Susanne Reindahl Rasmussen’s research while affiliated with Danish National Centre for Social Research and other places

Background Current estimates of lifetime costs of smoking are largely based on model analyses using etiologic fractions for a variety of diseases or Markov chain models. Direct estimation studies based on individual data for health costs by smoking status over a lifetime are non-existent. Methods We estimated lifetime costs in a societal perspective of 18-year-old daily-smokers (continuing smoking throughout adult life) and never-smokers in Denmark, as well as lifetime public expenditures in the two groups. Main outcomes were lifetime net public expenditures and lifetime health costs according to OECD definitions and lifetime earned incomes. Estimates of these outcomes were based on registries containing individual-level data. Confounder-adjusted differences between daily-smokers and never-smokers were interpreted as smoking-attributable lifetime public expenditures and costs. Results The net lifetime public expenditure is, on average, €20 520 higher for male 18-year-old daily-smokers than for never-smokers, but €9771 lower, for female daily-smokers compared with never-smokers. In male 18-year-old daily-smokers, average lifetime health costs are €9921 higher and average lifetime earned incomes are €91 159 lower than for never-smokers. The corresponding figures are €5849 higher and €23 928 lower, respectively, for women. Conclusion 18-year-old male daily-smokers are net public spenders over their lifetime compared with never-smokers, while the opposite applies for women. In Denmark, smoking is associated with higher lifetime health costs for society and losses in earned incomes—both for men and women.

Background The aim of this study was to analyse the additional treatment costs of acute patients admitted to a Danish hospital who suffered an adverse event (AE) during in-hospital treatment. MethodsA matched case-control design was utilised. Using a combination of trigger words and patient record reviews 91 patients exposed to AEs were identified. Controls were identified among patients admitted to the same department during the same 20-month period. The matching was based on age, gender, and main diagnosis. Cost data was extracted from the Danish National Cost Database for four different periods after beginning of the admission. ResultsPatients exposed to an AE were associated with higher mean cost of EUR 9505 during their index admission (p = 0.014). For the period of 6 months from the beginning of the admission minus the admission itself they were associated with higher mean cost of EUR 4968 (p = 0.016). For the period from the 7th month until the end of the 12th month there was no statistically significant difference (p = 0.104). For the total period of 12 month, patients exposed to an AE were associated with statistically significant higher mean cost of EUR 13,930 (p = 0.001). ConclusionsAEs are associated with significant hospital costs. Our findings suggest that a follow-up period of 6 months is necessary when investigating the costs associated with AEs among acute patients. Further research of specific types of AEs and the costs of preventing these types of AEs would improve the understanding of the relationship between adverse events and costs.

De nordiske lande står over for en række landespecifikke udfordringer i forhold til lægemiddelreguleringen. Udfordringerne skyldes bl.a. befolkningens størrelse, landets økonomi eller sundhedsvæsenets organisering. Fælles for landene er dog, at de søger måder at opnå omkostningskontrol, samtidig med at befolkningerne sikres så relevant et lægemiddeludbud som muligt. Introduktionen af en række nye, meget højt prissatte lægemidler udgør en udfordring på tværs af landene, fordi disse lægemidler kan have betydelig påvirkning på landenes medicinbudgetter. Samtidig markedsføres der til stadighed nye lægemidler til samme indikationer. Det bidrager til at øge behandlingsudbuddet, men skaber samtidig en reguleringsmæssig udfordring i forhold til at sikre, at det billigste lægemiddel anvendes. I rapporten sammenlignes reguleringen i de nordiske lande i forhold til disse to hovedudfordringer.

I landene omkring os er den overordnede tendens, at man inddrager værdibaseret prissætning, når man skal tage beslutninger om at finansiere ny sygehusmedicin. Landene bruger dog vidt forskellige modeller for, hvordan de foretager prioritering og beslutninger.