Latest Publications - Department of Health Management and Health Economics

• Birkeli, Gørill; Thomas, Owen Matthew Truscott; Ballangrud, Randi; Deilkås, Ellen Catharina Tveter & Lindahl, Anne Karin (2026). No effect of learning from excellence on patient safety culture in a postanaesthesia care unit: a longitudinal quasi-experimental study. BMC Health Services Research. 26(1). doi: 10.1186/s12913-026-15405-1. Full text in Research Archive
• Triantafyllou, Konstantinos; Tziatzios, Georgios; Tham, Tony C.; Beilenhoff, Ulrike; Lorenzo-Zúñiga, Vicente & Pouw, Roos E. [Show all 24 contributors for this article] (2026). Sedation for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Guideline. Endoscopy. ISSN 0013-726X. doi: 10.1055/a-2898-6540. Full text in Research Archive
• Rostad, Hanne Marie; Skinner, Marianne Sundlisæter; Burrell, Lisa Victoria; Yang, Fan; Tjerbo, Trond & Vatnøy, Torunn Kitty (2026). Explaining Variation in the Percentage of Admissions for Patients Aged 80 and Over in Municipal InPatient Acute Care Services: A Cross-Sectional Analysis From Norway. Health Services Insights (HSI Journal). 19. doi: 10.1177/11786329261490712. Full text in Research Archive Show summary

  Background Municipal Inpatient Acute Care (MIPAC) units in Norway provide short-term inpatient services, but structural and contextual disparities, spanning resources, competence, and accessibility, may affect utilization patterns. Objectives To examine to what extent variation in the percentage of admissions involving patients aged ≥80 years across MIPAC units is associated with structural and contextual conditions. Design Cross-sectional study using aggregated register and survey data. Methods The analytical sample included 147 MIPAC units, corresponding to 68% of the 215 units in the administrative dataset. Descriptive statistics describe sample characteristics and admissions by age group. Pearson correlations assessed interrelationships and multicollinearity before regression analysis. Results The model explained 38% of the variance. Unit location, registered nurse coverage, and driving distance to the nearest emergency department were associated with the percentage of admissions involving patients aged ≥80 years. Units located in GP out-of-hours clinics had a lower percentage compared to nursing home–based units (B = -17.12, 95% CI [-23.51 to -10.73], β =-0.41, p < 0.001). Greater registered nurse coverage (B = -0.12, 95% CI [-0.22 to -0.02], β = -0.18, p = 0.021) and longer driving distance to the nearest emergency department (B = -0.07, 95% CI [-0.11 to -0.04], β = -0.31, p < 0.001) were also associated with lower percentages. The estimate for the proportion of adults ≥80 years in the MIPAC catchment area was positive, but uncertain, as the confidence interval included zero (B = 1.76, 95% CI [-0.06 to 3.57], β = 0.20, p = 0.057). Conclusion MIPAC admission patterns for the oldest patients were associated with both service configuration and local context. These findings highlight variation in the use of MIPAC services across different units. Future research should examine how structural and contextual factors are related to patterns of MIPAC utilization and explore the mechanisms underlying these associations.

• Aars, Ole Kristian & Iversen, Tor (2026). Can nudging increase the uptake of recommended health services? PEC Innovation. 9. doi: 10.1016/j.pecinn.2026.100508. Full text in Research Archive Show summary

  Objective Type 2 diabetes (T2DM) represents a significant threat to global public health. When supported by their general practitioner (GP), patients who self-manage effectively can prevent or delay serious complications. This study examines whether an innovative information initiative can nudge members of the Norwegian Diabetes Association (NDA) with T2DM to schedule a comprehensive annual checkup with their GP. Methods We randomized 12,484 NDA members with T2DM into an intervention group with two subgroups and a control group with two subgroups. The intervention group received a message describing the health benefits of a comprehensive checkup, a link to an explanatory video, and a prompt to contact their GP to book an appointment. One intervention subgroup received an email followed by an SMS reminder 1 week later (Group 1); the other intervention subgroup received both messages by SMS (Group 2). The control group received no information. All groups were sent a questionnaire 4 weeks after the initial message. Results The overall effect of the intervention was 3.5 percentage points (p = 0.020). Participants in intervention Group 1 initiated a comprehensive annual checkup 4.2 percentage points (p = 0.024) more often than the control group. For Group 2, we did not find a statistically significant effect of the intervention. Conclusion This intervention nudging patients with T2DM to initiate a comprehensive annual checkup had a significant effect, particularly for the group that received initial information by email and a reminder by SMS. Innovation This study adds to the emerging literature on low-cost digital interventions by demonstrating that brief, scalable digital information can increase uptake of guideline-recommended preventive care among patients with T2DM. The findings suggest that such interventions may offer a cost-effective approach to increasing preventive-care uptake, which could in turn help reduce diabetes-related complications at the population level.

• Yaqub, Sheraz; Valberg, Morten; Bjørnbeth, Bjørn Atle; Angelsen, Jon-Helge; Brudvik, Kristoffer Watten & Eilertsen, Ina [Show all 43 contributors for this article] (2026). Aspirin after curative-intent treatment of colorectal cancer liver metastases (ASAC): a multicentre, phase 3, randomised, double-blind, placebo-controlled trial. The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. doi: 10.1016/s2468-1253(26)00260-8. Full text in Research Archive Show summary

  Background Colorectal cancer frequently metastasises to the liver. Recurrence after curative-intent treatment of colorectal cancer liver metastases is common. Aspirin has shown preventive and antitumour effects in colorectal cancer, but its role after treatment of metastatic disease is uncertain. We aimed to establish whether adjuvant aspirin improves disease-free survival after curative-intent treatment of colorectal cancer liver metastases. Methods In this phase 3, randomised, double-blind, placebo-controlled trial conducted at 14 centres in Norway, Sweden, and Denmark, patients who had undergone curative-intent treatment for colorectal cancer liver metastases were randomly assigned (1:1), stratified by study site using a centrally generated computerised sequence with variable block sizes, to aspirin 160 mg per day or matching placebo for up to 3 years or until recurrence, death, or treatment discontinuation. The primary outcome was disease-free survival in the full analysis set, comprising all patients who initiated study treatment. The trial is completed and this is the final analysis. This trial is registered with ClinicalTrials.gov, NCT03326791, and EudraCT, 2014-003601-15. Findings Between Dec 15, 2017, and Jan 27, 2022, 466 patients were randomly assigned, of whom 428 initiated study treatment and were included in the full analysis set (217 assigned aspirin and 211 assigned placebo); 272 (64%) were male, 156 (36%) were female, and the mean age was 62·2 years. 269 disease-free survival events occurred (138 in the aspirin group and 131 in the placebo group). Aspirin did not improve disease-free survival (hazard ratio [HR] for recurrence or death 1·08 [95·44% CI 0·85–1·38]; p=0·58). Median disease-free survival was 1·13 years (95·44% CI 0·92–1·44) with aspirin and 1·40 years (1·11–1·69) with placebo. Overall survival at 36 months was 76% (95% CI 69·4–82·7) with aspirin and 85% (79·5–90·8) with placebo (HR for death 1·64 [95% CI 1·01–2·65]; p=0·045). Time to recurrence did not differ between groups (adjusted cause-specific HR 1·06 [95% CI 0·83–1·35]; p=0·64). 24 serious adverse events occurred in 17 (8%) of 217 patients in the aspirin group and five serious adverse events occurred in four (2%) of 211 patients in the placebo group. Clinically relevant adverse events and serious adverse events that occurred more commonly in the aspirin group than in the placebo group were myocardial infarction (two vs 0), epistaxis (four vs 0), duodenal ulcer (two vs 0), and cerebral haemorrhage (two vs 0). There were no treatment-related deaths. Interpretation Adjuvant aspirin did not improve disease-free survival and was associated with lower overall survival and more serious adverse events. These findings do not support routine use of aspirin after curative-intent treatment of colorectal cancer liver metastases.

• Ullern, Andreas; Garborg, Kjetil Kjeldstad; Chauhan, Sudhir Kumar; Holm, Kristian; Bang, Corinna & Dunn, Claire [Show all 9 contributors for this article] (2026). Safety and efficacy of fecal microbiota transplantation in solid cancers resistant to immune checkpoint inhibitors: results of the MITRIC trial. Journal for ImmunoTherapy of Cancer (JITC). 14(7), p. 015122–015122. doi: 10.1136/jitc-2026-015122. Full text in Research Archive Show summary

  Background Fecal microbiota transplantation (FMT) has shown promise in overcoming resistance to immune checkpoint inhibitors (ICIs) in early-phase cancer trials. We investigated the safety, feasibility and efficacy of FMT from ICI responders to patients with advanced cancers progressing on ICIs. Methods This was a single-arm phase IIa basket trial (MITRIC; NCT05286294 ) including patients with ICI-refractory cancer. Long-term ICI responders were used as FMT donors. Patients received FMTs in combination with ICIs; two FMT administrations (by colonoscopy) were scheduled before the first radiological evaluation after 6 weeks, and up to three later FMTs were allowed (by enema). Co-primary endpoints were the evaluation of FMT-related adverse events and objective response rate. Feasibility, clinical benefit rate, progression-free survival (PFS), overall survival (OS), implant engraftment, immune response and biomarkers were among the secondary objectives. Results The study enrolled 12 patients with melanoma (n=9), head and neck squamous cell carcinoma (HNSCC; n=1), renal cell carcinoma (n=1) or microsatellite instability-high pancreatic cancer (n=1). FMT was well tolerated, whereas immune-related toxicity occurred in 6/12 patients. All patients received the first FMT; 10/12 patients also underwent the second FMT. No objective responses were observed, while 5/12 patients recorded stable disease. Clinical benefit per-protocol (stable disease >6 months) was achieved in a patient with melanoma, who had regression of some lesions and remains alive after 33 months without further systemic treatment. Mixed responses with regression of some lesions were observed in another melanoma patient, and in a patient with HNSCC. The median PFS was 1.5 months, and median OS was 10.1 months. Sequencing of fecal samples indicated engraftment after the first FMT in most patients. Mass cytometry analysis of peripheral blood cells suggested that an activated and differentiated T-cell signature was associated with improved PFS and OS, while a naïve T-cell phenotype and a myeloid-dominant environment were unfavorable. CD14 + monocytes and serum interleukin-8 increased at group level over time. Conclusion FMT in combination with ICIs was safe and feasible in patients with advanced cancers, but with limited clinical activity. Further studies are required to clarify the potential benefit of FMT, identify the appropriate patient population and define criteria for donor selection. Trial registration number NCT05286294 .

• Kravdal, Øystein; Grundy, Emily & Hart, Rannveig Kaldager (2026). Health Influences on Second‐ and Third‐Birth Probabilities in Norway. Population and Development Review. ISSN 0098-7921. 52(2), p. 650–650. doi: 10.1111/padr.70066. Full text in Research Archive Show summary

  Abstract We examined how several health variables were associated with mothers’ probability of having a second or third child and the timing of the second birth. Data from the Norwegian Mother, Father and Child Cohort Study (MoBa) and linked registers were used. Parents with certain potentially chronic health problems before or in pregnancy were less likely than others to have an additional (especially a second) child, net of differences in relationship status, education, and economic resources. Some pregnancy‐related and largely temporary health problems during the most recent previous pregnancy and adverse birth experiences were associated with reduced probabilities of a second or third birth, or both, as was generally poor physical health six months after birth and postnatal depression. The latter health indicators may reflect health implications of pregnancy, delivery, and having a relatively “demanding” young child, as well as underlying health problems. Only a few estimates suggested associations between indicators of potentially chronic health problems of the most recently born child and subsequent fertility, but fertility was reduced among one‐child mothers whose first child had colic and among one‐ and two‐child mothers whose most recently born child slept little. Possible reasons for and implications of these health–fertility associations are discussed.

• Nakken, Sigve; Edsjö, Anders; Lehtiö, Janne; Nygaard, Vigdis; Roepman, Paul & Rosenquist, Richard [Show all 69 contributors for this article] (2026). Towards an ecosystem of clinical decision support tools for precision cancer medicine. NPJ precision oncology. doi: 10.1038/s41698-026-01551-6. Full text in Research Archive Show summary

  Molecular tumor boards are supported by clinical decision support system (CDSS) tools for the interpretation of complex molecular data towards personalized treatments. Current CDSS tools are genomics-focused and characterized by tight couplings between data ingestion, guideline-based reasoning logic and curated knowledgebases. Next-generation CDSS solutions should integrate multimodal data and learn from outcomes in an interoperable ecosystem, leveraging explainable, trustworthy output from AI models through rigorous clinical validation processes.

• Müller, Marcel; Geisler, Benjamin P.; Shamas, Samar; Bomhard, Nikolaus v.; Hoster, Eva & Pfirrmann, Markus [Show all 7 contributors for this article] (2026). FAIR by design (TRACE): A Trusted Research Access & Collaboration Environment. BMC Medical Informatics and Decision Making. 26(1). doi: 10.1186/s12911-026-03840-3. Full text in Research Archive Show summary

  Background A tension exists between the open science imperative for data transparency through FAIR (Findable, Accessible, Interoperable, Reusable) data sharing and the stringent requirements of current data protection regulations for health data. Researchers lack efficient yet affordable tools to share sensitive data responsibly. Existing solutions are often either difficult to use, expensive, or lack features like variable-level access control and auditable and reproducible workflows. Our objective was to develop a solution that lowers the threshold for researchers to share sensitive data responsibly and that can be operated by existing institutional staff. Results TRACE (Trusted Research Access & Collaboration Environment) was designed to support several data-sharing elements highlighted in the 2025 SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) statements by providing controlled and auditable workflows and supporting reproducibility at the level of data and analysis code. Its features for data governance, sharing, reproducibility and security allow institutions to manage study data access and to establish consistent, transparent standard operating procedures through granular variable selection, integrated study visualisation, and provisioning into a sealed analysis environment. TRACE provides an automated workflow for selected data-access steps that had previously relied on manual curation and ad-hoc sharing. A core feature versions datasets together with the corresponding analysis scripts, supporting reproducibility at the level of data and code; the computational environment is not captured. TRACE has supported data governance across seven clinical studies and processed 56 data access applications. Across three studies, an uncontrolled before-and-after comparison found 42.4 manual interface exports per 30 days before TRACE and 4.7 after implementation; causality cannot be inferred. Conclusions Platforms like TRACE may help shift resource-intensive, expert-dependent data governance towards automated processes. Operated by existing institutional staff, TRACE may make controlled data sharing feasible for institutions with limited resources. By automating previously manual steps, TRACE is intended to reduce the administrative burden of governed data sharing; whether it shortens the interval from data request to analysis has not been measured. TRACE is used as a training environment for preparing and using data in sharing processes.

• Johansen, Inger; Moe, Rikke Helene; Eid, Idun; Fossmo, Hanne Ludt; Hole, Anniken Hjellbakk & Rajalahti, Tarja [Show all 10 contributors for this article] (2026). Standardised multidisciplinary rehabilitation improves health-related quality of life and productivity costs in patients with rheumatic, musculoskeletal and other diseases. EULAR Rheumatology Open (ERO). 2(1), p. 271–271. doi: 10.1016/j.ero.2026.02.002. Full text in Research Archive
• Bekkevold, Terese; Laake, Ida; Feiring, Berit; Søreng, Kristiane; Presthus, Gro & Alfsen, Glenny Cecilie [Show all 14 contributors for this article] (2026). HPV Genotype Distribution in Cervical Cancer and High-Grade Lesions in Norway, and Early Vaccine Impact. International Journal of Cancer. ISSN 0020-7136. doi: 10.1002/ijc.70712.
• Menso, Julia E.; Bruna, Caro L.; Nine, de Graaf; Emmen, Anouk M.L.H.; Ali, Mahsoem & Björnsson, Bergthor [Show all 38 contributors for this article] (2026). Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2): A Multicenter International Randomized Trial. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000007188.
• Schepers, Robin; Bennett, Schyler Marie; Anthun, Kjartan Sarheim; Asheim, Andreas; Bjerkeset, Ottar & Bjørnelv, Gudrun Maria Waaler [Show all 8 contributors for this article] (2026). Variation in general practitioners’ mental health diagnostic tendencies and subsequent patient care: a Norwegian registry study. BMC Health Services Research. doi: 10.1186/s12913-026-15516-9. Full text in Research Archive Show summary

  Background General practitioners (GPs) are often the first point of contact for adults presenting with symptoms of depression or anxiety. Practices may vary due to patient and physician tendencies, influencing treatment pathways. This study aimed to quantify variation in GPs’ diagnostic tendencies for depression and/or anxiety and their association with subsequent healthcare utilisation and sickness absence. Methods Using linked national registry data from 2008 to 2021, we studied adults assigned a new GP due to list closures, list reductions, or immigration. We constructed two measures of each GP’s diagnostic tendency: one based on their diagnostic rate among patients seen before the index patient was assigned (prior measure), and one based on patients seen after (current measure). Using ordinary least squares (OLS) regressions with fixed effects, we first examined the association between each tendency measure and the likelihood of receiving a depression and/or anxiety diagnosis, to verify that the measures capture meaningful variation in diagnostic tendencies. We then estimated associations between GP tendency and psychiatric and somatic healthcare utilisation and sickness absence over three-year follow-up. Results Diagnostic tendency exhibited moderate variation across GPs. A 1%-point increase in diagnostic tendency was associated with a 0.47 (95% CI: 0.44–0.49) percentage-point increase in the probability of receiving a diagnosis using the current measure, and 0.32 (95% CI: 0.29–0.34) using the prior measure, corresponding to approximately 27 and 13 additional diagnoses per 1,000 newly assigned patients, respectively, when comparing GPs one standard deviation above versus below the mean. A 5%-point increase in diagnostic tendency was associated with a 0.4 (95% CI: 0.2–0.5) percentage-point increase in non-acute psychiatric outpatient care and a 0.3 (95% CI: 0.1–0.4) percentage-point increase in repeated sickness absence, consistent across time and instruments, corresponding to approximately 2 to 6 and 3 to 4 additional cases per 1,000 patients per year, respectively. Associations with other outcomes were smaller and imprecise. Conclusion GPs vary in the extent to which they diagnose depression and/or anxiety, affecting patients’ likelihood of psychiatric care use and sick leave. Whether this is beneficial or harmful remains unclear and requires further investigation.

• Methi, Fredrik; Elgersma, Ingeborg Hess; Solberg, Runar Barstad; Kinge, Jonas Minet; Hart, Rannveig Kaldager & Telle, Kjetil Elias [Show all 8 contributors for this article] (2026). Norwegian Register-Based Studies on Sports & Health (NorSport): Study protocol. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948261459233. Full text in Research Archive
• Wu, Yansi; Burger, Emily Annika; Holmboe, Fredrik; Bangum, Magnus; Oteiza, Francisco & Bugge, Christoffer [Show all 8 contributors for this article] (2026). Integrating Structured Expert Elicitation with External Evidence to Inform Earlier Reimbursement Decisions: A Norwegian Case Study of Selpercatinib for Non-Small Cell Lung Cancer. PharmacoEconomics - Open. ISSN 2509-4262. 10(4), p. 679–694. doi: 10.1007/s41669-026-00656-9. Full text in Research Archive Show summary

  Background The Norwegian public–private partnership, CONNECT, identified the reimbursement submission case of selpercatinib—a first-line targeted therapy for RET fusion-positive non-small cell lung cancer (NSCLC)—as a unique opportunity to assess the role of structured expert elicitation (SEE) in conjunction with phase II evidence. Objective This study aims to compare the potential of using SEE and other sources of external evidence with phase III clinical trial results to explore the possibility of facilitating earlier (conditional) reimbursement decisions. Methods We conducted a series of cost-effectiveness analyses, grouping different sources of evidence (i.e., published clinical evidence and SEE) to estimate the long-term health and economic consequences of selpercatinib versus pembrolizumab plus pemetrexed and platinum-based chemotherapy for patients with advanced RET fusion-positive NSCLC in Norway. We developed a probabilistic partitioned survival model to estimate and compare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) associated with evidence potentially available early in the product lifecycle, including SEE, with those using phase III evidence. Results ICERs consistently ranged between $8257 and $19,819 per QALY gained when we used SEE, either alone or in combination with additional external evidence, or when we used the phase III randomized controlled trial (RCT) evidence. Conclusions The consistent cost-effectiveness results between pre-submission and post-submission phases support the potential of SEE to complement health technology assessment (HTA) and potentially inform earlier (conditional) reimbursement decisions for this single case study. However, future research should focus on refining SEE protocols for continued methodological development and validation to improve generalizability and applicability.

• Yang, Freda; Geisler, Benjamin Peter; d’Ancona, Grainne; Lee, Bohee; Jackson, David J. & Bloom, Chloe I. (2026). Prevalence and cost implications of broadening asthma biologic eligibility criteria. World Allergy Organization Journal. 19(9). doi: 10.1016/j.waojou.2026.101449. Full text in Research Archive Show summary

  Rationale: Eligibility for biologic therapy in severe asthma varies internationally because government-funded schemes apply stricter criteria than pivotal trials. While relaxing eligibility thresholds may expand access, the effects on prevalence and healthcare costs remain uncertain. Objective: To quantify how alternative biologic eligibility criteria affect prevalence, clinical characteristics, and budget impact in adults with asthma. Methods: We studied adults with active asthma (2004–2021) using nationally representative primary care and hospital records. Biologic eligibility was assessed yearly using asthma severity (inhaled corticosteroid dose, additional controllers, rescue therapy) and exacerbations (oral corticosteroid prescriptions, emergency visits and hospitalisations). We assessed prevalence using United Kingdom (UK) criteria (severe asthma, ≥3 exacerbations), Global criteria (severe asthma, ≥1 or ≥2 exacerbations) and RCT criteria (moderate asthma, ≥1 or ≥2 exacerbations). Anti-IL-5/5Rα eligibility was evaluated using blood eosinophil counts. Budget impact was modelled over 5 years. Results: Among 1,306,307 asthma patients, 7.2% had severe asthma. Under UK criteria, 19,093 patients were biologic-eligible (20.4% of severe asthma; 1.5% of all asthma). Global criteria increased eligibility to 2.4% (≥2 exacerbations) to 4.3% (≥1 exacerbation), while RCT criteria expanded eligibility to 4.7% (≥2 exacerbations) and 9% (≥1 exacerbation). Among patients with eosinophil data, 38–45% met anti-IL-5/5Rα criteria. UK-eligible patients had higher prevalence of lower respiratory tract infections, pneumonia, and bronchiectasis. Five-year costs were £261 M under UK criteria, £436–767 M under Global criteria, and £878M-1.6B under RCT criteria. Conclusion: Only one-fifth of patients with severe asthma met UK biologic eligibility. Global criteria tripled eligibility and RCT criteria increased it six-fold, with substantial budget implications.

• Maeda, Yasuharu; Kudo, Shin Ei; Ogata, Noriyuki; Takenaka, Kento; Takabayashi, Kaoru & Kuroki, Takanori [Show all 18 contributors for this article] (2026). AI-based quantification of inflammatory extent for relapse prediction in ulcerative colitis: a prospective cohort study. Journal of Crohn's and Colitis. ISSN 1873-9946. 20(7), p. 1–10. doi: 10.1093/ecco-jcc/jjag115. Full text in Research Archive
• Tengesdal, Stig; Molberg, Øyvind; Holme, Øyvind; Ghiasvand, Reza; Gran, Jan Tore & Myklebust, Geirmund (2026). Lifetime risk of malignancy in polymyalgia rheumatica: a population-based matched cohort study from southern Norway. Rheumatology. ISSN 1462-0324. 65(6). doi: 10.1093/rheumatology/keag297. Full text in Research Archive
• Hagen, Gunhild; Opheim, Anna K; Øverbø, Joakim; Aas, Eline & Provan, Sella A (2026). Cost-effectiveness of herpes zoster vaccination in patients with rheumatoid arthritis. Rheumatology. ISSN 1462-0324. 65(9). doi: 10.1093/rheumatology/keag448. Full text in Research Archive Show summary

  Objectives To assess the cost-effectiveness of vaccinating patients with rheumatoid arthritis (RA) with the adjuvanted recombinant zoster vaccine (RZV), compared with no vaccination. Methods To predict health gains and costs from vaccination, we developed a decision-analytic Markov model with five health states: no herpes zoster, herpes zoster (HZ), postherpetic neuralgia (PHN), recovered from herpes zoster, and death. The model follows a hypothetical cohort of 10,000 patients with RA over a lifetime perspective and records events of HZ and PHN, along with quality-adjusted life years (QALYs) and costs from a healthcare perspective. Costs and health effects were discounted with 4% annually. Model inputs were collected from published literature and publicly available sources. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER), expressed as EUR per quality adjusted life year (QALY), compared with a cost-effectiveness threshold of EUR 23,650 per QALY. We performed one-way and probabilistic sensitivity analyses. Results Vaccination led to a reduction of 2,550 cases of HZ and 1,303 cases of PHN per 10,000 patients with RA vaccinated, resulting in an ICER of EUR 11,205/QALY. One-way sensitivity analyses revealed that the results were particularly sensitive to changes in the probability of developing PHN as a sequela of HZ. The probabilistic analysis indicated that the RZV had a 98% probability of being cost-effective at the assumed threshold value. Conclusions Vaccinating patients with RA using RZV results in better health at higher cost compared with no vaccination. Under the assumptions made, vaccination is likely to be considered cost-effective for patients with RA.

• Kaló, Zoltán; Mölken, Maureen Rutten-van; Aas, Eline; Salcher-Konrad, Maximilian; Tesař, Tomáš & Belleman, Tom [Show all 13 contributors for this article] (2026). Principles of selecting cost-effectiveness thresholds in price-taker countries. Expert review of pharmacoeconomics & outcomes research. ISSN 1473-7167. p. 1–8. doi: 10.1080/14737167.2026.2715977. Full text in Research Archive Show summary

  Introduction Countries with relatively small market size lack the bargaining power to influence the prices set by pharmaceutical companies, so they function as price-taker rather than price-maker. For price-taker countries, carefully established cost-effectiveness thresholds (CETs) are essential tools to assess local economic value of new medicines. Areas covered This perspective paper provides an overview of how pharmaceutical price-taker countries may reconsider their CETs. Key aspects of selecting appropriate CETs in price-taker countries include i) the methodology for establishing the main CETs, ii) the selection of factors to modify the baseline CET, if higher spending for one unit of health gain seems justified, and iii) the process of using CETs in policy decisions. Expert opinion Many academic approaches described in scientific articles are not implemented; the majority of countries establish or make changes in their CETs without strong theoretical foundation. In the next years. several price-taker countries will introduce or update CETs. Lower-income countries, who linked their CETs to the GDP per capita and whose economy has been growing significantly, may reduce their baseline thresholds. There will be significant pressure on higher-income countries to increase their CETs, who did not adjust their CETs for economic growth and/or inflation in recent years.

• Phillipson, Juliette Catherine; Fenwick, Mary; Spehar, Ivan & Lyons, Oscar (2026). Developing leaders, strengthening systems: evaluation of a multidisciplinary healthcare leadership programme. Leadership in Health Services. ISSN 1751-1879. p. 17–17. doi: 10.1108/lhs-12-2025-0210. Full text in Research Archive Show summary

  Purpose Evaluations of healthcare leadership development programmes often rely on short-term self-report and rarely examine organisational impact. This study aims to evaluate four cohorts of the multidisciplinary emerging leaders programme (ELP), using a theory-informed mixed-methods design with longitudinal follow-up across all four Kirkpatrick levels (reaction, learning, behaviour and results). Design/methodology/approach The programme consisted of seven or eight full-day workshops and included team quality improvement (QI) projects as the experiential learning element. Ninety-four participants from multidisciplinary backgrounds within Oxford University Hospitals NHS Foundation Trust completed the programme. Qualitative data included 39 reflective essays and 21 semi-structured interviews conducted 3–4 years post-programme. These data were analysed using Braun and Clarke’s approach to thematic analysis. Quantitative data included workshop ratings, pre/post affective commitment scale (ACS), turnover intention scale (TIS-6) and an adapted medical leadership competency framework questionnaire (MLCFQ). 86 (91%) completed pre- and 72 (77%) completed post-programme questionnaires, resulting in 55 (58%) paired questionnaires. Results were compared using Wilcoxon signed-rank tests, adjusted for multiple comparisons. Findings Participants reported improvements in leadership knowledge, confidence and emotional intelligence. There were significant improvements across all MLCFQ domains (median change + 0.6 to + 0.9; adjusted p &lt; 0.005 for each). Participants reported application of QI tools, stakeholder engagement, conflict management and distributed leadership. The ACS and TIS-6 showed no significant pre/post changes. Participants described sustained service improvements and system contributions, including redesigned patient pathways, team processes, externally funded innovations and initiatives that maintained service continuity. Originality/value This study demonstrates an evolving and sustained impact of the ELP, with outcomes extending beyond individual capability gains to behavioural change and organisational benefits.

• Tjerbo, Trond; Hagen, Terje P. & Holte, Jon Helgheim (2026). When Policy Meets Reality: Municipal Leaders’ Views Amid Rising LTC Expenditure. Health Services Insights (HSI Journal). 19. doi: 10.1177/11786329251410041. Full text in Research Archive
• Godager, Geir (2026). 7. Allmennlegetjenestene. In Berg, Ole Trond; Hagen, Terje P.; Gjefsen, Hege Marie; Godager, Geir; Hart, Rannveig Kaldager; Kinge, Jonas Minet; Holte, Jon Helgheim; Aas, Eline; Kittelsen, Sverre A.C.; Moger, Tron Anders; Tjerbo, Trond; Veggeland, Frode & Øien, Henning (Ed.), Organisering og finansering av helsetjenester. Fagbokforlaget. ISSN 9788245061505. p. 151–176. doi: 10.55669/oa180907. Full text in Research Archive Show summary

  Allmennlegetjenestene, med fastlegeordningen som bærebjelke, spiller en avgjørende rolle i det norske helsevesenet. Da fastlegeordningen ble innført i 2001, representerte den et paradigmeskifte i organiseringen og finansieringen av primærhelsetjenesten. Overgangen fra faste driftstilskudd til per capita-betaling kombinert med stykkprisbetaling endret insentivstrukturen for både leger og kommuner. Dette bidro til å snu situasjonen fram legemangel til en situasjon med pasientmangel. De økonomiske insentivene har vist seg å være kraftfulle styringsverktøy. Per capita-betalingen motiverer fastlegene til å ta listeansvar for flere pasienter, mens stykkprisbetalingen gir insentiver for aktivitet og tilgjengelighet. Kombinasjonen gjør det mulig med lavere stykkpriser enn hva som ville vært mulig dersom legene bare mottok stykkprisbetaling. For kommunene medførte fastlegeordningen at utgiftene til allmennlegetjenesten ble uavhengige av tallet på allmennleger i kommunen, noe som gjorde det mer attraktivt å opprette nye fastlegestillinger. Samspillet mellom disse faktorene bidro til reduserte ventetider og bedre kontinuitet i lege-pasient-forholdet. Etter hvert oppstod kapasitetsutfordringer og ny legemangel. Svaret på dette var å øke fastlegenes basistilskudd og å innføre et pasienttilpasset basistilskudd fra 2023. Etter disse tiltakene har kapasitetsutviklingen snudd. Tallet på fastleger har økt sterkt i årene i 2023–2025, og det har bidratt til at kapasiteten i fastlegeordningen, målt ved samlet listetak, har økt betydelig.

• Godager, Geir & Hagen, Terje P. (2026). 3. Betalingssystemer. In Berg, Ole Trond; Hagen, Terje P.; Gjefsen, Hege Marie; Godager, Geir; Hart, Rannveig Kaldager; Kinge, Jonas Minet; Holte, Jon Helgheim; Aas, Eline; Kittelsen, Sverre A.C.; Moger, Tron Anders; Tjerbo, Trond; Veggeland, Frode & Øien, Henning (Ed.), Organisering og finansering av helsetjenester. Fagbokforlaget. ISSN 9788245061505. p. 39–83. doi: 10.55669/oa180903. Full text in Research Archive Show summary

  Utformingen av betalingssystemer for helsetjenesteleverandører er et betydningsfullt helsepolitisk virkemiddel. Betalingssystemer påvirker prak-tisk talt alle aspekter ved helsetjenesten ved å skape insentiver som former leverandørenes atferd, ressursallokering og til slutt pasientutfall. Selv om helsebeslutninger drives av kliniske hensyn og profesjonsetikk, har de øko-nomiske insentivene innebygd i betalingssystemene en betydelig påvirkning. Betalingssystemene etablerer den økonomiske strukturen som kliniske beslut-ninger tas innenfor.

• Iversen, Tor (2026). Impact of Increased Capitation on Revenue Distribution Among General Practitioners: A Norwegian Case Study. Health Policy. ISSN 0168-8510. 172. doi: 10.1016/j.healthpol.2026.105692. Full text in Research Archive Show summary

  Background During recent years, many countries have moved from pure fee-for-service (FFS) systems toward mixed payment arrangements combining capitation and FFS components. In Norway, regular general practitioners (GPs) typically provide primary care under mixed capitation and FFS remuneration. ​Recently, increased proportion of capitation has been suggested. Objective This study investigates the impact of increasing the proportion of capitation on GP revenue distribution. Flat capitation and two types of risk adjusted capitation are examined. Methods Detailed data from Oslo, Norway are used to describe the differences in list composition among GPs. Increased capitation is calculated under the restriction of constant aggregated revenue to GPs. Risk adjusted capitation is calculated according to existing formulas and ordinary least squares regression. Results Increasing the capitation fee to 50% of total revenue benefits GPs with long lists, but it disadvantages those with a high proportion of patients with a need for long-term care (LTC) services. However, risk-adjusted capitation according to patient-adjusted capitation (PAC) and need for LTC favors GPs with high proportions of frail patients, ensuring a more equitable revenue distribution. Conclusion This study underscores the importance of risk adjustment in capitation systems in order to prevent adverse incentives for patient selection and to maintain equitable income distribution among GPs. ​ An equitable revenue distribution among GPs is a precondition for implementing reforms of the payment system. Medical associations are powerful organizations that can block reforms considered desirable by governments. The results have broader implications for health policy, particularly around managing the financial sustainability and the service quality of primary care for an aging population. Policymakers are advised to consider these findings when debating changes to the remuneration system, to ensure that GPs are incentivized to provide comprehensive care without compromising access for high-need patients.

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• Fiva, Jon H.; Hagen, Terje P. & Sørensen, Rune Jørgen (2026). Kommunal organisering. Universitetsforlaget. ISBN 9788215076249. 241 p. Full text in Research Archive Show summary

  Kommunal organisering er det norske standardverket om kommuner, fylkeskommuner og stat-kommune-relasjoner. Boken både gir en analytisk gjennomgang og en helhetlig beskrivelse av hvordan kommunesektoren fungerer - og hvilke valg som vil forme den i årene som kommer. I 9. utgave (2026) er boken fullstendig revidert og oppdatert. Kommunesektoren står midt i en periode med store strukturelle endringer: aldring i befolkningen, knapphet på arbeidskraft, økt statlig styring og press på generalistkommuneprinsippet. Denne utgaven gir leseren verktøyene som trengs for å forstå - og analysere - disse utviklingstrekkene. Nytt i 9. utgave: Et helt nytt kapittel om kommunal økonomistyring, som analyserer samspillet mellom stat og kommune, vertikal fiskal ubalanse og risikoen for myke budsjettskranker. Et nytt avsluttende kapittel om alternativer for framtiden, der sentrale veivalg - kommunesammenslåing, interkommunalt samarbeid og oppgavedifferensiering - drøftes systematisk. Oppdaterte analyser av kommunereformen og endringer i kommunestrukturen. Nye drøftinger av statlig styring gjennom rettigheter, standarder og øremerking, og hvordan dette gradvis binder opp kommunenes handlingsrom. En grundig analyse av demografiske endringer og arbeidskraftmangel, og hva dette betyr for tjenestetilbud og organisering. Alle figurer og tabeller er oppdatert med nyeste tilgjengelige data. Boken gir leseren en grunnleggende forståelse av hvordan organisasjonsdesign i offentlig sektor påvirker effektivitet, likeverdige tjenester og lokaldemokratiets vitalitet. Kommunal organisering er en sentral lærebok på både bachelor- og masternivå og et uunnværlig referanseverk for alle som arbeider med, forsker på eller tar beslutninger om norsk kommuneforvaltning.

• Berg, Ole Trond; Hagen, Terje P.; Gjefsen, Hege Marie; Godager, Geir; Hart, Rannveig Kaldager & Kinge, Jonas Minet [Show all 13 contributors for this article] (2026). Organisering og finansering av helsetjenester. Fagbokforlaget. ISBN 9788245061505. 414 p. doi: 10.55669/oa1809. Full text in Research Archive Show summary

  Boken gir en bred innføring i organisering og finansiering av helsetjenester, med vekt på norske forhold. Den innledende bolken omfatter kapitler om helsetjenestesystemer og forsikringsordninger, betalingssystemer og demografiske endringer. I de følgende bolkene brukes de grunnleggende begrepene til å beskrive og analysere kommunehelsetjenesten og spesialisthelsetjenesten, samt samhandlingen mellom de to nivåene. Enkelte policy-orienterte temaer, som effektivitet og likhet i tilbudet, analyseres i egne kapitler. Den avsluttende bolken er viet komparativ helsepolitikk, med beskrivelser av land med sosialforsikringsordninger og private helseforsikringer. Utviklingen av EUs helsepolitikk beskrives i et eget kapittel. Bokens underliggende perspektiv er at organisering og finansiering er virkemidler i offentlig helsepolitikk. Dette er instrumenter som kan brukes til å redusere ulikhet i tjenestetilbudet, øke effektiviteten og heve kvaliteten. Boken inneholder oppdatert kunnskap om reformer og piloter fra de siste tiårene, også reformer i andre land som har relevans for norske forhold.

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• Hart, Rannveig Kaldager (2026). Ny NOU: Fødselstallsutvalget foreslår rullerende barnehageopptak. [Internet]. Barnehage.no. Full text in Research Archive Show summary

  Utvalget foreslår at alle barn får tilbud om barnehageplass fra fylte ett år, samtidig som det åpnes for at foreldre kan ha 70 uker med foreldrepenger med 70 prosent kompensasjon.

• Hart, Rannveig Kaldager & Skirbekk, Vegard Fykse (2026). Fødselstall under press. [Internet]. Tendens. Full text in Research Archive Show summary

  Norge får stadig færre barn. En ny utredning viser at årsakene handler om mer enn familiepolitikk.

• Horn, Sindre August; Omar, Omar Mwalim; Kagaigai, Alphoncina; Chola, Lumbwe & Chalise, Gita Dhakal (2026). Overcoming Uncertainty in Priority Setting: Multi-Country Experiences with Evidence-Informed Health Benefit Packages in Low- and Middle-income Countries. Full text in Research Archive
• Ekeli, Jonas Andersen; Kinge, Jonas Minet & Gjefsen, Hege Marie (2026). Sickness absence and Turnover in the Labor Market. Full text in Research Archive
• Danforth, Kristen; Botwright, Siobhan; Choudhary, Tarun Shankar; Hangoma, Peter & Chola, Lumbwe (2026). Integrating Systems Thinking into the FairChoices Model - Possibilities and Challenges. Full text in Research Archive
• Chola, Lumbwe; Kagaigai, Alphoncina; Johansson, Kjell Arne; Eldesoki, Nouran; Torpey, Kwasi & Omar, Omar Mwalim [Show all 7 contributors for this article] (2026). Explicit Priority Setting in Practice: Institutionalising Evidence-Informed and Value-Based Priority Setting for Universal Health Coverage. Full text in Research Archive
• Hart, Rannveig Kaldager (2026). Seminar om fødselstall. Full text in Research Archive Show summary

  Folkehelseinstituttet inviterer til seminar om fødselstall, helse og politikk på Litteraturhuset.

• Kravdal, Øystein & Hart, Rannveig Kaldager (2026). Health around the time of first birth matters for future fertility. Full text in Research Archive
• Hart, Rannveig Kaldager (2026). Fødsler i Norge: Kvinnen har vært både offer, skurk og helt. [Internet]. Forskning.no. Full text in Research Archive Show summary

  Hvordan kvinner omtales i norsk debatt om fødselstall, har endret seg de siste 50 årene. Men en ting går igjen: Ett kjønn får ansvaret, ifølge ny studie.

• Reme, Bjørn-Atle (2026). Legemiddelindustriens produktivitetsparadoks. Full text in Research Archive Show summary

  Når legemiddelindustrien og produsenter av medisinsk teknologi fremmer produktivitetsargumentet, argumenterer de i realiteten for økte budsjetter til seg selv.

• Berg, Inger Jorid; Asphaug, Lars; Kristianslund, Eirik; Tveter, Anne Therese; Gossec, Laure & Macfarlane, Gary J [Show all 12 contributors for this article] (2026). Patient-initiated follow-up is more cost-effective than remote monitoring or usual care in axial spondyloarthritis, results from the ReMonit randomized controlled trial. Full text in Research Archive
• Alvino, Miryam; Provan, Sella Aarrestad; Aas, Eline & Hagen, Gunhild (2026). COST-EFFECTIVENESS OF PNEUMOCOCCAL VACCINATION IN IN 50-YEAR-OLD PATIENTS WITH RHEUMATOID ARTHRITIS IN NORWAY-A MARKOV MODELLING ANALYSIS. doi: https:/scientific.sparx-ip.net/archiveeular/?c=a&searchfor=gunhild%20hagen&view=1&item=2026POS0422. Full text in Research Archive
• Hagen, Gunhild; Opheim, Anna K; Øverbø, Joakim; Aas, Eline & Provan, Sella Aarrestad (2026). COST-EFFECTIVENESS OF HERPES ZOSTER VACCINATION IN PATIENTS WITH RHEUMATOID ARTHRITIS. doi: https:/scientific.sparx-ip.net/archiveeular/?c=a&searchfor=gunhild%20hagen&view=1&item=2026POS0036. Full text in Research Archive
• Pavia, Fabiola; Provan, Sella Aarrestad; Aas, Eline; Dagfinrud, Hanne; Sveaas, Silje Halvorsen & Berg, Inger Jorid [Show all 8 contributors for this article] (2026). COST-EFFECTIVENESS OF A HIGH-INTENSITY EXERCISE PROGRAM FOR AXIAL SPONDYLOARTHRITIS: A MODELLING STUDY. doi: https:/scientific.sparx-ip.net/archiveeular/?c=a&searchfor=gunhild%20hagen&view=1&item=2026POS0192. Full text in Research Archive
• Schepers, Robin; Bennett, Schyler Marie; Anthun, Kjartan Sarheim; Asheim, Andreas; Bjerkeset, Ottar & Bjørnelv, Gudrun Maria Waaler [Show all 8 contributors for this article] (2026). Mental Health Diagnostic Practice Variation as an Instrument: Methodological Insights and Limitations. Full text in Research Archive
• Birkeli, Gørill; Ballangrud, Randi; Jacobsen, Hilde Kristin; Deilkås, Ellen Catharina Tveter & Lindahl, Anne Karin (2026). Collective Reflection and Learning Following the Green Cross Method. Full text in Research Archive Show summary

  The Green Cross method contributes to interprofessional discussions around patient safety incidents in daily safety briefings and weekly reflections. The Green Cross method was implemented in a Norwegian postanaesthesia care unit in February 2019. The purpose of this presentation is to report the findings following the implementation of the Green Cross method over a period of four years (2019-2022) regarding: How does the Green Cross method affect collective reflection and learning in a postanaesthesia care unit?

• Birkeli, Gørill; Lindahl, Anne Karin; Hammersbøen, Åse Marit; Deilkås, Ellen Catharina Tveter & Ballangrud, Randi (2026). Strategies and Tools to Learn from Work That Goes Well Within Healthcare Patient Safety Practices: A Mixed Methods Systematic Review. Full text in Research Archive
• Tjomsland, Ole; Thoresen, Christian; Ingebrigtsen, Tor; Jensen, Jens W; Møller, Henrik & Frich, Jan C [Show all 8 contributors for this article] (2026). Norwegian clinical dashboard: updated and expanded versions may lead to further Nordic collaboration. BMJ Leader. doi: 10.1136/leader-2026-001581. Full text in Research Archive
• Werdofa, Hirut Megersa & Lindahl, Anne Karin (2026). Perspectives on Disrespect and Abuse During Childbirth in a Tertiary Teaching Hospital in Ethiopia: Qualitative Studies of Women and Healthcare Providers. Universitetet i Oslo. ISSN 9788234809026. Full text in Research Archive Show summary

  Every woman deserves to give birth in a safe, respectful, and supportive environment. However, women experience disrespect and abuse during childbirth in healthcare facilities. This can affect their trust in healthcare services and their willingness to seek care in the future. This thesis explored what women and healthcare provides perceived about disrespect and abuse during childbirth at a teaching hospital in Southwest Ethiopia. The study used qualitative research design: in-depth interviews, focus group discussion and participant observation in the study hospital. Thirty-two women and thirty-two health providers (doctors, midwives, and nurses) shared their views in addition 325 hours participant observation conducted. Many women said they were neglected, had things done without consent and were treated as an object. Some had no privacy and could not have companion during labor. Some felt unable to make decisions about their care. Healthcare workers agreed care should be respectful, but sometimes perceived differently than the women. Staff shortages, workloads, and not enough supplies and lack of midwives involvement in women care identified as a factor. Some practice health care provides perceived as normal felt disrespectful to women. The study shows disrespect and abuse have many causes. To improve these sufficient supplies and providers may need to be trained to treat women with respect. Women may need to learn about their rights and make decisions about their own care. Communication, respecting women confidentiality, and working together as a team are important to reduce disrespect and abuse. Teaching hospitals need to balance student learning with women’s safety and comfort. Each form of disrespect or abuse might need to be explored as a distinct component to design appropriate intervention.

• Kaarbøe., Oddvar; Biele., Guido Philipp Emmanuel & Sannes, Joakim (2026). The Effect of Childhood Poverty on the Timing of Mental Health Diagnoses: Evidence From Norwegian Register Data. Universitetet i Oslo. Full text in Research Archive Show summary

  This master’s thesis examines whether persistent household poverty during childhood influences the timing of first mental health diagnoses among children in Norway. The background is the well-documented association between socioeconomic disadvantage and child mental health, and the challenge of separating the causal effect of poverty from the stable family characteristics that simultaneously predict both poverty exposure and mental health outcomes. The thesis addresses the following research question: To what extent does persistent household poverty during childhood influence the timing of first mental health diagnoses, and does this relationship differ across gender, immigration background, and diagnostic category? Three outcomes are studied: internalising disorders, ADHD, and autism spectrum disorder. Two complementary empirical approaches are employed using linked Norwegian administrative register data covering more than 1.2 million children observed from 2007 to 2022. The first uses a marginal structural model with inverse probability weighting to address time-varying confounding. The second uses a between-within Cox model with a Mundlak correction to control for stable unobserved family characteristics by separating within-family from between-family poverty variation. Both approaches use G-computation to derive marginal causal contrasts at age 15. The two approaches reach different conclusions, which is itself an important finding. The MSM finds that persistent poverty significantly increases the cumulative risk of a mental health diagnosis by age 15 for non-immigrant children across all three outcomes, with the strongest effect for ASD and the weakest for internalising disorders. The between-within model, which holds the family’s long-run poverty trajectory constant, finds no statistically significant within-family poverty effects for non-immigrant children. This divergence is consistent with the interpretation that the stable, chronic poverty environment of the family — rather than year-to-year income fluctuations — plays a more important role in the poverty-diagnosis association, though this conclusion depends on the identifying assumptions of the between-within model. For immigrant children, both approaches consistently document lower recorded diagnosis rates under persistent poverty, a pattern interpreted as reflecting systematic detection barriers including language barriers, cultural stigma, and reduced capacity to navigate the specialist referral system. The findings suggest that sustained poverty reduction may matter more than temporary income support for improving children’s mental health trajectories, and that reducing diagnostic inequalities among immigrant families requires culturally adapted outreach and improved support for navigating specialist referral pathways.

• Godager, Geir; Tjerbo, Trond; Mazzocchi, Mario & Schilfgaarde, Emiliya van (2026). Rewarding Reablement. A Qualitative Study of the Role of Provider Payment Systems in the Implementation of Reablement Interventions in the Dutch Healthcare System. Universitetet i Oslo. Full text in Research Archive Show summary

  Abstract Background: The Netherlands faces rising long-term care demand, increasing healthcare expenditure, and persistent workforce shortages, raising urgent questions about the sustainability of elderly care. Reablement, a person-centred and goal-oriented approach that helps older adults regain or maintain independence, has been identified in recent national agreements as a promising response. Despite growing international evidence and policy support, uptake in the Netherlands has remained limited. There is little research on how current payment systems are perceived to influence this limited implementation, particularly within the fragmented Dutch financing landscape. Research aim: This study aims to explore how stakeholders perceive the role of payment systems in the implementation of reablement interventions in Dutch elderly care, examine which barriers are seen to contribute to low uptake, and identify whether alternative financing mechanisms are considered relevant for supporting broader adoption. Methods: This study used a qualitative exploration through twenty semi-structured interviews with diverse stakeholders involved in reablement-based interventions. The analysis is informed by principal-agent theory, with attention to information asymmetry, moral hazard, common agency, and inter-domain externalities, and was conducted through reflexive thematic analysis. Key findings: Stakeholders generally regarded reablement as conceptually valuable and aligned with broader policy aims such as ageing in place and appropriate care. However, fee-for-service reimbursement was widely perceived to penalise successful reablement, as reduced future care use may lower provider revenues. Insufficient reimbursement of coordination, indirect care time, multidisciplinary collaboration, and paramedical services was reported as a further constraint. Fragmentation across financing structures was perceived to generate wrong-pocket externalities, weakening incentives for individual actors to invest in reablement. Short contracting cycles, evidence requirements, and dependence on temporary funding were described as additional barriers to structural embedding. Conclusion: Current payment systems are perceived as an important barrier to broader uptake of reablement in the Netherlands. No single payment model emerged as a complete solution. A combination of bundled payment, shared savings, pay-for-performance, multi-year contracting, and transition funding was considered more likely to support implementation. Payment reform alone, however, is regarded as insufficient without changes in leadership, organisational readiness, and cross-domain coordination.

• Holte, Jon Helgheim & Awoyemi, Opeyemi Linda R. (2026). Pasienttilfredshet og opplevd kvalitet i apotek. En PREM-basert studie (Patient Reported Experience Measures). Universitetet i Oslo. Full text in Research Archive Show summary

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• Kaarbøe, Oddvar Martin; Hegna, Bendik Westlund & Opheim, Ida Kristine (2026). Hovedtittel: Modellbasert sammenligning av elastomerpumper for hjemmebasert intravenøs antibiotikabehandling hos barn og ungdom Undertittel: En kostnadsminimeringsanalyse av hjemmebasert antibiotikabehandling hos barn og ungdom ved bruk av elastomerpumper, sammenlignet med tradisjonell behandling, med fokus på kostnadsbesparelser ved Akershus universitetssykehus. Universitetet i Oslo. Full text in Research Archive Show summary

  Sammendrag Fagområde og problemstilling Tradisjonell intravenøs antibiotikabehandling (CII) krever ofte opptil fire administreringer i døgnet, noe Avansert hjemmesykehus (AHS) ikke har kapasitet til. Pasientene må derfor behandles på sykehuset, som er dyrere enn behandling i AHS. Elastomerpumper (EIP) krever kun én administrering per døgn og gjør hjemmebehandling mulig. Studien undersøker derfor om økt bruk av EIP kan flytte flere pasienter til AHS og dermed redusere kostnader. Teorigrunnlag og hensikt Studien er en kostnadsminimeringsanalyse hvor behandlingsformene antas å ha like god effekt. Da sammenlignes kun kostnadene. Kostnadene beregnes ved å se på hvilke tjenester som inngår i behandlingen, og hensikten er å vurdere kostnader ved økt bruk av EIP. Metode Det er utviklet tre scenarioer som illustrerer ulike fordelinger mellom CII og EIP. Scenarioene kombineres med åtte behandlingsforløp som beskriver sykehusbehandling, overgang til hjemmebehandling og administrasjonsmetode. Det er også gjennomført en sensitivitetsanalyse der EIP-prisen justeres for å vurdere robustheten til analysen. Data og kilder Analysen bygger på anonyme interne data fra sykehuset. Kostnader for tjenester og personell er hentet fra tilgjengelige interne oversikter og gjeldende satser. Resultater og hovedkonklusjoner Dagens praksis gir en gjennomsnittskostnad på rundt 41 000 kroner per forløp, mens økt bruk av EIP gir om lag 37 000 kroner. Et scenario med høy andel hjemmebehandling gir en kostnad på omtrent 28 800 kroner. Analysen viser at kostnadene er lavest når behandlingen kan gjennomføres i AHS, og når antall daglige administrasjoner er få. EIP krever færre administrasjoner og gjør det dermed mulig at flere pasienter kan få behandling i AHS, som er rimeligere enn sykehusbehandling. CII krever flere administrasjoner og må derfor i praksis gis på sykehuset, noe som gir høyere kostnader. Studien viser dermed at behandlingssted og antall administrasjoner har størst påvirkning på kostnadene.

• Haugli-Stephens, Eline Aas - Thomas & Bjørnestad, Johanne Kristine Bondø (2026). Hovedtittel: Artificial Intelligence as decision support in early pharmaceutical development Undertittel: Comparing manual, Rule-based, and LLM-assisted extraction of HTA-reported parameters for early health economic modelling. Universitetet i Oslo. Full text in Research Archive Show summary

  Introduction Health technology assessments (HTA) and health economic modelling play a central role in determining access to new treatments in publicly funded healthcare systems. In early pharmaceutical development, models are built before mature clinical evidence is available and draw on multiple sources including existing HTA reports, particularly for informing the comparator arm. Manual extraction of relevant parameters is time-consuming and prone to error, motivating the exploration of automated and artificial intelligence (AI)-assisted approaches. This thesis examines how such methods perform in extracting model input parameters from HTA reports, and how differences in extracted inputs influence cost-effectiveness outcomes. Methods Three publicly available Norwegian HTA reports in oncology were included as data sources. Model input parameters were extracted using three methods: manual extraction, an automated R script developed with an AI-assisted coding tool, and LLM-assisted extraction using NotebookLM. Manual extraction served as the reference standard and methods were compared using completeness and agreement. Extracted inputs were applied in a predefined Excel-based early health economic model to assess practical relevance. A test case report and a short expert questionnaire were included to support methodological assessment. Results Performance was high for clearly defined parameters such as hazard ratios and the incremental cost-effectiveness ratio (ICER), but lower for parameters requiring analytical judgement. Differences in extracted inputs affected model outputs, and both automated extraction methods were considered to require human validation before use in early modelling. Conclusion AI-assisted extraction can support early health economic modelling by improving access to relevant HTA evidence, but extracted outputs require validation and expert interpretation. These methods assist rather than replace the health economists. As AI technology continues to evolve rapidly, further research should explore how extraction performance can be improved and integrated into early modelling workflows.

• Aas, Eline; Hagen, Gunhild & Senthilvasan, Niruththan (2026). Kostnadseffektivitet av Fracture Liaison Service ved fragilitetsbrudd. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Sammendrag og filene vil publiseres: 2028-05-15

• Frich, Jan & Hernes, Eivor (2026). Forskning blant norske leger. Strukturelle og arbeidsrelaterte faktorer assosiert med gjennomføring av doktorgradsstudier. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Sammendrag vil publiseres: 2031-05-05

• Grepperud, Sverre & Mohn, Kristin Greve-Isdahl (2026). Fra nødvendighet til virkelighet - Hvordan øke kliniske studier i Norge. En identifisering av hemmere og fremmere basert på intervju av ledere ved norske Universitet og Universitetssykehus. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Sammendrag og filene vil publiseres: 2027-05-05

• Hart, Rannveig Kaldager; Tiller, Heidi & Bogolova, Amina Issajevna (2026). The Cost of Postponement. A Health Economic Analysis of Maternal Age at First Birth and Delivery Costs. Universitetet i Oslo. Full text in Research Archive
• Spehar, Ivan & Midelfart-Hoff, Jana (2026). Den norske hjernehelsestrategien.Veien fra skrivebordsskuff til konkrete resultater. Universitetet i Oslo. Full text in Research Archive Show summary

  Bakgrunn og problemstilling: «Den norske hjernehelsestrategien 2018-2024» kom i 2017 som den første i sitt slag i verden. Bak stod et bredt fagmiljø, pasientstemmer, myndigheter og politikere. En vurdering gjort av Oslo Economics i etterkant, viste imidlertid at strategien i liten grad hadde ført til konkret handling. Dette ble blant annet knyttet til at strategien hadde en struktur med svært mange delmål, få målbare tiltak og ingen øremerket finansiering. Årlig lanseres det en rekke offentlige strategier i Norge, etter til dels ressurskrevende arbeidsprosesser i forkant. Spørsmålet er hva som blir resultatet av dem, og forskningsspørsmålet var derfor hva som skal til for at en strategi blir omdannet til handling Metode: Kvalitativ studie med semi-strukturerte intervju av ti nøkkelpersoner (ni norske, en internasjonal) innenfor helsevesenet, myndighetsnivå og politikk. Det var god spredning i bakgrunn og organisasjons tilknytning. Systematisk tekstkondensering ble brukt for å analysere data, som igjen ble tolket med inspirasjon fra organisasjonsteori og ledelsesteori. Resultater: Manglende øremerking av midler og medfølgende finansiering, og mangel på tydelighet og klare mål ble fremhevet som hemmere for implementering av en strategi. Mer overraskende var utsagnene om konflikt som nødvendig for å få oppmerksomhet og nå ut, fagfolks duale rolle (som kan både være fremmere og hemmere) samt behovet for forforståelse i befolkningen og betydelig jobbing før en strategi lanseres. Fysisk aktivitet var et tiltak for god hjernehelse mange kjente godt til. Konklusjon: For at en strategi på helsefeltet skal lykkes i å nå ut til befolkningen med effekt på samfunnsplanlegging og livsstil, må strategien prioritere og løfte frem noen tiltak. Effekten av tiltakene må være målbare og de må ha øremerket finansiering. Pasientinvolvering er viktig, og en strategi må følges av en informasjonspakke, hvor man gjerne kan bruke polarisering og tilstedeværelse i nye medier som virkemidler. På hjernehelsefeltet trengs tydelige fagstemmer, og de må få slippe til. En styrking av befolkningens hjernehelse vil forebygge sykdommer i hjernen og ha store positive ringvirkninger både for individ og samfunn.

• Tjerbo, Trond & Togobitska, Dana (2026). AI-Driven Recruitment Systems, Disability Inclusion, and Governance in Healthcare Organisations. Universitetet i Oslo. Full text in Research Archive Show summary

  Background Artificial intelligence (AI) is increasingly used in recruitment, particularly within healthcare organisations facing workforce shortages and pressures for efficiency. Although AI-driven recruitment systems are often presented as objective and efficient, concerns have emerged regarding their potential to reproduce exclusion, particularly for disabled candidates. Aim This study examines how AI-driven recruitment systems affect disability inclusion in healthcare organisations and explores how current governance approaches address these challenges. Methods A scoping review methodology was used to analyse 22 interdisciplinary sources on AI recruitment, algorithmic bias, disability inclusion, governance, and healthcare workforce pressures. The findings were synthesised through thematic analysis. Results The review found that exclusion operates not only through biased datasets, but also through the evaluative assumptions embedded within automated hiring systems. Standardised indicators of employability, communication, and productivity may disadvantage disabled candidates whose experiences do not align with dominant expectations. Existing governance frameworks were also found to focus mainly on measurable fairness metrics while overlooking broader structural and socio-technical forms of exclusion. Conclusion Improving inclusion in AI-driven recruitment requires more than technical bias mitigation. More effective approaches should incorporate accessibility-focused design, human oversight, and broader understandings of fairness that recognise diverse forms of experience and capability

• Hagen, Terje P. & Mohamed, Sadia (2026). Hospital Proximity and Outcomes in Sepsis: A Registry-Based Study. Universitetet i Oslo. Full text in Research Archive Show summary

  Abstract Background: Sepsis is a time-critical medical emergency in which treatment delay is directly associated with increased mortality. Norway's geography creates substantial variation in residential distance from the nearest emergency hospital, raising the question whether remote patients face systematically worse outcomes despite heavy investment in prehospital emergency services. Objectives: This research explores whether residential distance from the nearest emergency hospital is independently associated with clinical outcomes in Norwegian sepsis patients, including mortality, hospital length of stay, and readmission. Methods: Registry-based cohort study using NORCHER data. The study population comprised 46,060 sepsis admissions (2010–2019). Residential distance was categorised as 0–30 km, 31–80 km, and greater than 80 km. Logistic regression assessed the following binary outcomes (30-day, 60-day, and 365-day mortality, and 30-day readmission); linear regression assessed log-transformed length of stay. All models adjusted for age, sex, income, and 14 comorbidities. Results: No statistically significant association was found between residential distance and any mortality outcome or 30-day readmission. Point estimates for 30-day mortality showed a non-monotonic pattern (OR=1.14 for 31–80 km; OR=0.64 for >80 km), consistent with healthy survivor bias at the greatest distances. Patients residing more than 80 kilometres from hospital had significantly longer stays (β=0.092, p<0.001), corresponding to approximately 9.6% longer stays, equivalent to around 0.67 additional days at the median. A first-episode sensitivity analysis produced an apparent protective effect of distance (OR=0.43, p=0.042), also interpreted as healthy survivor bias. Conclusion: Residential distance from hospital is not significantly associated with sepsis mortality among admitted patients in Norway. This null finding is consistent with, but does not explicitly confirm, effective prehospital compensation for geographic barriers. A residual geographic inequality persists in hospital length of stay, with implications for geographic adjustment in hospital funding models.

• Hart, Rannveig Kaldager; Godøy, Anna Aasen & Jabnouni, Selma (2026). Foreldreskap og helserelatert fravær: En eventstudie av sykefravær, arbeidsavklaringspenger og uførepensjon. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Sammendrag og filene vil publiseres: 2031-05-15

• Hagen, Terje P. & Richardsen, Rebecca (2026). Hovedtittel: Transferring primary care responsibilities to the state-owned regional health authorities (RHAs) Understittel: How will alternative models of organizational and financial integration of primary care into the RHAs improve coordination of care? Universitetet i Oslo. Full text in Research Archive Show summary

  Background: Coordination issues in the Norwegian health care system stem from the organizational and financial split of responsibility (Sørge-for-ansvar) for primary care and specialist care, respectively between the municipalities and the state-owned regional health authorities (RHAs). In this master thesis, I evaluate how alternative models of organizational and financial integration of primary care services into the RHAs improve coordination of care. Methods: Qualitative data was derived through an iterative process from database literature searches, AI based literature searches, grey literature and elite interviews. The data was analyzed by a normative evaluation method. The alternative models are: 1) The current model (baseline) 2) Transferring the GPs to the RHAs, 2) Transferring the GPs + Nursing homes to the RHAs, 3) Transferring the GPs + Nursing homes + Home nursing to the RHAs, 4) Transferring the GPs + Nursing homes + Home nursing + Social care the RHAs. These five alternatives are evaluated against five criteria for health care improvement: reduced hospital use, better follow-up and rehabilitation, better cost control, provider well-being, and health equity. The cross-cutting section highlights the trade-offs related to cost control and local political participation for the alternatives. Results: The data reveals several advantages and disadvantages of the current health care model in Norway, but also for the alternative models of transferring primary care to the RHAs. It is found arguments that increasing the organizational and financial integration of care will reduce hospital use, provide better follow-up of patients, and enhance health equity. At the same time, there are evidence of significant challenges related to cost control and to some extent provider well-being. The alternatives relocate the main coordination failure rather than resolving it. Discussion: The results indicates that the alternative models accommodate different goals and intended effects. The model of recommendation depends on the prioritization of these goals. If the goal is coordination of care, this likely require transferring all primary care services. Implications: This thesis contributes to the field of health policy in Norway, and the lack of evidence on state responsibility of both primary care and specialist care. Further comparative studies are encouraged.

• Wangen, Knut Reidar; Lærdal, Fiona Béatrice & Prestegard, Maria Varmann (2026). Cost-effectiveness analysis of a treatment initiation for patients with chronic hepatitis B in Ethiopia​. Universitetet i Oslo. Full text in Research Archive Show summary

  Cost-effectiveness analysis of a treatment initiation for patients with chronic hepatitis B in Ethiopia​

• Hart, Supervisor: Rannveig Kaldager; Magnus, Co-supervisor: Maria Christine & Kussa, Meseret Urgecha (2026). Economic Burden of Delayed Childbearing: Maternal Pregnancy-Induced Hypertensive Disorder and Healthcare Costs. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract and files will be published: 2027-05-15

• Holman, Per Arne; Kristiansen, Ivar Sønbø & Knutsen, Amanda Bakker (2026). The Waiting Time Initiative: for politicians or patients? A study of Norwegian waiting time variation across urgency levels and organizational units (2024-2025). Universitetet i Oslo. Full text in Research Archive Show summary

  Title: The Waiting Time Initiative: for patients or politicians? Project description: This study examines how waiting times in specialist healthcare have changed following the implementation of the Waiting Time Initiative (WTI). The study focuses on how changes in waiting time were distributed across deadline levels, health trusts, specialties, and health trust units. Aim: The aim of the study is to describe the variation underlying the aggregate mean waiting time and to assess how deadline setting, waiting times and target attainment changed from 2024 to 2025. Background: Waiting times in Norway have increased in the years leading up to and following the COVID-19 pandemic. In response, the government launched the WTI in May 2024, aiming to reduce mean waiting times. Lower mean waiting times, however, do not necessarily translate into improved healthcare access for all. Methods: The study applied a retrospective observational design using administrative registry data from the Norwegian specialist healthcare service. The analyses included referrals ordinarily removed from the waiting lists in 2024 and 2025. Descriptive analyses were conducted to examine changes in assigned deadlines and mean waiting time following the WTI. Results: Mean waiting time decreased across most health trusts and specialties following the WTI. At the national level, mean waiting time declined from 72.6 to 63.6 days (-9.0 days), accompanied by a reduction of nearly 21,000 deadline breaches. In contrast, deadline setting changed only modestly, and deadlines became more standardized around weekly levels. The largest waiting time reductions occurred among patients with longer deadlines, with decreases of up to 49.8 days. Patients with the shortest deadlines experienced slight increase in mean waiting time, and more than 2,000 additional deadline breaches. Conclusion: Overall, the WTI appears to have improved waiting time performance, but not necessarily timely access for patients with the greatest medical need. Deadline setting changed only modestly. The largest changes occurred in how patients were scheduled relative to assigned deadlines. The findings highlight the limitation of mean waiting time as a stand-alone policy indicator and show the importance of examining who benefits from waiting time reductions.

• Chola, Lumbwe; Löffeler, Sven & Berg, Emma Sofie (2026). How cost-effective is immediate curative therapy versus conservative treatment for Norwegian men ≥75 years with non-metastatic high-risk prostate cancer? A pre-trial Markov model from a healthcare perspective. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract and files will be published: 2028-05-15

• PhD, Emily Annika Burger,; MSc, Jacopo Di Silvestre, & Andersrød, Sindre Wold (2026). Cost effectiveness of Atezolizumab plus Nab paclitaxel in metastatic triple negative breast cancer from a Norwegian perspective: A model-based analysis. Universitetet i Oslo. Full text in Research Archive Show summary

  Introduction: Metastatic triple negative breast cancer is an aggressive cancer subtype with limited treatment options in the metastatic setting. Atezolizumab plus nab paclitaxel is the recommended first line treatment option for patients with PD-L1 positive metastatic triple negative breast cancer. But the cost effectiveness of this treatment in Norway depends on updated survival evidence, comparator choice, treatment cost, and uncertainty in model inputs. The primary objective of this thesis was to update the existing cost effectiveness analysis with final overall survival and progression free survival data from Impassion130. This thesis also aims to examine the robustness and external relevance of the results using real world data but also identify at which price atezolizumab plus nab paclitaxel will be cost effective. Methods: A cost effectiveness analysis was conducted using a partitioned survival model with a 15-year time horizon to assess the cost effectiveness of atezolizumab plus nab paclitaxel compared with the relevant comparator for the Norwegian healthcare setting. Data was taken from Impassion130 trial, a randomized control trial conducted to look at atezolizumab plus nab paclitaxel versus nab paclitaxel alone. Data were obtained from the Norwegian CEA and from published literature. Results: Atezolizumab plus nab paclitaxel was associated with higher cost and improved health outcomes, in the probabilistic analysis it produced an incremental cost of 377 922 and an incremental QALY gain of 0,28, resulting in an ICER of NOK 1 332 802 per QALY gained. The incremental life years gain was 0,40, corresponding to an ICER of NOK 944 805 per LY gained. The secondary analysis with atezolizumab plus nab paclitaxel remained more costly and more effective, with an incremental QALY gain of 0,45, and an ICER of NOK 945 401 per QALY gained. In the threshold price analysis approximately 32% reduction in the acquisition cost of atezolizumab per dose was required for the intervention to become cost effective. Conclusion: Atezolizumab plus nab paclitaxel provided addition health benefits compared with the weighted standard treatment, but the incremental costs were high relative to QALY gains. The intervention needed approximately 32% discount on drug cost for it to becomt cost effective at WTP of 825 000 NOK. The intervention appeared not cost effective at the WTP threshold applied in this thesis.

• Choudary, Lumbwe Chola, Tarun & Siribeli, Rafael Reis (2026). The Economic Impact of Reimbursing the Treatment of Childhood Burkitt Lymphoma in Nigeria. An adapted cost-effectiveness analysis from a payer and societal perspective. Universitetet i Oslo. Full text in Research Archive Show summary

  Background: Burkitt Lymphoma (BL) is the biggest childhood malignancy and most common childhood cancer in sub-Saharan Africa, with survival rates significantly lower in low- and middle-income countries (LMICs) due to treatment abandonment, weak health systems, and socioeconomic barriers. Evidence from Ghana demonstrates that BL treatment can be highly cost-effective, and reimbursement through national health insurance schemes (NHIS) can reduce treatment abandonment and improve outcomes. This study evaluates the cost-effectiveness of National Health Insurance Authority (NHIA) reimbursement for BL treatment in Nigeria for children under 15 years and examines the transferability of an economic evaluation model from Ghana. Methods: A cost-effectiveness analysis was conducted using an adapted Markov model in Excel, comparing NHIA reimbursement with the current out-of-pocket treatment in Nigeria. The analysis adopted a societal perspective as the base case and a payer perspective as a secondary analysis. Costs included direct medical, direct non-medical, and indirect costs, while health outcomes were measured in disability-adjusted life years (DALYs). A lifetime horizon was applied according to Nigeria’s life expectancy, with a 3% discount rate for costs and outcomes. Model inputs were sourced from Nigeria and comparable sub-Saharan African settings due to data limitations. The threshold is based on the conservative WHO-CHOICE recommendation of one time the GDP per capita of Nigeria ($1084.20). Probabilistic sensitivity analysis (1,000 simulations), cost-effectiveness acceptability frontiers, and value-of-information analyses were conducted to assess uncertainty. A five-year budget impact analysis estimated the financial implications of NHIA reimbursement. Results: NHIA reimbursement increased treatment completion and reduced mortality, shifting survival from 13.5% to 32%. From a societal perspective, the incremental cost-effectiveness ratio (ICER) was of -$173 per DALY averted. From the payer perspective, the ICER was $199 per DALY averted. All probabilistic simulations were cost-effective under the assumed willingness-to-pay threshold. Direct non-medical costs accounted for approximately 55% of total costs, highlighting financial barriers as a major driver of treatment abandonment. The incremental budget impact of NHIA reimbursement increased from $0.89 million in 2027 to $4.20 million in 2031, representing approximately 0.04% of total health expenditure. Conclusion: NHIA reimbursement for childhood Burkitt lymphoma treatment in Nigeria is highly cost-effective and affordable, improving treatment completion by reducing financial barriers. Addressing both medical and non-medical costs is essential to reduce abandonment and improve survival. Furthermore, the consistency with evidence from similar settings supports the use of transferable economic models to inform timely policy decisions in data-limited LMIC contexts.

• Kinge, Jonas Minet & Lindstad, Ingrid Patricia Loennecken (2026). Economic viability of a single-responder paramedic vehicle in urban Norwegian emergency medical services: a micro-costing and break-even analysis. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract and files will be published: 2031-05-15

• Pedersen, Kine; Aas, Eline; Henkel, Pia Sofie & Horst, Annalena (2026). Evaluating ctDNA-guided Adjuvant Chemotherapy in Stage II Colon Cancer. A Distributional Cost-Effectiveness Analysis of Socioeconomic Inequalities in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  ctDNA-Guided Adjuvant Chemotherapy in Stage II Colon Cancer Introduction. Colon cancer places a substantial burden on healthcare systems worldwide. In Norway, 30% of patients are diagnosed with stage II disease, for which surgery is curative for most. However, recurrence risk remains heterogeneous, and decisions regarding adjuvant chemotherapy (ACT) often rely on clinician discretion due to limited prognostic indicators. Access to timely ACT may also be socially structured through differences in health literacy and patient–provider communication. Emerging diagnostics, such as circulating tumour DNA (ctDNA), may improve risk stratification in this population. This thesis, therefore, assessed the cost-effectiveness of ctDNA-guided ACT compared with standard care (SoC) in Norway and evaluated distributional impacts across socioeconomic (SES) groups. Methods. We conducted a model-based distributional cost-effectiveness analysis from a Norwegian healthcare perspective over a lifetime horizon. Model inputs were informed by Norwegian registry data and a previous Dutch cost-effectiveness analysis. Socioeconomic inequalities were incorporated through differences in timely ACT initiation (≤6 weeks). We developed a conceptual framework in which ctDNA could (1) reduce or (2) exacerbate health inequalities depending on implementation patterns. Treatment delays were assumed to reduce treatment effectiveness, increase ACT discontinuation, and cause utility decrements. Distributional outcomes included Atkinson and Kolm inequality indices and equally distributed equivalent (EDE) health. Results. Under base-case assumptions, ctDNA-guided care was cost-effective compared with SoC, with an ICER of NOK 388,238 at a cost-effectiveness threshold of NOK 495,000. Cost- effectiveness differences across SES groups were modest, with slightly more favourable outcomes in higher SES groups. Distributional analysis suggested a small reduction in relative inequality but a slight increase in absolute inequality. Although EDE health increased under both specifications, gains were smaller than those in mean health, indicating a marginal increase in inequality-related welfare loss (0.15%). Overall, the impact on health inequality was minimal. Timely access to ACT emerged as a key driver of both cost-effectiveness and distributional outcomes. Conclusion. ctDNA-guided care had a distributionally neutral effect on health inequality. The findings highlight the importance of timely ACT initiation in shaping both efficiency and equity outcomes. Incorporating a distributional perspective into conventional cost-effectiveness analysis may support more equity-informed decision-making in health technology assessment. Further research should better characterise ctDNA-related parameters and quantify the impact of treatment delays on health outcomes.

• Pedersen, Kine; Arneberg, Fredrik & Lana, Rebecca (2026). Cost-utility analysis of fenfluramine (Fintepla®) for CDKL5 deficiency disorder. An early health technology assessment for an orphan drug in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract will be published: 2027-05-15

• Berg, Ole Trond; Tenfjord, Mathea Nesset & Nguyen, Tina Thao (2026). Hovedtittel: Når regimer kolliderer Undertittel: En studie av styring og autonomi i den norske helseforetaksmodellen. Universitetet i Oslo. Full text in Research Archive Show summary

  Sammendrag Tittel: Når regimer kolliderer: En studie av styring og autonomi i den norske helseforetaksmodellen. Bakgrunn og formål: Masteroppgaven undersøker forholdet mellom styring og autonomi i spesialisthelsetjenesten etter helseforetaksreformen. Reformen ble lansert som en «ansvarsreform» der Stortinget skulle styre gjennom overordnede mål, mens helseforetakene ble tildelt økt autonomi for å fremme effektivitet. Formålet er å analysere om denne rolledelingen er realisert i praksis. Problemstillingen er: «Hvordan har forholdet mellom demokratisk styring på nasjonalt nivå og foretaksautonomi utviklet seg etter helseforetaksreformen, og hvorfor har det utviklet seg som det har?». Metode og teoretisk rammeverk: Oppgaven benytter et kvalitativt forskningsdesign basert på innholdsanalyse av blant annet parlamentariske data og statlige styringsdokumenter. I tillegg benyttes en casestudie av fødetilbudet i Kristiansund som et analytisk observasjonspunkt. Oppgaven anvender teori om styringsregimer, prinsipal-agent-teori og perspektiver fra New Public Management. Hovedfunn og konklusjon: Funnene viser at ambisjonen om Stortinget som «strategisk prinsipal» og foretakene som «autonome agenter» bare i begrenset grad er realisert. Utviklingen har i stedet vært preget av økt politisk involvering og mer detaljert styring, noe som har begrenset handlingsrommet på lavere nivåer. Årsaken til utviklingen kan forstås som en vedvarende kollisjon mellom styringsregimer, der effektivitetshensyn møter politiske krav om legitimitet og profesjonell autonomi. Politikernes insentiver til å gripe inn i enkeltsaker forsterker denne spenningen. Casestudien i Kristiansund viser at politiske vedtak utfordres av foretakenes faglige vurderinger og operative rammer. Oppgaven konkluderer med at spenningen mellom styringsregimene er en innebygd egenskap ved helseforetaksmodellen, som setter varige rammer for forholdet mellom politisk styring og foretaksautonomi.

• Godøy, Anna Aasen; Hart, Rannveig Kaldager & Pedersen, Maria (2026). Har komplisert fødsel konsekvenser for mødres sykefravær? En event studie med norske registerdata fra perioden 2009-2015. Universitetet i Oslo. Full text in Research Archive Show summary

  Har komplisert fødsel konsekvenser for mødres sykefravær? – En event studie med norske registerdata Bakgrunn: Norge har et av de høyeste sykefraværsnivåene i Europa, og kvinner er langt oftere sykemeldt enn menn. Sykefraværet øker markant for kvinner etter fødsel, men eksisterende litteratur skiller i liten grad mellom normale og kompliserte fødselsforløp. Det er begrenset forskning på de langsiktige konsekvensene av kompliserte fødsler for arbeidsmarkedstilknytningen. Denne studien har som mål å undersøke om komplisert fødsel er assosiert med høyere sykefravær og svakere arbeidsmarkedstilknytning sammenlignet med ukomplisert fødsel. Metode: Studien benytter koblede norske registerdata for 123 598 førstegangsfødende kvinner i perioden 2009-2015, og et event studie-design med et observasjonsvindu på fem år før og fem år etter fødsel. Differensielle effekter på sykefravær og arbeidsmarkedstilknytning estimeres ved ordinær minste kvadraters metode, med to sekundærutfall for bredere arbeidsmarkedstilknytning. Tre robusthetssjekker vurderer troverdigheten til hovedresultatene. Resultat: Hovedresultatet viser at kvinner med komplisert fødsel har gjennomsnittlig 0,532 færre sykefraværsdager per år i post-perioden, tilsvarende en reduksjon på 5,68 prosent relativt til kontrollgruppens gjennomsnitt. Analysen kan tyde på at resultatet drives av positiv seleksjon, der komplisertgruppen er eldre og har sterkere arbeidsmarkedstilknytning før fødselen. Når det kontrolleres for seleksjon på alder og yrkesinntekt, snur fortegnet på koeffisientene. Sekundærutfallene viser at komplisert fødsel er assosiert med svakere arbeidsmarkedstilknytning i post-perioden, men mønsteret kan reflektere konvergens mellom gruppene snarere enn en reell svekkelse. Konklusjon: Siden komplisert fødsel ikke er tilfeldig fordelt, kan ikke funnene tolkes kausalt. Funnene understreker viktigheten av å ta hensyn til seleksjon når sykefravær sammenlignes mellom grupper, og antyder at oppfølging etter kompliserte fødsler kan være et relevant område for videre forskning og politisk oppmerksomhet.

• Burger, Emily & Larsen, Vashti (2026). Keeping Mothers and Infants Together. A Cost-Effectiveness Analysis of Joint Inpatient Admission for Perinatal Mental Illness in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  Objective: This thesis, Keeping Mothers and Infants Together: A Cost-Effectiveness Analysis of Joint Inpatient Admission for Perinatal Mental Illness in Norway, evaluates whether specialist joint mother-baby inpatient psychiatric admission is cost-effective compared with single maternal inpatient psychiatric admission for women with severe perinatal mental illness in Norway. Perinatal mental illness can have serious consequences for mothers, infants, families, and healthcare systems, yet Norway has no widely established system of dedicated mother and baby units. Methods: A model-based cost-effectiveness analysis was conducted from a Norwegian healthcare sector perspective over a 12-month time horizon. A decision tree model compared specialist joint mother-baby admission with single maternal inpatient admission, including pathways for admission acceptance, recovery, readmission, persistent illness, community care, and delayed acute admission. Clinical probabilities were mainly informed by international comparative evidence, while costs were based on Norwegian unit cost sources, published literature, and structured assumptions where direct evidence was unavailable. Costs were expressed in 2025 Norwegian kroner (NOK), and outcomes were measured as maternal quality-adjusted life years (QALY). Probabilistic and deterministic sensitivity analyses assessed uncertainty, while secondary analyses explored integrated Norwegian joint admission arrangements and partner health spillover effects. Results: Joint admission produced higher maternal health outcomes than single admission, with mean QALYs of 0.70 and 0.59, respectively, corresponding to an incremental gain of 0.11 QALYs. However, joint admission was also more costly, with mean costs of NOK 376,066 compared with NOK 131,029. The incremental cost-effectiveness ratio was NOK 2,227,611 per QALY gained, exceeding the Norwegian willingness-to-pay threshold of NOK 825,000 per QALY. At this threshold, single admission had a 96% probability of being cost-effective. Secondary analyses indicated that results were sensitive to assumptions about service organization and broader family health effects. Conclusion: Specialist joint admission improved maternal health outcomes but was unlikely to be cost-effective under base-case assumptions. These findings should be interpreted while considering that the analysis used a healthcare-sector perspective, a 12-month time horizon, and international evidence for key parameters. Future research should prioritize Norwegian-specific evidence on costs, outcomes, quality of life, and long-term family impacts.

• Berg, Ole Trond; Tenfjord, Mathea Nesset & Nguyen, Tina Thao (2026). Hovedtittel: Når regimer kolliderer Undertittel: En studie av styring og autonomi i den norske helseforetaksmodellen. Universitetet i Oslo. Full text in Research Archive Show summary

  Sammendrag Tittel: Når regimer kolliderer: En studie av styring og autonomi i den norske helseforetaksmodellen. Bakgrunn og formål: Masteroppgaven undersøker forholdet mellom styring og autonomi i spesialisthelsetjenesten etter helseforetaksreformen. Reformen ble lansert som en «ansvarsreform» der Stortinget skulle styre gjennom overordnede mål, mens helseforetakene ble tildelt økt autonomi for å fremme effektivitet. Formålet er å analysere om denne rolledelingen er realisert i praksis. Problemstillingen er: «Hvordan har forholdet mellom demokratisk styring på nasjonalt nivå og foretaksautonomi utviklet seg etter helseforetaksreformen, og hvorfor har det utviklet seg som det har?». Metode og teoretisk rammeverk: Oppgaven benytter et kvalitativt forskningsdesign basert på innholdsanalyse av blant annet parlamentariske data og statlige styringsdokumenter. I tillegg benyttes en casestudie av fødetilbudet i Kristiansund som et analytisk observasjonspunkt. Oppgaven anvender teori om styringsregimer, prinsipal-agent-teori og perspektiver fra New Public Management. Hovedfunn og konklusjon: Funnene viser at ambisjonen om Stortinget som «strategisk prinsipal» og foretakene som «autonome agenter» bare i begrenset grad er realisert. Utviklingen har i stedet vært preget av økt politisk involvering og mer detaljert styring, noe som har begrenset handlingsrommet på lavere nivåer. Årsaken til utviklingen kan forstås som en vedvarende kollisjon mellom styringsregimer, der effektivitetshensyn møter politiske krav om legitimitet og profesjonell autonomi. Politikernes insentiver til å gripe inn i enkeltsaker forsterker denne spenningen. Casestudien i Kristiansund viser at politiske vedtak utfordres av foretakenes faglige vurderinger og operative rammer. Oppgaven konkluderer med at spenningen mellom styringsregimene er en innebygd egenskap ved helseforetaksmodellen, som setter varige rammer for forholdet mellom politisk styring og foretaksautonomi.

• Spehar, Ivan & Ikra, Ishrat Jahan (2026). Managing Studies, Motherhood, and Everyday Life: Challenges and Coping Strategies of Asian Immigrant Student Mothers in Oslo. Universitetet i Oslo. Full text in Research Archive Show summary

  Abstract Background: Research on the challenges and coping strategies of Asian immigrant student mothers in the Norwegian context remains limited, despite the substantial growth in the number of international female students in Norway. Aim: This study aims to investigate how Asian immigrant student mothers in Oslo manage their studies, motherhood, and everyday life, with a particular focus on the challenges they face, the coping strategies they employ, and the insights they gain from these experiences. Method: A qualitative phenomenological approach was employed. Semi-structured interviews were conducted with 11 first-generation immigrant mothers from six Asian countries, all enrolled in higher education while caring for at least one child under the age of six. Data were analyzed using thematic analysis. The study is grounded in intersectionality and role theory. Findings: Participants faced intersecting challenges across five domains: practical (role conflict, time scarcity, child sickness), structural (visa pressures, lack of online learning), financial, social and cultural (language barriers, absent family support, subtle discrimination), and emotional (maternal guilt, declining health). To cope with these challenges, participants relied on strategies such as spousal and peer support, advanced planning, lowering expectations, self-care, and use of formal welfare services such as kindergarten, healthcare, and Lånekassen. Despite these difficulties, participants reported personal growth, including increased self-confidence, multitasking abilities, and a greater sense of belonging through their student identity. Recommendations include expanding hybrid learning options, reviewing compulsory attendance policies, and extending family reunification visas for parents. Future research could include larger quantitative samples and immigrant student mothers engaged in paid work. Keywords: Immigrant student mothers; challenges; coping strategies; higher education; Norway.

• Hagen, Terje & Hart, Joshua (2026). Association Between Hospital Length of Stay and 365-Day Mortality Following Acute Myocardial Infarction: The Role of Post-Discharge Care Pathways in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  Abstract Association Between Hospital Length of Stay and 365-Day Mortality Following Acute Myocardial Infarction: The Role of Post-Discharge Care Pathways in Norway Background: Hospital length of stay (LOS) is often used when describing hospital activity and efficiency. However, LOS is difficult to interpret because it may reflect both the patient’s health condition and how care is organized after discharge. This is especially important for patients hospitalized with acute myocardial infarction (AMI), where recovery and follow-up may continue after the hospital stay. Objective: This thesis examines the association between hospital length of stay and 365-day mortality among patients hospitalized with AMI in Norway. It also examines whether this association differs between patients following a home-based care pathway and patients following an institutional care pathway after discharge. Methods: The analysis uses linked Norwegian registry data covering 36,349 AMI patients with an observed post-discharge care pathway. Logistic regression models are used to estimate the association between LOS and 365-day mortality. The analysis uses stepwise adjustment for care setting, age, sex, and comorbidities. An interaction model and stratified models are used to examine whether the LOS–mortality association differs by post-discharge care pathway. A propensity score matched analysis is added to compare institutional-care patients with similar home-based-care patients on observed characteristics. Robustness analyses are used to assess whether the results are sensitive to alternative LOS specifications and very long hospital stays. Results: The final analytical sample included 33,749 patients in the home-based care pathway and 2,600 patients in the institutional care pathway. Patients in the institutional care group were older, had more comorbidities, had longer hospital stays, and had higher observed 365-day mortality than patients in the home-based care group. In the unadjusted model, longer LOS was associated with higher odds of 365-day mortality. After adding a post-discharge care setting, the LOS estimate became smaller.The interaction model and stratified analyses showed that the LOS–mortality association moved in opposite directions across the two pathways: positive in the home-based care group and negative in the institutional care group. In the matched analysis, institutional care remained associated with higher 365-day mortality, while the difference in 30-day readmission was smaller and not statistically significant at the 5% level. Conclusion: The findings show that the association between LOS and 365-day mortality differs across post-discharge care pathways. LOS should not be interpreted as a direct measure of hospital quality or as a uniform indicator of patient risk. The findings suggest that what LOS captures depends on the post-discharge care pathway, and that it should be interpreted in that context rather than in isolation.

• Wangen, Knut Reidar; Lærdal, Fiona Béatrice & Prestegard, Maria Varmann (2026). ​​Cost-effectiveness analysis of a treatment initiation for patients with chronic hepatitis B in Ethiopia​. Universitetet i Oslo. Full text in Research Archive Show summary

  ​​Cost-effectiveness analysis of a treatment initiation for patients with chronic hepatitis B in Ethiopia​

• Berg, Ole & Rustadbakken, Marie K (2026). Doktor, hvordan har du det? En studie av utviklingen av legers arbeidstilfredshet - som en funksjon av legerolleutviklingen. Universitetet i Oslo. Full text in Research Archive
• Kittelsen, Sverre A. & Markussen, Tom E. (2026). Effektivitet i bruk av personell i kommunale omsorgstjenester: En DEA-analyse. Universitetet i Oslo. Full text in Research Archive Show summary

  Oppgaven analyserer effektivitet i bruk av personell i kommunale omsorgstjenester i Norge. Bakgrunnen er økende behov for omsorgstjenester og begrenset tilgang på arbeidskraft. Formålet er å undersøke nivået på teknisk effektivitet, variasjonen mellom kommuner, forskjellen mellom samlet og administrativ effektivitet, samt betydningen av skala og sentralitet. Analysen bygger på KOSTRA-data fra Statistisk sentralbyrå for 2024. Kommunene behandles som beslutningsenheter, og effektiviteten estimeres ved hjelp av dataomhyllingsanalyse (DEA). Modellen er inputorientert og estimeres med både variabelt og konstant skalautbytte. I standard DEA-modellen kan både administrative årsverk og pasient- og brukerrettede årsverk reduseres samtidig. I tillegg brukes en retningsbestemt DEA-modell (DEA.direct), der administrative årsverk kan reduseres, mens pasient- og brukerrettede årsverk holdes faste. Dette gir et mer isolert mål på administrativ effektivitet. Resultatene viser betydelig variasjon i effektivitet mellom kommunene. I standard DEA-modellen er gjennomsnittlig VRS-effektivitet 0,836 og medianen 0,834. Resultatene tyder dermed på at mange kommuner, gitt datagrunnlaget og modellens forutsetninger, har et potensial for å redusere samlet personellbruk uten å redusere tjenesteproduksjon. Skalaeffektiviteten er høy for de fleste kommuner, med en median på 0,981. Dette indikerer at forskjeller i skala bare i liten grad forklarer variasjonen i effektivitet. Administrativ effektivitet, målt med retningsbestemt DEA, er lavere enn samlet teknisk effektivitet. Median VRS-effektivitet i DEA.direct er 0,548. Dette tyder på større variasjon i bruken av administrative årsverk og støtte- og servicefunksjoner enn i samlet personellbruk. Resultatet må tolkes med forsiktighet, blant annet fordi variabelen også omfatter ledelse, renhold, kjøkken og andre støtte- og servicefunksjoner Analysen viser også at mer sentrale kommuner generelt har høyere effektivitet enn mindre sentrale kommuner. Dette kan henge sammen med geografiske rammebetingelser, reiseavstander, bosettingsstruktur og kommunestørrelse, men analysen gir ikke grunnlag for å fastslå årsakssammenhenger. Resultatene må tolkes som relative mål gitt den valgte modellen og datagrunnlaget. Analysen fanger ikke opp kvalitet, brukerbehov eller kompleksitet i tjenestene. Videre skiller ikke DEA mellom ineffektivitet, målefeil og tilfeldig variasjon.

• Moger, Tron Anders; Neumann, Kirill & Aamodt, Henrik (2026). Er robotassistert lungekreftkirurgi dyrt? Kostnader ved kirurgisk behandling av lungekreft før og etter oppstart av det robotkirurgiske programmet ved Akershus Universitetssykehus HF. Universitetet i Oslo. Full text in Research Archive Show summary

  I denne oppgaven blir kostnadene forbundet med tre ulike metoder for operasjon av lungekreft sammenlignet ved bruk av kostnad-per-pasient (KPP) data. Det sammenlignes to pasientkohort fra hhv. 2017 og 2025, eller før og etter at man tok i bruk en operasjonsrobot i 2018 ved Kar/thorax avdeling på Akershus Universitetssykehus HF (Ahus). Robotsystemene er dyrt utstyr, og for flere er det at man ikke ser at det gir besparelser eller bedre behandling det viktigste ankepunktet mot oppstart av robotkirurgiske programmer. Med denne oppgaven ønsket jeg å undersøke om oppstarten av robotkirurgien ved Kar/thorax avdeling ved Akershus Universitetsykehus HF har gitt økonomiske og behandlingsmessige gevinster eller ulemper for sykehus og pasienter. Undersøkelsen viser at robotassistert kirurgi har signifikant lavere kostnader enn begge de to andre metodene beregnet ved KPP data, både før og etter eksklusjon av kompliserte pasientforløp. Robotkirurgi har en prosedyrekostnad per pasient som er 22.700 NOK dyrere enn metodene brukt i 2017. Med komplikasjonsfrie forløp for alle metoder er likevel besparelsen i 2025 mot 2017 på omlag 30.000 NOK. Når alle faktorer ved pasientforløp, komplikasjoner og kostnader til drift beregnet ved KPP-variabler er medregnet, øker denne anslåtte innsparing per pasientforløp til om lag 80.000 NOK. De viktigste kostnadsdriverne for alle inngrepstypene var liggetid på sengepost og intensivavdeling samt operasjonstid. Denne oppgaven konkluderer med at bruk av robot i lungekreftkirurgien totalt sett er rimeligere og gir mindre kompliserte postoperative forløp, og at redusert komplikasjonsrate og kortere liggetid er hovedforklaringene på disse lavere kostnader.

• Feiring., Eli & Lyshaugen., Tonje (2026). Ledelse i endringsprosessen mot ny sykehusstruktur. En kvalitativ studie av fremmende og hemmende faktorer i Sykehuset Innlandet HF. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Sammendrag og filene vil publiseres: 2031-05-05

• Holte, Jon Helgheim & Sendi, Lorin (2026). Hovedtittel: Samhandling ved utskrivelse etter Samhandlingsreformen Undertittel: En narrativ litteraturstudie av samhandlingen mellom spesialist- og primærhelsetjenesten etter Samhandlingsreformen. Universitetet i Oslo. Full text in Research Archive Show summary

  Sammendrag Tittel: Samhandling ved utskrivelse etter Samhandlingsreformen En narrativ litteraturstudie av samhandlingen mellom spesialist- og primærhelsetjenesten etter Samhandlingsreformen. Prosjektbeskrivelse: Denne litteraturstudien undersøker hvordan samhandling mellom spesialist- og primærhelsetjenesten oppleves av helsepersonell i overgangsomsorgen, når pasienter skrives ut fra sykehus til kommunen. Bakgrunn og mål: Samhandlingsreformen ble innført med mål om å skape mer helhetlige og koordinerte helsetjenester gjennom bedre samhandling i helsetjenesten. 14 år senere peker en rekke evalueringer og studier på at samhandlingen mellom spesialist- og primærhelsetjenesten fortsatt er utfordrende. Når Helsereformutvalget i 2026 skal levere sin rapport om fremtidig organisering av norsk helsetjeneste, er det betydningsfullt å oppsummere hva forskningen faktisk har dokumentert om samhandlingen mellom tjenestenivåene. Hensikten med studien er å gi en oppdatert oversikt over hva forskningslitteraturen viser om samhandling mellom spesialist- og primærhelsetjenesten og hvilke faktorer som fremmer eller hemmer god samhandling. Metode: Studien er gjennomført som en narrativ litteraturstudie av norsk helseforskning, publisert etter Samhandlingsreformen trådte i kraft i 2012. Totalt 17 studier ble inkludert etter screening. Datamaterialet ble analysert ved tematisk syntese etter Thomas & Harden (2008). Resultater: Studiens overordnede funn er at samhandlingen mellom spesialist- og primærhelsetjenesten i overgang fra sykehus til kommune, er preget av svikt på flere områder. Litteraturen viser fire gjennomgående mønstre: svikt i informasjonsoverføringen, elektronisk kommunikasjon som utilstrekkelig løsning, maktasymmetri, kompetanseforskjeller og uklare ansvarsforhold og direkte kommunikasjon som fremmende faktor. Konklusjon: Samhandlingen mellom tjenestenivåene beskrives fortsatt som fragmentert, og funnene tyder på at forbedring krever tiltak på organisatorisk og strukturelt nivå. Studien gir et oppdatert kunnskapsgrunnlag som kan brukes til videre utvikling og forbedring av helsetjenesten.

• Morger, Tron; Spehar, Ivan & Fjermestad-Noll, Jane (2026). Big Five Personality Domains and Leadership Style A qualitative investigation among Healthcare Leaders in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  The study aimed at investigating the relationship between personality and leadership by looking at how personality influences leader emergence, leader effectiveness and leadership style, while also considering the effects of culture. The investigation was performed by qualitative interview of 6 leaders in the Norwegian public healthcare sector. Personality was assessed by using the Big Five Personality trait Domains, and leadership style was assessed by using Lewin’s leadership styles, autocratic, democratic and laissez-faire. Results from the study confirmed previous research by finding that leader emergence and leader effectiveness is positively linked to Extraversion, Openness, Conscientiousness and Emotional Stability, however the three different leadership styles showed different associations. The results further support previous findings showing that autocratic leadership style is correlated to high Extraversion, Conscientiousness and Emotional Stability, but negatively associated with Openness and Agreeableness. Democratic leadership style is associated with high Extraversion, Openness and Emotional Stability, and has a moderate positive link to Conscientiousness and Agreeableness. Laisses-faire leadership style is correlated to high Openness and Conscientiousness. The study found that all participants believed different leadership styles to be effective depending on the level of leadership, pointing to autocratic leadership style possibly being more effective at higher levels of leadership, democratic style may be desirable in middle management, and laisses-faire can be most effective in delegating leadership where competent and independent group members perform different tasks while working under a shared agenda. The participants reflections concurred with the theory of Lewin’s leadership style triangle, suggesting that the interplay between autocratic and democratic strategies yields an axis of structure, whereas the interplay of democratic and laissez-faire strategies yields the axis of freedom. In other words, top management should be utilised using autocratic strategies, providing structure, which can be translated into action by the democratic processes of middle management, by providing adequate levels of freedom and influence for the subordinates. Another way to put this is that autocracy requires distance, democracy requires proximity and laissez-faire/delegation requires trust and close collaboration. The study concluded that personality does indeed affect leader emergence and leader effectiveness, as the appropriate leadership style, shaped by the personality, is a mediating factor in effective leadership, and the cultural aspects outlining the leadership situation, are moderating factors of effective leadership.

• Aas, Eline & Kittelsen, Leo (2026). Cost-Utility Analysis of the KnowMAP Health Communication Intervention in Kidney Transplant Recipients in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  Background: Nonadherence to medication is a leading modifiable risk factor for late kidney graft failure. The KnowMAP health communication intervention significantly improved medication adherence in kidney transplant recipients at 24 months, but the economic value has not been assessed. Objective: To evaluate the cost-effectiveness of the KnowMAP intervention compared with standard post-transplant care in adult kidney transplant recipients in Norway from the perspective of the specialist healthcare service over a 24-month time horizon. Methods: A trial-based cost-utility analysis was conducted alongside the KnowMAP randomized controlled trial (ClinicalTrials.gov: NCT04296955) at Oslo University Hospital. Of 195 randomized patients, 191 were linked to hospital administrative data and 166 had complete quality-adjusted life year data after linear interpolation of missing intermediate values. Health-related quality of life was measured using the EQ-5D-5L scored with the Norwegian value set, and quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. Seven cost categories were estimated using Diagnosis-Related Group tariffs and the Norwegian unit cost database. Costs and effects accruing beyond 12 months were discounted at 4% per annum. Uncertainty was assessed using non-parametric bootstrapping with 5,000 replications. Deterministic and scenario sensitivity analyses were conducted. Results: Mean discounted costs were 157,621 NOK (KnowMAP) and 164,014 NOK (standard of care); mean discounted quality-adjusted life years were 1.717 (KnowMAP) and 1.688 (standard of care). The intervention was less costly (incremental cost: -6,393 NOK) and more effective (incremental QALYs: 0.029) and was therefore dominant over standard care. The incremental net monetary benefit was 14,396 NOK at a cost-effectiveness threshold of 275,000 NOK per QALY gained. The probability of cost-effectiveness was 84.2% at the Norwegian threshold, and the intervention was dominant in 62.0% of bootstrap replications. Results were robust across all sensitivity and scenario analyses. In a conservative scenario excluding hospitalization costs, the incremental cost-effectiveness ratio was 63,608 NOK per QALY gained, still well below the Norwegian threshold. Conclusions: The KnowMAP intervention was dominant compared with standard care over the 24-month trial period. Future model-based analysis incorporating long-term graft survival benefits may further strengthen the economic case.

• Spehar, Ivan & Mahamed, Hamdi Abdulkadir (2026). Migrant women's experiences of access to antenatal and intrapartum care in Europe: A scoping review. Universitetet i Oslo. Full text in Research Archive Show summary

  Abstract Title: Migrant women’s experiences of access to antenatal and intrapartum care in Europe: A scoping review Background: Migrant women may face several barriers when accessing maternity healthcare services in European countries, including language, cultural and structural barriers within healthcare systems. Although previous research has explored migrant women’s experiences of maternity care services, the literature remains scattered across different migrant groups and national contexts, while facilitators to care receive less attention. Aim: The aim of this thesis was to explore what is known about migrant women’s experiences of barriers and facilitators to accessing antenatal and intrapartum care in European countries. Method: A scoping review based on Arksey and O’Malley’s methodological framework was conducted to systematically map and synthesize existing literature related to migrant women’s experiences of accessing antenatal and intrapartum care in European countries. Results: The findings from this review indicate that migrant women’s experiences of accessing antenatal and intrapartum care are shaped by communication, structural, psychosocial, cultural, and social barriers. Communication and structural barriers between migrant women and healthcare professionals emerged as the most prominent barriers alongside cultural, psychosocial and social support barriers. Respectful, caring interactions with healthcare professionals, continuity of care, and social support were identified as important contributing to more positive care experiences. Conclusion: The findings highlight the importance of culturally aware and communication-oriented maternity care including antenatal and intrapartum services in improving migrant women’s care experiences in European countries.

• Pedersen, Kine & Christopher, Anojan (2026). Cost-effectiveness of digital home monitoring for patients with heart failure in Norway. Universitetet i Oslo. Full text in Research Archive
• Kinge, Jonas Minet & Haaland, Maiken (2026). Income-related Inequality in Chronic Pain: A population-wide registry-based study using the Concentration Index on diagnosed chronic pain conditions in Norwegian primary care (2008-2020). Universitetet i Oslo. Full text in Research Archive Show summary

  Abstract Background. Chronic pain is one of Norway's largest health burdens. About one in three adults report long-lasting pain, and its societal cost may reach four percent of GDP. It follows a socioeconomic gradient, yet its distribution across income has not been mapped population-wide. Universal healthcare and a strong welfare state cushion material pathways to inequality, making the country a useful setting. This study examines income-related inequality in diagnosed chronic pain in Norwegian primary care from 2008–2020, across diagnoses, age, sex, and time. Methods. The study uses a population-wide, repeated cross-sectional design covering over 65 million person-years. Three linked registers provided pain diagnoses from primary-care reimbursement claims, demographics from the population register, and household income from tax records. Eight pain diagnoses, six musculoskeletal and two headache-related, were studied alongside a composite any-pain indicator. Inequality was measured with the Concentration Index, ranking individuals by equivalized household income each year, with the Erreygers index as the primary measure. Results were tested for robustness with alternative variants, logistic regression, and demographic standardization. Results. Diagnosed chronic pain is concentrated among lower-income individuals, but the population-level gradient is small. The relationship is non-monotonic, peaking towards the middle and lowest at the top. It is several times stronger among working-age adults and steepest for musculoskeletal conditions, while pensioners show the opposite pattern. In the full population men lean pro-rich and women pro-poor; in working age both are pro-poor, more so among women. The gradient appears to weaken markedly over time, but standardization shows this is largely compositional: holding age, sex, and immigration constant, it does not fade and strengthens among working-age adults. The direction holds across robustness checks. Conclusion. Diagnosed chronic pain in Norway is unevenly distributed across income, with the greater burden at the lower end, mainly among working-age adults, women, and musculoskeletal conditions. Its apparent decline might reflect a changing population, not a weakening relationship. Because the gradient persists where access to care is comparatively equal, labor-market exposures merit attention. The findings describe pain diagnosed in primary care, not pain in the entire population, and make no causal claims.

• Wangen, Knut Reidar & Morka, Lars Kristian (2026). Audit findings in the risk-based reimbursement control of Norwegian general practitioners. A descriptive analysis of 2,429 controlled tariff items from reimbursement-control audits, 2020–2025. Universitetet i Oslo. Full text in Research Archive
• Burger, Emily; Bernie, Erwin & Pulkkinen, Laura (2026). Development of a Natural History Model of Oral Human Papillomavirus (HPV) and HPV-Attributable OPC in Norwegian Males for HPV Vaccination Policy Evaluation. Universitetet i Oslo. Full text in Research Archive Show summary

  Background: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and a recognised cause of oropharyngeal cancer (OPC), a malignancy whose incidence is rising and concentrated in men. Norway vaccinates adolescents with the bivalent vaccine and may move to a nonavalent vaccine at its next procurement tender, yet no Norwegian or Nordic model of oral HPV and its progression to OPC exists, and the country-specific evaluation that national guidelines require cannot currently be produced. Research objective: This thesis developed, calibrated, and partially validated a natural history model of persistent oral HPV infection and its progression to OPC in Norwegian males, intended as a methodological foundation for future cost-effectiveness analysis. Methods: A cohort-based, time-dependent state-transition model with duration-specific tunnel states was constructed to represent oral HPV acquisition, clearance, persistence, and progression to OPC across four genotype strata (HPV16, HPV18, HPV33, and HPVo). United States natural history curves were rescaled to a Northern European HPV16 prevalence target and to Norwegian HPV16-attributable OPC incidence through two-phase sequential calibration, combining deterministic optimisation with likelihood-weighted importance sampling. The calibrated model underwent internal and face validation and was applied to a Norwegian male birth cohort under no vaccination, bivalent, and nonavalent scenarios over a lifetime horizon. Results: The acquisition multiplier was 1.05, indicating that acquisition level is consistent with evidence, whereas progression required substantial downward scaling to 0.54 for earlier and 0.27 for later infection durations. Overall fit was statistically consistent with the Norwegian incidence data (chi-square 8.13, below the critical value of 16.92), and the deterministic and probabilistic estimates agreed closely. In the case application, bivalent vaccination averted 69.2% of lifetime OPC cases and a switch to nonavalent vaccination averted a further 53% of the remaining cases with the ranking of scenarios preserved across discount rates. Discussion and conclusion: This is the first Norwegian-calibrated natural history platform for oral HPV and HPV-attributable OPC in males. The dissociation between transferable acquisition and non-transferable progression shows that international curves cannot be applied to Norwegian policy questions without country-specific calibration. The results identify a substantial and largely preventable OPC burden in Norwegian men, while data scarcity and structural constraints define the priorities for subsequent development before a full cost-effectiveness analysis.

• Supervisors), Eline Aas (internal supervisors) / Gunhild Hagen & Sella Aarrestad Provan (External & Sihaloho-Nerås, Devina Aulia (2026). Healthcare Resource Utilization and Direct Cost Among patients with Axial Spondyloarthritis Before and After TNFi Initiation: A Norwegian Registry-Based Cohort Study. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract will be published: 2027-06-14

• Kinge, Jonas Minet & Larsen, Lena Osvoll (2026). Pharmaceutical Access in Norway: Why are New Medicines Rejected?. Rejection Rationales in Norway’s Decision Forum and Comparative Coverage Outcomes with Denmark. Universitetet i Oslo. Full text in Research Archive Show summary

  Despite sharing a common European regulatory starting point through the European Medicines Agency, countries differ substantially in how many authorized medicines become available within their national health systems. Norway ranks below both Denmark and the European average in cross-country availability surveys, raising questions about what drives negative coverage decisions in the Norwegian system. This thesis asks what justifications Norway's Decision Forum states for negative decisions, and whether Norway and Denmark differ systematically in their coverage outcomes when assessing the same hospital medicines. The thesis comprises two distinct analyses. First, the stated justifications for 213 negative decisions in Norway's Decision Forum were coded inductively from 66 published meeting protocols covering 2020-2025, yielding three main categories: high price, clinical uncertainty, and better-priced alternatives. Second, coverage outcomes were compared between Norway and Denmark using matched and unmatched samples of new active substances assessed in both countries during 2022-2025, with proportion tests and logistic regression. High price was the dominant stated justification in Norway, cited in 74.6% of negative decisions, while better-priced alternatives accounted for 23.0%. Uncertainty declined sharply from 44–46% in 2020–2021 to near zero from 2023 onward, a pattern that may reflect changes in protocol language rather than reduced evidentiary uncertainty. In the comparative analysis, Norway's approval rate exceeded Denmark's in the full dataset (69.4% versus 55.0%, p = 0.009), but this difference lost statistical significance when restricted to the same medicines assessed in both countries (p = 0.481). The findings suggest that the availability gap reported in cross-country surveys reflects differences in system architecture, particularly the extent of alternative access pathways, rather than differences in assessment outcomes. Excluding medicines accessible only on an individual patient basis from both countries' counts reduces Denmark's availability from 103 to approximately 65 and Norway's from 64 to approximately 62, leaving the two countries closely comparable. At the same time, the shift toward price-centered rejection language raises questions about whether protocol practices adequately distinguish between price barriers and evidentiary barriers to approval.

• Chola, Lumbwe; Kuhl, Melf-Jakob & Omondi, Nescillah Awino (2026). Cost-Effectiveness of FemBloc® vs. Tubal Ligation for Permanent Contraception in Norwegian Women Aged 25-50 A 25-year Hybrid Decision Tree Markov Model. Universitetet i Oslo. Full text in Research Archive Show summary

  This study assessed the cost-effectiveness of FemBloc®, a novel permanent contraceptive device, versus Tubal Ligation (TL), The standard of Care, for permanent contraception in Norwegian women aged 25-50 with secondary objectives being budget impact and equity. A hybrid decision-tree Markov model was developed over a 25-year time horizon using a hypothetical cohort of 1,000 women. Transition probabilities were derived from published literature, adjusted by an age-specific fecundity decay function. Uncertainty was characterised through probabilistic sensitivity analysis (PSA), Expected value of partial perfect information (EVPPI), scenario and subgroup analyses. FemBloc® was less costly (incremental saving: NOK 5,123) but yielded fewer Quality-Adjusted Life Years (QALYs) than TL (incremental difference: −0.0465), yielding an Incremental Cost-effectiveness ratio (ICER) of NOK 110,061/QALY. FemBloc® resulted in 0.2219 additional unintended pregnancies (UPs) per woman, with an incremental cost of NOK −23,088. However, CEAF showed TL remained optimal across all Willingness to pay (WTP) thresholds. FemBloc® was cost-effective in women aged 40–50 at NOK 100,000 WTP. EVPPI identified FemBloc® fail rate as the main parameter with uncertainty. FemBloc® is less effective but less costly than TL and its full adoption could save NOK 10.4 million for Regional Health Authorities. However, results support conditional reimbursement for women aged 40–50, pending long-term efficacy evidence.

• Burger, Emily & Santorelli, Alissa (2026). Cost-Utility and Budget Impact Analysis of Inavolisib in Combination with Palbociclib and Fulvestrant for PIK3CA-Mutated HR+/ HER2– Metastatic Breast Cancer in Italy. Universitetet i Oslo. Full text in Research Archive
• Øien, Henning; Holte, Jon Helgheim & Bergo, Henriette Ramm (2026). Socioeconomic Gradients in Influenza Vaccination Uptake: A Comparative Study of Norway and England. Universitetet i Oslo. Full text in Research Archive Show summary

  Influenza vaccination reduces the risk of severe illness and mortality among older adults. The WHO and EU have therefore set a target of 75 percent vaccination uptake among adults aged 65 years and older, but persistent socioeconomic inequalities in vaccination uptake hinder progress toward this target. Norway and England, with their distinct approaches to vaccine delivery, oer a unique opportunity to examine how structural dierences and broader social factors shape vaccination uptake. This study applies an observational panel design following the methodology of Currie and Schwandt (2016) to examine socioeconomic gradients in influenza vaccination uptake among adults aged 65 years and older in Norway and England across three influenza seasons. Local areas in both countries were ranked by socioeconomic status and divided into ventiles, each representing five percent of the population. Three regression models were employed to estimate the socioeconomic gradient within each country, analyze how it has evolved across influenza seasons, and compare trends between Norway and England. In Norway, the education-based gradient is strong and persistent, whereas the income- based gradient is weak and inconsistent. In England, the educational gradient is relatively flat, while the income gradient has increased progressively across influenza seasons. Cross-country comparisons indicate that trends in the income-based gradient diered significantly between the two countries. The socioeconomic gradients in Norway and England have moved in dierent direc- tions depending on the dimension of socioeconomic status examined. Each country faces distinct challenges that require tailored policy responses. In Norway, a more proactive model that reduces reliance on individual initiative, while England tar- geted policies in the most deprived upper-tier local authorities. The findings further demonstrate that socioeconomic inequality in vaccination uptake is shaped by the interplay among individual resources, local context, service organization, financing, and communication, and that vaccination policy should be evaluated not solely on national uptake levels but also on how uptake is distributed across the socioeconomic distribution.

• Tjerbo, Trond & Vanthournout, Chiara (2026). Emergency Department Nurses’ Experiences Caring for Patients with Harmful Substance Use: A Scoping Review. Universitetet i Oslo. Full text in Research Archive Show summary

  ABSTRACT Objective. To explore the challenges experienced by emergency department (ED) nurses when caring for patients with harmful substance use. Design. Scoping review using thematic synthesis of qualitative, quantitative and mixed methods studies. Data sources. Embase, Scopus, PubMed, CINAHL, PsycINFO, and Cochrane Library were searched for studies published between January 2010 and March 2026 Study Selection. Primary empirical studies examining the challenges, experiences, perceptions or attitudes of ED nurses caring for patients with harmful substance use were included. Studies conducted outside ED settings, studies focusing on psychiatric nurses, and non-empirical literature were excluded. Data Extraction. Data were extracted on study characteristics, methodology, study population and key findings. Findings were analysed using thematic analysis to identify recurring patterns and challenges across studies. Results. 15 studies were included in the final synthesis. Four overarching themes were identified: system and organisation constraints, safety and risk in the ED, perceptions of patients with harmful substance use, and care delivery. The findings indicate that substance- induced presentations intensified existing pressures within emergency care, particularly through time constraints, limited guidance, and inadequate preparedness. Nurses also reported substantial emotional and motivational strain, including frustration, hopelessness, and emotional distancing in response to repeated challenging patient encounters. Conclusion. Emergency nurses caring for patients with harmful substance use face substantial structural and emotional challenges. The findings point to a misalignment between the organisation and preparedness of emergency care and the needs of patients, underlining the need to reconsider how substance-induced presentations are managed in EDs to improve nurses’ well-being and patient care. Keywords: Emergency department, nurses, emergency nurses, substance use, substance use disorder, harmful substance use, scoping review

• Tjerbo, Trond; Mekelenkamp, Hilda & Aalders, Koen (2026). “When is it good?” Decisional needs and user preferences for a web-based decision support tool for paediatric patients and their caregivers considering haematopoietic stem cell transplantation or gene therapy: a qualitative focus group study. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract will be published: 2031-06-01

• Holte, Jon Helgheim & Hohmann, Simon Jonas (2026). Trajectories of Healthcare Utilization in patients with chronic obstructive pulmonary disease in Norway. As part of the INOREG project (INnovations in use Of REGister data). Universitetet i Oslo. Full text in Research Archive Show summary

  Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition requiring long-term, cross-sectoral healthcare management. This study applied state sequence analysis (SSA) to Norwegian national health registry data to identify distinct longitudinal healthcare utilisation trajectories among COPD patients following an index hospitalisation. The study population comprised 23,078 patients drawn from linked primary care, specialist, hospital, and medication registries with national coverage across Norway. Healthcare contacts were classified into seven mutually exclusive states combining care setting and reason for contact, and sequences were constructed over a 24-month post-index period using monthly time units. Dissimilarities between sequences were computed using optimal matching with transition-rate-based substitution costs, and hierarchical clustering using Ward's method was applied to the resulting dissimilarity matrix. A six-cluster solution was selected based on statistical criteria and clinical interpretability. The six groups ranged from near-complete disengagement from the healthcare system (28.6% of patients) to sustained high-intensity respiratory care with recurring hospitalisations (9.3%). In three of six groups, non-respiratory contacts came to dominate over respiratory care, suggesting that comorbidity burden substantially shapes care patterns even in a COPD-defined population. Respiratory medication intensity varied considerably across groups, with the highest-intensity trajectory showing continued escalation into the second post-index year while all other groups plateaued. Triple therapy was the most commonly reached regimen in the two highest-intensity groups (57.4% and 64.7%), though this remained below clinical expectations for a post-hospitalisation COPD population. The trajectory structures identified were broadly consistent with findings from two Canadian SSA studies, though notable differences — including a smaller low-use group and a larger share of non-respiratory-dominant trajectories — point to potential influences of healthcare system organisation. The study demonstrates the value of sequence-based methods for characterising chronic disease management at the population level and identifies subpopulations whose care patterns warrant further clinical and policy attention.

• Aas, Eline & Schoenmakers, Jurre (2026). Cost-effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated ABC-type Diffuse Large B-Cell Lymphoma. Universitetet i Oslo. Full text in Research Archive Show summary

  --- Abstract will be published: 2031-06-01

• Hagen, Terje P. & Jensen, Julie Westerveld (2026). Geographic Variation in the Allocation of User-Controlled Personal Assistance (BPA) across Norwegian Municipalities. A Two-Part Analysis Using Norwegian Register Data from 2022 and 2023. Universitetet i Oslo. Full text in Research Archive Show summary

  Background: User-controlled personal assistance (BPA) is an alternative form of practical assistance for persons with a high level of functional impairment. In Norway the scheme was enacted as an individual statutory right in 2015, but remains financed and administered by municipalities. Variation in access to the scheme and in the number of hours granted has long been debated and is often referred to as a “postcode lottery”. This study analyses geographical variation in BPA allocation and its association with characteristics of the individual and the municipality. Methods: Individual register data from the Norwegian Patient Registry (NPR) and the Norwegian Registry of Primary Health Care (KPR) were linked to municipal data, with prior home care measured in 2022 and BPA receipt and hours observed in 2023. Allocation was modelled as two decisions: receipt of BPA, estimated with a multilevel logistic regression, and weekly hours among recipients, estimated with a Gamma generalized linear mixed model with log link. Both included a random municipal intercept and adjusted for individual need and municipal characteristics, with free revenues per capita as the main variable of interest. The primary analysis used a homogeneous sample of N = 48,992 individuals in five diagnostic groups common in the scheme; the models were estimated on the full home care population (N = 120,894) as a robustness check. Results: Of 120,894 home care recipients, 3,036 received BPA in 2023, in 257 of 355 municipalities, while 98 had none. Between 9 and 14 per cent of variation in both receipt and hours lay at the municipal level. In the diagnosis sample, need dominated both margins. Prior home care above the statutory thresholds was the strongest predictor of receipt (OR roughly 29 and 73), and a one-SD increase in physical impairment was associated with 42% more weekly hours (RR 1.42). Adjusting for need, demographics and municipal characteristics, free revenues per capita showed no association with hours (rate ratio 0.99-1.00). For receipt only a weak association in the full sample (OR 1.15), with no concentration in the discretionary 25-32 hour band. Population size was the only municipal characteristic consistently associated with receipt (OR 1.33). Conclusion: Variation in allocation was associated mainly with individual need, while municipal fiscal capacity was at most weakly associated with receipt and unrelated to hours, a finding that runs counter to previous research on home care services, but may reflect a strongly rights-anchored scheme.

• Spehar, Ivan & Lahn-Johannessen, Matilde (2026). What Makes People Stay?, Leadership Practices and Sustainable Work Environments in Norwegian Residential Care Homes. Universitetet i Oslo. Full text in Research Archive Show summary

  This thesis examines how leadership practices are experienced and understood in relation to the work environment and employee retention in Norwegian municipal residential care homes for people with varying support needs. Against the background of a documented workforce crisis in the Norwegian health and care sector, in which high turnover and sickness absence threaten the sustainability of services, this study asks not why employees leave but what makes them stay. A qualitative case study was conducted across three residential care homes, drawing on ten semi-structured interviews with eight frontline employees and two unit managers. The data were analysed using thematic analysis, guided by a conceptual framework combining leadership theory and the Job Demands-Resources model. Four themes were identified: relational bonds, present and supportive leadership, structural job resources and systemic challenges threatening sustainability. The findings suggest that the bond employees form with residents and colleagues is the most fundamental retention factor, though one that may be difficult to sustain over time without supportive unit-level leadership and sufficient organisational resources. Present, recognising and structurally clear leadership came through as central to a sustainable work environment, while chronic understaffing and unresponsive district and municipal leadership were found to undermine it. This study adds nuance to the Job Demands-Resources model by showing how collegial support can simultaneously buffer and mask unsustainable demands, delaying rather than preventing organisational strain. The thesis concludes that retention should be understood not as the absence of turnover but as the product of relational, leadership and structural conditions that must be actively created at every level of the system.  

• Hagen, Terje P. & Nilsen, Jørgen Agnalt (2026). Do Hospital Waiting Times Affect General Practitioners' Referral Rates for Obesity Care and Bariatric Surgery? (2010-2024). Universitetet i Oslo. Full text in Research Archive Show summary

  Background: Waiting times for elective specialist care are a persistent policy concern in Norway. General practitioners act as gatekeepers to specialist services, and variation in referral rates may reflect both patient need and supply-side constraints such as waiting times. This thesis examined trends and variation in GP referral rates for obesity-related specialist care in Norway over the period 2010–2024, with a particular focus on whether waiting times affected referral behavior. Methods: Individual-level registry data from NPR, KUHR, and SSB were used, covering 143,382 referrals across 22 hospital trusts (HFs). The primary analysis used negative binomial multilevel regression at municipality level, with lagged mean waiting time as the key explanatory variable. A supplementary OLS regression was conducted at the HF level. Both analyses added patient characteristics, capacity, socioeconomic and GP variables sequentially. Results: Referral volumes more than doubled between 2010 and 2021, while bariatric surgery volumes declined after 2019. Mean waiting time to first consultation improved markedly over the period, while total waiting time to surgery increased. Considerable variation in referral rates was observed across regions and hospital trusts, with Helse Nord recording the highest population-adjusted rate despite having the smallest catchment population. Lagged mean waiting time was not statistically significant in any model, with an implied demand elasticity of −0.034, lower than comparable international estimates. Comorbidity burden and the share of elderly patients were positively associated with referral rates, while higher education levels and list pressure were negatively associated. Junior GPs referred more than experienced GPs, suggesting clinical experience influences referral thresholds. Explained variance increased from 24.5% to 83.3% when HF fixed effects were added, indicating that stable between-HF differences dominated variation in referral rates. Conclusion: No evidence was found that waiting times affected GP referral rates for obesity care in this study. Persistent structural differences across hospital trusts, rather than time-varying capacity constraints, appeared to be the main driver of variation. These findings suggest that reducing unwanted referral variation may require more attention to referral quality, GP support, and socioeconomic differences in access, than to waiting time management alone. However, the observational design limits causal conclusions.

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