Background Health-related quality of life and glycaemic control are some of the central outcomes in clinical diabetes care and research. The purpose of this study was to describe the health-related quality of life and assess its association with glycaemic control in adults with type 1 and type 2 diabetes in a nationwide setting. Methods In this cross-sectional survey, people with type 1 ( n = 2479) and type 2 diabetes ( n = 2469) were selected at random without replacement from the Swedish National Diabetes Register. Eligibility criteria were being aged 18–80 years with at least one registered test of glycated haemoglobin (HbA 1c ) the last 12 months. The generic 36-item Short Form version 2 (SF-36v2) was answered by 1373 (55.4%) people with type 1 diabetes and 1353 (54.8%) with type 2 diabetes. Results Correlation analyses showed weak correlations between scores on the SF-36v2 and glycaemic control for both diabetes types. After the participants were divided into three groups based on their levels of HbA 1c , multivariate regression analyses adjusted for demographics, other risk factors and diabetes complications showed that among participants with type 1 diabetes, the high-risk group (≥70 mmol/mol/8.6%) had statistically significantly lower means in five out of eight domains of the SF-36v2 and the mental component summary measure, as compared with the well-controlled group (< 52 mmol/mol/6.9%). Among the participants with type 2 diabetes, the high-risk group had the lowest statistically significantly means in seven domains and both summary measures. Conclusions Among people with type 1 and type 2 diabetes, adults with high-risk HbA 1c levels have lower levels of health-related quality of life in most but not all domains of the SF-36v2. This finding was not explained by demographics, other risk factors, or diabetes complications. The weak individual-level correlations between HRQOL scores and levels of glycaemic control argues for the need to not focus exclusively on either HbA 1c levels or HRQOL scores but rather on both because both are important parts of a complex, life-long, challenging condition. Electronic supplementary material The online version of this article (10.1186/s12955-019-1212-z) contains supplementary material, which is available to authorized users.

A retrospective chart review was performed at 3 Swedish hospitals to evaluate the utilization, outcomes, and cost of using epoetin alfa or darbepoetin alfa to treat cancer patients with chemotherapy-related anemia. Data on dosage, duration of treatment, hematologic response, red blood cell transfusions, and healthcare resource consumption were collected and analyzed at various time points following the initiation of drug therapy. A significantly faster hematologic response and increase in hemoglobin were observed in patients treated with epoetin alfa. Dosages used in clinical practice appeared to be lower than those recommended by Swedish treatment guidelines. There were no significant differences in resource utilization or healthcare costs between the 2 treatment groups. By day 112, the mean treatment cost per patient, in Swedish kronors (SEK), was SEK74,701 (approximately US$9800 or approximately 8300) with epoetin alfa and SEK85,285 (approximately US$11,000 or approximately 9500) with darbepoetin alfa. Drug acquisition and administration accounted for 81% and 67% of the total cost of epoetin alfa and darbepoetin alfa therapy, respectively; the remainder of the total cost was for hospitalization and transfusions.

In this economic evaluation, conducted alongside a randomized, double-blind clinical trial, economic data were collected from 339 patients with moderate-persistent asthma randomized to receive twice-daily, double-blind treatment with budesonide/formoterol 160/4.5 microg in a single inhaler (n=166) or fluticasone propionate 250 microg (n=173) for 12 weeks. The mean number of episode-free days (EFD) per patient was significantly greater in the budesonide/formoterol group than the fluticasone group (48.71 compared with 42.34, P=0.0185). Data on medication use, visits to healthcare professionals, and hospitalization were pooled across all six countries and combined with German and Dutch unit cost data to calculate total healthcare costs. Using German unit costs, budesonide/formoterol was associated with significantly lower total healthcare costs per patient over the 12-week period compared with fluticasone (euro 131 compared with euro 210, P=0.0043). Using Dutch unit costs, total healthcare costs were slightly numerically lower in the budesonide/formoterol group than the fluticasone group (euro 102 compared with euro 104), but the difference did not reach statistical significance. Budesonide/formoterol in a single inhaler is more effective than a higher microgram dose of fluticasone alone. It is cost-neutral and may provide cost-savings in some countries.

Abstract:The rising trend in the prevalence of obesity has become a major public health concern in many countries during the past decades, partly because being obese is associated with comorbidities and death. The cost of treatment for obesity related diseases has become a heavy burden on the national health care budget in many countries. The treatment options for obesity are mainly weight management therapies in the form of diet and exercise, pharmacological therapy, and surgery. The incidence of bariatric surgery in Sweden has increased eight-fold in the last decade. Our objective was to assess the cost-effectiveness of gastric bypass surgical treatments for obesity in adult patients, in comparison with conventional treatment, in Sweden from a societal perspective. The conventional treatment alternative consisted of the prevalent mixture of non-surgical obesity treatments. A model of individual patients was used to simulate the outcomes of the patients in terms of treatment costs, indirect costs, life years, and quality adjusted life years (QALY) over a lifetime perspective. In patients with a Body Mass Index of 40-44 kg/m 2 , surgery was estimated to be cost-saving in men and judged cost-effective in women, with an incremental cost per QALY gained of SEK 26 thousand (EUR 3 thousand). The incremental cost associated with gastric bypass decreases with BMI, increases with the patient's age, and is higher in women than in men. Taking patient characteristics and uncertainty in input data and model design into account, the incremental cost is estimated to be at most SEK 160 thousand per QALY gained (about EUR 18 thousand per QALY). In conclusion, gastric bypass surgery appears to be a cost-effective intervention compared to conventional treatment in adult persons with obesity in Sweden.