Health outcomes and economic evaluation

Health economics may be defined as the application of economic theories and methods on health and health care.

Health and its value is one sub area of health economics that includes perceived attributes of health, value of life, health state index, and utility scaling. Another sub area concerns what influences health and a third is about economic evaluation.

The Health Outcomes and Economic Evaluation Research Group performs methodological and applied research using patient-reported outcome measures (PROMs) with focus on measurement and valuation of health, determinants for health and inequalities in health. The research group belongs to Stockholm Centre for Healthcare Ethics (CHE) at the department; health economics and ethics are linked, especially valuation of health and priority setting in health care.

The EQ-5D is used in several projects carried out within the research group. The generic EQ-5D instrument is a PROM applicable to a wide range of health conditions and treatments and can be used in clinical settings, as a health care performance indicator, in economic evaluation and in measurement of population health in surveys. It provides a simple descriptive profile, a health state, and a health state index.

An EQ-5D health state may be converted to an index value by applying a formula that essentially attaches values to each of the levels in each dimension of health. A value set can be obtained using different methods for the valuation of health states, e.g. the time trade-off (TTO) method and the visual analogue scale (VAS) method. A central question is whether valuations should be based on preferences from individuals who are actually in the health state, i.e. experience-based values, or from individuals to whom the health states are described, i.e. hypothetical values. The index value can be used to estimate the quality-of-life component in quality-adjusted life years (QALYs). The EQ-5D for adults as and the EQ-5D-Y for youth are applied in studies.

We have ongoing collaboration with Stockholm County Council and carry out research commissioned by the Health Services Administration (Hälso- och sjukvårdsförvaltningen, HSF) to the Centre for health economics, informatics and health care research (CHIS).

Research group

Kristina Burström

Group leader, Associate Professor of Health Economics

Other members

Jenny Berg (PhD), Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Affiliated

Peter Lindgren (PhD), Professor of Health Economics and Research Director at the Swedish Institute for Health Economics (IHE)

Jonas Lundkvist (PhD), Associate Professor of Health Economics, Affiliated

Ola Rolfsson (MD, PhD) Professor at the University of Gothenburg, Sahlgrenska Academy, Department of Orthopaedics, and the Swedish Hip Arthroplasty Register, Affiliated

Sun Sun, (PhD), Research Fellow, Department of Epidemiology and Global Health, Umeå University, Affiliated

Mimmi Åström (MSc/MPH), Doctoral student

The research group collaborates with the Equity and Health Policy (EPH) research group at the Department of Global Public Health.

Collaborative partners

Several of the research group members are members in the international multidisciplinary research group, the EuroQol Group Association and members of the Youth Special Interest Group and the Inequalities Special Interest Group.

Jiaying Chen, Professor, Nanjing Medical University, China

Shaofan Chen, PhD, Nanjing Medical University, China

Haiting Jiang, Doctoral student, Nanjing Medical University, China

Xuanxuan Wang, PhD, Nanjing Medical University, China

Ongoing Projects

  • Measurement and valuation of health states in adults
  • Measurement and valuation of health states in youths
  • Analyses of EQ-5D data across patient groups in the National Quality Registers
  • Application of EQ-5D-3L value sets in different patient groups
  • Studies using generic and condition-specific health-related quality of life instruments in patient groups
  • Population health
  • Development of the EQ-5D-Y-5L
  • EQ-5D-Y-5L in psychiatric inpatient care for children and adolescents
  • Inequalities in health and health in disadvantaged groups
  • Use of PROMs and PREMs in the evaluation of the Chinese health care reform


The course Health Outcomes Measurement within the Master’s Programme in Health Economics, Policy and Management is a responsibility of the research group. We also supervise master students’ thesis work.

Selected publications

Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States.
Burström K, Teni FS, Gerdtham UG, Leidl R, Helgesson G, Rolfson O, Henriksson M
Pharmacoeconomics 20 April 2020; doi: 10.1007/s40273-020-00905-7

Värderingssystem för EQ-5D-5L nu med svenska data.
Burström K, Henriksson M.
Läkartidningen 2020, 21-22;117:706-707

Whom should we ask? A systematic literature review of the arguments regarding the most accurate source of information for valuation of health states.
Helgesson G, Erntsson O, Åström M, Burström K
Quality of Life Research, 3 February 2020; doi:0.1007/s11136-020-02426-4

Swedish experience-based value sets for EQ-5D health states.
Burström K, Sun S, Gerdtham UG, Henriksson M, Johannesson M, Levin LÅ, et al
Qual Life Res 2014 Mar;23(2):431-42

Population health status based on the EQ-5D-Y-3L among adolescents in Sweden: Results by sociodemographic factors and self-reported comorbidity.
Åström M, Persson C, Lindén-Boström M, Rolfson O, Burström K
Qual Life Res 2018 Nov;27(11):2859-2871

Differential Impact of an Education-Based Intervention for Patients with Type 2 Diabetes Mellitus in Rural China.
Chen S, Burström B, Sparring V, Qian D, Burström K
Int J Environ Res Public Health 2019 07;16(15):

The influence of progression of atrial fibrillation on quality of life: a report from the Euro Heart Survey.
Dudink EAMP, Erküner Ö, Berg J, Nieuwlaat R, de Vos CB, Weijs B, et al
Europace 2018 06;20(6):929-934

Patient Characteristics, Procedural and Safety Outcomes of Bariatric Surgery in England: a Retrospective Cohort Study-2006-2012.
Sun S, Borisenko O, Spelman T, Ahmed AR
Obes Surg 2018 04;28(4):1098-1108

Exploring pathways to outpatients' satisfaction with health care in Chinese public hospitals in urban and rural areas using patient-reported experiences.
Wang X, Chen J, Burström B, Burström K
Int J Equity Health 2019 02;18(1):29

Assessment of the Swedish EQ-5D experience-based value sets in a total hip replacement population.
Nemes S, Burström K, Zethraeus N, Eneqvist T, Garellick G, Rolfson O
Qual Life Res 2015 Dec;24(12):2963-70

Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008.
Sun S, Chen J, Johannesson M, Kind P, Xu L, Zhang Y, et al
Qual Life Res 2011 Apr;20(3):309-20

Updated Cost-effectiveness Analysis of Evolocumab in Patients With Very High-risk Atherosclerotic Cardiovascular Disease.
Fonarow GC, van Hout B, Villa G, Arellano J, Lindgren P
JAMA Cardiol 2019 Jul;4(7):691-695

Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review.
Burström B, Burström K, Nilsson G, Tomson G, Whitehead M, Winblad U
Int J Equity Health 2017 01;16(1):29

EQ-5D-Y-5L: developing a revised EQ-5D-Y with increased response categories.
Kreimeier S, Åström M, Burström K, Egmar AC, Gusi N, Herdman M, et al
Qual Life Res 2019 Jul;28(7):1951-1961

Experience-Based Values: A Framework for Classifying Different Types of Experience in Health Valuation Research.
Cubi-Molla P, Shah K, Burström K
Patient 2018 06;11(3):253-27

Financing (external funders)

  • Health Services Administration (HSF), Stockholm County Council
  • EuroQol Research Foundation
  • FORTE (Swedish Research Council for Health, Working Life and Welfare)
  • ALF-2019
  • National Natural Chinese Foundation of China
  • Chinese Scholarship Council