Eline Aas

• 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.

• 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.

• 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.

• 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.

• Hjelle, Ellen Gabrielsen; Nielsen, Tove Lise; Bragstad, Line Kildal; Kruse, Naja Benigna; Vester, Louise Buus & Haavaag, Silje Bjørnsen [Show all 16 contributors for this article] (2026). Feasibility and acceptability of the cross-national multisectoral OPTIM-PARK intervention for people affected with Parkinson’s disease and their family carers. BMC Health Services Research. doi: 10.1186/s12913-026-14912-5. Full text in Research Archive Show summary

  Abstract Background Parkinson’s disease (PD) is a common neurological disease worldwide. Management of PD is complex, requiring person-centred care to address the physical, emotional, social, and economic impacts of the disease. The OPTIM-PARK intervention was developed to enhance the process of living with PD for people affected and their family carers (FCs) by designing inter- and multisectoral collaboration and incorporating a coordinator role in four European countries: Denmark, Norway, Spain, and the United Kingdom. The aim of this cross-national study was to evaluate the feasibility and acceptability of the OPTIM-PARK intervention in community settings. Methods A mixed-methods convergent design was applied, including quantitative analysis of registrations, outcome measures and an Acceptability scale, as well as qualitative analysis of Logs and Mapping of Resources, and semistructured interviews. The focus of the three months intervention was a PD coordinator who undertook a personalized needs assessment and provided information and support, strengthened multi- and intersectoral collaboration, and optimized access to and use of community resources and other third sector support systems. Results A total of 130 participants were included in the intervention, 72 people with PD and 58 of their FCs. The intervention was typically provided in three consultations. The PD coordinator focus was on individualized support through active listening in the delivery of healthcare interventions. Inclusion of FCs were highly valued. Completion of the outcome measures was feasible, 105 (81%) participants were able to complete outcomes at both time points with <5% missing data. Most participants (92%) found it easy to answer the questionnaires, the use of digital tools for data collection was found beneficial if the participant were comfortable with the digital format. Conclusions To the best of our knowledge this is the first cross-national European study exploring the feasibility of a PD coordinator focussed support to enhance the process of living with PD. The findings suggest that the OPTIM-PARK intervention was feasible and well-received in a community setting across different countries, suggesting potential for wider application and further evaluation in a larger-scale trial.

• Geisler, Benjamin P.; Holmboe, Fredrik; Starinieri, Irene & Aas, Eline (2026). Applications of Structural Expert Elicitations for Economic Evaluations: A Systematic Review Update. PharmacoEconomics (Auckland). ISSN 1170-7690. doi: 10.1007/s40273-026-01628-x. Full text in Research Archive Show summary

  Background Structured expert elicitation (SEE) has become increasingly important in health technology assessment and economic evaluations. Complementing previous work, we aimed to synthesize recent developments in published SEE applications within health economics over the past 8 years. Methods A systematic literature search was conducted in Medline and Embase databases from April 2017 to February 2026, supplemented with snowball sampling, to identify applications of SEE as part of economic evaluations. Data extraction and synthesis focused on expert selection, elicitation methods, and analytical techniques to identify commonalities and gaps. Results In total, 28 studies met the inclusion criteria. SEE applications covered diverse health interventions, from rare diseases treatments to diagnostic accuracy assessments. The number of experts recruited through purposive sampling varied from 1 to 18 clinicians per study. SEE processes remain bespoke and diverse, spanning from paper-based to software-assisted remote techniques. The studies used mainly variable and fixed interval methods (29% versus 67%) for encoding. Aggregation methods were mainly mathematical, with some studies using consensus approaches. Most studies (75%) directly incorporated pooled expert distributions into decision models. Conclusions While SEE methods vary considerably across applications, suggesting that optimal approaches have yet to emerge, there is growing recognition of their potential for informing healthcare decision-making where empirical data are scarce, particularly in rare diseases and early-stage technology assessment. Future research should prioritize standardizing best practices, validating expert predictions against subsequently available empirical data, and developing enhanced bias mitigation strategies to improve the credibility of expert-informed health economic evaluations.

• Henkel, Pia Sofie; Pedersen, Kine; Tasken, Kjetil; Hult, Ebba Hallersjö; Gelderblom, Hans & Fagereng, Gro Live [Show all 8 contributors for this article] (2026). Precision cancer medicine in Europe: a mixed-methods study on infrastructure for extended molecular diagnostics. Journal of Cancer Research and Clinical Oncology. ISSN 0171-5216. 152. doi: 10.1007/s00432-026-06468-y. Full text in Research Archive Show summary

  Purpose Precision cancer medicine (PCM), targeting cancer treatment to patients’ individual genomic profiles, has the potential to improve diagnosis and outcomes substantially. Implementing PCM in healthcare systems requires that extended molecular diagnostics are accessible as part of routine practice. We conducted a mixed-methods study to identify and inform the infrastructure necessary for the implementation of extended molecular diagnostics as part of the health care system. Methods To identify and inform relevant categories of necessary infrastructure, we combined a survey, a structured literature search, and expert interviews. The survey included questions on reimbursement and technology assessment of diagnostics for PCM. Findings from the structured literature search were grouped to identify categories of infrastructure together with emerging themes in interviews with experienced oncologists, pathologists, and health technology assessment experts. Results 44 respondents from 20 countries participated in our survey. We identified and included 45 published papers, and seven experts were interviewed. We identified six key categories for implementing PCM as part of the healthcare system: physical, financial, organisational, competency, data and legal infrastructure. Our combined data sources revealed several themes to promote implementation, including the importance of centralisation of testing, the need for sustainable reimbursement, engagement of relevant stakeholders, interoperability of data infrastructure, and inter-disciplinary collaboration. Conclusion Our results highlight the need for interdisciplinary approaches and the value of initiatives to establish infrastructure within and across countries. While several European countries have come a long way in implementing diagnostics for PCM, considerable work remains to ensure equitable access for patients in need.

• Holly, Teresa; Brun, Marthe Kirkesæther; Jørgensen, Kristin Kaasen; Goll, Guro Løvik; Sexton, Joseph & Gehin, Johanna [Show all 15 contributors for this article] (2026). Cost-effectiveness of proactive therapeutic drug monitoring of maintenance infliximab treatment in patients with immune-mediated inflammatory diseases: results from a randomised controlled trial. RMD Open. 12(1), p. 11–11. doi: 10.1136/rmdopen-2025-006329. Full text in Research Archive Show summary

  Objective: Proactive therapeutic drug monitoring (pTDM) intends to optimise tumour necrosis factor (TNF) inhibitor treatment through regular assessment of drug and antidrug antibody levels, enabling individualised dosing. However, health economic evidence for this strategy is limited. This study aims to evaluate the health benefits and costs of pTDM with infliximab compared with standard therapy. Methods: Based on the 52-week randomised, controlled, open-label, multicentre Norwegian Drug Monitoring trial (NOR-DRUM) B trial, we estimated the cost-effectiveness of pTDM compared with standard infliximab maintenance therapy in patients with six different immune-mediated inflammatory diseases. For each patient (n=454), we estimated the 12-month healthcare costs, including pharmaceuticals, biochemical tests and other types of resource use. Reported in 2024 Euros, unit costs were based on market prices, diagnosis-related group cost weights and reimbursement schedules. We evaluated health outcomes with quality-adjusted life-years (QALYs), using the EuroQol five-dimension, three-level questionnaire (EQ-5D-3L) and Short Form six-dimension health utility measure (SF-6D). Indicator of cost-effectiveness was the incremental cost-effectiveness ratio, expressed as Euros/QALY, compared with an assumed cost-effectiveness threshold value of €23 755. We assessed sampling uncertainty using the non-parametric bootstrap. Results: The mean 1-year cost per patient in the pTDM group was lower than in the standard therapy group, with a difference of €592 (95% CI −1304 to 107), while the QALYs based on EQ-5D-3L were 0.0018 higher (95% CI −0.0126 to 0.0165). Based on the bootstrap results, pTDM has a probability of 95% of being cost-effective. In explorative subgroup analyses, pTDM appeared cost-effective for some, but not all diagnoses. Conclusion: pTDM is very likely a cost-effective treatment strategy for patients with immune-mediated inflammatory diseases on infliximab maintenance therapy.

• Haukaas, Fredrik Schaug; Bjørnelv, Gudrun Maria Waaler & Aas, Eline (2026). Opportunity costs and cost-effectiveness thresholds. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.25.0759. Full text in Research Archive Show summary

  Alternativkostnaden legges til grunn for innføring av nye behandlinger i Norge og skal bidra til bruk av kostnadseffektive tiltak. Stortinget har i vurdering av ny prioriteringsmelding bedt regjeringen utrede et sikrere anslag på alternativkostnaden basert på norske helsedata. Hva betyr det?

• Frisell, Oskar; Aas, Eline; Henkel, Pia Sofie; Fagereng, Gro Live; Tasken, Kjetil & Hult, Ebba Hallersjö [Show all 8 contributors for this article] (2026). A conceptual health economic modelling framework to assess the cost-effectiveness of molecular target–driven treatment regimens in oncology. Acta Oncologica. ISSN 0284-186X. 65, p. 141–147. doi: 10.2340/1651-226x.2026.45088. Full text in Research Archive Show summary

  Background and purpose: Molecularly targeted cancer therapies challenge conventional health economic evaluation frameworks that are structured around tumour-specific indications, comparators, and trial designs. Existing models often rely on pooled estimates from heterogeneous early-phase evidence or single-indication analyses, creating uncertainty for reimbursement decision-makers. We propose a conceptual modelling framework that aligns cost-effectiveness analyses with the biological rationale of precision oncology, evaluating therapies according to shared molecular alterations across tumour types. Patient/material and methods: We examined the methodological limitations of conventional partitioned survival models (PSMs) commonly applied in oncology and evaluated their suitability for tumour-agnostic indications. Based on the collected literature, we developed a dynamic, modular PSM framework that integrates multiple tumour sites expressing a common biomarker. The framework supports pooled and tumour-specific analysis of cost-effectiveness and enables progressive disaggregation of subgroups as additional evidence becomes available. Results: The proposed modelling approach facilitates transparent synthesis of heterogeneous evidence across tumour types using epidemiologically informed weighting, while preserving the ability to estimate tumour-specific cost-effectiveness where data permit. It addresses key challenges in tumour-agnostic evaluation, including variation in standard of care, treatment effects, and resource use across cancer sites. The modular design promotes internal consistency, reduces duplication of analytical effort, and enables iterative re-assessment of both overall and subgroup-specific cost-effectiveness. Interpretation: A dynamic, weighted multi-site modelling framework represents a coherent and adaptable extension of current health-technology assessment-practice for tumour-agnostic therapies. By structuring evidence around molecular targets, the framework can improve transparency and robustness of cost-effectiveness estimates, thereby supporting more equitable and efficient reimbursement decisions in the context of precision oncology.

• Groot, Carin A. Uyl-de; Xander, Nicolas S.H.; Belleman, Tom; Burger, Emily Annika; Doeswijk, Robin & Durand-Zaleski, Isabelle [Show all 23 contributors for this article] (2026). Bridging affordability and sustainability of health innovations via novel pricing, cost-effectiveness, and reimbursement models to improve patient access: The ASCERTAIN project. Health Policy and Technology. ISSN 2211-8837. 15(2). doi: 10.1016/j.hlpt.2026.101155. Full text in Research Archive Show summary

  Objectives Disparities in access to potential innovative health technologies (pIHTs) persist across Europe due to differing healthcare budgets, pricing policies, and health technology assessment (HTA) practices. The ASCERTAIN project aims to reduce these inequalities by developing integrated pricing, cost-effectiveness, and reimbursement approaches that enhance affordability, long-term sustainability, and timely patient access. Methods The project applies a mixed-methods approach, including literature review, stakeholder surveys, interviews, and focus groups, to ensure relevance across diverse health systems. It integrates access-based pricing, value-driven HTA, and adaptable reimbursement models into a practical, open-access ACCESS2MEDS Toolbox. This includes access-based pricing frameworks, cost-effectiveness models, and budget impact and reimbursement analyses, all adaptable to country-specific conditions to reduce uncertainty and improve transparency. Tools are co-created with patients, developers, clinicians, and policymakers and will be tested and validated using three use cases representing high-impact areas of innovation: precision oncology medicines, cell and gene therapies, and next-generation sequencing tests. Results Outputs will include validated tools enabling improved evaluation of clinical benefit, cost-effectiveness, and financial sustainability, strengthening value-based decision-making across Europe. Innovative access- and outcome-based pricing strategies will support responsible innovation while encouraging fair reimbursement and improved budget control. Policy roadmaps will guide the adoption of equitable access models and support system-level implementation. Conclusions ASCERTAIN will provide a harmonized framework that balances cost control, innovation incentives, and patient-centered care. By facilitating consistent, evidence-based pricing and reimbursement decisions, the project supports fair and sustainable access to pIHTs across Europe, with continued multi-stakeholder collaboration driving its wider adoption and real-world impact.

• Martinsen, Kristin; Aas, Eline; Ingul, Jo Magne; Lisøy, Carina; Adolfsen, Frode & Rasmussen, Lene-Mari Potulski [Show all 8 contributors for this article] (2025). Cost-effectiveness analysis of preventive strategies for child anxiety and depression: a health service perspective. Child and Adolescent Psychiatry and Mental Health (CAPMH). 19(1). doi: 10.1186/s13034-025-00962-w. Full text in Research Archive Show summary

  Background The rising prevalence of mental health problems presents economic and social challenges with youth anxiety and depression as major contributors. While strengthening preventive measures is essential to mitigate the impacts of these conditions, limited resources necessitate careful prioritization of interventions. This underscores the need for cost-effectiveness studies to inform resource allocation and decision-making. Methods This study utilized data from a trial employing the MOST framework to optimize a targeted group CBT intervention for youths exhibiting anxiety and depressive symptoms. Experimental strategies were evaluated for cost-effectiveness using real-world data examining intervention costs, child mental health outcomes: anxious and depressive symptoms and quality-adjusted life-years (QALYs). Three intervention factors were examined: delivery format (16 sessions vs. 8 sessions + 8 web-based sessions), parental involvement (five sessions vs. parental brochure), and measurement feedback system (MFS) (feedback vs. no feedback), producing eight intervention strategies. The study included 701 children aged 8 to 12, recruited from 52 public schools in 39 municipalities in Norway. Statistical analysis was conducted using R. Results For depressive symptoms and QALYs, cost-effective strategies included the long in-person version with low parental involvement and no feedback, and the hybrid format (in-person + web-based sessions) with low parental involvement and no feedback. For depressive symptoms, the hybrid format with parental involvement and no feedback was a feasible strategy. For anxiety symptoms, cost-effective strategies involved the long in-person version with low parental involvement and feedback, and the hybrid format with low parental involvement and feedback. Discussion In resource-constrained environments, the least resource-intensive strategies can ensure symptom reduction at minimal cost. Parental involvement is a viable alternative under conditions of intermediate resources, balancing costs, and clinical benefits. When symptom reduction is prioritized, and cost is secondary, the long in-person format with low parental involvement and no feedback may be preferable. Conclusion The study highlights trade-offs between cost containment, reach, and intervention effectiveness. Policymakers must weigh costs against desired levels of symptom reduction when making decisions.

• Wikerøy, Annette Konstanse Bordewich; Randsborg, Per-Henrik; Aas, Eline; Fuglesang, Hendrik Frølich & Jakobsen, Rune Bruhn (2025). Cost-effectiveness analysis of locking nail compared with locking plate for displaced 3- and 4-part proximal humerus fractures: a secondary analysis of a randomized trial comparing the Multiloc nail and PHILOS plate. Acta Orthopaedica. ISSN 1745-3674. 96, p. 806–813. doi: 10.2340/17453674.2025.44881. Full text in Research Archive Show summary

  Background and purpose: Previous studies show no clear difference in functional outcomes between locking nails and plates for proximal humerus fractures (PHFs). Economic evaluations provide valuable insights into cost-effectiveness to guide healthcare decisions. We aimed to conduct a cost-effectiveness analysis based on a semidouble-blinded randomized controlled trial comparing nailing and plating for displaced 3- and 4-part PHFs with 2-year follow-up.Methods: 79 patients with displaced 3- or 4-part PHFs were randomized to undergo open reduction and internal fixation using either a nail or a plate. Patients were followed for 2 years, with costs tracked for the index surgery, hospital stay, additional healthcare services, and secondary procedures. Quality-adjusted life years (QALYs) were calculated using EQ-5D, and incremental cost-effectiveness ratios (ICERs) were used to compare treatments.Results: 38 patients in each group were eligible for analysis. Mean total costs were €21,654 (standard deviation [SD] 10,448) for nails and €16,374 (SD 3,886) for plates, with a mean difference of €5,296 (95% confidence interval [CI] 1,989–8,603). Extra costs for reoperations and other non-regular follow-ups were €3,746 (SD 10,448) for nails and €265, (SD 1,217) for plates, resulting in a mean difference of €3,480 (CI –868 to 7,829) extra costs for nails. The mean QALY showed no statistical difference between groups of 0.09 (CI –0.003 to 0.17) (1.65 in the nail group and 1.74 in the plate group).Conclusion: Plates were more cost-effective compared with nails but did not result in a statistically significant difference in QALY.

• Thoresen, Lisbeth; Aas, Eline; McCaffrey, Nikki; Engel, Lidia; Løkkevik, Nina & Michel, Yvonne Anne [Show all 7 contributors for this article] (2025). What matters to patients with cancer receiving home care at the end of life? A qualitative study comparing patients’ and healthcare professionals’ views. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 20(1). doi: 10.1080/17482631.2025.2517358. Full text in Research Archive Show summary

  Purpose To improve care for patients in the last phase of life, healthcare professionals (HCPs) need to understand what matters to them in terms of care and follow-up. Therefore, in our study, we investigated how patients with cancer in Norway who are receiving home care perceive their situations and what matters to them at the end of life and compared it with HCPs’ views on what matters to such patients. Methods Following a qualitative design, we conducted in-depth interviews with eight patients with late-stage cancer living at home and four focus group interviews with 21 hCPs, mainly nurses. Patients and HCPs were recruited from two municipalities in Southeast and mid-Norway. The study period lasted from December 2020 to October 2022. We performed reflexive, thematic analyses of both data sets. Results The views of all eight patients and all 21 hCPs were interpreted according to five themes: cancer impacts all aspects of life, navigating the healthcare system, living with dying, the paramount importance of relationships, and dying at home. Conclusion Entering the end of life, patients feel exhausted, lonely, and abandoned. They lack confidence in HCPs and the healthcare system. HCPs characterized plans and predictability as being important during end-of-life care, whereas patients were often hesitant to talk about and plan for the last phase of life.

• Henkel, Pia S.; Aas, Eline; Russnes, Hege Elisabeth Giercksky; Dyvik, Ingrid; Fagereng, Gro Live & Helland, Åslaug [Show all 9 contributors for this article] (2025). Microcosting Study of Genomic Profiling for Precision Cancer Medicine. Application from the National Infrastructure for Precision Diagnostics in Norway. Journal of Molecular Diagnostics. ISSN 1525-1578. 27(10), p. 945–953. doi: 10.1016/j.jmoldx.2025.06.006. Full text in Research Archive Show summary

  Detailed cost analyses of genomic profiling for precision cancer medicine can inform strategic planning and cost-effectiveness analysis. A flexible costing framework was developed in this study to conduct microcosting of genomic profiling in precision cancer medicine using the broad gene panel TruSight Oncology 500 and accounting for its integration into the molecular tumor board within the national Infrastructure for Precision Diagnostics in Norway. The framework enables calculation of costs per sample, by workflow steps and cost categories. Site visits and discussions with staff at Oslo University Hospital informed the diagnostic workflow, validation of the framework, and resource use inputs. Sensitivity analysis addressed alternative resource use estimates, higher batch sizes, and investment costs for automation of the library preparation step. Total costs per sample were $2944 USD, ranging from $2366 to $4307 when considering uncertainties in estimates. Consumables and personnel were the most resource-intensive cost categories across analyses. Automating the resource-intensive library preparation step enabled a higher weekly batch size with slightly lower costs per sample ($2881) despite the additional equipment costs. The dynamic costing framework highlights how the choice of equipment and batch sizes affects sample costs and personnel needs for genomic profiling. Consumables and personnel offer the largest potential for costs savings, but potential personnel bottlenecks need to be considered when further upscaling capacity.

• Fu, Jinjing; Franzen, Nora; Aas, Eline; Mijn, J. C. Koen van der; Leeuwen, Pim J. van & Retel, Valesca P. (2025). Early Cost-Effectiveness Analysis of Using Whole-Genome Sequencing for Patients With Castration-Resistant Prostate Cancer. Value in Health. ISSN 1098-3015. 28(5), p. 720–729. doi: 10.1016/j.jval.2025.02.004. Full text in Research Archive
• Gottschlich, Katharina Natalie; Zolic-Karlsson, Zinajda; Aas, Eline; Stokke, Silje Agnethe; Bø, Lars & Torkildsen, Øivind [Show all 7 contributors for this article] (2024). Healthcare utilization and costs associated with autologous haematopoietic stem cell transplantation in Norwegian patients with relapsing remitting multiple sclerosis. Multiple Sclerosis and Related Disorders. ISSN 2211-0348. 84. doi: 10.1016/j.msard.2024.105507. Full text in Research Archive Show summary

  Multiple sclerosis (MS) patients experience long-term deterioration of neurological function, reduced quality of life, long-lasting treatment cycles, and an increased risk of early workability loss imposing an economic burden to society. Autologous haematopoietic stem cell transplantation (AHSCT) has shown promising treatment effects for relapsing remitting MS (RRMS). This study employs a micro-costing approach to estimate healthcare utilization and costs associated with AHSCT in Norwegian RRMS patients. Patient-level data were extracted from medical journals of 30 RRMS patients receiving AHSCT treatment at Haukeland University Hospital in the period from January 2015 to January 2018. The time horizon for the analysis was from the pretransplant screening until one year after AHSCT. A correlation was found between patient body weight and total healthcare cost. The average total healthcare cost of AHSCT for RRMS patients was estimated to EUR 66 304 (95% CI: EUR 63 598 – EUR 69 010) including costs associated with the pre-AHSCT period, AHSCT treatment phases and one-year follow-up. The majority of the costs, EUR 64 329, occurred during the treatment phase and within the first 100 days after AHSCT. The results indicate that long-term healthcare cost savings may be achieved using AHSCT in selected patients with aggressive RRMS. This is due to the high costs of most used disease modifying treatments. Further research including long-term clinical data is needed to determine the cost-effectiveness of this treatment.

• Bjørnelv, Gudrun Maria Waaler; Aas, Eline; Aaltonen, Mari; Hagen, Terje P.; Thoresen, Lisbeth & Forma, Leena (2024). Place of living at end-of-life according to cause of death: a comparative analysis of all decedents 70 years or older in 2009-2013 in Finland and Norway. Annals of Palliative Medicine. ISSN 2224-5820. 13(3). doi: 10.21037/apm-23-269. Full text in Research Archive Show summary

  Background: Time at home at end-of-life is perceived as valuable to individuals. Increasing home care is therefore often a political goal. Yet, little is known about where individuals live towards their end-of-life. Our aim was to describe where individuals reside their last 6 months of life in Finland and Norway, and how this differed by cause of death, sex, age, marital status, and income. Methods: We used individual-leveled national registry data on all decedents aged >70 years in 2009–2013 to describe the number of days individuals spent at home, in hospital, in long-term care (LTC) and short-term care (STC) facilities. We described the place of residence for all and by causes of death: cancer, diseases of the circulatory system, disease in the respiratory system, and mental and behavioral disorders (primarily dementia). We analyzed how age, marital status (indicating informal care), and income associated with place of residence. Analyses were stratified by sex and country. Results: During the last 6 months of life, decedents in Finland (n=186,017) and Norway (n=159,756) spent similar amounts of days in hospital (8 and 11 days) and in STC facilities (15 and 13 days). Finnish decedents spent more days at home (96 vs. 84 days) and fewer days in LTC facilities (64 vs. 80 days). Living arrangement differed similarly by cause of death in the two countries, e.g., decedents from cancer and mental and behavioral disorders spent 123 [113] vs. 29 [21] days at home in Finland (Norway). In both countries, for all causes of death, lower age and marital status were associated with more days at home, for both males and females. While those with higher income spent more days at home in Norway, the opposite was found in Finland. Conclusions: Older individual’s living arrangements in the last 6 months of life were similar in Finland and Norway but differed by cause of death. Younger individuals and those with access to informal care spent more days at home, compared to their counterparts. With aging populations, more individuals will likely need LTC at their end of life. Policies should align with these needs when developing future health care services.

• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H.; Aas, Eline; Kolle, Ingrid Tryland & Reinertsen, Rikke [Show all 15 contributors for this article] (2024). Impacts of a health literacy-informed intervention in people with chronic obstructive pulmonary disease (COPD) on hospitalization, health literacy, self-management, quality of life, and health costs – A randomized controlled trial. Patient Education and Counseling. ISSN 0738-3991. 123. doi: 10.1016/j.pec.2024.108220. Full text in Research Archive Show summary

  Objective: To compare the effect of motivational interviewing (MI) and tailored health literacy (HL) follow-up with usual care on hospitalization, costs, HL, self-management, Quality of life (QOL), and psychological stress in people with chronic obstructive pulmonary disease (COPD). Methods: A RCT was undertaken in Norway between March 2018-December 2020 (n = 127). The control group (CG, n = 63) received usual care. The intervention group (IG, n = 64) received tailored HL follow-up from MI-trained COPD nurses with home visits for eight weeks and phone calls for four months after hospitalization. Primary outcomes were hospitalization at eight weeks, six months, and one year from baseline. The trial was registered with ClinicalTrials.gov (NCT03216603) and analysed per protocol. Results: Compared with the IG, the CG had 2.8 higher odds (95% CI [1.3 to 5.8]) of hospitalization and higher hospital health costs (MD=€ −6230, 95% CI [−6510 to −5951]) and lower QALYs (MD=0.1, 95% CI [0.10 to 0.11]) that gives an ICER = − 62,300. The IG reported higher QOL, self-management, and HL (p = 0.02- to <0.01). Conclusion: MI-trained COPD nurses using tailored HL follow-up is cost-effective, reduces hospitalization, and increases QOL, HL, and self-care in COPD. Practice implication: Tailored HL follow-up is beneficial for individuals with COPD and the healthcare system.

• Schlander, Michael; Harten, Wim van; Retèl, Valesca P; Pham, Phu Duy; Vancoppenolle, Julie M & Ubels, Jasper [Show all 25 contributors for this article] (2024). The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions. The Lancet Oncology. ISSN 1470-2045. 25(4), p. 152–163. doi: 10.1016/S1470-2045(23)00636-8. Full text in Research Archive
• Rasmussen, Mari Storli; Zhang, Yuan; Andelic, Nada & Aas, Eline (2024). Health care costs and service utilization in the first year following moderate to severe traumatic injury. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-12016-6. Full text in Research Archive Show summary

  Background Most of the previous studies on costs following trauma have focused solely on in-hospital costs and costs associated with the acute treatment and early rehabilitation. As a result, post-hospital costs are often neglected in the estimation of total costs. We aimed to describe service utilization and total costs for health care services, rehabilitation services, and social support in the periods 0–6 months and 7–12 months after moderate-to severe traumatic injury. Further, we explored costs and their associations with sociodemographic, clinical and injury-related variables. Methods Data were obtained from a prospective, 12 months follow-up study of patients in all ages with moderate-to-severe traumatic injury determined by a New Injury Severity Score (NISS)>9, admitted directly or within 72 h to the trauma referral centres in year 2020. Data on utilization of health care and rehabilitation services from the Norwegian Patient Register (NPR), the Municipal patient and user register (KPR), and the Norwegian Control and Payment of Health Reimbursements Database (KUHR) were used. Results A total of 601 patients were included, 24% with moderate and 76% with severe injuries. The overall mean total health care cost per patient in the first year after traumatic injury was 846,877 (SD 1,042,649) Norwegian Kroner (NOK). The mean total cost of rehabilitation per patient was 251,487 (SD 317,050) NOK. Most costs were attributable to secondary care in the first six months post-injury. Severely injured patients had a higher health care utilization and average cost compared to those with moderate injury. Injury severity factors were the most prominent cost drivers, and number of injuries, severe head, spine, and extremity injuries were significantly associated with higher costs during the first year following trauma. Conclusions The findings give a holistic insight into health care utilization and costs for patients across all ages with complex needs following trauma and can contribute to the planning and provision of services for this patient group.

• Edsjö, Anders; Russnes, Hege Elisabeth Giercksky; Lehtiö, Janne; Tamborero, David; Hovig, Eivind & Stenzinger, Albrecht [Show all 65 contributors for this article] (2024). High-throughput molecular assays for inclusion in personalised oncology trials – State-of-the-art and beyond. Journal of Internal Medicine. ISSN 0954-6820. 295(6), p. 785–803. doi: 10.1111/joim.13785. Full text in Research Archive Show summary

  In the last decades, the development of high-throughput molecular assays has revolutionised cancer diagnostics, paving the way for the concept of personalised cancer medicine. This progress has been driven by the introduction of such technologies through biomarker-driven oncology trials. In this review, strengths and limitations of various state-of-the-art sequencing technologies, including gene panel sequencing (DNA and RNA), whole-exome/whole-genome sequencing and whole-transcriptome sequencing, are explored, focusing on their ability to identify clinically relevant biomarkers with diagnostic, prognostic and/or predictive impact. This includes the need to assess complex biomarkers, for example microsatellite instability, tumour mutation burden and homologous recombination deficiency, to identify patients suitable for specific therapies, including immunotherapy. Furthermore, the crucial role of biomarker analysis and multidisciplinary molecular tumour boards in selecting patients for trial inclusion is discussed in relation to various trial concepts, including drug repurposing. Recognising that today's exploratory techniques will evolve into tomorrow's routine diagnostics and clinical study inclusion assays, the importance of emerging technologies for multimodal diagnostics, such as proteomics and in vivo drug sensitivity testing, is also discussed. In addition, key regulatory aspects and the importance of patient engagement in all phases of a clinical trial are described. Finally, we propose a set of recommendations for consideration when planning a new precision cancer medicine trial.

• Michel, Yvonne Anne; Aas, Eline; Augestad, Liv Ariane; Burger, Emily Annika; Thoresen, Lisbeth & Bjørnelv, Gudrun Maria Waaler (2024). Healthcare use and costs in the last six months of life by level of care and cause of death. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10877-5. Full text in Research Archive Show summary

  Background: Existing knowledge on healthcare use and costs in the last months of life is often limited to one patient group (i.e., cancer patients) and one level of healthcare (i.e., secondary care). Consequently, decision-makers lack knowledge in order to make informed decisions about the allocation of healthcare resources for all patients. Our aim is to elaborate the understanding of resource use and costs in the last six months of life by describing healthcare use and costs for all causes of death and by all levels of formal care. Method: Using five national registers, we gained access to patient-level data for all individuals who died in Norway between 2009 and 2013. We described healthcare use and costs for all levels of formal care—namely primary, secondary, and home- and community-based care —in the last six months of life, both in total and differentiated across three time periods (6-4 months, 3-2 months, and 1-month before death). Our analysis covers all causes of death categorized in ten ICD-10 categories. Results: During their last six months of life, individuals used an average of healthcare resources equivalent to €46,000, ranging from €32,000 (Injuries) to €64,000 (Diseases of the nervous system and sense organs). In terms of care level, 63% of healthcare resources were used in home- and community-based care (i.e., in-home nursing, practical assistance, or nursing home care), 35% in secondary care (mostly hospital care), and 2% in primary care (i.e., general practitioners). The amount and level of care varied by cause of death and by time to death. The proportion of home- and community-based care which individuals received during their last six months of life varied from 38% for cancer patients to 92% for individuals dying with mental diseases. The shorter the time to death, the more resources were needed: nearly 40% of all end-of-life healthcare costs were expended in the last month of life across all causes of death. The composition of care also differed depending on age. Individuals aged 80 years and older used more home- and community-based care (77%) than individuals dying at younger ages (40%) and less secondary care (old: 21% versus young: 57%). Conclusions: Our analysis provides valuable evidence on how much healthcare individuals receive in their last six months of life and the associated costs, broken down by level of care and cause of death. Healthcare use and costs varied considerably by cause of death, but were generally higher the closer a person was to death. Our findings enable decision-makers to make more informed resource-allocation decisions and healthcare planners to better anticipate future healthcare needs.

• Kenseth, Anna; Kantorova, Dominika; Seo, Mikyung Kelly; Aas, Eline; Cairns, John Alexander & Kerr, David [Show all 8 contributors for this article] (2024). Is Risk-Stratifying Patients with Colorectal Cancer Using a Deep Learning-Based Prognostic Biomarker Cost-Effective? PharmacoEconomics (Auckland). ISSN 1170-7690. doi: 10.1007/s40273-024-01371-1. Full text in Research Archive
• Vervaart, Mathyn Adrianus Marinus; Aas, Eline; Claxton, Karl; Strong, Mark; Welton, Nicky J. & Wisløff, Torbjørn [Show all 7 contributors for this article] (2023). General-Purpose Methods for Simulating Survival Data for Expected Value of Sample Information Calculations. Medical decision making. ISSN 0272-989X. 43(5), p. 595–609. doi: 10.1177/0272989X231162069. Full text in Research Archive Show summary

  Background Expected value of sample information (EVSI) quantifies the expected value to a decision maker of reducing uncertainty by collecting additional data. EVSI calculations require simulating plausible data sets, typically achieved by evaluating quantile functions at random uniform numbers using standard inverse transform sampling (ITS). This is straightforward when closed-form expressions for the quantile function are available, such as for standard parametric survival models, but these are often unavailable when assuming treatment effect waning and for flexible survival models. In these circumstances, the standard ITS method could be implemented by numerically evaluating the quantile functions at each iteration in a probabilistic analysis, but this greatly increases the computational burden. Thus, our study aims to develop general-purpose methods that standardize and reduce the computational burden of the EVSI data-simulation step for survival data. Methods We developed a discrete sampling method and an interpolated ITS method for simulating survival data from a probabilistic sample of survival probabilities over discrete time units. We compared the general-purpose and standard ITS methods using an illustrative partitioned survival model with and without adjustment for treatment effect waning. Results The discrete sampling and interpolated ITS methods agree closely with the standard ITS method, with the added benefit of a greatly reduced computational cost in the scenario with adjustment for treatment effect waning. Conclusions We present general-purpose methods for simulating survival data from a probabilistic sample of survival probabilities that greatly reduce the computational burden of the EVSI data-simulation step when we assume treatment effect waning or use flexible survival models. The implementation of our data-simulation methods is identical across all possible survival models and can easily be automated from standard probabilistic decision analyses. Highlights Expected value of sample information (EVSI) quantifies the expected value to a decision maker of reducing uncertainty through a given data collection exercise, such as a randomized clinical trial. In this article, we address the problem of computing EVSI when we assume treatment effect waning or use flexible survival models, by developing general-purpose methods that standardize and reduce the computational burden of the EVSI data-generation step for survival data. We developed 2 methods for simulating survival data from a probabilistic sample of survival probabilities over discrete time units, a discrete sampling method and an interpolated inverse transform sampling method, which can be combined with a recently proposed nonparametric EVSI method to accurately estimate EVSI for collecting survival data. Our general-purpose data-simulation methods greatly reduce the computational burden of the EVSI data-simulation step when we assume treatment effect waning or use flexible survival models. The implementation of our data-simulation methods is identical across all possible survival models and can therefore easily be automated from standard probabilistic decision analyses.

• Erbe, Amanda Whitney; Kendzia, Dana; Busink, Ellen; Carroll, Suzanne & Aas, Eline (2023). Value of an Integrated Home Dialysis Model in the United Kingdom: A Cost-Effectiveness Analysis. Value in Health. ISSN 1098-3015. 26(7), p. 984–994. doi: 10.1016/j.jval.2023.02.009. Full text in Research Archive
• Kunst, Natalia; Burger, Emily Annika; Coupé, Veerle M. H.; Kuntz, Karen M. & Aas, Eline (2023). A Guide to an Iterative Approach to Model-Based Decision Making in Health and Medicine: An Iterative Decision-Making Framework. PharmacoEconomics (Auckland). ISSN 1170-7690. p. 1–9. doi: 10.1007/s40273-023-01341-z. Full text in Research Archive
• Østerås, Nina; Aas, Eline; Moseng, Tuva; Bodegom-Vos, Leti van; Dziedzic, Krysia & Natvig, Bård [Show all 11 contributors for this article] (2023). Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial. Osteoarthritis and Cartilage. ISSN 1063-4584. 32(1), p. 108–119. doi: 10.1016/j.joca.2023.10.003. Full text in Research Archive Show summary

  Objective To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. Design In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8–12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0–100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). Results Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. Conclusions This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care.

• Jamshidi, Amirparviz; Daroudi, Rajabali; Aas, Eline & Khalili, Davood (2023). A cost-effectiveness analysis of risk-based intervention for prevention of cardiovascular diseases in IraPEN program: A modeling study. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1075277. Full text in Research Archive
• Aas, Eline; Thorjussen, Christian B. Holth & Godager, Geir (2023). The Role of Health Status and Social Capital in Cancer Mortality: Insights from Matched Register and Survey Data. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 6–27. doi: 10.5617/njhe.10304. Full text in Research Archive Show summary

  Cancer mortality has been shown to be associated with social- and human capital. Several channels have been suggested, such as early detection, better compliance to treatment and better health prior to diagnosis. In this paper we study how health status and social capital jointly affect cancer mortality and cancer severity at the time of diagnosis. The analyses are based on study sample of individuals with cancer diagnosis. Our merged dataset contain information on cancer diagnosis and death from the Cancer Registry of Norway and health status, social capital and other individual level data from several national health surveys measured before the time of diagnosis. Health status and social capital are treated as unobserved latent variables, and we apply generalized structural equation modelling framework to estimate conditional statistical associations of social capital and individual health on cancer severity and mortality. We find that health has negative, and statistically significant effect, on cancer mortality, while we cannot conclude on the association between health and cancer severity (metastasis yes/no). We cannot conclude that cancer mortality and the probability of cancer metastasis is associated nor disassociated with social capital. Our results add nuance to prior studies, which frequently report a significant association between social capital and cancer mortality.

• Kinge, Jonas Minet; Linde, Astrid de; Dieleman, Joseph; Vollset, Stein Emil; Knudsen, Ann Kristin Skrindo & Aas, Eline (2023). Production losses from morbidity and mortality by disease, age and sex in Norway. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–5. doi: 10.1177/14034948231188237. Full text in Research Archive Show summary

  Aim: The inclusion of production losses in health care priority setting is extensively debated. However, few studies allow for a comparison of these losses across relevant clinical and demographic categories. Our objective was to provide comprehensive estimates of Norwegian production losses from morbidity and mortality by age, sex and disease category. Methods: National registries, tax records, labour force surveys, household and population statistics and data from the Global Burden of Disease were combined to estimate production losses for 12 disease categories, 38 age and sex groups and four causes of production loss. The production losses were estimated via lost wages in accordance with a human capital approach for 2019. Results: The main causes of production losses in 2019 were mental and substance use disorders, totalling NOK121.6bn (32.7% of total production losses). This was followed by musculoskeletal disorders, neurological disorders, injuries, and neoplasms, which accounted for 25.2%, 7.4%, 7.4% and 6.5% of total production losses, respectively. Production losses due to sick leave, disability insurance and work assessment allowance were higher for females than for males, whereas production losses due to premature mortality were higher for males. The latter was related to neoplasms, cardiovascular disease and injuries. Across age categories, non-fatal conditions with a high prevalence among working populations caused the largest production losses. Conclusions: The inclusion of production losses in health care priority debates in Norway could result in an emphasis on chronic diseases that occur among younger populations at the expense of fatal diseases among older age groups.

• Walsem, Marleen Regina Van; Frich, Jan C; Castaneda, Monica Gomez; Howe, Emilie; Pihlstrøm, Lasse & Andelic, Nada [Show all 7 contributors for this article] (2022). Health related quality of life, service utilization and costs for patients with Huntington’s disease in Norway. BMC Health Services Research. 22(1), p. 1–12. doi: 10.1186/s12913-022-08881-8. Full text in Research Archive Show summary

  Background Huntington’s disease (HD) is a progressive genetic neurodegenerative disease accompanied by mental and neurocognitive disabilities, which requires long-term and comprehensive treatment and care. Information on the health and economic burden of HD is scarce, but essential for conducting health economic analyses, in light of the prospect of new therapies for HD. In this study, we aim to identify values for Health-Related Quality of Life (HRQoL), describe service utilization and costs, and their associations with clinical and socio-demographic variables across all phases of HD. Methods A cross-sectional study including 86 patients across all phases of HD. Values of HRQoL were calculated based on EQ-5D-3L index scores. Additionally, health care and societal costs were estimated based on service utilization collected using the Client Service Receipt Inventory (CSRI) and data from the patients’ interviews. Total societal costs included costs of primary and secondary health care services, informal care and productivity loss of the patients. Multiple regression analyses were used to investigate associations between socio-demographic and clinical variables on HRQoL and costs. Results HRQoL values declined, while total costs increased across disease severity. Total six-month healthcare costs and total societal costs were € 18,538 and € 66,789 respectively. Healthcare and societal costs doubled from early to middle phase, and tripled from middle to advanced disease phase. Main six-month cost components for the three disease phases were informal care costs (€ 30,605) accounting for approximately half the total societal costs, and costs due to production loss (€ 18,907) being slightly higher than the total healthcare costs. Disease severity and gender were found to have the strongest effect on both values of HRQoL and costs. Conclusions Reported values of HRQoL and costs including costs for production loss may be used in modelling the cost-effectiveness of treatment for HD. Our results highlight the crucial role the informal caregivers play in the care provided to HD patients in all disease phases. Future research should focus on the estimation of productivity loss among informal caregivers.

• Bjørnelv, Gudrun Maria Waaler; Zolic-Karlsson, Zinajda; Dueland, Svein; Line, Pål Dag & Aas, Eline (2022). Cost-effectiveness of liver transplantation versus last-resort systemic therapy for colorectal liver metastases. British Journal of Surgery. ISSN 0007-1323. 109(6), p. 483–485. doi: 10.1093/bjs/znac022. Full text in Research Archive Show summary

  Approximately 50 per cent of patients with colorectal cancer have metastases at the time of diagnosis or subsequently develop metastases. The most frequent metastatic site is the liver1–3. Palliative chemotherapy is the treatment option for most patients with colorectal liver metastases (CRLMs). Regorafenib and TAS-102 have recently been approved by the European Medicines Agency and US Food and Drug Administration for patients with CRLMs who have progressed from second- or third-line treatments4–6. In randomized studies, regorafenib and TAS-102 prolonged median overall survival by 1.4–1.8 months compared with best supportive care (BSC)7,8. The authors have previously shown that deceased-donor liver transplantation (LT) is a cost-effective treatment alternative for patients with CRLMs compared with chemotherapy alone, particularly for selected low-risk patients (those with a low Oslo Score)9,10. LT may also be an option for patients with advanced liver-only CRLMs11. In the present study, a previously validated model was used to evaluate the cost-effectiveness of LT in patients with progressive disease, for whom the only available treatment options were TAS-102, regorafenib or BSC9.

• Ree, Anne Hansen; Mælandsmo, Gunhild Mari; Flatmark, Kjersti; Russnes, Hege Elisabeth Giercksky; Casteneda, Monica Gomez & Aas, Eline (2022). Cost-effectiveness of molecularly matched off-label therapies for end-stage cancer – the MetAction precision medicine study. Acta Oncologica. ISSN 0284-186X. 61(8), p. 955–962. doi: 10.1080/0284186X.2022.2098053. Full text in Research Archive Show summary

  Background: Precision cancer medicine (PCM), frequently used for the expensive and often modestly efficacious off-label treatment with medications matched to the tumour genome of end-stage cancer, challenges healthcare resources. We compared the health effects, costs and cost-effectiveness of our MetAction PCM study with corresponding data from comparator populations given best supportive care (BSC) in two external randomised controlled trials.<p> <p>Methods: We designed three partitioned survival models to evaluate the healthcare costs and qualityadjusted life years (QALYs) as the main outcomes. Cost-effectiveness was calculated as the incremental cost-effectiveness ratio (ICER) of PCM relative to BSC with an annual willingness-to-pay (WTP) threshold of EUR 56,384 (NOK 605,000). One-way and probabilistic sensitivity analyses addressed uncertainty. <p>Results: We estimated total healthcare costs (relating to next-generation sequencing (NGS) equipment and personnel wages, molecularly matched medications to the patients with an actionable tumour target and follow-up of the responding patients) and the health outcomes for the MetAction patients versus costs (relating to estimated hospital admission) and outcomes for the BSC cases. The ICERs for incremental QALYs were twice or more as high as the WTP threshold and relatively insensitive to cost decrease of the NGS procedures, while reduction of medication prices would contribute significantly towards a cost-effective PCM strategy. <p>Conclusions: The models suggested that the high ICERs of PCM were driven by costs of the NGS diagnostics and molecularly matched medications, with a likelihood for the strategy to be cost-effective defying WTP constraints. Reducing drug expenses to half the list price would likely result in an ICER at the WTP threshold. This can be an incentive for a public-private partnership for sharing drug costs in PCM, exemplified by ongoing European initiatives.

• Aas, Eline; Gomez, Monica & Tariq, Fawaz (2022). Health Technology Assessment (HTA) of GLP-1 receptor agonists and SGLT-2 inhibitors in combination with metformin as first-line treatment in patient with type 2 diabetes mellitus (T2DM) and established cardiovascular or chronic kidney disease. HERO skriftserie / Working paper. ISSN 1501-9071. 3. Full text in Research Archive
• Botteri, Edoardo; Hoff, Geir; Randel, Kristin Ranheim; Holme, Øyvind; Lange, Thomas de & Bernklev, Tomm [Show all 16 contributors for this article] (2022). Characteristics of nonparticipants in a randomised colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing. International Journal of Cancer. ISSN 0020-7136. 151(3), p. 361–371. doi: 10.1002/ijc.34025. Full text in Research Archive Show summary

  Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once-only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty-four thousand one hundred and fifty-nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.

• Bjørnelv, Gudrun Maria Waaler; Hagen, Terje P.; Forma, Leena & Aas, Eline (2022). Care pathways at end-of-life for cancer decedents: registry based analyses of the living situation, healthcare utilization and costs for all cancer decedents in Norway in 2009-2013 during their last 6 months of life. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08526-w. Full text in Research Archive Show summary

  Background Research on end-of-life care is often fragmented, focusing on one level of healthcare or on a particular patient subgroup. Our aim was to describe the complete care pathways of all cancer decedents in Norway during the last six months of life. Methods We used six national registries linked at patient level and including all cancer decedents in Norway between 2009-2013 to describe patient use of secondary, primary-, and home- and community-based care. We described patient’s car pathway, including patients living situation, healthcare utilization, and costs. We then estimated how cancer type, individual and sociodemographic characteristics, and access to informal care influenced the care pathways. Regression models were used depending on the outcome, i.e., negative binomial (for healthcare utilization) and generalized linear models (for healthcare costs). Results In total, 52,926 patients were included who died of lung (16%), colorectal (12%), prostate (9%), breast (6%), cervical (1%) or other (56%) cancers. On average, patients spent 123 days at home, 24 days in hospital, 16 days in short-term care and 24 days in long-term care during their last 6 months of life. Healthcare utilization increased towards end-of-life. Total costs were high (on average, NOK 379,801). 60% of the total costs were in the secondary care setting, 3% in the primary care setting, and 37% in the home- and community-based care setting. Age (total cost-range NOK 361,363-418,618) and marital status (total cost-range NOK354,100-411,047) were stronger determining factors of care pathway than cancer type (total cost-range NOK341,318- 392,655). When patients died of cancer types requiring higher amounts of secondary care (e.g., cervical cancer), there was a corresponding lower utilization of primary, and home- and community-based care, and vice versa. Conclusion Cancer patient’s care pathways at end-of-life are more strongly associated with age and access to informal care than underlying type of cancer. More care in one care setting (e.g., the secondary care) is associated with less care in other settings (primary- and home- and community based care setting) as demonstrated by the substitution between the different levels of care in this study. Care at end-of-life should therefore not be evaluated in one healthcare level alone since this might bias results and lead to suboptimal priorities.

• Howe, Emilie; Andelic, Nada; Fure, Silje Christine Reistad; Røe, Cecilie; Søberg, Helene L. & Hellstrøm, Torgeir [Show all 12 contributors for this article] (2022). Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial. BMC Health Services Research. 22(22). doi: 10.1186/s12913-022-07585-3. Full text in Research Archive Show summary

  Background: Traumatic brain injury (TBI) represents a fnancial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes. Methods: One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER). Results: The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary beneft (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU. Conclusions: Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.

• Aas, Eline; Iversen, Tor & Kaarbøe, Oddvar Martin (2021). The Economic Sustainability of the Norwegian Healthcare System. In Baltagi, Badi H. & Moscone, Francesco (Ed.), The Sustainability of Health Care Systems in Europe. Emerald Group Publishing Limited. ISSN 9781839094996. p. 81–101. doi: 10.1108/S0573-855520210000295010. Full text in Research Archive Show summary

  The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals. The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel. We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement(cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.

• Vervaart, Mathyn Adrianus Marinus; Strong, Mark; Claxton, Karl; Welton, Nicky; Wisløff, Torbjørn & Aas, Eline (2021). An Efficient Method for Computing Expected Value of Sample Information for Survival Data from an Ongoing Trial. Medical decision making. ISSN 0272-989X. doi: 10.1177/0272989X211068019. Full text in Research Archive Show summary

  Background - Decisions about new health technologies are increasingly being made while trials are still in an early stage, which may result in substantial uncertainty around key decision drivers such as estimates of life expectancy and time to disease progression. Additional data collection can reduce uncertainty, and its value can be quantified by computing the expected value of sample information (EVSI), which has typically been described in the context of designing a future trial. In this article, we develop new methods for computing the EVSI of extending an existing trial’s follow-up, first for an assumed survival model and then extending to capture uncertainty about the true survival model.<p> <p>Methods - We developed a nested Markov Chain Monte Carlo procedure and a nonparametric regression-based method. We compared the methods by computing single-model and model-averaged EVSI for collecting additional follow-up data in 2 synthetic case studies.<p> <p>Results - There was good agreement between the 2 methods. The regression-based method was fast and straightforward to implement, and scales easily to include any number of candidate survival models in the model uncertainty case. The nested Monte Carlo procedure, on the other hand, was extremely computationally demanding when we included model uncertainty.<p> <p>Conclusions - We present a straightforward regression-based method for computing the EVSI of extending an existing trial’s follow-up, both where a single known survival model is assumed and where we are uncertain about the true survival model. EVSI for ongoing trials can help decision makers determine whether early patient access to a new technology can be justified on the basis of the current evidence or whether more mature evidence is needed.

• Ersbøll, Annette Kjær; Sengupta, Kaushik; Pukkala, Eero; Bolin, Kristian; Aas, Eline & Emneus, Martha [Show all 14 contributors for this article] (2021). Desloratadine Exposure and Incidence of Seizure: A Nordic Post‑authorization Safety Study Using a New‑User Cohort Study Design, 2001–2015. Drug Safety. ISSN 0114-5916. 44, p. 1231–1242. doi: 10.1007/s40264-021-01106-7. Full text in Research Archive
• Kleive, Dyre; Aas, Eline; Angelsen, Jon-Helge; Bringeland, Erling Audun; Nesbakken, Arild & Nymo, Linn Såve [Show all 9 contributors for this article] (2021). Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases: Contemporary Practice, Evidence and Knowledge Gaps. Oncology and Therapy. ISSN 2366-1070. 9(1), p. 111–120. doi: 10.1007/s40487-021-00148-2. Full text in Research Archive Show summary

  The timing of surgical resection of synchronous liver metastases from colorectal cancer has been debated for decades. Several strategies have been proposed, but high-level evidence remains scarce. Simultaneous resection of the primary tumour and liver metastases has been described in numerous retrospective audits and meta-analyses. The potential benefits of simultaneous resections are the eradication of the tumour burden in one procedure, overall shorter procedure time, reduced hospital stay with the likely benefits on quality of life and an expected reduction in the use of health care services compared to staged procedures. However, concerns about accumulating complications and oncological outcomes remain and the optimal selection criteria for whom simultaneous resections are beneficial remains undetermined. Based on the current level of evidence, simultaneous resection should be restricted to patients with a limited liver tumour burden. More high-level evidence studies are needed to evaluate the quality of life, complication burden, oncological outcomes, as well as overall health care implications for simultaneous resections.

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• 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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• 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
• Pahilaj, Varun Kumar; Aas, Eline; Ruscio, Francesco Di; Molvik, Mari; Handal, Nina & Raastad, Ragnhild [Show all 12 contributors for this article] (2026). Cost-effectiveness of expanded AMR screening strategies in Norwegian hospitals. Full text in Research Archive
• Pahilaj, Varun Kumar; Aas, Eline; Ruscio, Francesco Di; Molvik, Mari; Handal, Nina & Raastad, Ragnhild [Show all 11 contributors for this article] (2026). Cost-effectiveness of proposed screening guideline for resistant microbes compared to current screening guideline for patients upon admission to Norwegian hospitals. Full text in Research Archive Show summary

  Healthcare-associated infections (HAIs) caused by antimicrobial-resistant (AMR) microbes are an increasing concern, even in low-prevalence countries like Norway [1,2]. Norway has updated the risk-based screening guideline for AMR upon hospital admission, but the cost-effectiveness remains unassessed. Objective: To evaluate the cost-effectiveness of the proposed screening guideline for resistant microbes compared to current screening guideline for patients upon admission in Norwegian hospitals.

• Hjelle, Ellen Gabrielsen; Nielsen, Tove Lise; Bragstad, Line Kildal; Kruse, Naja Benigna; Vester, Louise Buus & Haavaag, Silje Bjørnsen [Show all 16 contributors for this article] (2026). OPTIM-PARK - A cross-national multisectoral intervention for people affected with Parkinson’s disease and their family carers. Full text in Research Archive Show summary

  Introduction/Rationale: Parkinson’s disease (PD) is a common neurological disorder that requires a complex approach. Objectives: The OPTIM-PARK intervention was developed to improve the living with PD through intersectoral collaboration and follow up by a coordinator in Denmark, Norway, Spain, and the UK. Methods/Approach: The three-month OPTIM-PARK intervention included face-to-face, digital or telephone consultations with a PD coordinator who had a background in occupational therapy, physical therapy, or nursing. Participants had at least one initial meeting and one follow-up after three months, with additional meetings as needed. The meetings were conducted with people with PD, family carers, or both, based on preference. Coordinators logged the follow up and used a template to guide the meetings, detailing resources beneficial to people with PD and family carers across "Body function and structure," "Activity and participation," and "Environmental factors." Each country identified local resources fitting these classifications. Results/Practice Implications: Fifty-eight coordinator logs were collected. Most intervention topics were raised by the participant with PD, while family carers focused on the person with PD needs, providing direct help or increasing training and general follow-up. Key issues included disease management, exercise, home care, practical help, and social support. The OPTIM-PARK intervention highlighted the importance of tailored, person-centered care and intersectoral collaboration in managing Parkinson’s disease. Conclusions and contribution to the occupational therapy profession The intervention shows how occupational therapists and other health care professionals, through personalized care and collaboration, can address complex needs, enhance quality of life, and support the management of long-term conditions, such as PD.

• Aas, Eline; Kinge, Jonas Minet; Burger, Emily Annika; Pedersen, Kine; Iversen, Tor & Godager, Geir [Show all 14 contributors for this article] (2025). Feil tallgrunnlag kan koste liv i helsetjenesten. Full text in Research Archive
• Aas, Eline (2025). Terskelverdi. Full text in Research Archive
• Aas, Eline (2025). Terskelverdi. Full text in Research Archive
• Aas, Eline (2025). Precision Medicine – A Health Economics Perspective. Full text in Research Archive
• Aas, Eline (2025). Stukturert klinikerinnspill i metodevurderinger. Full text in Research Archive
• Aas, Eline (2025). Prioriteringsmeldingen. Full text in Research Archive
• Aas, Eline (2025). Presisjonsmedisin: Metodevurdering og økonomisk evaluering. Full text in Research Archive
• Aas, Eline (2025). Helseøkonomi og PROMS. Full text in Research Archive
• Aas, Eline (2025). Cost-effectiveness analyses of medical devices. Full text in Research Archive
• Aas, Eline; Bjørnelv, Gudrun Maria Waaler; Edwards, Christina Hansen & Hjort, Ingrid (2025). Perspektiver på prioritering. 145(12), p. 1–8. doi: 10.4045/tidsskr.25.0419. Full text in Research Archive Show summary

  Når nye tiltak skal innføres i helsetjenesten, må vi som samfunn ta stilling til om tiltaket er verdt ressursene det krever. Vi må prioritere. Men hvilke hensyn skal telle med i vurderingen?

• Holly, Teresa; Brun, Marthe Kirkesæther; Jørgensen, Kristin Kaasen; Goll, Guro Løvik; Sexton, Joseph & Gehin, Johanna [Show all 16 contributors for this article] (2025). Cost-effectiveness of proactive therapeutic drug monitoring (TDM) in patients with inflmmatory disease-results from the Nor-Drum trial. Full text in Research Archive
• Hjort, Ingrid; Aas, Eline; Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2025). Skal samfunnsgevinster telle? Full text in Research Archive
• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H.; Aas, Eline; Andersen, Marit Helen & Moum, Torbjørn [Show all 7 contributors for this article] (2024). Health literacy-informed intervention reduces hospitalization and health economic costs, while improving health literacy, self-management, and quality of life in Chronic Obstructive Pulmonary Disease (COPD). Full text in Research Archive
• Borge, Christine Råheim; Larsen, Marie Hamilton; Osborne, Richard H; Aas, Eline; Andersen, Marit Helen & Moum, Torbjørn [Show all 7 contributors for this article] (2024). Health literacy-informed intervention reduces hospitalization and health economic costs, while improving health literacy, self-management, and quality of life in COPD. Full text in Research Archive
• Aas, Eline (2024). Økonomisk evaluering av tiltak - hvor er vi på vei? Full text in Research Archive
• Aas, Eline (2024). Screening in a Health Economics perspective. Full text in Research Archive
• Aas, Eline (2024). Tilgangsavtaler. Full text in Research Archive
• Aas, Eline (2024). Økonomisk evaluering. Full text in Research Archive
• Aas, Eline (2024). Paneldiskusjon - prioriteringsmeldingen. Full text in Research Archive
• Aas, Eline (2024). Effekten av samfunnsperspektiv på estimering av kostnadseffektivitet. Full text in Research Archive
• Aas, Eline; Bjørnelv, Gudrun Maria Waaler; Grauer, Ann-Christin Dorothea & Bekker-Grob, Esther de (2024). Health literacy and health care utilization at end of life: Role of higher education versus type of education. Full text in Research Archive
• Aas, Eline; Wu, Yansi; Burger, Emily Annika; Sæther, Erik Magnus; Bugge, Christoffer & Francisco, Oteiza [Show all 8 contributors for this article] (2024). Strukturert klinikerinnspill. Full text in Research Archive
• Rasmussen, Mari Storli; Andelic, Nada; Selj, Joanna Nordhagen; Danielsen, Vilde Marie; Løvstad, Marianne & Howe, Emilie Isager [Show all 30 contributors for this article] (2024). Self-management support program delivered in the sub-acute phase after traumatic injury-study protocol for a pragmatic randomized controlled trial. Trials. 25(1), p. 639–639. doi: 10.1186/s13063-024-08492-0. Full text in Research Archive Show summary

  Background Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury. Methods This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure. Discussion This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers. Trial registration The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

• Kinge, Jonas Minet; Aas, Eline & Godager, Geir (2023). Ønsker vi virkelig å redusere kvaliteten på helsetjenesten? Full text in Research Archive
• Bjørnelv, Gudrun Maria Waaler & Aas, Eline (2023). Kostnadseffektivitetsanalyse: et rammeverk for prioriteringskriteriene. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(16), p. 1424–1425. doi: 10.4045/tidsskr.23.0474. Full text in Research Archive
• Aas, Eline; Wu, Yansi; Burger, Emily Annika; Sæther, Erik Magnus; Bugge, Christoffer & Francisco, Oteiza [Show all 8 contributors for this article] (2023). Hvordan kan systematisk klinikerinnspill redusere usikkerhet og bidra til raskere innføring av nye behandlinger. Full text in Research Archive
• Aas, Eline (2023). Økonomisk evaluering i kjølvannet av en klinisk studie. Full text in Research Archive
• Aas, Eline (2023). God tverrsektoriell samhandling gjør at flere kan bo hjemme med verdighet lenger. Full text in Research Archive
• Aas, Eline (2023). Precision medisin and HTA in Norway. Full text in Research Archive
• Aas, Eline; Godager, Geir; Hagen, Terje P.; Häkkinen, Unto; Karlsson, Martin & Kittelsen, Sverre [Show all 8 contributors for this article] (2023). Advancing and Inspiring Health Economics: A Special Issue in Honor of Tor Iversen. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 1–5. doi: 10.5617/njhe.10299. Full text in Research Archive Show summary

  Professor Tor Iversen is a distinguished and highly respected health economist who has made significant contributions to the field of health economics. With this special issue, we celebrate his work.

• Bjørnelv, Gudrun Maria Waaler; Burger, Emily Annika & Aas, Eline (2023). Hvor ble det av prioriteringskriteriene for ABC-klinikken? Full text in Research Archive Show summary

  ABC-klinikken ved Ullevål skal legges ned i mars. Argumentene for nedleggelsen er økonomisk motivert. Men hvilke økonomiske argumenter skal egentlig telle ved prioritering i Norge – og hvordan påvirker disse tilliten som befolkningen har til ulike beslutninger?

• Tasken, Kjetil; Russnes, Hege Elisabeth Giercksky; Aas, Eline; Bjørge, Line; Blix, Egil Støre & Ahlquist, Terje C. [Show all 116 contributors for this article] (2022). A national precision cancer medicine implementation initiative for Norway. Nature Medicine. ISSN 1078-8956. 28(5), p. 885–887. doi: 10.1038/s41591-022-01777-4. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Bjørnelv, Gudrun Maria Waaler; Aas, Eline; Aaltonen, Mari; Hagen, Terje P. & Forma, Leena (2022). Place of living during end-of-life according to cause of death: a comparative analysis from Finland and Norway. Full text in Research Archive
• Aas, Eline & Burger, Emily Annika (2022). Økonomisk evaluering. Full text in Research Archive
• Aas, Eline (2022). Økonomisk evaluering av nye tiltak: fokus på infeksjoner. Full text in Research Archive
• Aas, Eline (2022). Bruk av registerdata for utforming av prisavtaler. Full text in Research Archive
• Aas, Eline (2022). Cost-effectiveness analysis of precision cancer medicine: The case of MetAction. Full text in Research Archive
• Helland, Åslaug; Russnes, Hege Elisabeth Giercksky; Fagereng, Gro Live; Al-Shibli, Khalid Ibrahim; Andersson, Yvonne & Berg, Thomas [Show all 53 contributors for this article] (2022). Correction to: Improving public cancer care by implementing precision medicine in Norway: IMPRESS-Norway (Journal of Translational Medicine, (2022), 20, 1, (225), 10.1186/s12967-022-03432-5). Journal of Translational Medicine. 20(1). doi: 10.1186/s12967-022-03518-0. Full text in Research Archive
• Helland, Åslaug; Russnes, Hege Elisabeth Giercksky; Fagereng, Gro Live; Al-Shibli, Khalid Ibrahim; Andersson, Yvonne & Berg, Thomas [Show all 53 contributors for this article] (2022). Improving public cancer care by implementing precision medicine in Norway: IMPRESS-Norway. Journal of Translational Medicine. 20(1), p. 1–11. doi: 10.1186/s12967-022-03432-5. Full text in Research Archive Show summary

  Background Matching treatment based on tumour molecular characteristics has revolutionized the treatment of some cancers and has given hope to many patients. Although personalized cancer care is an old concept, renewed attention has arisen due to recent advancements in cancer diagnostics including access to high-throughput sequencing of tumour tissue. Targeted therapies interfering with cancer specific pathways have been developed and approved for subgroups of patients. These drugs might just as well be efficient in other diagnostic subgroups, not investigated in pharma-led clinical studies, but their potential use on new indications is never explored due to limited number of patients. Methods In this national, investigator-initiated, prospective, open-label, non-randomized combined basket- and umbrella-trial, patients are enrolled in multiple parallel cohorts. Each cohort is defined by the patient’s tumour type, molecular profile of the tumour, and study drug. Treatment outcome in each cohort is monitored by using a Simon two-stage-like ‘admissible’ monitoring plan to identify evidence of clinical activity. All drugs available in IMPRESS-Norway have regulatory approval and are funded by pharmaceutical companies. Molecular diagnostics are funded by the public health care system.

• Aas, Eline (2022). Håndtering av usikkerhet i helseøkonomiske analyser, hvilke utfordringer og muligheter ser dere fremover? Full text in Research Archive
• Aas, Eline (2022). Presisjonsmedisin - evaluering og finansisering. Full text in Research Archive
• Vervaart, Mathyn Adrianus Marinus; Aas, Eline; Asphaug, Lars; Bjørnelv, Gudrun Maria Waaler; Burger, Emily Annika & Wisløff, Torbjørn (2021). Undervurdering av en kompleks problemstilling. Dagens medisin. ISSN 1501-4290. Full text in Research Archive
• Hagen, Terje P.; Forma, Leena & Aas, Eline (2021). En komparativ analyse av sammensetningen av helsetjenester, bosituasjon og totale helsetjenestekostnader for personer med kreft ved livets slutt. Full text in Research Archive
• Aas, Eline (2021). Helseøkonomi og persontilpasset medisin - paneldebatt. Full text in Research Archive
• Aas, Eline (2021). Determinants and Disparities in End-of-Life Care Costs: Evidence from Real World Data in Norway, Ireland and the United States. Full text in Research Archive
• Aas, Eline (2021). Hva kan vi gjøre for å redusere usikkerhet ved bruk av registerdata i helseøkonomiske vurderinger. Full text in Research Archive
• Aas, Eline (2021). Hvordan kan helseøkonomiske analyser integreres i ortopedisk studier? Full text in Research Archive
• Aas, Eline (2021). PRECISE - A Health Economics Approach to Evaluate Uncertainty in Precision Medicine. Full text in Research Archive
• Melberg, Hans Olav; Aas, Eline; Hjort, Ingrid; Vorland, lars; Barra, Mathias & Husbyn, Hallstein [Show all 10 contributors for this article] (2024). Perspektiv og prioriteringer: Rapport fra ekspertgruppen perspektiv i prioritering nedsatt av Helse- og omsorgdepartementet. Helse- og omsorgdepartementet. Full text in Research Archive

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