Linda Ryen

Background: The number of adults in need of psychiatric care is increasing in Sweden. To meet this need, new working methods are implemented. Home-based mobile specialist psychiatric nursing teams (SPOT) are being introduced to function as a complement to outpatient care and inpatient care, but still little is known about how healthcare professionals experience such efforts. The purpose of this study was thus to capture mental healthcare professionals’ experiences of the early phase of the introduction of SPOT. Methods: Focus group discussions and semi-structured interviews were conducted with 11 mental healthcare professionals, including nurses, psychiatric aides working within psychiatric care and on the SPOT team and psychiatrists who had a consultative role in SPOT. The data was inductively analysed through reflexive thematic analysis. Results: The discussions and interviews revolved around three themes: The phases and conditions of the change , Opportunities and challenges in the new form of intermediate care and Care in the patient’s home for patient empowerment and engagement . Different perspectives on the new form of care emerged and many were positive about patients’ increased engagement in care when it was offered in the home environment. However, it was also emphasised that the need for different forms of care remains and that a new level of care should not exclude other forms of care. The results further showed a need to engage and offer continuous support to healthcare professionals at different levels when new working methods are introduced. Specifically, support from managers and increased competence and skills development in performing new work tasks were requested. Conclusions: Providing care in the home environment through SPOT interventions can help increase patients’ engagement in their own care. Preparing and equipping healthcare professionals at all levels and offering them knowledge support and influence in the introduction of new forms of care is important to reduce the vulnerability that professionals may initially experience in change processes and new ways of working.

Atopic dermatitis (AD) is associated with impaired health-related quality of life (HRQoL), especially in moderate-to-severe disease. The Dermatology Life Quality Index (DLQI) is the most widely used dermatology-specific measure, whereas the EuroQol Five-Dimension, Five-Level questionnaire (EQ-5D-5L), a generic preference-based instrument, assesses health status across diseases. This study examined the relationship between DLQI and EQ-5D-5L in Swedish adults with ADatopic dermatitis and developed a mapping model to estimate EQ-5D-5L utilities from DLQI scores. In this cross-sectional study, 112 Swedish adults with self-reported physician-diagnosed ADatopic dermatitis, recruited through the Swedish Asthma and Allergy Patient Association, completed both questionnaires. DLQI scores correlated strongly and negatively with EQ-5D-5L index values (r=−-0.64, p<0.001). Each 5-point increase in DLQI corresponded on average to a 0.07 decrease in EQ-5D-5L utility. A fractional logit regression model including covariates age, sex, and disease severity, showed good calibration and explained 27 % of the variance in EQ-5D-5L values. These findings demonstrate that DLQI scores meaningfully reflect generic HRQoL among adults with ADatopic dermatitis and can be used to estimate EQ-5D-5L utilities when preference-based data are unavailable. The results enhance understanding of how DLQI relaterelates to overall health status and support the application of DLQI-derived utilities in cost-effectiveness analyses and health technology assessments.

Atopic dermatitis (AD) is a chronic skin disease associated with impaired quality of life. Evidence from Sweden on out-of-pocket expenses and productivity losses remains limited. This study assessed the burden of AD among adults in relation to health-related quality of life (HRQoL), work productivity, activity impairment, willingness to pay for symptom relief, economic outcomes, considering comorbid asthma, allergies, depression and anxiety. A cross-sectional survey was conducted between 2024 and 2025 among 220 members of the Swedish Asthma and Allergy Patient Association. Validated instruments included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensions, five-levels instrument (EQ-5D-5L), Patient Benefit Index, and Work Productivity and Activity Impairment questionnaire. Descriptive and regression analyses were performed. Respondents (89.8% female; mean age 43 years) reported moderate HRQoL impairment (mean DLQI 10.1). DLQI and EQ-5D-5L were worse among those with allergic or non-atopic comorbidities but did not differ by asthma status. Mean annual out-of-pocket costs and productivity losses were €900 (95% CI: 401.1–1,758.4) and €1,972 (95% CI: 1,198.7–2,828.0), respectively. Itch intensity and activity impairment were associated with lower HRQoL and higher costs. AD is related to worsened work and activity functioning and high economic burden, suggesting the need for improved support and management strategies for affected adults.

Economic evaluations can be a powerful tool to assist policymakers in prioritizing interventions to reduce the number of suicides. However, the number of economic evaluations of suicide prevention is low and their quality vary. The aim of this paper is to review the literature on economic evaluations for suicide prevention, specifically focusing on the methods used to measure and value the effect of interventions. To identify articles, we searched PubMed, Web of Science and Scopus for the period from 2000 to 2023. Since the aim was to investigate how a reduction in the number of suicides is measured and valued when evaluating suicide prevention interventions, we only included studies containing effects on mortality. In total 560 unique hits were identified. Most studies were excluded after the first screening of abstracts and titles. The most common reason for exclusion was that the study did not evaluate an intervention for suicide prevention. The final analysis included 16 studies. The number of economic evaluations of suicide prevention is still low, but there is a positive trend and methodological improvements have been made. Nevertheless, several areas where more research is needed were identified, regarding both how to measure and value the effect.

Background and Objective Mapping algorithms can be used for estimating quality-adjusted life years (QALYs) when studies apply non-preference-based instruments. In this study, we estimate a regression-based algorithm for mapping between the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the preference-based instrument SF-6D to obtain preference estimates usable in health economic evaluations. This was done separately for the working and non-working populations, as WHODAS 2.0 discriminates between these groups when estimating scores. Methods Using a dataset including 2258 participants from the general Swedish population, we estimated the statistical relationship between SF-6D and WHODAS 2.0. We applied three regression methods, i.e., ordinary least squares (OLS), generalized linear models (GLM), and Tobit, in mapping onto SF-6D from WHODAS 2.0 at the overall-score and domain levels. Root mean squared error (RMSE) and mean absolute error (MAE) were used for validation of the models; R² was used to assess model fit. Results The best-performing models for both the working and non-working populations were GLM models with RMSE ranging from 0.084 to 0.088, MAE ranging from 0.068 to 0.071, and R² ranging from 0.503 to 0.608. When mapping from the WHODAS 2.0 overall score, the preferred model also included sex for both the working and non-working populations. When mapping from the WHODAS 2.0 domain level, the preferred model for the working population included the domains mobility, household activities, work/study activities, and sex. For the non-working population, the domain-level model included the domains mobility, household activities, participation, and education. Conclusions It is possible to apply the derived mapping algorithms for health economic evaluations in studies using WHODAS 2.0. As conceptual overlap is incomplete, we recommend using the domain-based algorithms over the overall score. Different algorithms must be applied depending on whether the population is working or non-working, due to the characteristics of WHODAS 2.0.

In Sweden, physical activity on prescription (PAP) is used to support patients in increasing their levels of physical activity (PA). The role of healthcare professionals in supporting PA behavior change requires optimization in terms of knowledge, quality and organization. This study aims to evaluate the cost-effectiveness of support from a physiotherapist (PT) compared to continued PAP at a healthcare center (HCC) for patients who remained insufficiently active after 6-month PAP treatment at the HCC. The PT strategy was constituted by a higher follow-up frequency as well as by aerobic physical fitness tests. The analysis was based on an RCT with a three-year time horizon, including 190 patients aged 27–77 with metabolic risk factors. The cost per QALY for the PT strategy compared to the HCC strategy was USD 16,771 with a societal perspective (including individual PA expenses, production loss and time cost for exercise, as well as healthcare resource use) and USD 33,450 with a healthcare perspective (including only costs related to healthcare resource use). Assuming a willingness-to-pay of USD 57,000 for a QALY, the probability of cost-effectiveness for the PT strategy was 0.5 for the societal perspective and 0.6 for the healthcare perspective. Subgroup analyses on cost-effectiveness based on individual characteristics regarding enjoyment, expectations and confidence indicated potential in identifying cost-effective strategies based on mediating factors. However, this needs to be further explored. In conclusion, both PT and HCC interventions are similar from a cost-effectiveness perspective, indicating that both strategies are equally valuable in healthcare’s range of treatments.

Background Functional abdominal pain disorders (FAPDs) affect children worldwide, being more prevalent among girls. The individual and societal burdens of the disease are substantial, and evidence-based interventions are needed. Non-pharmacological treatments have generally produced promising results, with dance and yoga specifically having potential as an effective treatment option. Beside efficacy, the cost-effectiveness of interventions is important when prioritizing and allocating public resources. Objective This study evaluated the cost-effectiveness of an 8-month dance and yoga intervention for girls with functional abdominal pain or irritable bowel syndrome, based on a randomized control trial called ‘Just in TIME’. Methods The intervention, performed in Sweden, was studied using a decision analysis tool, i.e., a decision tree within the trial followed by a Markov model with a time horizon of 10 years. The base case considered healthcare costs as well as productivity losses, measuring the effects in gained quality-adjusted life-years (QALYs) and presenting an incremental cost-effectiveness ratio (ICER). Results The base case results show that the intervention, compared with current practice, was the dominant strategy from both the 12-month and long-term perspectives. The sensitivity analyses indicated that the long-term, but not the short-term, findings were robust for different assumptions and changes in parameter estimates, resulting in ICERs similar to those of the base case scenario. Conclusions Offering dance and yoga to young girls with FAPDs generates small QALY gains and monetary savings compared with standard healthcare and is likely cost-effective. These findings make a valuable contribution to an area where evidence-based and cost-effective treatment interventions are needed. Clinical Trials Registration Number ClinicalTrials.gov identifier: NCT02920268; Name: Just in TIME—Intervention With Dance and Yoga for Girls With Recurrent Abdominal Pain