Ulf-Göran Gerdtham is a Professor in Health Economics at the Department of Economics and at the Department of Clinical Sciences at Lund University as well as a research director at the Swedish Institute for Health Economics in Lund. He is also an Adjunct Professor at the Centre for Health Economics at Monash University, Melbourne. Professor Gerdtham research focuses on exploring the relationship between economic factors and individuals' health-related behavior. He is particularly interested in measuring and explaining the sources of income-related inequality in health. He is also interested in the consequences of risky behavior and chronic diseases. His other research focus is on the economic evaluations of health interventions, health system effects on health care costs and productivity.
International Journal of Environmental Research and Public Health, 2020
Using observational data to assess the treatment effects on outcomes of kidney transplantation re... more Using observational data to assess the treatment effects on outcomes of kidney transplantation relative to dialysis for patients on renal replacement therapy is challenging due to the non-random selection into treatment. This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2−25.0) and 9.3 years (95% CI: 7.8−10.8) for kidney transplantation an...
International journal of environmental research and public health, Feb 27, 2018
Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for asse... more Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for assessing the value of interventions. The objective of this study was to estimate WTP and its predictors in a randomized controlled trial of a lifestyle intervention exclusively targeting Middle Eastern immigrants living in Malmö, Sweden, who are at high risk of type 2 diabetes. We used the contingent valuation method to evaluate WTP. The questionnaire was designed following the payment-scale approach, and administered at the end of the trial, giving an ex-post perspective. We performed logistic regression and linear regression techniques to identify the factors associated with zero WTP value and positive WTP values. The intervention group had significantly higher average WTP than the control group (216 SEK vs. 127 SEK; = 0.035; 1 U.S.$ = 8.52 SEK, 2015 price year) per month. The regression models demonstrated that being in the intervention group, acculturation, and self-employment were sign...
We assess the relationship between business cycles and mortality risk using a large individual le... more We assess the relationship between business cycles and mortality risk using a large individual level data set on over 40,000 individuals in Sweden who were followed for 10-16 years (leading to over 500,000 person-year observations). We test the effect of six alternative business cycle indicators on the mortality risk: the unemployment rate, the notification rate, the deviation from the GDP trend, the GDP change, the industry capacity utilization, and the industry confidence indicator. For men we find a significant countercyclical relationship between the business cycle and the mortality risk for four of the indicators and a non-significant effect for the other two indicators. For women we cannot reject the null hypothesis of no effect for any of the business cycle indicators.
We test whether individual health status is related to area-level social capital measured by rate... more We test whether individual health status is related to area-level social capital measured by rates of voting participation in municipal political elections, controlling for personal characteristics, where health status is measured by mapping responses to interview survey questions into the generic health-related quality of life measure (HRQoL) the EQ-5D in order to derive the health state scores. The analysis is based on unbalanced panel data from Statistic Sweden's Survey of Living Conditions (the ULF survey) and a 3-level multilevel regression analysis, where level 1 consists of a total of 31,585 observations for 24,419 individuals at level 2 nested within 275 Swedish municipalities at level 3. We find that the health state scores increase significantly with municipality election rates. This result is robust to a number of measurement and specification issues explored in a sensitivity analysis. However, almost all variation in health status exists across individuals (more than...
In recent work, the concentration index has been widely used as a measure of income‐related healt... more In recent work, the concentration index has been widely used as a measure of income‐related health inequality. The purpose of this note is to illustrate two different methods for decomposing the overall health concentration index using data collected from a Short Form (SF‐36) survey of the general Australian population conducted in 1995. For simplicity, we focus on the physical functioning scale of the SF‐36. Firstly we examine decomposition ‘by component’ by separating the concentration index for the physical functioning scale into the ten items on which it is based. The results show that the items contribute differently to the overall inequality measure, i.e. two of the items contributed 13% and 5%, respectively, to the overall measure. Second, to illustrate the ‘by subgroup’ method we decompose the concentration index by employment status. This involves separating the population into two groups: individuals currently in employment; and individuals not currently employed. We find ...
Expert Review of Pharmacoeconomics & Outcomes Research, 2004
The objective of this review is to examine how drug spending in different age groups changed duri... more The objective of this review is to examine how drug spending in different age groups changed during the 1990s. Time series analysis of registered data on prescription drug spending were performed, along with two decompositions, one of which was spending in three components: price, quantity (defined daily dose) and residual. The size of the residual is a measure of the impact of changes in drug treatment patterns on drug spending. The other decomposition was of the quantity component in three subcomponents: defined daily doses per person on medication, population share on medication and population size. Both decompositions are made separately for different age groups. How spending for different age groups has developed in different therapeutic areas was also studied. The main outcome measures were prescription drug spending over time within different anatomical therapeutic chemical groups and across different age groups of the population. It was found that the older the age group, the more drug spending had increased, both in absolute and in relative terms, during the 1990s. However, for some anatomical therapeutic chemical groups, younger age groups have experienced faster spending growth. The most notable example being anatomical therapeutic chemical group N CNS, where spending grew fastest by 350%, for those aged between 20 and 39 years. Furthermore, changed treatment patterns, such as a switch to more expensive drugs, is the main explanation for higher spending in all age groups. Higher spending is also due to a larger number of defined daily doses sold, which is almost totally due to the fact that each person on medication in the year 2000 utilized more defined daily doses than in 1990. Changing age structure explains a negligible share of the increase in drug spending, but elderly patients did have a key role in the spending surge since they increased their per capita spending the most.
ABSTRACTAim To establish the current level of knowledge of the effect of drinking cessation on t... more ABSTRACTAim To establish the current level of knowledge of the effect of drinking cessation on the risk of developing oesophageal cancer.Method 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.Result 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...
Introduction Universal Health Coverage is not only about access to health services but also about... more Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ exp...
The purpose of this study is threefold; 1) to establish the current level of knowledge regarding ... more The purpose of this study is threefold; 1) to establish the current level of knowledge regarding cost-effectiveness of organ transplantation, 2) to identify knowledge gaps, and 3) to suggest a framework for future studies. A systematic literature review of economic evaluations of transplantations of solid organs was conducted in October 2010. Economic evaluations published since 2000 and reviews published since 1987 for kidney, liver, lung, heart, pancreas, and small bowel transplantations were collected. The studies were analysed regarding results and study characteristics. The review demonstrates a lack of economic evaluations for all included organ transplantations. The cost-effectiveness of kidney transplantation, and to some extent liver transplantation, compared to a non-transplant alternative appears to be established. However, cost-effectiveness for transplantation of lung, heart, pancreas, and small bowel can neither be established nor rejected based on earlier studies. Man...
International Journal of Environmental Research and Public Health, 2020
Using observational data to assess the treatment effects on outcomes of kidney transplantation re... more Using observational data to assess the treatment effects on outcomes of kidney transplantation relative to dialysis for patients on renal replacement therapy is challenging due to the non-random selection into treatment. This study applied the propensity score weighting approach in order to address the treatment selection bias of kidney transplantation on survival time compared with dialysis for patients on the waitlist. We included 2676 adult waitlisted patients who started renal replacement therapy in Sweden between 1 January 1995, and 31 December 2012. Weibull and logistic regression models were used for the outcome and treatment models, respectively. The potential outcome mean and the average treatment effect were estimated using an inverse-probability-weighted regression adjustment approach. The estimated survival times from start of renal replacement therapy were 23.1 years (95% confidence interval (CI): 21.2−25.0) and 9.3 years (95% CI: 7.8−10.8) for kidney transplantation an...
International journal of environmental research and public health, Feb 27, 2018
Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for asse... more Willingness-to-pay (WTP) techniques are increasingly being used in the healthcare sector for assessing the value of interventions. The objective of this study was to estimate WTP and its predictors in a randomized controlled trial of a lifestyle intervention exclusively targeting Middle Eastern immigrants living in Malmö, Sweden, who are at high risk of type 2 diabetes. We used the contingent valuation method to evaluate WTP. The questionnaire was designed following the payment-scale approach, and administered at the end of the trial, giving an ex-post perspective. We performed logistic regression and linear regression techniques to identify the factors associated with zero WTP value and positive WTP values. The intervention group had significantly higher average WTP than the control group (216 SEK vs. 127 SEK; = 0.035; 1 U.S.$ = 8.52 SEK, 2015 price year) per month. The regression models demonstrated that being in the intervention group, acculturation, and self-employment were sign...
We assess the relationship between business cycles and mortality risk using a large individual le... more We assess the relationship between business cycles and mortality risk using a large individual level data set on over 40,000 individuals in Sweden who were followed for 10-16 years (leading to over 500,000 person-year observations). We test the effect of six alternative business cycle indicators on the mortality risk: the unemployment rate, the notification rate, the deviation from the GDP trend, the GDP change, the industry capacity utilization, and the industry confidence indicator. For men we find a significant countercyclical relationship between the business cycle and the mortality risk for four of the indicators and a non-significant effect for the other two indicators. For women we cannot reject the null hypothesis of no effect for any of the business cycle indicators.
We test whether individual health status is related to area-level social capital measured by rate... more We test whether individual health status is related to area-level social capital measured by rates of voting participation in municipal political elections, controlling for personal characteristics, where health status is measured by mapping responses to interview survey questions into the generic health-related quality of life measure (HRQoL) the EQ-5D in order to derive the health state scores. The analysis is based on unbalanced panel data from Statistic Sweden's Survey of Living Conditions (the ULF survey) and a 3-level multilevel regression analysis, where level 1 consists of a total of 31,585 observations for 24,419 individuals at level 2 nested within 275 Swedish municipalities at level 3. We find that the health state scores increase significantly with municipality election rates. This result is robust to a number of measurement and specification issues explored in a sensitivity analysis. However, almost all variation in health status exists across individuals (more than...
In recent work, the concentration index has been widely used as a measure of income‐related healt... more In recent work, the concentration index has been widely used as a measure of income‐related health inequality. The purpose of this note is to illustrate two different methods for decomposing the overall health concentration index using data collected from a Short Form (SF‐36) survey of the general Australian population conducted in 1995. For simplicity, we focus on the physical functioning scale of the SF‐36. Firstly we examine decomposition ‘by component’ by separating the concentration index for the physical functioning scale into the ten items on which it is based. The results show that the items contribute differently to the overall inequality measure, i.e. two of the items contributed 13% and 5%, respectively, to the overall measure. Second, to illustrate the ‘by subgroup’ method we decompose the concentration index by employment status. This involves separating the population into two groups: individuals currently in employment; and individuals not currently employed. We find ...
Expert Review of Pharmacoeconomics & Outcomes Research, 2004
The objective of this review is to examine how drug spending in different age groups changed duri... more The objective of this review is to examine how drug spending in different age groups changed during the 1990s. Time series analysis of registered data on prescription drug spending were performed, along with two decompositions, one of which was spending in three components: price, quantity (defined daily dose) and residual. The size of the residual is a measure of the impact of changes in drug treatment patterns on drug spending. The other decomposition was of the quantity component in three subcomponents: defined daily doses per person on medication, population share on medication and population size. Both decompositions are made separately for different age groups. How spending for different age groups has developed in different therapeutic areas was also studied. The main outcome measures were prescription drug spending over time within different anatomical therapeutic chemical groups and across different age groups of the population. It was found that the older the age group, the more drug spending had increased, both in absolute and in relative terms, during the 1990s. However, for some anatomical therapeutic chemical groups, younger age groups have experienced faster spending growth. The most notable example being anatomical therapeutic chemical group N CNS, where spending grew fastest by 350%, for those aged between 20 and 39 years. Furthermore, changed treatment patterns, such as a switch to more expensive drugs, is the main explanation for higher spending in all age groups. Higher spending is also due to a larger number of defined daily doses sold, which is almost totally due to the fact that each person on medication in the year 2000 utilized more defined daily doses than in 1990. Changing age structure explains a negligible share of the increase in drug spending, but elderly patients did have a key role in the spending surge since they increased their per capita spending the most.
ABSTRACTAim To establish the current level of knowledge of the effect of drinking cessation on t... more ABSTRACTAim To establish the current level of knowledge of the effect of drinking cessation on the risk of developing oesophageal cancer.Method 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.Result 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...
Introduction Universal Health Coverage is not only about access to health services but also about... more Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ exp...
The purpose of this study is threefold; 1) to establish the current level of knowledge regarding ... more The purpose of this study is threefold; 1) to establish the current level of knowledge regarding cost-effectiveness of organ transplantation, 2) to identify knowledge gaps, and 3) to suggest a framework for future studies. A systematic literature review of economic evaluations of transplantations of solid organs was conducted in October 2010. Economic evaluations published since 2000 and reviews published since 1987 for kidney, liver, lung, heart, pancreas, and small bowel transplantations were collected. The studies were analysed regarding results and study characteristics. The review demonstrates a lack of economic evaluations for all included organ transplantations. The cost-effectiveness of kidney transplantation, and to some extent liver transplantation, compared to a non-transplant alternative appears to be established. However, cost-effectiveness for transplantation of lung, heart, pancreas, and small bowel can neither be established nor rejected based on earlier studies. Man...
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Papers by Ulf-Göran Gerdtham