Dietary intake and risk of metabolic syndrome in long-term survivors of pediatric allogeneic hematopoietic stem cell transplantation.

We explored the dietary intake and metabolic syndrome (MetS) in 85 survivors of pediatric stem cell transplantation (median age 30 years, median follow-up time 20 years). Overall, the distribution of fatty acid deviated from the recommendations with a higher intake of saturated fat and a lower intake of unsaturated fat but was comparable to that of the background population. The prevalence of MetS was 27%, corresponding to that of the elderly background population.

Metabolic syndrome as a late effect of childhood hematopoietic stem cell transplantation - A thorough statistical evaluation of putative risk factors.

Background: Metabolic syndrome (MetS) is frequent among survivors of childhood hematopoietic stem-cell transplantation (HSCT), but assessment of risk factors is challenged by survivor and participation bias in long-term follow-up studies.

Methods: A cohort of 395 pediatric patients transplanted between 1980 and 2018 was investigated. MetS was assessed at follow-up between December 2018 and March 2020.

Hospital centralization and performance in Denmark-Ten years on.

Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform.

Potentially avoidable hospitalizations in five European countries in 2009 and time trends from 2002 to 2009 based on administrative data.

Introduction: Potentially avoidable hospitalizations in chronic conditions are used to evaluate health-care performance. However, evidence comparing different countries at small geographical areas is still scarce. The aim of the present study is to describe and discuss differences in rates and time-trends across health-care areas from five European countries.

Socioeconomic inequality in hip replacement in four European countries from 2002 to 2009--area-level analysis of hospital data.

Background: Cross-country comparisons of socioeconomic equity in health care typically use sample survey data on general services such as physician visits. This study uses comprehensive administrative data on a specific service: hip replacement.

Methods: We analyse 651 652 publicly funded hip replacements, excluding fractures and accidents, in adults over 35 in Denmark, England, Portugal and Spain from 2002 to 2009.

Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system: results from a 5-year follow-up cohort study.

Objective: To examine the costs to the public health care system of couples in medically assisted reproduction.

Design: Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment.

Setting: Specialized public fertility clinics in Denmark.

Ten years of structural reforms in Danish healthcare.

A major structural reform of the Danish public sector took place in 2007 when the number of administrative units at the regional and municipal levels was reduced. The larger administrative units allowed for a new hospital structure with a reduced number of acute hospitals covering a population of between 200,000 and 400,000 inhabitants. The restructuring involves creation of acute hospitals with a 24-h acute service by a range of specialists.

Register-based studies of healthcare costs.

Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark.

Research Topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity.

Economic evaluation of home blood pressure telemonitoring: a randomized controlled trial.

Aims: The purpose of the present study was to compare the costs of home blood pressure (BP) telemonitoring (HBPM) with the costs of conventional office BP monitoring. In a randomized controlled trial, 105 hypertensive patients performed HBPM and 118 patients received usual care with conventional office BP monitoring during 6 months. Costs were quantified from the healthcare perspective.

Ageing and health care expenditure in EU-15.

The purpose of this paper is to investigate the relationship between ageing and the evolution of health care expenditure per capita in the EU-15 countries. A secondary purpose is to produce estimates that can be used in projections of future health care costs. Explanatory variables include economic, social, demographic and institutional variables as well as variables related to capacity and production technology in the health care sector.

[Lack of equity in access to health care].

Equity in access is seen when needs determine access irrespective of population characteristics such as socioeconomic status and ethnicity. Equity in access is often investigated using indirect measures like utilisation as an equity proxy; however, disease stage and survival constitute alternative measures. Despite that equity in access to health care is a local and global political objective, inequities in access are still widespread even e.

Interchangeability of the EQ-5D and the SF-6D in long-lasting low back pain.

Objectives: The objective of this study was to investigate the interchangeability of the EuroQol 5D (EQ-5D) and the Short Form 6D (SF-6D) in individuals with long-lasting low back pain to guide the optimal choice of instrument and to inform decision-makers about any between-measure discrepancy, which require careful interpretation of the results of cost-utility evaluations.

Methods: A cross-sectional study was conducted across 275 individuals who had spinal surgery on indication of chronic low back pain. EQ-5D and SF-6D were mailed to respondents for self-completion.

Drugs, sex, money and power: an HPV vaccine case study.

In this paper we compare the experiences of seven industrialized countries in considering approval and introduction of the world's first cervical cancer-preventing vaccine. Based on case studies, articles from public agencies, professional journals and newspapers we analyse the public debate about the vaccine, examine positions of stakeholder groups and their influence on the course and outcome of this policy process. The analysis shows that the countries considered here approved the vaccine and established related immunization programs exceptionally quickly even though there still exist many uncertainties as to the vaccine's long-term effectiveness, cost-effectiveness and safety.

Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty.

Background: Accelerated perioperative rehabilitation protocols following total hip and knee arthroplasties are currently being implemented worldwide, but the cost-effectiveness of these protocols from a societal perspective is not known. We compared the cost-effectiveness of an accelerated perioperative care and rehabilitation protocol with that of a more standard protocol for patients treated with total hip and knee arthroplasty.

Methods: A cost-effectiveness study was undertaken as a study piggybacked on a randomized clinical trial comparing early outcomes of an accelerated and intensive postoperative rehabilitation regimen with those of a more standard rehabilitation protocol.

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems.

Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain.

Study Design: Cost-utility evaluation of a randomized, controlled trial with a 4- to 8-year follow-up.

Objective: To investigate the incremental cost per quality-adjusted-life-year (QALY) when comparing circumferential fusion to posterolateral fusion in a long-term, societal perspective.

Summary Of Background Data: The cost-effectiveness of circumferential fusion in a long-term perspective is uncertain but nonetheless highly relevant as the ISSLS prize winner 2006 in clinical studies reported the effect of circumferential fusion superior to the effect of posterolateral fusion.

Determinants of cost-effectiveness in lumbar spinal fusion using the net benefit framework: a 2-year follow-up study among 695 patients.

Up to one third of patients undergoing lumbar spinal fusion show no improvement after the procedure and thus, despite evidence from RCTs, there might be a rationale for observational studies clarifying indications. Similarly, selection of the right patients for the right procedure could have significant impact on cost-effectiveness, which in some countries, in turn, affects whether procedures are to be available through the National Health Service. The aim of this study was to investigate determinants of cost-effectiveness in lumbar spinal fusion.

Handling value added tax (VAT) in economic evaluations: should prices include VAT?

In health economic evaluations, value added tax is commonly treated as a transfer payment. Following this argument, resources are valued equal to their net-of-tax prices in economic evaluations applying a societal perspective. In this article we argue that if there is the possibility that a new healthcare intervention may expand the healthcare budget, the social cost of input factors should be the gross-of-tax prices and not the net-of-tax prices.

Decomposition of health inequality by determinants and dimensions.

The study integrates two methodologies so that income-related inequality in general health can be decomposed into contributions from socio-demographic characteristics to each of the dimensions defining general health. It is found that these relative contributions vary substantially across dimensions. For policy purposes such information is valuable as it indicates at which population groups and at which aspects of health efforts to reduce inequalities in health should be targeted.

Costs and effects in lumbar spinal fusion. A follow-up study in 136 consecutive patients with chronic low back pain.

Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient-level, (2) to investigate the correlation between costs and effects, (3) to investigate the influence of selected patient characteristics on cost-effectiveness and, (4) to investigate the incremental cost-effectiveness ratio of (a) posterior instrumentation and (b) intervertebral anterior support in lumbar spinal fusion. We hypothesized a positive correlation between costs and effects, that determinants of effects would also determine cost-effectiveness, and that posterolateral instrumentation and anterior intervertebral support are cost-effective adjuncts in posterolateral lumbar fusion.

The impact of population ageing on future Danish drug expenditure.

Population ageing is likely to place an increasing burden on future health care budgets. Several studies, however, have demonstrated that the impact of ageing on future hospital expenditures will be overestimated when not accounting for proximity to death. This is because the greater health care expenditures among the elderly are not only due to age per se but due to the high "costs of dying".

The Danish health care system: evolution--not revolution--in a decentralized system.

The Danish health care system has undergone gradual changes, but not radical reforms, from 1970 until 2004. Theoretically, the development can be viewed from the perspective of fiscal federalism, decentralization, and incentives embodied in reimbursement systems. Furthermore, path dependence and incrementalism have characterized the system.

Health policy in Denmark: leaving the decentralized welfare path?

In this article, we investigate developments in Danish health care policy. After a short presentation of its historical roots, we focus on the decades after the administrative reform of 1970, which shaped the current decentralized public health care system. Theories of path dependency and institutional inertia are used to explain the relative stability in the overall structure, and theories of policy process and reform are used to discuss gradual changes within the overall framework.

Measuring inequality in self-reported health-discussion of a recently suggested approach using Finnish data.

Health surveys often include a general question on self-assessed health (SAH), usually measured on an ordinal scale with three to five response categories, from 'very poor' or 'poor' to 'very good' or 'excellent'. This paper assesses the scaling of responses on the SAH question. It compares alternative procedures designed to impose cardinality on the ordinal responses.