To ensure that the resources of the health care sector are used effectively, new technologies need to be evaluated before implementation to examine if they generate health outcomes at an acceptable cost. This information can be collected by performing health economic evaluations in which the costs and health outcomes of different technologies are compared. To estimate the effect on health care budgets, there is also a need for information about the prevalence of the specific disease. Health outcomes in health economic evaluations are often measured in quality-adjusted life years (QALYs), which are calculated by multiplying the remaining life years after an intervention by a weight representing the health-related quality of life (HRQoL) during those years. This thesis aims to provide deeper knowledge of the health economic aspects of diabetic retinopathy (DR), an eye complication that affects patients with diabetes and may in the worst case lead to blindness. The focus is on three empirical and two methodological health economic research questions. The empirical research areas cover prevalence, costs, and HRQoL related to patients with DR. The methodological research questions explore the performance of different methods for estimation of QALY weights. This is of interest since it has been argued that the most common methods for estimating QALY weights may not capture all relevant vision-related aspects of quality of life. The analyses comprehend the validity of different methods for estimating QALY weights among patients with DR and if the results of one of the specific methods for estimating QALY weights, the time trade-off (TTO) exercise, are affected by patients’ subjective life expectancy (SLE). The empirical results demonstrate that DR is seen in approximately 40% and 30% of patients with type I and type II diabetes respectively, indicating that the prevalence of DR has decreased in both of these patient groups. Healthcare costs vary considerably between different severity levels of the disease, being estimated at €26, €257, €216, and €433 per patient per year for background retinopathy, proliferative diabetic retinopathy (PDR), diabetic macular oedema (DMO), and PDR combined with DMO respectively. Blindness due to DR is associated with an increased use of transportation services, caregiving services, and assistive technologies as well as productivity losses. This suggests that preventing the progression of DR may lower healthcare costs. Patients with vision impairment due to DR have lowered HRQoL in various dimensions, but the diagnosis of DR in itself has only a limited effect on HRQoL. The results on the methodological research questions show that different methods for estimating QALY weights seem to give different results. In comparison to EQ-5D, the Health Utilities Index Mark 3 (HUI-3) is the most sensitive method for detecting differences in QALY weights due to DR, and if decisions are to be made based on values from the general public, it can be recommended for use in cost-utility analyses of interventions directed at DR. Neither of the direct methods, TTO and the visual analogue scale, seems to be sensitive to differences in visual function, and more research is needed concerning the role of vision in people’s responses to the TTO exercises. In TTO exercises with time frames based on actuarial life expectancy, the patients’ SLE has an effect on their willingness to trade off years for full health. Thus, applying time frames deviating from patients’ SLE may result in biased QALY weights. Such bias may appear stronger within patient populations than within the general public. In conclusion, this thesis offers estimates for prevalence, costs, and QALY weights that can be used in economic evaluations of interventions directed at DR and as benchmarks for future DR research in order to follow up consequences of changes in diabetes care. In addition, it demonstrates that the choice of method for estimating QALY weights may have an impact on whether an intervention is considered cost-effective.

Background: Health economic evaluations are becoming an increasingly important means of analysing which care alternative resource utilisation is the most cost effective. It is a new topic in the medical device industry that causes much uncertainty and unstructured use of the actors involved. Study questions: Why is it difficult to develop, implement and disseminate this standardized health economic evaluation models in medical technology? Is there a possibility to standardize health economic evaluations within the medical device industry? Purpose: The purpose of this study is to investigate the standardization issues for health economic evaluations within the medical device industry. Method: A qualitative approach was used in the form of interviews with five actors that are active or have a connection to the medical device industry. The data collection consists of journals, reports, Internet searches and literature among other things. Conclusion: It is possible to standardize, but with certain restrictions such as the county council's budget, influence of industry-specific factors, lack of knowledge and the important interaction between actors.

Physical activity among children and adolescents around the world is decreasing and will imply negative effects on their current and future health, which also contributes to higher costs for the society. Interventions promoting physical activity among youths could increase their physical activity and, at the same time, reduce the costs for society. The purpose of this study is to evaluate interventions for increased physical activity targeted towards children and adolescents from a health economic perspective. The results indicate that there exist different types of interventions and that the choice of health economic evaluation method differs widely between studies. In order for policymakers to choose the most effective interventions that allocate the society’s scarce resources in the best way, there is a need for a more streamlined methodological approach for health economic evaluations of the interventions that promote psychical activity among children and adolescents. / Fysisk aktivitet minskar bland barn och ungdomar runt om i världen och kan medföra negativa effekter på deras nuvarande och kommande hälsa, vilket också bidrar till högre kostnader för samhället. En intervention som främjar fysisk aktivitet bland barn och ungdomar, kan öka den fysiska aktiviteten och samtidigt minska samhällets kostnader. Syftet med denna studie är att utvärdera interventioner som främjar fysisk aktivitet riktad mot barn och ungdomar ur ett hälsoekonomiskt perspektiv. Resultaten indikerar att det finns olika typer av interventioner och att valet av hälsoekonomisk utvärdering skiljer sig mellan interventioner. För att beslutsfattare ska kunna välja de mest effektiva interventioner som fördelar samhällets knappa resurser på bästa sätt finns det ett behov av gemensamma tillvägagångssätt i hälsoekonomiska utvärderingar på interventioner som främjar psykisk aktivitet bland barn och ungdomar.