Cost-effectiveness analysis of an mHealth application (SMART4MD) and analysis of the effect of dialysis treatments on labor market outcomes : Health technology assessment of two treatment methods

Abstract: Health Technology Assessment is an important factor for decision making in the healthcare sector in Sweden. It helps to curtail the rising costs associated with the healthcare sector and aids in the efficient allocation of scarce public health resources. This thesis investigates the cost-effectiveness and the effectiveness in general of two health technologies, addressing the following research objectives: i) assessing the cost-effectiveness of mobile health (mHealth) interventions designed for older adults diagnosed with mild cognitive impairment, and ii) assessing the effectiveness of peritoneal dialysis (PD) treatment on labor market outcomes in comparison with institutional hemodialysis (IHD) treatment in Swedish settings.Study I and Study II are related to the first research objective. In Study I, we summarized and critically assessed the current evidence on the cost-effectiveness of mHealth interventions focusing on older adults; we found some evidence supporting the cost-effectiveness of these interventions. In Study II, we conducted a within-trial cost-effectiveness analysis of the software application Support, Monitoring and Reminder Technology for Mild Dementia (SMART4MD) from a healthcare perspective for a period of six months. A total of 345 Swedish dyads (MCI patient and informal caregiver) participated in this study. For a short time period of six months, we found that SMART4MD is not cost-effective for MCI patients (statistically insignificant); however, a trend was observed that indicated that it might be cost-effective for informal caregivers, although results remained statistically insignificant (p > 0.05).Study III is related to the second research objective. In Study III, we investigated the effect of PD on labor market outcomes (employment rate, work income, and disability pension) in comparison to IHD. We found that PD is associated with a treatment advantage over IHD in terms of increased employment, work income, and reduced disability pension in the Swedish population after controlling for non-random selection for the treatment.