Cost-Effectiveness Analysis and Health Care Cost studies

A large part of my most recent applied work focuses on cost-effectiveness studies alongside Randomized Controlled Trials (RCTs) as well as decision analytic models. Given my interest in the research methods per se, I am involved in applied studies in a large range of medical areas, including cardiovascular, psychiatry, orthopedics etc. I have also been, but nowadays to a lesser degree, involved in descriptive cost studies. Publications include:


Program Evaluation based on Quasi-Experimental Approaches

There has been great advances during the last 10-20 years in the application of methods to estimate causal effects of programs and interventions using non-randomized data. This is especially important in settings where we have rich register data (e.g. in the Scandinavian countries) that typically is under-utilized for research purposes other than descriptive studies (which is also important, of course!). Some of my research in this area includes:


The Value of a Statistical Life

How much resources should we allocate in public policy making in order to (statistically) prevent one death? This is something that we must consider in a large range of public policy decisions, e.g. how much to spend on environmental regulation, infrastructure improvements, and health care and public health programs. Explicit estimate of the value of preventing one death is also necessary for cost-benefit analyses of public policies when the outcomes include mortality reductions. Analysts apply what is called the value of a statistical life to compare the costs of policies with the benefit of saving lives (more formally, preventing fatalities).


Estimates of the value of a statistical life (VSL) is based on the marginal willingness to pay for (small) risk reductions scaled up on a population level. It is well known that there are a large number of empirical challenges in estimating the VSL. I started my research as a PhD student on topics related to VSL and methodological challenges in empirically estimating VSL. I still do some research related to this issue, but not running any current projects on VSL. My publications on VSL include:


The Value of a QALY

In economic evaluation of health care programs, analysts typically use cost-effectiveness analysis rather than cost-benefit analysis. In cost-effectiveness analysis the costs of a program is compared to the benefits of the program, where the benefits are measured using a non-monetary metric. The most common non-monetary metric used to measure and value health benefits is Quality Adjusted Life Years (QALYs). A QALY is the product of life expectancy and health related quality of life. The main limitation of a cost-effectiveness analysis is that the cost per gained QALY (with some program) does not directly indicate whether or not the program is cost-effective (because costs and benefits are measured using different metrics). The result, the so called Incremental Cost-Effectiveness Ratio (ICER), thus needs to be compared to some maximum value that we are willing to pay for a QALY. The value of a QALY may be based on the opportunity cost of a fixed health care budget or the consumer value (demand-side) of the health improvement. In the paper together with Hultkrantz (see below) we discuss these issues on a more conceptual level, whereas the other papers on this topic contain empirical estimates of the value of a QALY.


Economic Conditions and Health

How does population health vary with macroeconomic conditions? Long-run economic development is fundamental to improve population health and increase life expectancy. However, there has been a field of research arguing that short-term fluctuations in the economy may also have significant effects on population health, and counter-intuitely some authors have argued that short-term economic upturns have detrimental health effects. I have contributed to this research in a few number of papers, and we typically do not find support for that view, rather we find that economic upturns have positive (or no) significant effects on health also in the short-term.


Public health etc.

I have broad interests and from time to time get involved in research not directly related to my "ordinary" research program. Below are papers that do not directly fit into any of the research themes as outlined above.