Health Economic Evaluation and Health System Research – Niklas Zethraeus' team
Health economic evaluation involves measuring and valuing health outcomes, assessing the effectiveness of interventions, and estimating their costs and consequences.
To evaluate the effectiveness and cost-effectiveness of health technologies, we collect and analyze clinical, epidemiological, and economic data using advanced statistical and decision-analytic modelling. Health economic evaluation can be defined as "the comparative analysis of alternative courses of action in terms of both their costs and consequences." Such evaluations provide evidence to guide decisions that seek to maximize health outcomes and improve the efficiency of resource allocation in health care.
Health system Research examines how health care systems are organized, financed, and governed, and how policy reforms affect health outcomes, equity, efficiency, and access to care. We study the impacts of different policy interventions and reimbursement systems, investigate incentives for providers and patients, and evaluate reforms aimed at improving the performance and sustainability of health care systems.
Ongoing research
The following projects represent examples of ongoing research.
· Health economic aspects of pancreatic cancer
As part of a Horizon Europe funded project (add link) the aim is to increase the understanding of the societal impact of pancreatic cancer. Based on comprehensive Swedish registry data, we investigate the loss in life expectancy following pancreatic cancer, and whether society should invest in screening strategies for the potential earlier identification of pancreatic cancer.
· Health economic evaluation of oncology drugs and decision making
As part of a FORTE-funded project, we are investigating how survival predictions in cost-effectiveness analyses (CEAs) can be improved to better inform reimbursement and recommendation decisions for oncology drugs in Sweden. One part of the project involves reviewing the availability of clinical evidence on overall survival outcomes and the methods used for survival extrapolation in CEAs submitted to support decision-making by the Dental and Pharmaceutical Benefits Agency (TLV) and the New Therapies Council (NT Council). In a related study, we evaluated the accuracy of survival extrapolations in CEAs used by TLV to inform reimbursement decisions for oncology drugs in Sweden (Björnerstedt et al., 2024).
· Primary care structures, processes and system efficiency for patients with chronic illness
The overall aim of the project is to investigate to what extent strengthening primary care can contribute to increased system efficiency in healthcare, with a particular focus on patients with chronic diseases. The intention is to identify indicators for strong primary care and analyse how these affect costs and care utilization from a system perspective.
· NORCHER (Nordic comparisons of health care outcomes and costs)
The principal aim of the project is to further develop Nordic Data infrastructure that allows for within and between countries comparison of health outcomes and costs. The aim is to create databases to enable comparison of performance in the care of specific patient groups between countries, within countries (regions and hospitals), and over time, using patient-level administrative health care data. The principal aim also include development of econometric methods that allow for applying the infrastructure in evaluating the effect of health care reforms
Previous research
Different health care technologies have been assessed with respect to health outcomes and costs, for instance hormone replacement therapy, spinal cord stimulation, physiotherapy, and chiropractic care. We have also contributed to methodological developments on how to handle and present uncertainty in economic evaluations by developing the net benefit approach, which has facilitated confidence interval estimations, and the interpretation of cost-effectiveness acceptability curves.
We have also conducted research in behavioral economics, an interdisciplinary field that combines insights from economics and psychology to better understand decision-making. Here we studied the causal relationship between hormones and economic behaviour and health. Studies indicate that birth control pills do not impact economic behaviour and may negatively impact well-being and some dimensions of sexual function, and that sex hormones do not impact economic behaviour outcomes (PNAS 2009; J Clin Endocrinol Metab 2016; Fertility & Sterility 2017; Management Science 2018).