Cost-Effectiveness Analysis and 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:
Anna Holst, Cecilia Björkelund, Alexandra Metsini, Jens Henrik Madsen, Dominique Hange, Eva-Lisa Petersson, Maria Eriksson, Marie Kivi, Per-Åke Andersson and Mikael Svensson, (2018), “A cost-effectiveness analysis of internet mediated cognitive behavioural therapy for depression in the primary care setting: results based on a controlled trial”, BMJ Open, forthcoming
- Josefine Persson, Lars-Åke Levin, Lukas Holmegaard, Petra Redfors, Mikael Svensson, Katarina Jood, Christina Jern, Christian Blomstrand and Gunilla Forsberg-Wärleby, (2017), “Long-term cost of spouses’ informal support for dependent midlife stroke survivors“, Brain and Behavior, 7: e000716.
- Ryen Linda and Svensson Mikael, (2016), “Modeling the Cost-Effectiveness of Impact-Absorbing Flooring in Swedish Residential Care Facilities“, European Journal of Public Health, 26: 407-4011.
- Dorjdagva Javkhlanbayr, Batbaatar Enkhjargal, Mikael Svensson, Dorjsuren Bayarsaikhan, Kauhanen Jussi, (2016), “Catastrophic health expenditure and impoverishment in Mongolia“, International Journal for Equity in Health, 15: 105.
- Beckman Linda and Svensson Mikael, (2016), “The Cost-Effectiveness of the Olweus Bullying Prevention Program: Results from a Modelling Study“, Journal of Adolescence, 45: 127-137.
- Linda Beckman, Mikael Svensson, Ann Frisén, (2015), “Preference-Based Health-Related Quality of Life among Victims of Bullying“, Quality of Life Research, 25: 303-309.
- Olesen Jes, Gustavsson Anders, Svensson Mikael, Wittchen H-U and Jönsson Bengt, (2012), “The economic cost of brain disorders in Europe”, European Journal of Neurology, 19: 155-162.
- Gustavsson Anders, Svensson Mikael, Jacobi Frank, Allgulander Christer, Alosno Jordi, Beghi Ettore et al., (2011), “Cost of disorders of the brain in Europe 2010“, European Neuropsychopharmacology, 21: 718-779.
- Wittchen H.U., Jacobi F., Rehm J., Gustavsson A., Svensson Mikael and Jönsson B. et al., (2011), “The size and burden of mental disorders and other disorders of the brain in Europe 2010“, European Neuropsychopharmacology, 21: 655-679.
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:
- Linda Beckman, Mikael Svensson, Susanna Geidne and Charli Eriksson, (2017), “Effects on Alcohol Use of a Swedish School-Based Prevention Program for Early Adolescents: A Longitudinal Study“, BMC Public Health, 17:2.
- Henning Finseraas, Niklas Jakobsson and Mikael Svensson, (2017), “Do Knowledge Gains from Public Information Campaigns Persist Over Time? Results from a Survey Experiment on the Norwegian Pension Reform“, Journal of Pension Economics and Finance, 16: 108-117.
- Carl Bonander, Niklas Jakobsson, Federico Podestá and Mikael Svensson, (2016), “Universities as engines for regional growth? Using the synthetic control method to analyze the effects of research universities“, Regional Science and Urban Economics, 60: 198-207.
- Niklas Jakobsson and Mikael Svensson, (2016), “Copayments and Physician Visits: A panel data study of Swedish regions 2003-2012”, Health Policy, 120: 1095-1099.
- Niklas Jakobsson and Mikael Svensson, (2016), “The effects of copayments on primary care utilization: Results from a Quasi-experiment“, Applied Economics, 2016: 3752-3762.
- Daniela Andrén and Mikael Svensson, (2012), “Part-time sick leave as a treatment method for individuals with muskuloskeletal disorders”, Journal of Occupational Rehabilitation, 22: 418-426.
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:
- Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety (with Henrik Andersson and Arne Risa Hole), Journal of Environmental Economics and Management, 2016, 75: 41-53.
- Scale Sensitivity and Question Order in the Contingent Valuation Method (with Henrik Andersson), Journal of Environmental Planning and Management, 2014, 57: 1746-1761.
- The Value of a Statistical Life in Sweden: A review of the empirical literature (with Lars Hultkrantz), Health Policy, 2012, 108: 302-310.
- Willingness to Pay for Private and Public Safety: Why the Difference? (with Maria Vredin-Johansson), Accident Analysis & Prevention, 2010, 42: 1205-1212.
- Precautionary Behavior and Willingness to Pay for a Mortality Risk Reduction: Searching for the Expected Relationship”, Journal of Risk and Uncertainty, 2009, 39: 65-85.
- The Impact of Real Options on Willingness to Pay for Mortality Risk Reductions (with Niclas Kruger), Journal of Health Economics, 2009, 28: 563-569.
- The Value of a Statistical Life in Sweden: Estimates from Two Studies using the ‘Certainty Approach’ Calibration, Accident Analysis & Prevention, 2009, 41: 430-437.
- Cognitive Ability and Scale Bias in the Contingent Valuation Method: An Analysis of Willingness to Pay to Reduce Mortality Risks (with Henrik Andersson), Environmental and Resource Economics, 2008, 39: 481-495.
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.
- Björn Sund and Mikael Svensson, (2018) “Estimating a constant Willingness to Pay for a QALY – a mission impossible?”, European Journal of Health Economics, forthcoming.
- Lars Hultkrantz and Mikael Svensson, (2018), “A Comparison of Cost-Benefit and Cost-Effectiveness Analysis in Practice: Divergent Policy Practices in Sweden”, Nordic Journal of Health Economics, forthcoming
- Mikael Svensson, Karl Arnberg and Fredrik Nilsson, (2015), “Reimbursement decisions for pharmaceuticals in Sweden: the impact of disease severity and cost-effectiveness“, Pharmacoeconomics, 33: 1229-1336.
- Linda Ryen and Mikael Svensson, (2015), “The Willingness to Pay for a QALY: A Review of the Empirical Literature“, Health Economics, 24: 1289-1301.
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.
- Niclas Krüger and Mikael Svensson, (2012), “Mortality and economic fluctuations”,Journal of Population Economics, 25: 1215-1235.
- Mikael Svensson and Curt Hagquist, (2010), “Adolescent Alcohol-use and Economic Conditions: findings from a multilevel study during a period of big economic changes”, European Journal of Health Economics, 11: 533-541.
- Mikael Svensson, (2010), “Economic Upturns are Good for Your Heart but Watch out for Accidents”, Applied Economics, 42(5): 615-625.
- Niclas Krüger and Mikael Svensson, (2010), “Good Times are Drinking Times: Empirical Evidence on Business Cycles and Alcohol Sales in Sweden 1861-2000”, Applied Economics Letters, 17(6): 543-546.
- Mikael Svensson, (2007), “Don’t Go Breaking your Heart: Do Economic Upturns Really Increase Heart Attack Mortality?”, Social Science & Medicine, 2007, 65: 833-841.
I have broad interests and from time to time get involved in research not directly related to my ordinary research. Below are papers that does not directly fit into any of the research themes as outlined above.
- Louise Persson and Mikael Svensson, (2017), “Classmate characteristic’s, class composition and children’s perceived classroom climate“, Journal of Public Health, 25: 473-480.
- Javkhlanbayar Dorjdagva, Enkhjargal Batbaatar, Mikael Svensson, Bayarsaikhan Dorjsuren, Burenjargal Batmunkh, and Jussi Kauhanen, “Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia“, International Journal for Equity in Health, 16:73.
- Björn Sund, Mikael Svensson, Henrik Andersson, (2017), “Demographic determinants of incidence experience and risk perception: Do high-risk Groups accurately perceive themselves as high-risk?“, Journal of Risk Research, 20: 99-117.
- Mattias Persson and Mikael Svensson, (2013), “The Willingness to Pay to Reduce School Bullying“, Economics of Education Review, 35: 1-11.
- Niklas Jakobsson, Mattias Persson and Mikael Svensson, (2013), “Class-Size Effects on Adolescents’ Mental Health and Well-Being in Swedish Schools“, Education Economics, 21: 248-263.
- Mikael Svensson, (2010), “Alcohol Use and Social Interactions among Adolescents: Do peer effects exist within and/or between the majority population and immigrants?”, Social Science & Medicine, 70: 1858-1864.
- Mikael Svensson and Curt Hagquist, (2010), “Adolescent Alcohol- and Illicit Drug-Use in First and Second Generation Immigrants in Sweden”, Scandinavian Journal of Public Health, 38: 184-191.