Change search
Link to record
Permanent link

Direct link
Publications (10 of 53) Show all publications
Bonander, C., Nilsson, A., Li, H., Sharma, S., Nwaru, C., Gisslén, M., . . . Nyberg, F. (2024). A Capture-Recapture-based Ascertainment Probability Weighting Method for Effect Estimation with Under-ascertained Outcomes. Epidemiology, 35(3), 340-348
Open this publication in new window or tab >>A Capture-Recapture-based Ascertainment Probability Weighting Method for Effect Estimation with Under-ascertained Outcomes
Show others...
2024 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 35, no 3, p. 340-348Article in journal (Refereed) Published
Abstract [en]

Outcome under-ascertainment, characterized by the incomplete identification or reporting of cases, poses a substantial challenge in epidemiologic research. While capture-recapture methods can estimate unknown case numbers, their role in estimating exposure effects in observational studies is not well established. This paper presents an ascertainment probability weighting framework that integrates capture-recapture and propensity score weighting. We propose a nonparametric estimator of effects on binary outcomes that combines exposure propensity scores with data from two conditionally independent outcome measurements to simultaneously adjust for confounding and under-ascertainment. Demonstrating its practical application, we apply the method to estimate the relationship between health care work and coronavirus disease 2019 testing in a Swedish region. We find that ascertainment probability weighting greatly influences the estimated association compared to conventional inverse probability weighting, underscoring the importance of accounting for under-ascertainment in studies with limited outcome data coverage. We conclude with practical guidelines for the method’s implementation, discussing its strengths, limitations, and suitable scenarios for application. 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
Keywords
Information bias, Misclassification, Register completeness, Sensitivity, Under-coverage
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-99733 (URN)10.1097/EDE.0000000000001717 (DOI)001249410000019 ()38442421 (PubMedID)2-s2.0-85190851009 (Scopus ID)
Funder
Swedish Research Council FormasLund UniversityScience for Life Laboratory, SciLifeLabSwedish Research Council, 2021-02648, 2021-04665, 2019-00198Forte, Swedish Research Council for Health, Working Life and Welfare, 2020-00962Knut and Alice Wallenberg Foundation, 2020.0241, 2020.0182, 2021-05405, 2021-06545
Available from: 2024-05-22 Created: 2024-05-22 Last updated: 2024-07-03Bibliographically approved
Svensson, M., Strand, G. C., Bonander, C., Johansson, N. & Jakobsson, N. (2024). Analyses of quality of life in cancer drug trials - a review of measurements and analytical choices in post-reimbursement studies. BMC Cancer, 24(1), Article ID 311.
Open this publication in new window or tab >>Analyses of quality of life in cancer drug trials - a review of measurements and analytical choices in post-reimbursement studies
Show others...
2024 (English)In: BMC Cancer, E-ISSN 1471-2407, Vol. 24, no 1, article id 311Article, review/survey (Refereed) Published
Abstract [en]

Objectives: For drugs reimbursed with limited evidence of patient benefits, confirmatory evidence of overall survival (OS) and quality of life (QoL) benefits is important. For QoL data to serve as valuable input to patients and decision-makers, it must be measured and analyzed using appropriate methods. We aimed to assess the measurement and analyses of post-reimbursement QoL data for cancer drugs introduced in Swedish healthcare with limited evidence at the time of reimbursement. Methods: We reviewed any published post-reimbursement trial data on QoL for cancer drugs reimbursed in Sweden between 2010 and 2020 with limited evidence of improvement in QoL and OS benefits at the time of reimbursement. We extracted information on the instruments used, frequency of measurement, extent of missing data, statistical approaches, and the use of pre-registration and study protocols. Results: Out of 22 drugs satisfying our inclusion criteria, we identified published QoL data for 12 drugs in 22 studies covering multiple cancer types. The most frequently used QoL instruments were EORTC QLQ-C30 and EQ-5D-3/5L. We identified three areas needing improvement in QoL measurement and analysis: (i) motivation for the frequency of measurements, (ii) handling of the substantial missing data problem, and (iii) inclusion and adherence to QoL analyses in clinical trial pre-registration and study protocols. Conclusions: Our review shows that the measurements and analysis of QoL data in our sample of cancer trials covering drugs initially reimbursed without any confirmed QoL or OS evidence have significant room for improvement. The increasing use of QoL assessments must be accompanied by a stricter adherence to best-practice guidelines to provide valuable input to patients and decision-makers. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Cancer, Health-related quality of life, Patient-reported outcomes, Quality assessment, Randomized controlled trials
National Category
Cancer and Oncology Health Care Service and Management, Health Policy and Services and Health Economy Surgery
Research subject
Economics
Identifiers
urn:nbn:se:kau:diva-99184 (URN)10.1186/s12885-024-12045-8 (DOI)001180646300008 ()38448848 (PubMedID)2-s2.0-85186928709 (Scopus ID)
Funder
Jan Wallander and Tom Hedelius Foundation and Tore Browaldh Foundation, P21-0018
Available from: 2024-04-04 Created: 2024-04-04 Last updated: 2024-07-04Bibliographically approved
Labori, F., Persson, J., Svensson, M. & Bonander, C. (2024). The impact of stroke on spousal and family income: a difference-in-difference study from Swedish national registries. Topics in Stroke Rehabilitation, 31(4), 381-389
Open this publication in new window or tab >>The impact of stroke on spousal and family income: a difference-in-difference study from Swedish national registries
2024 (English)In: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 31, no 4, p. 381-389Article in journal (Refereed) Published
Abstract [en]

AimTo investigates the financial consequences in the overall population spouses of persons with stroke in Sweden as well as for subgroups based on spouses age, sex and modified Rankin Scale (mRS) of the person with stroke.MethodsThe study population consists of spouses aged <= 60 during the year of their partner's stroke event. Each spouse was matched to four reference individuals. This longitudinal registry data covers spouses and a reference population between 2005 and 2016. We use difference-in-differences to estimate the impact on individual income from paid work, disposable individual income, and disposable family income.ResultsThe primary analysis shows a small and statistically insignificant decrease on spouses' individual income from paid work and disposable individual income. In the subgroup analysis based on mRS, the largest effect is seen in mRS 4-5, where spouses' individual income from paid work and disposable individual income increases after their partner's stroke. Further, younger female spouses' individual income from paid work decreases by 1 614 EUR (p = 0.008) on average.ConclusionThe financial consequences are small in the overall population of spouses. However, for some subgroups, younger women, and spouses of persons with stroke and mRS 4-5, the financial consequences are more prominent.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Spouse, informal care, caregiver, income, disposable income, stroke, modified Rankin Scale
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social Work
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-97291 (URN)10.1080/10749357.2023.2269674 (DOI)001083974800001 ()37842918 (PubMedID)2-s2.0-85174230445 (Scopus ID)
Available from: 2023-11-03 Created: 2023-11-03 Last updated: 2024-04-16Bibliographically approved
Nilsson, A., Björk, J., Strömberg, U. & Bonander, C. (2023). Can non-participants in a follow-up be used to draw conclusions about incidences and prevalences in the full population invited at baseline?: An investigation based on the Swedish MDC cohort. BMC Medical Research Methodology, 23(1), Article ID 228.
Open this publication in new window or tab >>Can non-participants in a follow-up be used to draw conclusions about incidences and prevalences in the full population invited at baseline?: An investigation based on the Swedish MDC cohort
2023 (English)In: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 23, no 1, article id 228Article in journal (Refereed) Published
Abstract [en]

Background: Participants in epidemiological cohorts may not be representative of the full invited population, limiting the generalizability of prevalence and incidence estimates. We propose that this problem can be remedied by exploiting data on baseline participants who refused to participate in a re-examination, as such participants may be more similar to baseline non-participants than what baseline participants who agree to participate in the re-examination are. Methods: We compared background characteristics, mortality, and disease incidences across the full population invited to the Malmö Diet and Cancer (MDC) study, the baseline participants, the baseline non-participants, the baseline participants who participated in a re-examination, and the baseline participants who did not participate in the re-examination. We then considered two models for estimating characteristics and outcomes in the full population: one (“the substitution model”) assuming that the baseline non-participants were similar to the baseline participants who refused to participate in the re-examination, and one (“the extrapolation model”) assuming that differences between the full group of baseline participants and the baseline participants who participated in the re-examination could be extended to infer results in the full population. Finally, we compared prevalences of baseline risk factors including smoking, risky drinking, overweight, and obesity across baseline participants, baseline participants who participated in the re-examination, and baseline participants who did not participate in the re-examination, and used the above models to estimate the prevalences of these factors in the full invited population. Results: Compared to baseline non-participants, baseline participants were less likely to be immigrants, had higher socioeconomic status, and lower mortality and disease incidences. Baseline participants not participating in the re-examination generally resembled the full population. The extrapolation model often generated characteristics and incidences even more similar to the full population. The prevalences of risk factors, particularly smoking, were estimated to be substantially higher in the full population than among the baseline participants. Conclusions: Participants in epidemiological cohorts such as the MDC study are unlikely to be representative of the full invited population. Exploiting data on baseline participants who did not participate in a re-examination can be a simple and useful way to improve the generalizability of prevalence and incidence estimates. 

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Generalizability, Representativity, Self-selection, Mortality, Risk factors, Continuum of resistance
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-97450 (URN)10.1186/s12874-023-02053-w (DOI)37821822 (PubMedID)2-s2.0-85173853748 (Scopus ID)
Funder
Swedish Cancer Society, 20 0719Forte, Swedish Research Council for Health, Working Life and Welfare, 2020–00962
Available from: 2023-11-22 Created: 2023-11-22 Last updated: 2024-01-17Bibliographically approved
Chauca Strand, G., Johansson, N., Jakobsson, N., Bonander, C. & Svensson, M. (2023). Cancer Drugs Reimbursed with Limited Evidence on Overall Survival and Quality of Life: Do Follow-Up Studies Confirm Patient Benefits?. Clinical drug investigation, 43(8), 621-633
Open this publication in new window or tab >>Cancer Drugs Reimbursed with Limited Evidence on Overall Survival and Quality of Life: Do Follow-Up Studies Confirm Patient Benefits?
Show others...
2023 (English)In: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 43, no 8, p. 621-633Article in journal (Refereed) Published
Abstract [en]

Background and ObjectiveCancer drug costs have increased considerably within healthcare systems, but many drugs lack quality-of-life (QoL) and overall survival (OS) data at the time of reimbursement approval. This study aimed to review the extent of subsequent literature documenting improvements in OS and QoL for cancer drug indications where no such evidence existed at the time of reimbursement approval.MethodsDrug indications with claims of added therapeutical value but a lack of evidence on OS and QoL that were reimbursed between 2010 and 2020 in Sweden were included for review. Searches were conducted in PubMed and ClinicalTrial.gov for randomized controlled trials examining OS and QoL.ResultsOf the 22 included drug indications, seven were found to have at least one trial with conclusive evidence of improvements in OS or QoL after a mean follow-up of 6.6 years. The remaining 15 drug indications either lacked subsequent randomized controlled trial data on OS or QoL (n = 6) or showed no statistically significant improvements (n = 9). Only one drug demonstrated evidence of improvement in both OS and QoL for its indication.ConclusionsA considerable share of reimbursed cancer drug indications continue to lack evidence of improvement in both OS and QoL. With limited healthcare resources and an increasing cancer burden, third-party payers have strong incentives to require additional post-reimbursement data to confirm any improvements in OS and QoL.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
renal-cell carcinoma, european medicines agency, early breast-cancer, clinical benefit, lung-cancer, phase-III, end-points, open-label, everolimus, outcomes
National Category
Cancer and Oncology Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Economics
Identifiers
urn:nbn:se:kau:diva-96400 (URN)10.1007/s40261-023-01285-4 (DOI)001039851200001 ()37505421 (PubMedID)2-s2.0-85169757424 (Scopus ID)
Funder
The Jan Wallander and Tom Hedelius Foundation, P21-0018University of Gothenburg
Available from: 2023-08-17 Created: 2023-08-17 Last updated: 2023-09-19Bibliographically approved
Nilsson, A., Strömberg, U., Björk, J., Forsberg, A., Fritzell, K., Kemp Gudmundsdottir, K. R., . . . Bonander, C. (2023). Examining the continuum of resistance model in two population-based screening studies in Sweden. Preventive Medicine Reports, 35, Article ID 102317.
Open this publication in new window or tab >>Examining the continuum of resistance model in two population-based screening studies in Sweden
Show others...
2023 (English)In: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 35, article id 102317Article in journal (Refereed) Published
Abstract [en]

In studies recruited on a voluntary basis, lack of representativity may impair the ability to generalize findings to the target population. Previous studies, primarily based on surveys, have suggested that generalizability may be improved by exploiting data on individuals who agreed to participate only after receiving one or several reminders, as such individuals may be more similar to non-participants than what early participants are. Assessing this idea in the context of screenings, we compared sociodemographic characteristics and health across early, late, and non-participants in two large population-based screening studies in Sweden: STROKESTOP II (screening for atrial fibrillation; 6,867 participants) and SCREESCO (screening for colorectal cancer; 39,363 participants). We also explored the opportunities to reproduce the distributions of characteristics in the full invited populations, either by assuming that the non-participants were similar to the late participants, or by applying a linear extrapolation model based on both early and late participants. Findings showed that early and late participants exhibited similar characteristics along most dimensions, including civil status, education, income, and health examination results. Both these types of participants in turn differed from the non-participants, with fewer married, lower educational attainments, and lower incomes. Compared to early participants, late participants were more likely to be born outside of Sweden and to have comorbidities, with non-participants similar or even more so. The two empirical models improved representativity in some cases, but not always. Overall, we found mixed support that data on late participation may be useful for improving representativeness of screening studies.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Generalizability, Selection, Screening, Atrial fibrillation, Colorectal cancer, Continuum of resistance
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cancer and Oncology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-96300 (URN)10.1016/j.pmedr.2023.102317 (DOI)001048231400001 ()2-s2.0-85164993302 (Scopus ID)
Funder
Swedish Cancer Society, 20 0719Forte, Swedish Research Council for Health, Working Life and Welfare, 2020–00962
Available from: 2023-08-09 Created: 2023-08-09 Last updated: 2023-09-04Bibliographically approved
Svensson, M., Strand, G. C., Bonander, C., Johansson, N. & Jakobsson, N. (2023). Measurement and Analysis of Health-Related Quality of Life Data in Cancer Drug Trials: A Review of Post-Reimbursement Data. Value in Health, 26(6), Article ID S353.
Open this publication in new window or tab >>Measurement and Analysis of Health-Related Quality of Life Data in Cancer Drug Trials: A Review of Post-Reimbursement Data
Show others...
2023 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 26, no 6, article id S353Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Economics
Identifiers
urn:nbn:se:kau:diva-96581 (URN)10.1016/j.jval.2023.03.2763 (DOI)001031473302276 ()
Available from: 2023-09-04 Created: 2023-09-04 Last updated: 2023-09-04Bibliographically approved
Nilsson, A., Björk, J. & Bonander, C. (2023). Proxy Variables and the Generalizability of Study Results. American Journal of Epidemiology, 192(3), 448-454
Open this publication in new window or tab >>Proxy Variables and the Generalizability of Study Results
2023 (English)In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 192, no 3, p. 448-454Article in journal (Refereed) Published
Abstract [en]

When individuals self-select (or are selected) into a study based on factors that influence the outcome, conclusions may not generalize to the full population. To compensate for this, results may be adjusted, for example, by standardization on the set of common causes of participation and outcome. Although such standardization is useful in some contexts, the common causes of participation and outcome may in practice not be fully observed. Instead, the researcher may have access to one or several variables related to the common causes, that is, to proxies for the common causes. This article defines and examines different types of proxy variables and shows how these can be used to obtain generalizable study results. First of all, the researcher may exploit proxies that influence only participation or outcome but which still allow for perfect generalizability by rendering participation and outcome conditionally independent. Further, generalizability can be achieved by leveraging 2 proxies, one of which is allowed to influence participation and one of which is allowed to influence the outcome, even if participation and outcome do not become independent conditional on these. Finally, approximate generalizability may be obtained by exploiting a single proxy that does not itself influence participation or outcome.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
directed acyclic graphs, external validity, generalizability, proxy variables
National Category
Probability Theory and Statistics
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-93839 (URN)10.1093/aje/kwac200 (DOI)000926247900001 ()36352507 (PubMedID)
Available from: 2023-03-06 Created: 2023-03-06 Last updated: 2023-03-06Bibliographically approved
Eklund, E., Holmberg, R., Svensson, M., Gustavsson, J. & Bonander, C. (2023). Quasi-experimental evaluation of municipal ice cleat distribution programmes for older adults in Sweden. Injury Prevention, 29(5), 378-383
Open this publication in new window or tab >>Quasi-experimental evaluation of municipal ice cleat distribution programmes for older adults in Sweden
Show others...
2023 (English)In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 29, no 5, p. 378-383Article in journal (Refereed) Published
Abstract [en]

IntroductionFall injuries caused by icy road conditions are a prevalent public health problem during winters in Sweden, especially in older populations. To combat this problem, many Swedish municipalities have distributed ice cleats to older adults. While previous research has shown promising results, there is a lack of comprehensive empirical data on the effectiveness of ice cleat distribution. We address this gap by investigating the impact of these distribution programmes on ice-related fall injuries among older adults. MethodsWe combined survey data on ice cleat distribution in Swedish municipalities with injury data from the Swedish National Patient Register (NPR). The survey was used to identify municipalities that have distributed ice cleats to older adults at some point between 2001 and 2019. Data from NPR were used to identify municipality-level data on patients who have been treated for injuries related to snow and ice. We used a triple differences design-a generalisation of difference in differences-that compared ice-related fall injury rates before and after intervention in 73 treatment and 200 control municipalities, with unexposed age groups serving as within-municipality controls. ResultsWe estimate that the average ice cleat distribution programmes reduced ice-related fall injury rates by -0.24 (95% CI -0.49 to 0.02) per 1000 person-winters. The impact estimate was larger in municipalities that distributed more ice cleats (-0.38 (95% CI -0.76 to -0.09)). No similar patterns were found for fall injuries unrelated to snow and ice. ConclusionOur results suggest that ice cleat distribution can decrease the incidence of ice-related injuries among older adults.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Fall, Community, Older People, Equipment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Risk and Environmental Studies
Identifiers
urn:nbn:se:kau:diva-95378 (URN)10.1136/ip-2022-044808 (DOI)000998618100001 ()37217288 (PubMedID)2-s2.0-85164528859 (Scopus ID)
Available from: 2023-06-16 Created: 2023-06-16 Last updated: 2023-12-11Bibliographically approved
Bonander, C., Ekman, M. & Jakobsson, N. (2023). When do default nudges work?. Oxford Open Economics, 2, Article ID odad094.
Open this publication in new window or tab >>When do default nudges work?
2023 (English)In: Oxford Open Economics, E-ISSN 2752-5074, Vol. 2, article id odad094Article in journal (Refereed) Published
Abstract [en]

Nudging is a burgeoning topic in science and in policy, but evidence on the effectiveness of nudges among differentially incentivized groups is lacking. This paper exploits regional variations in the rollout of the Covid-19 vaccine in Sweden to examine the effect of a nudge on groups whose intrinsic incentives are different: 16- to 17-year-olds, for whom Covid-19 is not dangerous, and 50- to 59-year-olds, who face a substantial risk of death or severe disease. We find a significantly stronger response in the younger group compared with the older (11.7 vs 3.6 percentage point increase in our study period), consistent with the theory that nudges are more effective for choices that are not meaningful to the individual.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
behavioral intervention, default, decision-making, nudge, pre-booked
National Category
Economics
Research subject
Economics
Identifiers
urn:nbn:se:kau:diva-98394 (URN)10.1093/ooec/odad094 (DOI)
Available from: 2024-02-07 Created: 2024-02-07 Last updated: 2024-02-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-1189-9950

Search in DiVA

Show all publications