costly, time- and resource-consuming and causes prolonged patient suffering. Although specialised manual therapy (MT) is effective, its use is not mainstream. Costs and effects after more than 12 months of treatment that may shorten waiting lists have never been evaluated. What did the researchers do? Quality of life and costs were compared in 75 patients with nonsurgical disorders referred to orthopaedic surgeons at 8 years after treatment with specialised MT or standard orthopaedic care. A health economics model for the probability of recovery was also developed and tested. What did the researchers find? Compared with the control group, the study participants treated with specialised MT had a better quality of life, required fewer health care interventions, underwent less surgery, incurred significantly lower costs and demonstrated an increased probability of recovery. What do these findings mean? It seems probable that using specialised MT for an old, well-known structural problem may yield better treatment effects at a significantly lower cost. Our study findings suggest that policy recommendations should focus on costs and effects rather than resource utilisation alone. The study is small and requires expansion using its economic health model.

AbstractObjective:Apart from improved health outcomes, treatment convenience per semay have a value to individuals. This is sometimes referred to as process utility and can be estimated in terms of willingness-to-pay (WTP) or quality-adjusted life-years (QALYs). Previous research has produced multiple studies on QALY gains and WTP estimates of insulin-related attributes. There are, however, significant variations between studies, and it is not clear to what extent the value is a reflection of the true preferences or a consequence of the methodological approach. The aim of this study is to estimate the preferences for treatment attributes associated with basal insulin (administration frequency, administration flexibility, and treatment-induced weight gain) using both QALYs—elicited using time trade-off (TTO) and WTP—among a sample of the Swedish general population and among a sample of the Swedish diabetes population.Methods:Data was collected using web-based surveys which were distributed to members of internet panels. The WTP survey presented five hypothetical scenarios with an offer to pay the incremental cost to receive basal insulin with improved attributes. The TTO survey presented six hypothetical scenarios where the respondent could choose between living for the rest of his/her life with diabetes and receiving treatment with a basal insulin with certain attributes or live for a shorter time with full health. The scenarios were combined with either a basal or a basal–bolus treatment regimen. Results from the TTO analysis were translated into monetary estimates using a threshold value of SEK500,000 per QALY.Results:In total, 2012 responses were included. The ratings of the attributes were almost identical, irrespective of method for the general population, while it differed to some extent for the diabetes population. The methods produced the same value for flexibility, but the estimates generated with the TTO approach were higher for one less injection and avoided weight gain. The general population assigned a higher utility gain to convenience attributes, while the diabetes population assigned a higher utility gain to avoiding weight gain.Limitations:About a quarter of the respondents did not accept the scenario in the WTP survey, i.e. protesters.Conclusions:The ranking of the attributes was generally independent of evaluation method, but the TTO method resulted in similar or higher values compared to the WTP method.

AbstractObjective:To evaluate long-run cost-effectiveness in a Swedish setting for liraglutide compared with sulphonylureas (glimepiride) or sitagliptin, all as add-on to metformin for patients with type 2 diabetes insufficiently controlled with metformin in monotherapy.Methods:The IHE Cohort Model of Type 2 Diabetes was used to evaluate clinical and economic outcomes from a societal perspective. Model input data were obtained from two clinical trials, the Swedish National Diabetes Register and the literature. Cost data reflected year 2013 price level. The robustness of results was checked with one-way-sensitivity analysis and probability sensitivity analysis.Results:The cost per QALY gained for liraglutide (1.2 mg) compared to SU (glimepiride 4 mg), both as add-on to metformin, ranged from SEK 226,000 to SEK 255,000 in analyzed patient cohorts. The cost per QALY for liraglutide (1.2 mg) vs sitagliptin (100 mg) as second-line treatment was lower, ranging from SEK 149,000 to SEK 161,000. Costs of preventive treatment were driving costs, but there was also a cost offset from reduced costs of complications of ∼20. Notable cost differences were found for nephropathy, stroke, and heart failure. The predicted life expectancy with liraglutide increased the cost of net consumption for liraglutide.Limitations:The analysis was an ex-ante analysis using model input data from clinical trials which may not reflect effectiveness in real-world clinical practice in broader patient populations. This limitation was explored in the sensitivity analysis. The lack of specific data on loss of production due to diabetes complications implied that these costs may be under-estimated.Conclusions:Treatment strategies with liraglutide 1.2 mg improved the expected quality-of-life and increased costs when compared to SU and to sitagliptin for second-line add-on treatments. The cost per QALY for liraglutide was in the range considered medium by Swedish authorities.

Drugs for ultra-rare disorders (URDs) rank prominently among the most expensive medicines on a cost-per-patient basis. Many of them do not meet conventional standards for cost–effectiveness. In light of the high fixed cost of R&D, this challenge is inversely related to the prevalence of URDs. The present paper sets out to explain the rationale underlying a recent expert consensus on these issues, recommending a more rigorous assessment of the clinical effectiveness of URDs, applying established standards of evidence-based medicine. This may include conditional approval and reimbursement policies, which should be combined with a firm expectation of proof of a minimum significant clinical benefit within a reasonable time. In contrast, current health economic evaluation paradigms fail to adequately reflect normative and empirical concerns (i.e., morally defensible 'social preferences') regarding healthcare resource allocation. Hence there is a strong need for alternative economic evaluation models for URDs.

Goodpasture's disease (GP) is a rare but severe disease characterized by anti-glomerular basement membrane antibodies, rapidly progressive glomerulonephritis and lung haemorrhage. The autoantibodies are restricted to a narrow epitope region on the NC1 domain of the alpha 3 chain of type IV collagen. GP is strongly associated with major histocompatibility complex (MHC) allele HLA DRB1-15. Recent research, however, has failed to identify a T-cell epitope with molecular characteristics that explain the relationship between the MHC class II molecule and the autoantibody generation. We hypothesized that an as yet unidentified sequence variant in exons 48-52 of the COL4A3 gene that encodes the NC1 domain of the type IV collagen alpha 3 chain could generate a new peptide sequence that, through interaction with specific MHC class II molecules, would increase the risk of developing GP.

We estimated resource use and costs in patients with Parkinson's disease (PD), thereby providing baseline data for future economic evaluations of therapeutic interventions. Data were collected from medical records of a South Swedish cohort of 127 PD patients during 1 year (1996) and a mailed questionnaire inquiring about cost‐related consequences and resource use in 1996 and in 2000. Annual costs were calculated based on prevalence and expressed in SEK (monetary value of the year 2000). Direct health care costs averaged approximately SEK 29,000 (≈USD 2,900; EUR 3,200) per patient per year, of which drugs were the most costly component. Nonmedical direct costs were higher than direct health care costs, averaging approximately SEK 43,000 (≈USD 4,300; EUR 4,800) per patient per year, and costs due to lost production were approximately SEK 52,000 (≈USD 5,200; EUR 5,800) per patient per year. The mean total annual cost for PD in our sample approximated SEK 124,000 (≈USD 12,400; EUR 13,800) per patient. These findings are roughly within the same range as estimates from other countries and show that PD causes a considerable societal burden. In addition to other outcomes, evaluations of the economic implications of new therapeutic interventions are highly warranted. In this perspective, the present study provides valuable baseline data. © 2002 Movement Disorder Society

A mathematic model is created to determine the economic cost per year of anticipated prolongation of life that would result from a program of abdominal ultrasonographic (US) screening for abdominal aortic aneurysm. The protocol involves US screening at age 60,67, and 74 years with additional annual follow-up US and examination if an aneurysm of less than 40 mm is detected. Larger aneurysms are assumed to be sent for early elective resection. The benefits and risks for a subset of men with symptoms of intermittent claudication (IC) as an additional risk factor of atherosclerosis is calculated for comparison.

Setting - Five primary health centres in the west of Sweden.Participants - 101 consecutive patients treated for streptococcal tonsillitis.Main outcome measure - the cost estimation included costs for physician visit and drug, travel costs to and from the primary health centre, cost of lost production resulting from the patient's or the guardian's absence from work for physician visit or sick-leave, and cost of telephone consultation with a physician or nurse.Results - the period of illness was on average seven days, time to recovery after treatment five days, and the mean period of sick-leave 2.5 days. the total cost of a tonsillitis episode was about SEK 3 300 (385 USD). of this sum, the cost for the antibiotic accounted for only 3% and loss of production for 75%.Conclusion - Differences in the cost of drugs only have a minor influence on the total cost, while factors causing loss of production, such as efficacy and side effects of the drug, have a greater influence. Economic evaluation of pharmaceuticals will be more relevant in the future, and in the search for the most effective treatment, cost effective studies will be integrated with clinical trials.Objective - To estimate the cost of a streptococcal tonsillitis episode from the data of a questionnaire.

The purpose of this study was to analyze long-term costs for foot ulcers in diabetic patients. Patients were treated and followed prospectively by a foot care team. A retrospective economic analysis was performed of costs for 274 patients during 3 years from healing of an initial foot ulcer, with or without amputation. Costs were estimated for inpatient care, outpatient care, home care, and social service. The cost calculations include costs due to complications and disability related to the initial ulcer, costs related to recurrence of ulcer, and costs for prevention of new ulcers.Expected total present value cost per patient during 3 years of observation was $26,700 (U.S. dollars) for primary healed patients with critical ischemia and $16,100 for primary healed patients without critical ischemia. For patients who healed with an amputation, the corresponding costs were $43,100 after a minor amputation and $63,100 after a major amputation.When estimating the costs for diabetic foot ulcers, it is not sufficient to calculate short-term costs. Long-term costs are high, mainly due to the need for increased home care and social service, but also due to costs for recurrent ulcers and new amputations.

The clinical and economic effects of each of 3 alternatives—no prophylaxis, general prophylaxis, and selective treatment—have been assessed in conjunction with 3 types of surgery—general surgery, the subset surgery for cholelithiasis, and elective hip surgery. The costs of thromboembolic and hemorrhagic complications have been calculated from the figures for 28 patients hospitalized at the Department of Surgery, Malmö General Hospital, Malmö, Sweden. The anticipated number of thromboembolic complications—and thus even the number of fatal pulmonary embolisms—can be minimized in all 3 types of surgery by means of general prophylaxis. General prophylaxis with low-dose heparin is, however, accompanied by the greatest incidence of hemorrhagic complications.

Cost-effectiveness ratios were estimated for each of 2 plasma cholesterol-lowering drug therapies, the HMG-CoA reductase inhibitor simvastatin and the well established cholestyramine, in comparison with a nonpreventive drug treatment alternative. The study was confined to Swedish men (aged 37 to 64 years at start of therapy) with total serum cholesterol levels above 6.2 mmol/L who were free of coronary artery disease (CAD). Costs included expected direct costs of plasma cholesterol-lowering treatment less expected savings resulting from preventing CAD. Effects were defined as changes in life expectancy. A discount rate of 5% and Swedish kronor (SEK) 1988 prices were used. The impact on CAD risks was calculated using multivariate logistic risk estimates from the Framingham Heart Study; Swedish estimates were used to calculate intervention costs and changes in healthcare costs. Over the range of cholesterol levels examined (6.2 to 9.8 mmol/L), simvastatin was consistently more cost-effective than cholestyramine.

In an attempt to obtain an appropriate estimate of the excess costs of production losses arising from morbidity in patients with diabetes, we compared the number of sick days and permanently disabled individuals in a diabetic population and the corresponding general population. These comparisons show that the rate of premature retirement for both insulin-dependent diabetes mellitus (IDDM, type I diabetes) or non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes) patients was twice that of the average population. Insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people aged 20 to 64 years with type II diabetes were about $US7000 per individual and year. Most of these excess costs were attributed to permanent disability in the 40- to 64-year age groups.

Allergic type I reactions to medicines range in their clinical presentation from rhinitis and urticaria to severe bronchoconstriction and anaphylactic shock. We examined all cases of suspected drug induced reactions classified as anaphylactic reactions or shock reported in Sweden between 1972 and 1995 with regard to patient characteristics and drug(s) suspected. Some comparisons with drug sales and prescription data were also made. During the study period of a total of 1338 reports concerned anaphylactic/oid shock or reactions with at least a possible causal relation to medicine giving an overall reporting rate of seven cases per million inhabitants per year of drug‐induced anaphylaxis. Of these 1338 patients 51 (3·8%) died from their reactions. Among the non‐fatal cases, 460 (34·4%) were diagnosed as shock and 827 (61·8%) as anaphylactic reactions. In total 46·3% of all reports concerned men but men were over‐represented among the older patients and among the fatal cases (65%). There were 201 different drugs reported as ‘suspected’ them most common of which were dextrans (418 reports), X‐ray contrast media (161 reports) and antibiotics (153 reports).

In a prospective randomized Canadian trial, addition of radionuclide strontium (89Sr) to external radiotherapy (ER) was found to prolong the time to further ER by 15 weeks (35 versus 20, P= 0.006) compared to ER alone in patients with hormone-refractory metastatic prostate cancer (HRMPC). The total direct lifetime costs within the Swedish health care system for the following two treatment strategies was estimated as follows: (a) ER initially and in the event of relapse and (b) ER + 89Sr initially and ER in the event of relapse.

The measurement errors in a CO_2 laser differential absorption system caused by optical interference effects are analyzed. Major sources of errors are identified and design suggestions to improve the system accuracy are made. The effects of temperature changes, short measurement paths, and spectral features of the measured species are taken into account.

A differential absorption lidar (DIAL) using a Q-switched CO_2 laser and a heterodyne receiver has been developed. The DIAL system is highly automated with computer-controlled laser-line selection and signal processing. The transmitter operates at a pulse-repetition frequency of 20 kHz and has an average output power of 1.8 W. A wideband HgCdTe detector is used together with a high speed adding buffer to detect the return signals. The system has been used in a field experiment to monitor ethylene emission from a petrochemical factory.

A compact computer-controlled CO_2-laser long-path absorption system has been developed. It is specifically designed to monitor gaseous pollutants in the working environment. The instrument uses a closed-cycle cooling system for the lasers and operates with room-temperature pyroelectric detectors. The high degree of automation and the compact design make the system easy to use. It has been used to measure several different species such as ammonia and methyl ethyl ketone in various industrial environments.

A mathematic model is created to determine the economic cost per year of anticipated prolongation of life that would result from a program of abdominal ultrasonographic (US) screening for abdominal aortic aneurysm. The protocol involves US screening at age 60,67, and 74 years with additional annual follow-up US and examination if an aneurysm of less than 40 mm is detected. Larger aneurysms are assumed to be sent for early elective resection. The benefits and risks for a subset of men with symptoms of intermittent claudication (IC) as an additional risk factor of atherosclerosis is calculated for comparison. Many of the factors on which these calculated costs and benefits are based are approximations and inferences. These include operative mortality for elective and emergent cases, charges for each such condition, cost of US, and anticipated survival following successful aneurysmectomy both with and without concomitant IC. Sensitivity analysis is performed to show how variations in the major parameters alter the outcome of the calculated cost per year of anticipated extension of life. On a mis au point un modèle mathématique pour déterminer les coûts annuels engendrés par la prolongation de vie anticipée par la pratique de l'échographie abdominale de routine pour détecter les anévrysmes de l'aorte abdominale. Le protocole comporte des examens à l'âge de 60, 67, et 74 ans et, par la suite, chaque année si un anévrysme inférieur à 40 mm est détecté. Les anévrysmes plus volumineux sont sensés être adressés en chirurgie vasculaire pour une cure à froid. A titre de comparaison, on a calculé les avantages et les inconvénients d'un sousgroupe de patients présentant des symptômes de claudication intermittente comme un facteur de risque supplémentaire. Bien des facteurs avec lesquels on a calculé le coût et les bénéfices ne sont que des approximations: mortalite opératoire des interventions urgentes et électives, coût de ces opérations, coût de l'échographie, survie anticipée après excision d'anévrysme avec ou sans claudication intermittente concomitante. L'analyse des sensibilités montre comment les variations des paramètres essentiels modifient l'évolution du coût par an de la prolongation de la vie. Se ha creado un modelo matemático para determinar los costos económicos anuales de la prolongación de la vida que puede esperarse de un programa de tamizaje por ultrasonografía (US) abdominal para la detección de aneurismas asintomáticos de la aorta abdominal. El protocolo implica el tamizaje por US a las edades de 60, 67, y 74 años, con seguimiento anual por US y examen si se detecta un aneurisma de menos de 40 mm. Se asume que aneurismas de un tamaño mayor son remitidos para resección electiva. Para efectos de comparación se han calculado los riesgos y beneficios para un subgrupo de hombres con síntomas de claudicación intermitente (CI) como un factor de riesgo adicional de aterosclerosis. Muchos de los factores sobre los cuales se han calculado los costos y beneficios se fundamentan en aproximaciones y en inferencias. Estos incluyen mortalidad operatoria para casos electivos y de emergencia, cargos para tales condiciones, costos de la US, y predicción de la supervivencia después de un aneurismectomía electiva en patientes con y sin CI concomitante. Se realizó un análisis de sensibilidad para demostrar como las variaciones en los parámetros mayores alteran el cálculo de los costos anuales de la predecible extensión de la vida.

Cost effectiveness was compared between substitution with autologous blood, implying no risk of transmission of diseases, and homologous blood, with a definite risk of transmission. Primary and revision hip arthroplasties were included in this study, as well as scoliosis operations. the risk of contracting chronic non-A, non-B hepatitis (NANBH) was included in the calculations of the long-term economic consequences of a transmittable disease.Our study showed that predonated blood alone, with a donation of up to four units, was the most suit-able and cost-effective method for substitution of blood losses up to about 2.5-3 liters A combination of predonated blood and intraoperative autotransfusion was more suitable and less expensive for substituting blood losses of 2.5 liters or more. Homologous blood was the least cost-effective alternative considering the influence of non-A, non-B hepatitis.

Allergic type I reactions to medicines range in their clinical presentation from rhinitis and urticaria to severe bronchoconstriction and anaphylactic shock. We examined all cases of suspected drug induced reactions classified as anaphylactic reactions or shock reported in Sweden between 1972 and 1995 with regard to patient characteristics and drug(s) suspected. Some comparisons with drug sales and prescription data were also made. During the study period of a total of 1338 reports concerned anaphylactic/oid shock or reactions with at least a possible causal relation to medicine giving an overall reporting rate of seven cases per million inhabitants per year of drug-induced anaphylaxis. Of these 1338 patients 51 (3·8%) died from their reactions. Among the non-fatal cases, 460 (34·4%) were diagnosed as shock and 827 (61·8%) as anaphylactic reactions. In total 46·3% of all reports concerned men but men were over-represented among the older patients and among the fatal cases (65%). There were 201 different drugs reported as ‘suspected’ them most common of which were dextrans (418 reports), X-ray contrast media (161 reports) and antibiotics (153 reports). For dextrans the rate of anaphylactic reactions, shock and fatal cases reported were 128,101 and 21 per million bottles respectively. This decreased to 10·3, 9·8, and 0·4 per million bottles after the introduction of preventive treatment with dextran 1 in 1983. The reporting rate for ionic contrast media were 0·14, 0·13 and 0·02 per 1000 l for reactions, shock and fatal cases respectively whilst for non-ionic contrast media they were 0·7/1000 l for reactions, 0·02/1000 l for shock, but there was no report of a fatal case. For phenoxymethylpenicillin the reported rate of anaphylaxis was 0·14 cases per million defined daily doses and for benzylpenicillin it was 3·7 cases per million defined daily doses. During the study period several drugs have been identified as important causes of anaphylaxis and measures have been taken to decrease the risk of anaphylaxis e.g. the introduction of preventive treatment with dextran 1, the shift from ionic to non-ionic contrast media and the abolition of polyethoxylated castor oil as a solvent. Spontaneous reporting of drug-induced anaphylaxis remains an important surveillance model but needs to be complemented by better quantitative methods. © 1998 John Wiley & Sons, Ltd.

Economic appraisal of Pharmaceuticals is becoming increasingly important. In a retrospective study of patient records from 58 organ or bone marrow-transplanted patients with systemic mycoses, the cost-effectiveness of treatment with a liposomal amphotericin B formulation was compared with that of conventional amphotericin B. Treatment with liposomal amphotericin B results in fewer adverse reactions, increased life expectancy and higher costs than treatment with conventional amphotericin B. Pricing liposomal amphotericin B at about SEK6000 per patient treatment day will result in an additional cost per life-year gained of about SEK150 000 relative to that using conventional amphotericin B for patients receiving kidney, kidney and pancreas, or pancreas transplants. For liver and bone marrow transplant (BMT) recipients the marginal cost-effectiveness ratio was about SEK195 000 and SEK150 000 per life-year gained. Compared with alternative use of resources in society and health care, use of liposomal amphotericin B rather than conventional amphotericin treatment can be considered cost-effective at the price assumed.

Without Abstract:

The clinical and economic effects of each of 3 alternatives—no prophylaxis, general prophylaxis, and selective treatment—have been assessed in conjunction with 3 types of surgery—general surgery, the subset surgery for cholelithiasis, and elective hip surgery. The costs of thromboembolic and hemorrhagic complications have been calculated from the figures for 28 patients hospitalized at the Department of Surgery, Malmö General Hospital, Malmö, Sweden. The anticipated number of thromboembolic complications—and thus even the number of fatal pulmonary embolisms—can be minimized in all 3 types of surgery by means of general prophylaxis. General prophylaxis with low-dose heparin is, however, accompanied by the greatest incidence of hemorrhagic complications. Health care costs are minimized with general prophylaxis in elective hip and general surgery, while no prophylaxis is the best alternative in surgery for cholelithiasis. From the patient's point of view, general prophylaxis minimizes the duration of thromboembolic disease in general surgery as well as in elective hip surgery. In surgery for cholelithiasis, however, no differences in health loss for the individual are shown between the 2 main alternatives, no prophylaxis and general prophylaxis. Selective treatment means treatment after diagnosis of thrombosis with some screening method. The alternative selective treatment was the least satisfactory of those 3 studied. Les effets cliniques et financiers de 3 comportements variables: absence de prophylaxie, prophylaxie, traitement sélectif ont été évalué en fonction de trois types de chirurgie: chirurgie générale, chirurgie spéciale de la lithiase biliaire, chirurgie élective de la hanche. Les coûts des complications thrombo-emboliques et hémorragiques ont été calculés à partir des données numériques concernant 28 malades hospitalisés dans le service de chirurgie. Le nombre envisagé des complications thromboemboliques et par conséquent le nombre d'embolie pulmonaire fatale a été réduit dans les 3 types de chirurgie choisis grâce au traitement prophylactique. Cependant il convient de noter que le traitement prophylactique à l'aide de faible dose d'héparine s'accompagne de complications hémorragiques plus nombreuses. Les coûts des soins de la chirurgie élective de la hanche et de la chirurgie générale sont réduits grâce au traitement prophylactique alors que l'absence de traitement prophylactique représente la meilleure modalité à observer dans le traitement de la chirurgie biliaire. En ce qui concerne le point de vue du malade le traitement prophylactique réduit la durée de la maladie thromboembolique compliquant la chirurgie générale ou la chirurgie de la hanche. En revanche dans la chirurgie de la lithiase biliaire aucun inconvénient pour la santé du malade ne s'observe que le traitement prophylactique soit ou ne soit pas appliqué. Le traitement sélectif qui répond au traitement institué après que le diagnostic ait été posé par des méthodes de dépistage est la moins satisfaisante des trois attitudes envisagées. Los efectos clínicos y económicos de cada una de 3 alternatives en la profilaxis tromboembólica (no profilaxis, profilaxis general con heparina de baja dosis, y tratamiento selectivo) fueron valorados en 3 tipos de cirugía: cirugía general (abdominal), el subgrupo de cirugía general para colelitiasis, y cirugía electiva de cadera. Los costos de las complicaciones tromboembólicas y hemorrágicas fueron calculados a partir de las cifras observadas en 28 pacientes hospitalizados en el Departmento de Cirugía. El número de predicción de complicaciones tromboembólicas, y el número de embolismos pulmonares fatales pueden ser minimizados en los 3 tipos de cirugía mediante la profilaxis general. Sin embargo, la profilaxis general con heparina de baja dosis se acompaña de la más alta incidencia de complicaciones hemorrágicas. Los costos de la atención pueden ser minimizados mediante la profilaxis general en cirugía electiva de cadera y en cirugía general abdominal, en tanto que la no profilaxis es la mejor alternativa para la cirugía de colelitiasis. Desde el punto de vista del paciente, la profilaxis general minimiza la duración de la enfermedad tromboembólica en la cirugía general abdominal así como en la cirugía electiva de cadera. En la cirugía para colelitiasis, sin embargo, no se demuestran diferencias entre las dos alternatives principales, no profilaxis y profilaxis general. El tratamiento selectivo significa tratamiento una vez establecido el diagnóstico de trombosis mediante algún método de tamizaje. La alternativa de tratamiento selectivo fue la menos satisfactoria de las 3 alternatives estudiadas.

This article present an instrument applicable to in-process measurement of surface roughness. In the process a grinding machine is used. In the first experiment surfaces in the roughness area of 0/09 μm ≤ Ra≤0.06 μm were measured, in the second 3.0 μm ≤ Ra≤3.4 μm. The method presented here is generally applicable, i.e., more rough surfaces can be measured if a laser with appropriate wavelength and a detector sensitive to that wavelength is chosen.