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Three methodological approaches were applied to analyze whether the cost-effectiveness of drotrecogin alfa (activated) (Xigris) as an adjunct to standard care compared with standard care alone is a cost-effective alternative for the treatment of Swedish patients with severe sepsis and organ dysfunction. Health-economic model simulations were applied to (1) Swedish treatment pattern data, (2) international trial data and local unit prices, and (3) Swedish local patient data combined with trial age structure to adjust for differences in the age structure between the trial and the Swedish patient sample. The methodological approach had no effect on the overall conclusion that the intervention was cost-effective in the treatment of Swedish patients with severe sepsis and organ dysfunction. However, the cost-effectiveness ratios were sensitive to the approach applied. The results indicate the importance of collecting not only information on local prices but also information about treatment pattern and patient characteristics when conducting country-specific health-economic model applications.

BACKGROUND: The choice between different attention-deficit/hyperactivity disorder (ADHD) medications depends on different drug attributes. Economic evaluations of drugs often disregard the utility of other attributes compare with the drugs' efficacy.AIMS: The aim of this study was to assess patient's preferences and elicit willingness-to-pay (WTP) for different drug attributes in the treatment of ADHD.METHODS: 285 patients (117 parents for children below 15 years, 52 adolescents 15-17 years and 116 adults aged 18 years and above) from Sweden, Denmark and Norway completed a questionnaire concerning their ADHD drug treatment, and answered questions on their preferences using a discrete choice experiment (DCE). Included attributes were effectiveness, side-effects, dosing and price.RESULTS: Effectiveness was the most important attribute, followed by side-effects and the number of dosings per day (all P < 0.001). The estimated monthly WTP for a drug generating full effectiveness, no side-effects and once-daily dosing was €790 for adolescents and €360 for adults. The estimated WTP for ADHD drugs with characteristics similar to existing drugs on the market was higher or in line with market prices (€37-180 for adolescents and €16-80 for adults). Regarding experience with current treatment, 19% of all patients in the study reported good functioning during the morning, day and evening.CONCLUSIONS: The gap between the monetary valuation of existing products and an optimally valued product suggest that there is room for improvements in the clinical management of ADHD. The results suggest that DCE is a method that can be used to value not only hypothetical scenarios but also can be used to value and distinguish between real-life scenarios.

The study aims to compare health care utilisation and workdays lost for individuals with and without asthma in Sweden. Individual data on self-perceived asthma problems, self-reported utilisation of outpatient care and official data on inpatient care, and official data on workdays lost was obtained from the HILDA database (health and individuals: longitudinal data and analysis). The study covered 13,000 individuals. Independent t-tests were performed to compare average differences in primary care visits, emergency room visits, days in hospital and workdays lost. Individuals with severe asthma, as compared with the general population, were found to utilise primary care visits, emergency room visits and hospitalisation according to the following ratios: 1.9(:1), 4.9 and 4.3 per year, respectively. For workdays lost the ratio was 1.9. All differences were statistically significant. For individuals reporting mild asthma, no significant differences were found compared with the general population. This finding may be due to the success of asthma management in this population. Both the official data and the self-reported data provided evidence of the burden of asthma to individuals and society. Briefly, self-reported severe asthmatics utilised 2-5 times more resources than the general population, while there were no differences in resource utilisation between self-reported mild asthmatics and the general population.