Health Economics and Policy – Niklas Zethraeus' group

Bringing together expertise from economics, medicine, health technology assessment, statistics, and policy, we conduct research that supports evidence-based health care decisions. Our work focuses on evaluating the impacts, effectiveness, and cost-effectiveness of interventions and reforms to improve health outcomes and the use of societal resources.

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The Centre for Health Economics and Policy

The Centre for Health Economics and Policy and its associated research group were established in 2024. The Centre aims to strengthen and coordinate research and educational activities in health economics conducted at the Department of Learning, Informatics, Management and Ethics (LIME) at Karolinska Institutet and within Research, Development, Education and Evaluation (RDEE) at Stockholm Health Care Services (SLSO), Region Stockholm. The Centre serves as a platform for collaboration across disciplines and organizations within and outside KI, promoting high-quality research, education, and evidence-informed healthcare decision-making.

Organization

Our research group is organized into the following research teams:

Further information about each team's research activities and areas of expertise is available on their respective webpages. Research projects and activities in Health Economic Evaluation and Health Systems Research are presented under the tab above.

News from the research group

Region Stockholm decided to offer all three-year-olds in region Stockholm free vaccination against TBE partly based on this report, see article in Dagens Nyheter (2025-03-17). 

Press-release, KI (2022): “People with long-term neuropathic pain took significantly fewer sick days from work after treatment with spinal cord stimulation”, published in PAIN. 

What we do

Bringing together expertise

We bring together expertise from economics, medicine, health technology assessment, medical statistics, and policy to address important challenges in health care decision-making. Our research group consists of approximately 35 researchers and collaborators, including both employed at KI and affiliated members from the Region Stockholm, and other organizations. 

How it started

Health economics may be defined as a sub-discipline of economics and involves the application of theories and methods of economics on health and health care. Research in health economics at LIME started in 2003. The Centre for Health Economics and Policy and also the research group, was established in 2024. 

Licentiate and doctoral degree theses

Emma Medin, ”Using benchmarking to assess aspects of specialisation in healthcare”, doctoral thesis 2025 

Sofia Sveréus, ”Patient choice and provider incentives : socioeconomic differentials in effects from market reform in Swedish primary care”, doctoral thesis 2024 

Cecilia Dahlgren “Do patients behave as expected on a healthcare market in transition? Consequences of expanding patient choice and introducing telemedicine in primary healthcare”, doctoral thesis, 2022 

Fanny Goude “Hips don’t lie – the use of benchmarking and register data to assess the performance of orthopaedic care”, doctoral thesis, 2021 

Emma Söreskog, “Spinal cord stimulation in chronic pain: A study of health outcomes and costs”, licentiate thesis, KI, 2021 

Olivia Ernstsson, “Making use of patient-reported outcome measures in health care: the case of EQ-5D in the Swedish national quality registries”, doctoral thesis, KI, 2021 

Filip Gedin, “The burden of back pain: evaluation of costs and health outcomes”, doctoral thesis, KI, 2020 

Oskar Ström, “Pharmacoepidemiology and health economics of adherence to pharmaceutical fracture prevention”, doctoral thesis, KI, 2020 

Sayem Ahmed, “Healthcare financing challenges and opportunities to achieving universal health coverage in the low- and middle-income country context”, KI, doctoral thesis 2020

For more theses, search in the KI Open Archive.

Publications

Selected publications

All publications from group members

Reports

Zethraeus N. Health Technology Assessment (HTA) och ekonomisk utvärdering vid utvärdering av hälso- och sjukvårdens metoder. Stockholm: Karolinska Institutets folkhälsoakademi, 2009. Rapport 2009:19.

Johannesson M, Jönsson B, Jönsson L, Kobelt G, Zethraeus N. Why Should Economic Evaluations of Medical Innovations Have a Societal Perspective? OHE Briefing No 51, 2009.

Lindgren, P., Ersättning i sjukvården. Modeller, effekter och rekommendationer. 2014, Stockholm: SNS Förlag.

Staff and contact

Group leader

All members of the group

Collaborations

Research

Our research collaborations include expertise in medicine, biostatistics, and register-based research, and we collaborate with research groups at 

  • Karolinska Institutet 
    • Department of Medical Epidemiology and Biostatistics, MEB
    • Department of Clinical Science, Intervention and Technology, CLINTEC
    • Department of Neurobiology, Care Sciences and Society, NVS
    • Department of Medicine Solna, MedS
    • Department of Medicine Huddinge, MedH
  • Karolinska University Hospital
  • Uppsala University
  • The Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket, TLV) 

Scientific experts

Some group members also act as scientific experts within Clinicum at KI offering methodological support for researchers at KI and Region Stockholm. 

International

We have developed extensive international collaborations with the 

  • University Medical Center Hamburg-Eppendorf (UKE) in Germany
  • Natural Resources Institute Finland (LUKE)

National

We are also part of a collaboration with the Department of Neurobiology, Care Sciences and Society, NVS at KI,  and Precision Medicine Center Karolinska, PMCK at the Karolinska University Hospital and KI, aimed at contributing increased knowledge about health economic aspects and the societal value of precision medicine. 

Health systems

In the field of health systems, collaboration takes place with the University of Oslo, the Finnish Institute for Health and Welfare (THL), the University of Southern Denmark, and Brown University, among others."

Education

Master's Programme in Health Economics, Policy and Management

Education in health economics is a central component of the research group's activities, with the Master's Programme in Health Economics, Policy and Management playing a particularly important role. 

The programme comprises two years of full-time study at the second-cycle (Master's) level and awards 120 credits. It provides students with the theoretical knowledge and practical skills needed to analyse health and healthcare issues from organisational, managerial, and policy perspectives. 

Health economics focuses on the financing of healthcare, methods for the economic evaluation of healthcare technologies, and the measurement and valuation of health outcomes. The policy component covers health planning as well as methods for the development, implementation, and evaluation of healthcare policies. Management focuses on approaches to the organisation and management of health and medical care services. 

Health Economic Evaluation and Health System Research

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 (PANCAID) 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; JESA 2019). 

Contact

Niklas Zethraeus

Niklas Zethraeus

Professor