Ulf-G Gerdtham

Lund University, Lund, Skåne, Sweden

Are you Ulf-G Gerdtham?

Claim your profile

Publications (80)114.99 Total impact

  • Source
    Gustav Kjellsson, Philip Clarke, Ulf-G Gerdtham
    [Show abstract] [Hide abstract]
    ABSTRACT: Self-reported data on health care use is a key input in a range of studies. However, the length of recall period in self-reported health care questions varies between surveys, and this variation may affect the results of the studies. This study uses a large survey experiment to examine the role of the length of recall periods for the quality of self-reported hospitalization data by comparing registered with self-reported hospitalizations of respondents exposed to recall periods of one, three, six, or twelve months. Our findings have conflicting implications for survey design, as the preferred length of recall period depends on the objective of the analysis. For an aggregated measure of hospitalization, longer recall periods are preferred. For analysis oriented more to the micro-level, shorter recall periods may be considered since the association between individual characteristics (e.g., education) and recall error increases with the length of the recall period.
    Journal of Health Economics 02/2014; 35C:34-46. · 1.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study estimates health utilities (HU) in Sweden for a range of type 2 diabetes-related complications using EQ-5D and two alternative tariffs (UK and Swedish) from 1757 patients with type 2 diabetes from the Swedish National Diabetes Register (NDR). Ordinary least squares were used for statistical analysis. Lower HU was found for female gender, younger age at diagnosis, higher BMI, and history of complications. Microvascular and macrovascular complications had the most negative effect on HU among women and men, respectively. The greatest decline in HU was associated with kidney disorders (-0.114) using the UK tariff and stroke (-0.059) using the Swedish tariff. Multiple stroke and non-acute ischaemic heart disease had higher negative effect than a single event. With the UK tariff, each year elapsed since the last microvascular/macrovascular complication was associated with 0.013 and 0.007 units higher HU, respectively. We found important heterogeneities in effects of complications on HU in terms of gender, multiple event, and time. The Swedish tariff gave smaller estimates and so may result in less cost-effective interventions than the UK tariff. These results suggest that incorporating subgroup-specific HU in cost-utility analyses might provide more insight for informed decision-making.
    International Journal of Environmental Research and Public Health 01/2014; 11(5):4939-52. · 2.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To estimate Swedish experience-based value sets for EQ-5D health states using general population health survey data. Approximately 45,000 individuals valued their current health status by means of time trade off (TTO) and visual analogue scale (VAS) methods and answered the EQ-5D questionnaire, making it possible to model the association between the experience-based TTO and VAS values and the EQ-5D dimensions and severity levels. The association between TTO and VAS values and the different severity levels of respondents' answers on a self-rated health (SRH) question was assessed. Almost all dimensions (except usual activity) and severity levels had less impact on TTO valuations compared with the UK study based on hypothetical values. Anxiety/depression had the greatest impact on both TTO and VAS values. TTO and VAS values were consistently related to SRH. The inclusion of age, sex, education and socioeconomic group affected the main effect coefficients and the explanatory power modestly. A value set for EQ-5D health states based on Swedish valuations has been lacking. Several authors have recently advocated the normative standpoint of using experience-based values. Guidelines of economic evaluation for reimbursement decisions in Sweden recommend the use of experience-based values for QALY calculations. Our results that anxiety/depression had the greatest impact on both TTO and VAS values underline the importance of mental health for individuals' overall HRQoL. Using population surveys is in line with recent thinking on valuing health states and could reduce some of the focusing effects potentially appearing in hypothetical valuation studies.
    Quality of Life Research 08/2013; · 2.86 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In recent years, there has been growing interest in measuring the efficiency of hospitals in Iran and several studies have been conducted on the topic. The main objective of this paper was to review studies in the field of hospital efficiency and examine the estimated technical efficiency (TE) of Iranian hospitals. Persian and English databases were searched for studies related to measuring hospital efficiency in Iran. Ordinary least squares (OLS) regression models were applied for statistical analysis. The PRISMA guidelines were followed in the search process. A total of 43 efficiency scores from 29 studies were retrieved and used to approach the research question. Data envelopment analysis was the principal frontier efficiency method in the estimation of efficiency scores. The pooled estimate of mean TE was 0.846 (+/-0.134). There was a considerable variation in the efficiency scores between the different studies performed in Iran. There were no differences in efficiency scores between data envelopment analysis (DEA) and stochastic frontier analysis (SFA) techniques. The reviewed studies are generally similar and suffer from similar methodological deficiencies, such as no adjustment for case mix and quality of care differences. The results of OLS regression reveal that studies that included more variables and more heterogeneous hospitals generally reported higher TE. Larger sample size was associated with reporting lower TE. The features of frontier-based techniques had a profound impact on the efficiency scores among Iranian hospital studies. These studies suffer from major methodological deficiencies and were of sub-optimal quality, limiting their validity and reliability. It is suggested that improving data collection and processing in Iranian hospital databases may have a substantial impact on promoting the quality of research in this field.
    BMC Health Services Research 08/2013; 13(1):312. · 1.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In the Bagnardi et al. (2001) meta-analysis, it was found that alcohol consumption increases the risk of stomach cancer (OR = 1.32 for heavy drinkers). However, it is unknown if drinking cessation reverses this alcohol-elevated risk. A systematic literature review was performed to provide the information for a meta-analysis where the dose-risk trend was estimated for years since drinking cessation and the risk of stomach cancer. A random effect generalised least squares model for trend estimation was used, employing study characteristics to control for heterogeneity. Nineteen observational studies were identified in the literature review, of which five studies quantified duration of cessation and risk of stomach cancer, giving a total of 1947 cancer cases. No significant effect of drinking cessation on the risk of stomach cancer could be found (OR = 0.99 CI: 0.97-1.02). This result should be interpreted with caution due to the limited number of studies in this area. Recent findings suggest a link between heavy drinking and stomach cancer, especially gastric noncardia, but not for moderate drinking. Since all but one of the included studies in this meta-analysis failed to control for consumption level, the current study could not test if the risk decline following drinking cessation differs between moderate and high consumers.
    BMC Public Health 06/2013; 13(1):600. · 2.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective Predicting the risk of future events is an essential part of health economic simulation models. In pursuit of this goal, the current study aims to predict the risk of developing first and second acute myocardial infarction, heart failure, non-acute ischaemic heart disease, and stroke after diagnosis in patients with type 2 diabetes, using data from the Swedish National Diabetes Register. Material and Methods Register data on 29,034 patients with type 2 diabetes were analysed over five years of follow up (baseline 2003). To develop and validate the risk equations, the sample was randomly divided into training (75%) and test (25%) subsamples. The Weibull proportional hazard model was used to estimate the coefficients of the risk equations, and these were validated in both the training and the test samples. Results In total, 4,547 first and 2,418 second events were observed during the five years of follow up. Experiencing a first event substantially elevated the risk of subsequent events. There were heterogeneities in the effects of covariates within as well as between events; for example, while for females the hazard ratio of having a first acute myocardial infarction was 0.79 (0.70–0.90), the hazard ratio of a second was 1.21 (0.98–1.48). The hazards of second events decreased as the time since first events elapsed. The equations showed adequate calibration and discrimination (C statistics range: 0.70–0.84 in test samples). Conclusion The accuracy of health economic simulation models of type 2 diabetes can be improved by ensuring that they account for the heterogeneous effects of covariates on the risk of first and second cardiovascular events. Thus it is important to extend such models by including risk equations for second cardiovascular events.
    PLoS ONE 05/2013; 8(5):e62650. · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: During past decades, the number of dentists has continuously increased in Iran. Beside the quantity, the distribution of dentists affects the oral health status of population. The current study aimed to assess the pure and social disparities in distribution of dentists across the provinces in Iran in 2009. Data on provinces' characteristics, including population and social situation, were obtained from multiple sources. The disparity measures (including Gini coefficient, index of dissimilarity, Gaswirth index of disparity and relative index of inequality (RII)) and pairwise correlations were used to evaluate the pure and social disparities in the number of dentists in Iran. On average, there were 28 dentists per 100,000 population in the country. There were substantial pure disparities in the distribution of dentists across the provinces in Iran. The unadjusted and adjusted RII values were 3.82 and 2.13, respectively; indicating area social disparity in favor of people OPEN ACCESS Int. J. Environ. Res. Public Health 2013, 10 1883 in better-off provinces. There were strong positive correlations between density of dentists and better social rank. It is suggested that the results of this study should be considered in conducting plans for redistribution of dentists in the country. In addition, further analyses are needed to explain these disparities.
    International Journal of Environmental Research and Public Health 05/2013; 10:1882-1894. · 2.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the current study was to provide updated time-path equations for risk factors of type-2-diabetes-related cardiovascular complications for application in risk calculators and health economic models. Observational data from the Swedish National Diabetes Register were analysed using Generalized Method of Moments estimation for dynamic panel models (íµí± = 5, 043, aged 25– 70 years at diagnosis in 2001–2004). Validation was performed using persons diagnosed in 2005 (íµí±› = 414). Results were compared with the UKPDS outcome model. The value of the risk factor in the previous year was the main predictor of the current value of the risk factor. People with high (low) values of risk factor in the year of diagnosis experienced a decreasing (increasing) trend over time. BMI was associated with elevations in all risk factors, while older age at diagnosis and being female generally corresponded to lower levels of risk factors. Updated time-path equations predicted risk factors more precisely than UKPDS outcome model equations in a Swedish population. Findings indicate new time paths for cardiovascular risk factors in the post-UKPDS era. The validation analysis confirmed the importance of updating the equations as new data become available; otherwise, the results of health economic analyses may be biased.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the current study was to provide updated time-path equations for risk factors of type-2-diabetes-related cardiovascular complications for application in risk calculators and health economic models. Observational data from the Swedish National Diabetes Register were analysed using Generalized Method of Moments estimation for dynamic panel models (íµí± = 5, 043, aged 25– 70 years at diagnosis in 2001–2004). Validation was performed using persons diagnosed in 2005 (íµí±› = 414). Results were compared with the UKPDS outcome model. The value of the risk factor in the previous year was the main predictor of the current value of the risk factor. People with high (low) values of risk factor in the year of diagnosis experienced a decreasing (increasing) trend over time. BMI was associated with elevations in all risk factors, while older age at diagnosis and being female generally corresponded to lower levels of risk factors. Updated time-path equations predicted risk factors more precisely than UKPDS outcome model equations in a Swedish population. Findings indicate new time paths for cardiovascular risk factors in the post-UKPDS era. The validation analysis confirmed the importance of updating the equations as new data become available; otherwise, the results of health economic analyses may be biased.
    Experimental Diabetes Research 02/2013; 2013. · 1.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Lifestyle interventions affect patients' risk factors for metabolic syndrome (MeSy), a pre-stage to cardiovascular diseases, diabetes and related complications. An effective lifestyle intervention is the Swedish Björknäs intervention, a 3-year randomized controlled trial in primary care for MeSy patients. To include future disease-related cost and health consequences in a cost-effectiveness analysis, a simulation model was used to estimate the short-term (3-year) and long-term (lifelong) cost-effectiveness of the Björknäs study. A Markov micro-simulation model was used to predict the cost and quality-adjusted life years (QALYs) for MeSy-related diseases based on ten risk factors. Model inputs were levels of individual risk factors at baseline and at the third year. The model estimated short-term and long-term costs and QALYs for the intervention and control groups. The cost-effectiveness of the intervention was assessed using differences-in-differences approach to compare the changes between the groups in the health care and societal perspectives, using a 3% discount rate. A 95% confidence interval (CI), based on bootstrapping, and sensitivity analyses describe the uncertainty in the estimates. In the short-term, costs are predicted to increase over time in both groups, but less in the intervention group, resulting in an average cost saving/reduction of US$-700 (in 2012, US$1=six point five seven SEK) and US$-500, in the societal and health care perspectives. The long-term estimate also predicts increased costs, but considerably less in the intervention group: US$-7,300 (95% CI: US$-19,700 to US$-1,000) in the societal, and US$-1,500 (95% CI: US$-5,400 to US$2,650) in the health care perspective. As intervention costs were US$211 per participant, the intervention would result in cost saving. Furthermore, in the long-term an estimated 0.46 QALYs (95% CI: 0.12 to 0.69) per participant would be gained. The Swedish Björknäs study appears to reduce demands on societal and health care resources and increase health-related quality of life.
    PLoS ONE 01/2013; 8(11):e80672. · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the effect of alcohol cessation on the risk of developing laryngeal and pharyngeal cancers, combining available evidence in the scientific literature in a meta-analysis. A systematic literature review was conducted, and a meta-analysis was applied on the retrieved studies. The generalised least squares method was used to estimate the trend from dose-response data to assess changes in the risks of laryngeal and pharyngeal cancers after drinking cessation. A total of 9 case-control studies were included in the meta-analysis (4 and 8 estimates for laryngeal and pharyngeal cancers, respectively). On average, alcohol drinking cessation was associated with a 2% yearly reduction in the risk of developing laryngeal and pharyngeal cancers. There was a considerable heterogeneity between the studies of pharyngeal cancer, but this was mostly due to two studies. The increased risk of laryngeal and pharyngeal cancers caused by alcohol was reversible; the time periods until the risks became equal to those of never drinkers were 36 (95% CI 11-106) and 39 (95% CI 13-103) years, respectively. Moreover, 5 years of drinking cessation was associated with a reduction of around 15% in the alcohol-related elevated risk of laryngeal and pharyngeal cancers. Although a long time period is required to completely eliminate the alcohol-related elevated risk of laryngeal and pharyngeal cancers, a substantial risk reduction can be seen in the short term (5-10 years), and drinking cessation should therefore be encouraged to reduce the incidence of these cancers.
    PLoS ONE 01/2013; 8(3):e58158. · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Vietnam has achieved considerable success in economic development, poverty reduction, and health over a relatively short period of time. However, there is concern that inequalities in health outcomes and intervention coverage are widening. This study explores if inequalities in reproductive, maternal, newborn and child health and nutrition changed over time in Vietnam in 1997--2006, and if inequalities were different depending on the type of stratifying variable used to measure inequalities and on the type of outcome studied. METHODS: Using data from four nationally representative household surveys conducted in 1997--2006, we study inequalities in reproductive, maternal, newborn and child health and nutrition outcomes and intervention coverage by computing concentration indices by living standards, maternal education, ethnicity, region, urban/rural residence, and sex of child. RESULTS: Inequalities in maternal, newborn and child health persisted in 1997--2006. Inequalities were largest by living standards, but not trivial by the other stratifying variables. Inequalities in health outcomes generally increased over time, while inequalities in intervention coverage generally declined. The most equitably distributed interventions were family planning, exclusive breastfeeding, and immunizations. The most inequitably distributed interventions were those requiring multiple service contacts, such as four or more antenatal care visits, and those requiring significant support from the health system, such as skilled birth attendance. CONCLUSIONS: Three main policy implications emerge. First, persistent inequalities suggest the need to address financial and other access barriers, for example by subsidizing health care for the poor and ethnic minorities and by support from other sectors, for example in strengthening transportation networks. This should be complemented by careful monitoring and evaluation of current program design and implementation to ensure effective and efficient use of resources. Second, greater inequalities for interventions that require multiple service contacts imply that inequalities could be reduced by strengthening information and service provision by community and village health workers to promote and sustain timely care-seeking. Finally, larger inequalities for interventions that require a fully functioning health system suggest that investments in health facilities and human resources, particularly in areas that are disproportionately inhabited by the poor and ethnic minorities, may contribute to reducing inequalities.
    BMC Health Services Research 12/2012; 12(1):456. · 1.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study analyzes the socioeconomic gradient in drug utilization. We use The Swedish Prescribed Drug Register, merged with the Survey of Living Conditions (the ULF), and the study sample consists of 8138 individuals. We find a positive education gradient (but no income gradient) in drug utilization, after controlling for health indicators. Whereas high-educated men use a larger number of drugs, high-educated women use both a larger number of drugs and more expensive drugs. For males, but not as clearly for females, we find that the education gradient is weaker for more health-related drugs but stronger for more expensive drugs. We conclude that the main reason for the education gradient in drug utilization is doctors' behaviour rather than compliance with medication and affordability of drugs.
    Social Science [?] Medicine 11/2012; · 2.73 Impact Factor
  • Source
    Gustav Kjellsson, Ulf-G Gerdtham
    [Show abstract] [Hide abstract]
    ABSTRACT: This article discusses measurement of socioeconomic inequalities in the prevalence of a health condition, in response to the recent exchange between Guido Erreygers and Adam Wagstaff, in which they discuss the merits of their own corrections to the frequently used concentration index. We first reconcile their debate and discuss the value judgments implicit in their indices. Next, we provide a formal definition of the previously undefined value judgment in Wagstaff's correction. Finally, we show empirically that the choice of index matters, as illustrated by comparisons between countries using data from the European Survey of Health, Ageing and Retirement.
    Journal of Health Economics 11/2012; · 1.60 Impact Factor
  • Frida Hjalte, Jonas Brännström, Ulf-G Gerdtham
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this study was to perform a critical and systematic literature review of studies on societal costs due to hearing disorders. We used predefined search terms and inclusion/exclusion criteria. Systematic searches were conducted in Medline, Cochrane Library, Google Scholar, and other relevant websites. The review included studies written in English or Swedish between 1995 and the end of January 2012. We identified four published studies and four reports that met the pre-defined inclusion criteria. Swedish cost studies primarily focused on costs of hearing aids. International studies with a societal perspective used different costing approaches and were limited to specific patient populations. Hearing disorders impact the social welfare system more than the medical care system. Indirect costs account for the major part and direct medical costs for a minor part of the total costs of hearing disorders. There is a need for further studies estimating societal costs for all degrees of hearing disorders, in particular since a large part of the people with hearing disorders are of working age.
    International journal of audiology 06/2012; 51(9):655-62. · 1.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR) intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. METHODS: The study is designed as a long-term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1) Intervention group (IG): multi-professional team intervention with PAR, 2) Control group A (CA): physical activity prescription in usual care and 3) Control group B: treatment as usual (retrospective data collection). The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ) and expressed as metabolic equivalent of task (MET)-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients' health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions By helping patients to overcome practical, social and cultural obstacles and increase their internal motivation for physical activity we aim to improve their physical health in a long-term perspective. The targeted patients belong to a patient category that is supposed to benefit from increased physical activity in terms of improved physiological values, mental status and quality of life, decreased risk of complications and maybe a decreased need of medication. Trial registration: ClinicalTrials.gov NCT01187576.
    BMC Health Services Research 06/2012; 12(1):173. · 1.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The concentration index and decomposition analysis are commonly used in economics to measure and explain socioeconomic inequalities in health. Such analysis builds on the strong assumption that a health production function can be estimated without substantial bias implying that health is caused by socioeconomic outcomes, which is hard to prove. This article contributes to the decomposition literature by applying a twin design to standard decomposition analysis of socioeconomic health inequalities in Sweden. The twin-based decomposition estimates, which control for unobserved endowments at the twin-pair level, are much lower in magnitude than estimates obtained via typical OLS on the same sample. This demonstrates that OLS-based decompositions are severely upward biased due to underlying confounders, exaggerating the contribution of income and education to health inequality, which in turn limits the usefulness of such decompositions for policy purposes.
    01/2012;
  • Johan Jarl, Ulf-G Gerdtham
    [Show abstract] [Hide abstract]
    ABSTRACT:   To establish the current level of knowledge of the effect of drinking cessation on the risk of developing oesophageal cancer.   A meta-analysis was conducted based on relevant studies identified through a systematic literature review. A generalized least squares model for trend estimation of summarized dose-response data were utilized in order to estimate the effect of years since drinking cessation on risk of oesophageal cancer.   Seventeen studies that estimate the risk reduction after quantified drinking cessation were identified in the systematic literature review. Nine of these were appropriate for inclusion in the meta-analysis. A large degree of heterogeneity existed between the studies, but this was explainable and the increased risk of oesophageal cancer caused by alcohol consumption was found to be reversible, with a common trend between studies. A required time-period of 16.5 years (95% confidence interval 12.7-23.7) was estimated until no risk from former drinking remained, although this might have been an overestimation due to sample characteristics. The dose-response relationship was found to have an exponential decay. This means that about half the reduction in alcohol-related risk occurred after just a third of the time-period required to eliminate the additional risk.   The alcohol-related increased risk of oesophageal cancer is reversible following drinking cessation. It is most likely that about 16 years are required until all elevated risk has disappeared. Due to lack of research and data, more research is urgently required to increase the robustness of the estimates and to approach study limitations.
    Addiction 12/2011; 107(7):1234-43. · 4.58 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Using longitudinal data, this paper investigates the penalty for excess weight in the Swedish labor market, distinguishing between the productivity and the discrimination hypotheses. We analyze employment, income, and sickness absence, using the latter as a direct measure of productivity. We find that excess weight women, but not men, experience a significant employment penalty. Both genders experience a significant income penalty for obesity. We conclude that the penalties are associated with lower productivity, primarily in terms of health. We find no evidence of discrimination.
    01/2011;
  • [Show abstract] [Hide abstract]
    ABSTRACT: In a dynamic Two-Part Model (2 PM), we find the effect of previous smoking on the participation decision to be decreasing with education among Swedish women, i.e. more educated are less state dependent. However, we do not find an analogous effect of education on the conditional intensity of consumption.
    Health Economics 09/2010; 20(7):876-81. · 2.23 Impact Factor

Publication Stats

2k Citations
114.99 Total Impact Points

Institutions

  • 1996–2014
    • Lund University
      • • Department of Economics
      • • Department of Clinical Sciences
      • • Institute of Economic Research
      • • Faculty of Medicine
      Lund, Skåne, Sweden
  • 2012
    • Swedish Institute for Health Economics
      Lund, Skåne, Sweden
  • 2008–2009
    • University of Aberdeen
      • • Health Economics Research Unit
      • • Department of Economics
      Aberdeen, SCT, United Kingdom
    • University of Sydney
      • School of Public Health
      Sydney, New South Wales, Australia
  • 2005
    • Malmö University
      Malmö, Skåne, Sweden
  • 1996–2001
    • Stockholm School of Economics
      • • Department of Economics
      • • Centre for Health Economics
      Tukholma, Stockholm, Sweden