Health Outcomes and Economic Evaluation Research Network

The Health Outcomes and Economic Evaluation Research Network belongs to Stockholm Centre for Healthcare Ethics (CHE) at LIME department. Health economics may be defined as the application of economic theories and methods on health and health care. Health economics and ethics are linked, especially valuation of health and priority setting in 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 Network performs methodological and applied research using patient-reported outcome measures (PROMs) with focus on measurement and valuation of health among adults and children and adolescents, determinants for health and inequalities in health. We use both quantitative and qualitative methods.

The EQ-5D is used in several projects carried out within the research network. 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). We have a close collaboration with the Equity and Health Policy Research Group, Department of Global Public Health, Karolinska Institutet.

We have ongoing collaboration with Region Stockholm through the unit of health economics at Centre for health economics, informatics and health care research (CHIS).

Mimmi Åström and Sun Sun

Research network members

Health Outcomes and Economic Evaluation Research Network is led by Mimmi Åström, Karolinska Institutet and Sun Sun, Karolinska Institutet and Umeå University.

Mimmi Åström,
Sun Sun,


Mimmi Åström, PhD

Sun Sun, PhD

Jenny Berg, PhD

Kristina Burström, Associate Professor

Ling-Hsiang Chuang, PhD

Peter Lindgren, Professor

Jahangir Khan

Thet Lwin Zin Min, IHE

Collaborative partners

We collaborate with authorities, national quality registers, Region Stockholm and other regions, departments at Karolinska Institutet, other Swedish universities, and international universities, research networks for example Nanjing Medical University, China, University of Sheffield, UK and EuroQol Group. Several of the members in the network are members in the international multidisciplinary research group, the EuroQol Group Association and members of the Special Interest Group for EQ-5D in Younger Populations and the Health Inequalities Special Interest Group.


  • Measurement and valuation of health states in adults
  • Measurement and valuation of health states in children and adolescents
  • Analyses of EQ-5D data across patient groups in the National Quality Registers
  • Application of EQ-5D value sets in different patient groups
  • Investigation of EQ VAS data
  • Population health among adults and children and adolescents
  • Application 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

Selected publications

Åström M, Conte H, Berg J, Burström K. 'Like holding the axe on who should live or not': adolescents' and adults' perceptions of valuing children's health states using a standardised valuation protocol for the EQ-5D-Y-3L [published online ahead of print, 2022 Feb 24]. Qual Life Res. 2022;10.1007/s11136-022-03107-0.

Åström M, Rolfson O, Burström K. Exploring EQ-5D-Y-3L Experience-Based VAS Values Derived Among Adolescents. Appl Health Econ Health Policy. 2022;20(3):383-393.

Longitudinal study of patients' health-related quality of life using EQ-5D-3L in 11 Swedish National Quality Registers. Teni FS, Rolfson O, Devlin N, Parkin D, Nauclér E, Burström K; Swedish Quality Register (SWEQR) Study Group. BMJ Open. 2022 Jan 6;12(1):e048176. doi: 10.1136/bmjopen-2020-048176. PMID: 34992101 Free PMC article.

Mai VQ, Giang KB, Minh HV, Lindholm L, Sun S, Sahlen KG. Qual Life Res. 2022 Feb;31(2):539-550. doi: 10.1007/s11136-021-02959-2. Epub 2021 Aug 9. PMID: 34370187 Reference data among general population and known-groups validity among hypertensive population of the EQ-5D-5L in Vietnam.

Inequality and heterogeneity in health-related quality of life: findings based on a large sample of cross-sectional EQ-5D-5L data from the Swedish general population. Teni FS, Gerdtham UG, Leidl R, Henriksson M, Åström M, Sun S, Burström K. Qual Life Res. 2022 Mar;31(3):697-712. doi: 10.1007/s11136-021-02982-3. Epub 2021 Oct 10. PMID: 34628587 Free PMC article.

Rural-Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015. Jiang H, Burström B, Chen J, Burström K. Int J Environ Res Public Health. 2021 Jun 18;18(12):6557. doi: 10.3390/ijerph18126557. PMID: 34207132 Free PMC article.

Money matters - primary care providers' perceptions of payment incentives.  Vengberg S, Fredriksson M, Burström B, Burström K, Winblad U. J Health Organ Manag. 2021 Feb 2;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-06-2020-0225. PMID: 33522211 Free article.

Validation of the patient-reported experience measure for care in Chinese hospitals (PREM-CCH).  Wang X, Chen J, Yang Y, Burström B, Burström K. Int J Equity Health. 2021 Jan 7;20(1):25. doi: 10.1186/s12939-020-01370-6. PMID: 33413446 Free PMC article.

Concordance among Swedish, German, Danish, and UK EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register. Teni FS, Rolfson O, Berg J, Leidl R, Burström K. J Clin Med. 2021 Sep 17;10(18):4205. doi: 10.3390/jcm10184205. PMID: 34575317 Free PMC article.

Velickovic VM, Lembelembe JP, Cegri F, Binic I, Abdelaziz AB, Sun S, Niki B, Dawn S, Rippon MG, Abreha SK, Sturges J. Int J Low Extrem Wounds. 2021 May 3:15347346211009399. doi: 10.1177/15347346211009399. Online ahead of print. PMID: 33939496  Superabsorbent Wound Dressing for Management of Patients With Moderate-to-Highly Exuding Chronic Leg Ulcers: An Early Stage Model-Based Benefit-Harm Assessment.

Lindgren P, Löfvendahl S, Brådvik G, Weiland O, Jönsson B. Value appropriation in hepatitis C [published online ahead of print, 2021 Dec 2]. Eur J Health Econ. 2021;10.1007/s10198-021-01409-7. doi:10.1007/s10198-021-01409-7.

Lindgren P, Löfvendahl S, Brådvik G, Weiland O. Reduced work absenteeism in patients with hepatitis C treated with second-generation direct-acting antivirals. J Viral Hepat. 2021;28(1):142-146. doi:10.1111/jvh.13398.

Lindgren P, Althin R. Something borrowed, something new: measuring hospital performance in the context of value based health care. Eur J Health Econ. 2021;22(6):851-854. doi:10.1007/s10198-020-01209-5.

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, Ernstsson O*, Åström M*, Burström K. Qual Life Res. 2020 Jun;29(6):1465-1482. doi: 10.1007/s11136-020-02426-4. Epub 2020 Feb 3. PMID: 32016683 Free PMC article. * *Made equal contributions to the pape

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. 2020 Aug;38(8):839-856. doi: 10.1007/s40273-020-00905-7. PMID: 32307663

Reporting and valuing one's own health: a think aloud study using EQ-5D-5L, EQ VAS and a time trade-off question among patients with a chronic condition. Ernstsson O, Burström K, Heintz E, Mølsted Alvesson H. Health Qual Life Outcomes. 2020 Dec 17;18(1):388. doi: 10.1186/s12955-020-01641-4. PMID: 33334348 Free PMC article.

Impact of an educational intervention in primary care on fasting blood glucose levels and diabetes knowledge among patients with type 2 diabetes mellitus in rural China. Chen S, Qian D, Burström K, Burström B. Patient Educ Couns. 2020 Sep;103(9):1767-1773. doi: 10.1016/j.pec.2020.03.010. Epub 2020 May 11. PMID: 32414563 Clinical Trial.

Predictive ability of the American Society of Anaesthesiologists physical status classification system on health-related quality of life of patients after total hip replacement: comparisons across eight EQ-5D-3L value sets. Teni FS, Burström K, Berg J, Leidl R, Rolfson O. BMC Musculoskelet Disord. 2020 Jul 6;21(1):441. doi: 10.1186/s12891-020-03399-8. PMID: 32631419 Free PMC article.

Åström M, Krig S, Ryding S, Cleland N, Rolfson O, Burström K. EQ-5D-Y-5L as a Patient-Reported Outcome Measure in psychiatric inpatient care for children and adolescents – A cross-sectional study. Health and Quality of Life Outcomes. 2020;18(1):164.

Krig S, Åström M, Kulane A, Burström K. Acceptability of the health-related quality of life instrument EQ-5D-Y-5L among patients in child and adolescent psychiatric inpatient care. Acta Paediatrica. 2020, DOI: 10.1111/apa.15547.

Mai VQ, Sun S, Minh HV, Luo N, Giang KB, Lindholm L, Sahlen KG. Qual Life Res. 2020 Jul;29(7):1923-1933. doi: 10.1007/s11136-020-02469-7. Epub 2020 Mar 27. PMID: 32221805 An EQ-5D-5L Value Set for Vietnam.

Hofmarcher T, Lindgren P, Wilking N, Jönsson B. The cost of cancer in Europe 2018. Eur J Cancer. 2020;129:41-49. doi:10.1016/j.ejca.2020.01.011.

Keel G, Muhammad R, Savage C, Spaak J, Gonzalez I, Lindgren P, Guttmann C, Mazzocato P. Time-driven activity-based costing for patients with multiple chronic conditions: a mixed-method study to cost care in a multidisciplinary and integrated care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden. BMJ Open. 2020;10(6):e032573. Published 2020 Jun 3. doi:10.1136/bmjopen-2019-032573.

Misra VP, Danchenko N, Maisonobe P, Lundkvist J, Hunger M. Economic evaluation of AbobotulinumtoxinA vs OnabotulinumtoxinA in real-life clinical management of cervical dystonia [published correction appears in J Clin Mov Disord. 2020 Jul 29;7:6]. J Clin Mov Disord. 2020;7:2. Published 2020 Feb 11. doi:10.1186/s40734-020-0083-0.

Eriksson J, Kobelt G, Gannedahl M, Berg J. Association between Disability, Cognition, Fatigue, EQ-5D-3L Domains, and Utilities Estimated with Different Western European Value Sets in Patients with Multiple Sclerosis. Value Health. 2019;22(2):231-238. doi:10.1016/j.jval.2018.08.002

Kreimeier S, Åström M, Burström K, Egmar AC, Gusi N, Herdman M, et al. EQ-5D-Y-5L: developing a revised EQ-5D-Y with increased response categories. Quality of Life Research. 2019;28(7):1951-61.

Lindgren P, Myrtennäs K, Forsman M, et al. A likelihood ratio-based approach for improved source attribution in microbiological forensic investigations. Forensic Sci Int. 2019;302:109869. doi:10.1016/j.forsciint.2019.06.027.

Landfeldt E, Zethraeus N, Lindgren P. Standardized Questionnaire for the Measurement, Valuation, and Estimation of Costs of Informal Care Based on the Opportunity Cost and Proxy Good Method. Appl Health Econ Health Policy. 2019;17(1):15-24. doi:10.1007/s40258-018-0418-2

Time Trade-Off Value Set for EQ-5D-3L Based on a Nationally Representative Chinese Population Survey. Zhuo L, Xu L, Ye J, Sun S, Zhang Y, Burstrom K, Chen J. Value Health. 2018 Nov;21(11):1330-1337. doi: 10.1016/j.jval.2018.04.1370. Epub 2018 May 18. PMID: 30442281

Dudink EAMP, Erküner Ö, Berg J, et al. The influence of progression of atrial fibrillation on quality of life: a report from the Euro Heart Survey. Europace. 2018;20(6):929-934. doi:10.1093/europace/eux217

Du X, Khamitova A, Kyhlstedt M, Sun S, Sengoelge M. Int J Cardiol Heart Vasc. 2018 Mar 9;19:90-97. doi: 10.1016/j.ijcha.2018.02.006. eCollection 2018 Jun. PMID: 29955668 Utilisation of real-world data from heart failure registries in OECD countries - A systematic review.

Sun S, Borisenko O, Spelman T, Ahmed AR. Obes Surg. 2018 Apr;28(4):1098-1108. doi: 10.1007/s11695-017-2978-x. PMID: 29076010 Patient Characteristics, Procedural and Safety Outcomes of Bariatric Surgery in England: a Retrospective Cohort Study-2006-2012.

Åström M, Persson C, Linden-Bostrom M, Rolfson O, Burström K. Population health status based on the EQ-5D-Y-3L among adolescents in Sweden: Results by sociodemographic factors and self-reported comorbidity. Quality of Life Research. 2018;27(11):2859-71.

Hjalte F, Calara PS, Blaxhult A, Helleberg M, Wallace K, Lindgren P. Excess costs of non-infectious comorbidities among people living with HIV - estimates from Denmark and Sweden. AIDS Care. 2018;30(9):1090-1098. doi:10.1080/09540121.2018.1476661

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 Jan 28;16(1):29. doi: 10.1186/s12939-017-0524-z. PMID: 28129771 Free PMC article. Review.

Brundin L, Kobelt G, Berg J, Capsa D, Eriksson J; European Multiple Sclerosis Platform. New insights into the burden and costs of multiple sclerosis in Europe: Results for Sweden. Mult Scler. 2017;23(2_suppl):179-191. doi:10.1177/1352458517708682              

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. doi: 10.1007/s11136-015-1020-9. Epub 2015 Jun 3. PMID: 26038221

Kobelt G, Eriksson J, Phillips G, Berg J. The burden of multiple sclerosis 2015: Methods of data collection, assessment and analysis of costs, quality of life and symptoms. Mult Scler. 2017;23(2_suppl):4-16. doi:10.1177/1352458517708097

Berg J, Lindgren P, Mejhert M, Edner M, Dahlström U, Kahan T. Determinants of Utility Based on the EuroQol Five-Dimensional Questionnaire in Patients with Chronic Heart Failure and Their Change Over Time: Results from the Swedish Heart Failure Registry. Value Health. 2015;18(4):439-448. doi:10.1016/j.jval.2015.02.003.

Experience-based VAS values for EQ-5D-3L health states in a national general population health survey in China. Sun S, Chen J, Kind P, Xu L, Zhang Y, Burström K. Qual Life Res. 2015 Mar;24(3):693-703. doi: 10.1007/s11136-014-0793-6. Epub 2014 Sep 24. PMID: 25246184 Free PMC article.

Berg J, Lindgren P, Kahan T, et al. Health-related quality of life and long-term morbidity and mortality in patients hospitalised with systolic heart failure. JRSM Cardiovasc Dis. 2014;3:2048004014548735. Published 2014 Aug 28. doi:10.1177/2048004014548735.

Swedish experience-based value sets for EQ-5D health states. Burström K, Sun S, Gerdtham UG, Henriksson M, Johannesson M, Levin LÅ, Zethraeus N. Qual Life Res. 2014 Mar;23(2):431-42. doi: 10.1007/s11136-013-0496-4. Epub 2013 Aug 22. PMID: 23975375 Free PMC article.

Berg J, Sauriol L, Connolly S, Lindgren P. Cost-effectiveness of dronedarone in patients with atrial fibrillation in the ATHENA trial. Can J Cardiol. 2013;29(10):1249-1255. doi:10.1016/j.cjca.2013.01.016

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, Burström K. Qual Life Res. 2011 Apr;20(3):309-20. doi: 10.1007/s11136-010-9762-x. Epub 2010 Nov 2. PMID: 21042861 Free PMC article.

Erik Landfeldt  1 Jonas LundkvistOskar Ström The societal burden of poor persistence to treatment of osteoporosis in Sweden. Bone  2011 Feb;48(2):380-8. doi: 10.1016/j.bone.2010.09.012. Epub 2010 Sep 17.

Lundkvist J, Kastäng F, Kobelt G. The burden of rheumatoid arthritis and access to treatment: health burden and costs. Eur J Health Econ. 2008;8 Suppl 2:S49-S60. doi:10.1007/s10198-007-0088-8.

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