Gudrun Maria Waaler Bjørnelv

• Menso, Julia E.; Bruna, Caro L.; Nine, de Graaf; Emmen, Anouk M.L.H.; Ali, Mahsoem & Björnsson, Bergthor [Vis alle 38 forfattere av denne artikkelen] (2026). Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2): A Multicenter International Randomized Trial. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000007188.
• Schepers, Robin; Bennett, Schyler Marie; Anthun, Kjartan Sarheim; Asheim, Andreas; Bjerkeset, Ottar & Bjørnelv, Gudrun Maria Waaler [Vis alle 8 forfattere av denne artikkelen] (2026). Variation in general practitioners’ mental health diagnostic tendencies and subsequent patient care: a Norwegian registry study. BMC Health Services Research. doi: 10.1186/s12913-026-15516-9. Fulltekst i vitenarkiv Vis sammendrag

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

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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?

• Nguyen, Cindy; Burger, Emily Annika; Aasdahl, Lene; Morgante, Niccolò; Fimland, Marius Steiro & Bjørnelv, Gudrun Maria Waaler (2025). A cost-utility analysis for return-to-work interventions comparing alternative methods for handling missing health-related quality of life data. Journal of Rehabilitation Medicine. ISSN 1650-1977. 57. doi: 10.2340/jrm.v57.42359. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Perform a cost-utility analysis for return-to-work interventions with missing health-related quality-of-life (HRQoL) data while transparently demonstrating the impact of different methods of handling missing data on outcomes. Methods: The costs and quality-adjusted life-years over a 2-year period were estimated for 2 return-to-work interventions, inpatient multimodal occupational rehabilitation (I-MORE) and outpatient acceptance and commitment therapy (O-ACT), using a healthcare perspective and a limited societal perspective. Four methods were used to handle the missing HRQoL data: complete case analysis, single imputation, multiple imputation, and linear mixed models. The cost-effectiveness outcomes were expressed as incremental net monetary benefit. Results: The average incremental quality-adjusted life-years comparing I-MORE with O-ACT ranged between –0.001 and 0.330 depending on missingness method. From a healthcare perspective, I-MORE was consistently not cost-effective (incremental net monetary benefits ranged from –€7,094 to –€9,363) while from a limited societal perspective, I-MORE was consistently cost-effective (incremental net monetary benefits ranged from €1,293 to €16,277). Conclusion: While cost-effectiveness findings remained consistent within each analytical perspective, the choice of different missingness methods led to variations in incremental quality-adjusted life-years. Multiple imputation is recommended to handle missing HRQoL data as it is transparent and flexible. How-ever, a thorough investigation of the missing data mechanism should still be conducted.

• Thoresen, Lisbeth; Aas, Eline; McCaffrey, Nikki; Engel, Lidia; Løkkevik, Nina & Michel, Yvonne Anne [Vis alle 7 forfattere av denne artikkelen] (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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Asheim, Andreas; Næss, Lars Eide; Krüger, Andreas Jørstad; Uleberg, Oddvar; Dale, Jostein & Haugland, Helge [Vis alle 11 forfattere av denne artikkelen] (2025). Does Delayed Response Due to Busy Ambulances Impact Risk of Death and Hospital Service Use?: A Cohort Study of 240,000 Medical Emergencies. Epidemiology. ISSN 1044-3983. 36(6), s. 830–840. doi: 10.1097/ede.0000000000001894. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: When ground ambulances are busy with any task, delays are likely for concurrent emergencies. Whereas time-critical conditions are affected by delays, general impacts remain unclear. We aimed to assess how delayed ambulance response due to busy ambulances affects risk of death and use of hospital services. Methods: We studied individuals with out-of-hospital emergencies that precipitated a call to the medical emergency number in Central Norway from 2013 to 2022. Emergency service and hospital data were linked to assess subsequent death and hospitalizations. We addressed potential bias by multivariable adjustment and a natural experiment: For emergencies that occurred in the same area at similar times, we compared outcomes for patients with differences in busy ambulances to analyze delays in response that were arguably unrelated to prioritization due to the patient severity. Results: Among 239,320 acute emergencies, 4.1% of patients died within 7 days. An interquartile range of variation in the probability a busy ambulance was associated with a 2.9-minute delay (95% confidence interval [CI] = 2.8, 3.0). Overall, a 5-minute delay was associated with a risk difference of 0.10 percentage points in the risk of death (95% CI = −0.17, 0.36) and 1.24 for hospitalization (95% CI = 0.59, 1.94). The cost of hospital treatment within 1 year increased by 616 euros (95% CI = 183, 1069). Conclusion: While we found no substantial increase in the overall risk of death associated with delayed ambulance response, the observed rise in hospital costs suggests a potential increase in morbidity.

• Andvig, Jørgen Garberg; Johnsen, Lars Gunnar; Nilsen, Sara Marie; Bjørnelv, Gudrun Maria Waaler & Asheim, Andreas (2025). Falling rates but projected rising numbers of fractures in elderly Norwegians: a study of fracture rates in the Norwegian patient registry from 2010 to 2021, extrapolated to 2041. Acta Orthopaedica. ISSN 1745-3674. 96, s. 182–188. doi: 10.2340/17453674.2024.42634. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Our aim was to calculate rates of major fractures by fracture location in elderly Norwegians over the years 2010 to 2021 and thereby estimate the volume of fractures in this population by 2041. Methods: We identified fractures in persons aged 65 years and over from the Norwegian Patient Registry. We summarized age- and sex-specific numbers of fractures and incidence rates by fracture location. Extrapolating adjusted incidence rates combined with population projections from Statistics Norway, we estimated the expected numbers of fracture cases for the following 20 years. Results: The total number of major fractures rose from 22,581 in 2010 to 27,596 in 2021. While the number of hip fractures was relatively stable (8,164 to 8,194 over the period), there were substantial increases in the number of fractures in the upper extremities, spine and pelvis, and lower extremities. Annual changes in incidence rates adjusted for age and sex were 0.6% (95% confidence interval [CI] 0.4–0.7), 1.2% (CI 0.9–1.4), 0.4% (CI 0.1–0.7), and –1.9% (CI –2.0 to –1.7) for upper extremity, spine and pelvis, lower extremity, and hip respectively. Extrapolating trends in incidence rates, we estimate a 64% (95% prediction interval 48–70) overall increase in the number of major fractures by 2041 compared with 2021, primarily due to the aging of the population. Conclusion: Incidence rates of hip fractures decreased over the period, while rates of other major fractures increased. We can expect a substantial increase in the number of fractures over the coming years, primarily due to the expected aging of the population.

• Hagman, Emilia; Halsteinli, Vidar; Putri, Resthie R.; Edwards, Christina Hansen; Bjørnelv, Gudrun Maria Waaler & Marcus, Claude [Vis alle 7 forfattere av denne artikkelen] (2025). Association between adolescent obesity and early adulthood healthcare utilization—a two-cohort prospective study. BMC Medicine. 23(1). doi: 10.1186/s12916-025-03866-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Pediatric obesity is a growing global health challenge, with long-term implications for individuals and healthcare systems. Existing studies on the association between pediatric obesity and healthcare use in adulthood are limited and often rely on mathematical simulation models. This study aims to provide real-world data on the impact of adolescent obesity on specialized healthcare utilization and costs in early adulthood. Methods This study analyzed data from two longitudinal cohorts: a population-based cohort from Norway (Young-HUNT) and a clinical cohort from Sweden (BORIS), the latter with matched general population comparators. Individuals included were born between 1987 and 1994, with BMI measurements at ages 13–19, and follow-up data from ages 20 to 30 years. Healthcare utilization and costs were assessed using national patient registries. Results A total of 7592 individuals from Norway (5.7% with adolescent obesity) and 1543 individuals from Sweden with adolescent obesity, accompanied with 7330 matched general population comparators, were included. Among females, adolescent obesity was associated with significantly higher specialized healthcare utilization and costs in young adulthood, e.g., in Sweden, females with adolescent obesity had a 57% probability of annual specialized healthcare visits at ages 25–29, compared to 49% among the general population, p < 0.0001. In Norway, a similar pattern was observed. Among males, the association between obesity and healthcare utilization/annual specialized visits was less prominent. Annual excess costs for females with a history of adolescent obesity ranged from €578 to €835, while males showed minimal or no annual excess costs. Conclusions Analyses of real-world data cohorts from Norway and Sweden reveal that adolescent obesity is associated with increased healthcare utilization and costs in young adulthood, exceeding previous estimates. A distinct sex difference was evident, with females incurring higher costs compared to males.

• Bjørnelv, Gudrun Maria Waaler & Michel, Yvonne Anne (2024). Kostnadseffektivitetsanalyser – hvordan beregnes helsegevinster? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(15). doi: 10.4045/tidsskr.24.0474. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Edwards, Christina Hansen; Bjørngaard, Johan Håkon; Kinge, Jonas Minet; Vie, Gunnhild Åberge; Halsteinli, Vidar & Ødegård, Rønnaug Astri [Vis alle 8 forfattere av denne artikkelen] (2024). The healthcare costs of increased body mass index–evidence from The Trøndelag Health Study. Health Economics Review. 14. doi: 10.1186/s13561-024-00512-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Earlier studies have estimated the impact of increased body mass index (BMI) on healthcare costs. Various methods have been used to avoid potential biases and inconsistencies. Each of these methods measure different local effects and have different strengths and weaknesses. Methods In the current study we estimate the impact of increased BMI on healthcare costs using nine common methods from the literature: multivariable regression analyses (ordinary least squares, generalized linear models, and two-part models), and instrumental variable models (using previously measured BMI, offspring BMI, and three different weighted genetic risk scores as instruments for BMI). We stratified by sex, investigated the implications of confounder adjustment, and modelled both linear and non-linear associations. Results There was a positive effect of increased BMI in both males and females in each approach. The cost of elevated BMI was higher in models that, to a greater extent, account for endogenous relations. Conclusion The study provides solid evidence that there is an association between BMI and healthcare costs, and demonstrates the importance of triangulation.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Sjule, Hanna Meidell; Vinter, Caroline Andrea; Dueland, Svein; Line, Pål Dag; Burger, Emily Annika & Bjørnelv, Gudrun Maria Waaler (2024). The Spillover Effects of Extending Liver Transplantation to Patients with Colorectal Liver Metastases: A Discrete Event Simulation Analysis. Medical decision making. ISSN 0272-989X. 44, s. 529–542. doi: 10.1177/0272989X241249154. Fulltekst i vitenarkiv Vis sammendrag

  Background: Liver transplantation is an alternative treatment for patients with nonresectable colorectal cancer liver-only metastases (CRLM); however, the potential effects on wait-list time and life expectancy to other patients on the transplant waiting list have not been considered. We explored the potential effects of expanding liver transplantation eligibility to include patients with CRLM on wait-list time and life expectancy in Norway. Methods: We developed a discrete event simulation model to reflect the Norwegian liver transplantation waiting list process and included 2 groups: 1) patients currently eligible for liver transplantation and 2) CRLM patients. Under 2 alternative CRLM-patient transplant eligibility criteria, we simulated 2 strategies: 1) inclusion of only currently eligible patients (CRLM patients received standard-of-care palliative chemotherapy) and 2) expanding waiting list eligibility to include CRLM patients under 2 eligibility criteria. Model outcomes included median waiting list time, life expectancy, and total life-years. Results: For every additional CRLM patient listed per year, the overall median wait-list time, initially 52 d, increased by 8% to 11%. Adding 2 additional CRLM patients under the most restrictive eligibility criteria increased the CRLM patients’ average life expectancy by 10.64 y and decreased the average life expectancy for currently eligible patients by 0.05 y. Under these assumptions, there was a net gain of 149.61 life-years over a 10-y programmatic period, which continued to increase under scenarios of adding 10 CRLM patients to the wait-list. Health gains were lower under less restrictive CRLM eligibility criteria. For example, adding 4 additional CRLM patients under the less restrictive eligibility criteria increased the CRLM patients’ average life expectancy by 5.64 y and decreased the average life expectancy for currently eligible patients by 0.12 y. Under these assumptions, there was a net gain of 96.36 life-years over a 10-y programmatic period, which continued to increase up to 7 CRLM patients. Conclusions: Our model-based analysis enabled the consideration of the potential effects of enlisting Norwegian CRLM patients for liver transplantation on wait-list time and life expectancy. Enlisting CRLM patients is expected to increase the total health effects, which supports the implementation of liver transplantation for CRLM patients in Norway. Highlights: • Given the Norwegian donor liver availability, adding patients with nonresectable colorectal cancer liver-only metastases (CRLM) to the liver transplantation waiting list had an overall modest, but varying, impact on total waiting list time. • Survival gains for selected CRLM patients treated with liver transplantation would likely outweigh the losses incurred to patients listed currently. • To improve the total life-years gained in the population, Norway should consider expanding the treatment options for CRLM patients to include liver transplantation. • Other countries may also have an opportunity to gain total life-years by extending the waiting list eligibility criteria; however, country-specific analyses are required.

• Aasdahl, Lene; Gismervik, Sigmund Østgård; Johnsen, Roar; Vasseljen, Ottar; Bjørnelv, Gudrun Maria Waaler & Bjørngaard, Johan Håkon [Vis alle 7 forfattere av denne artikkelen] (2024). Effects of Inpatient Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy on Sick Leave and Cost of Lost Production: 7-Year Follow-Up of a Randomized Controlled Trial. Journal of occupational rehabilitation. ISSN 1053-0487. doi: 10.1007/s10926-024-10195-x. Fulltekst i vitenarkiv
• Morgante, Niccolo; Bjørnelv, Gudrun Maria Waaler; Aasdahl, Lene; Nguyen, Cindy; Fimland, Marius Steiro & Kunst, Natalia [Vis alle 7 forfattere av denne artikkelen] (2024). Evaluating the Health and Economic Impacts of Return-to-Work Interventions: A Modeling Study. Value in Health. ISSN 1098-3015. doi: 10.1016/j.jval.2024.10.3850. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Asheim, Andreas; Nilsen, Sara Marie; Anthun, Kjartan Sarheim; Carlsen, Fredrik & Aam, Stina [Vis alle 8 forfattere av denne artikkelen] (2023). Mortality and subsequent healthcare use among older patients discharged to a municipality with excess demand for elderly care. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), s. 28–44. doi: 10.5617/njhe.10145. Fulltekst i vitenarkiv Vis sammendrag

  There is limited knowledge on how excess demand for elderly care influences patient outcomes. We used a natural experiment to estimate the causal effect of discharging elderly patients from hospital to municipalities with excess demand. In Norway, hospital in-patients are defined as ready-for-discharge when hospital treatment is completed, but the patient needs further care from municipal services. After this, the municipality of residence is obliged to either provide care for the patient or to pay the hospital a fixed fee per day that the patient spends in hospital. Municipal fee-days may thus indicate excess municipal demand. In the current paper, we studied how excess municipal demand, indicated by the number of fee-days accumulated in the municipality 30 days before an acute admission, influenced patient outcomes. To minimize confounding, we compared patients living within the same municipality, admitted during the same type of day, in the same year, but with varying excess demand. Our outcomes were mortality, resource use and healthcare costs at the primary and secondary care level, within 30 days. Between 2012 and 2016, 354,834 individuals (age≥70 years) had a total of 895,892 acute admissions. There was a 2% increased 30-day mortality per standard deviation change in accumulate fee-days (Hazard ratio (HR) of 1.02, 95% confidence interval (CI) 1.01-1.03). Individuals living in small municipalities (population<10,000) had HR of 1.04, (95% CI 1.02-1.07), while individuals living in larger municipalities (population>10,000) had HR of 1.01 (95% CI 1.00-1.03). We found no substantial effect on subsequent healthcare use or costs. Relevance tests supported that fee-days was a good indication of excess demand, and balance tests supported that patients were comparable between periods with different excess demand. In conclusion, our results imply that older patients who are discharged to a municipality with excess demand have slightly elevated mortality, particularly in small municipalities.

• Aasdahl, Lene; Fimland, Marius Steiro; Bjørnelv, Gudrun Maria Waaler; Gismervik, Sigmund Østgård; Johnsen, Roar & Vasseljen, Ottar [Vis alle 7 forfattere av denne artikkelen] (2023). Economic Evaluation of Inpatient Multimodal Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy for Sick-Listed Workers with Musculoskeletal- or Common Mental Disorders. Journal of occupational rehabilitation. ISSN 1053-0487. 33, s. 463–472. doi: 10.1007/s10926-022-10085-0. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: To evaluate the cost-effectiveness and cost-benefit of inpatient multimodal occupational rehabilitation (I-MORE) compared to outpatient acceptance and commitment therapy (O-ACT) for individuals sick listed due to musculoskeletal- or common mental disorders during two-years of follow-up. Methods: We conducted an economic evaluation with a societal perspective alongside a randomized controlled trial with 24 months follow-up. Individuals sick listed 2 to 12 months were randomized to I-MORE (n = 85) or O-ACT (n = 79). The outcome was number of working days. Healthcare use and sick leave data were obtained by registry data. Results: Total healthcare costs during the 24 months was 12,057 euros (95% CI 9,181 to 14,933) higher for I-MORE compared to O-ACT, while the difference in production loss was 14,725 euros (95% CI -1,925 to 31,375) in favour of I-MORE. A difference of 43 (95% CI -6 to 92) workdays, in favour of I-MORE, gave an incremental cost-effectiveness ratio of 278 euros for one workday, less than the cost of one day production (339 euros). Net societal benefit was 2,667 euros during two years of follow-up. Conclusion: Despite considerable intervention costs, the lower production loss resulted in I-MORE being cost-effective when compared to O-ACT. Based on economic arguments, I-MORE should be implemented as a treatment alternative for individuals on long-term sick leave. However, more research on subgroup effects and further follow-up of participants’ permanent disability pension awards are warranted.

• Edwards, Christina Hansen; Bjørnelv, Gudrun Maria Waaler; Øvretveit, Karsten; Hveem, Kristian & Bjørngaard, Johan Håkon (2023). Helsetjenestekostnader ved overvekt og fedme på individnivå versus populasjonsnivå – en HUNT-studie. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(13), s. 1138–1143. doi: 10.4045/tidsskr.22.0726. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Måten forskningsresultater blir presentert på, påvirker hvordan resultatene blir tolket. Vi viser betydningen av å presentere sammenhengen mellom kroppsmasseindeks (BMI) og helsetjenestekostnader både fra et individperspektiv og et populasjonsperspektiv. MATERIALE OG METODE Med målinger av høyde og vekt fra Helseundersøkelsen i Trøndelag (HUNT) koblet til registeropplysninger om spesialisthelsetjenestekostnader og demografi estimerte vi sammenhengen mellom BMI og spesialisthelsetjenestekostnader gjennom regresjonsanalyser. RESULTATER Fra et individperspektiv var sammenhengen mellom BMI og spesialisthelsetjenestekostnader sterkest hos personer med fedme grad 2 og 3 (BMI ≥ 35 kg/m2). Fra et populasjonsperspektiv var derimot sammenhengen sterkest ved overvekt (BMI ≥ 25 kg/m2) eller fedme grad 1 (BMI ≥ 30 kg/m2), siden det er flere som befinner seg i dette BMI-området. FORTOLKNING Studien understreker viktigheten av å inkludere populasjonsperspektivet i forskningsstudier og i politiske beslutningsprosesser. Personer med alvorlig fedme har høy individuell risiko, men deres forbruk av helsetjenester har mindre betydning for de totale helsetjenestekostnadene, siden de er færre i antall.

• Jagtenberg, Caroline Jeanne; Uleberg, Oddvar; Bjørnelv, Gudrun Maria Waaler & Røislien, Jo (2023). Utopia for Norwegian helicopter emergency medical services: Estimating the number of bases needed to radically bring down response times, and lives needed to be saved for cost effectiveness. PLOS ONE. 18(3). doi: 10.1371/journal.pone.0281706. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Helicopter Emergency Medical Services (HEMS) throughout Europe are generally on scene within 10–15 minutes. In Norway, however, with its 13 HEMS bases, only 75% of the population can currently be reached within half an hour. We estimate the number of HEMS bases needed to reach the full Norwegian population within 10–15 minutes, and discuss implications regarding cost effectiveness. Methods Using geographic location and population characteristics from Norway’s 428 municipalities as input to the Maximal Covering Location Problem–a mathematical location optimization model–we estimate the number of HEMS bases required along with accompanying personnel and healthcare costs. We estimate the minimum number of lives that would have to be saved to achieve a net social benefit of zero. Results To reach 99% or 100% of the Norwegian population by HEMS within 15 minutes 78 or 104 bases are needed, respectively. The incremental need for personnel going from 20 to 15 minutes for 99/100% of the population is 602/728, with an accompanying incremental cost of 228/276 million EURO per year. A yearly total of 280/339 additional lives would have to be saved to obtain a net social benefit of zero. Then, the HEMS-system as a whole would be cost effective although the least efficient bases still would not be. Conclusions Reducing Norwegian HEMS response times to 10–15 minutes requires a drastic increase in the number of HEMS bases needed. Choice of ethical philosophy (utilitarianism or egalitarianism) determines when the expansion might be considered cost effective.

• 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), s. 483–485. doi: 10.1093/bjs/znac022. Fulltekst i vitenarkiv Vis sammendrag

  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.

• 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. Fulltekst i vitenarkiv Vis sammendrag

  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.

• Aghayan, Davit; Kazaryan, Airazat; Dagenborg, Vegar Johansen; Røsok, Bård Ingvald; Fagerland, Morten Wang & Bjørnelv, Gudrun Maria Waaler [Vis alle 10 forfattere av denne artikkelen] (2020). Long-term oncologic outcomes after laparoscopic versus open resection for colorectal liver metastasis. Annals of Internal Medicine. ISSN 0003-4819. 174(2), s. 175–182. doi: 10.7326/M20-4011. Fulltekst i vitenarkiv Vis sammendrag

  Background: Despite the recent worldwide dissemination of laparoscopic liver surgery, no high-level evidence supports the oncologic safety of this approach. Objective: To evaluate long-term oncologic outcomes after laparoscopic versus open liver resection in patients with colorectal metastases. Design: A single-center, assessor-blinded, randomized controlled trial (OSLO-COMET [Oslo Randomized Laparoscopic Versus Open Liver Resection for Colorectal Metastases Trial]). (ClinicalTrials.gov: NCT01516710) Setting: Oslo University Hospital, the only provider of liver surgery for the 3 million inhabitants of southeastern Norway. Participants: Patients with resectable colorectal liver metastases were randomly assigned to have open or laparoscopic liver resection. Intervention: From February 2012 to January 2016, a total of 280 patients were included in the trial (laparoscopic surgery: n = 133; open surgery: n = 147). Measurements: The primary outcome was postoperative morbidity within 30 days. Five-year rates of overall and recurrence-free survival were predefined secondary end points. Results: At a median follow-up of 70 months, rates of 5-year overall survival were 54% in the laparoscopic group and 55% in the open group (between-group difference, 0.5 percentage point [95% CI, −11.3 to 12.3 percentage points]; hazard ratio, 0.93 [CI, 0.67 to 1.30]; P = 0.67). Rates of 5-year recurrence-free survival were 30% in the laparoscopic group and 36% in the open group (between-group difference, 6.0 percentage points [CI, −6.7 to 18.7 percentage points]; hazard ratio, 1.09 [CI, 0.80 to 1.49]; P = 0.57). Limitation: The trial was not powered to detect differences in secondary end points and was not designed to address a noninferiority hypothesis for survival outcomes. Conclusion: In this randomized trial of laparoscopic and open liver surgery, no difference in survival outcomes was found between the treatment groups. However, differences in 5-year overall survival up to about 10 percentage points in either direction cannot be excluded. This trial should be followed by pragmatic multicenter trials and international registries. Primary Funding Source: The South-Eastern Norway Regional Health Authority.

• Bjørnelv, Gudrun Maria Waaler; Halsteinli, Vidar; Kulseng, Bård Eirik; Sonntag, Diana & Ødegård, Rønnaug (2020). Modeling Obesity in Norway (The MOON Study): A Decision-Analytic Approach—Prevalence, Costs, and Years of Life Lost. Medical decision making. ISSN 0272-989X. doi: 10.1177/0272989X20971589. Fulltekst i vitenarkiv Vis sammendrag

  Background. Limited knowledge exists on the expected long-term effects and cost-effectiveness of initiatives aiming to reduce the burden of obesity. Aim. To develop a Norwegian obesity-focused disease-simulation model: the MOON model. Material and Methods. We developed a Markov model and simulated a Norwegian birth cohort’s movement between the health states ‘‘normal weight,’’ ‘‘overweight,’’ ‘‘obese 1,’’ ‘‘obese 2,’’ and ‘‘dead’’ using a lifetime perspective. Model input was estimated using longitudinal data from health surveys and real-world data (RWD) from local and national registers (N = 99,348). The model is deterministic and probabilistic and stratified by gender. Model validity was assessed by estimating the cohort’s expected prevalence, health care costs, and mortality related to overweight and obesity. Results. Throughout the cohort’s life, the prevalence of overweight increased steadily and stabilized at 45% at 45 y of age. The number of obese 1 and 2 individuals peaked at age 75 y, when 44% of women and 35% of men were obese. The incremental costs per person associated with obesity was highest in older ages and, when accumulated over the lifetime, higher among women (e12,118, e9,495–e15,047) than men (e6,646, e5,252–e10,900). On average, obesity shortened the life expectancy of women/men in the whole cohort by 1.31/1.08 y. The life expectancy for normal-weight women/men at age 30 was 83.31/80.31. The life expectancy was reduced by 1.05/0.65 y if the individual was overweight, obese (2.87/2.71 y), or obese 2 (4.06/4.83 y). Conclusion. The high expected prevalence of obesity in the future will lead to substantial health care costs and large losses in lifeyears. This underscores the need to implement interventions to reduce the burden of obesity; the MOON model will enable economic evaluations for a wide range of interventions.

• Bjørnelv, Gudrun Maria Waaler; Edwin, Bjørn; Fretland, Åsmund Avdem; Deb, Partha & Aas, Eline (2020). Till death do us part: the effect of marital status on health care utilization and costs at end-of-life. A register study on all colorectal cancer decedents in Norway between 2009 and 2013. BMC Health Services Research. 20, s. 1–13. doi: 10.1186/s12913-019-4794-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Economic analyses of end-of-life care often focus on single aspects of care in selected cohorts leading to limited knowledge on the total level of care required to patients at their end-of-life. We aim at describing the living situation and full range of health care provided to patients at their end-of-life, including how informal care affects formal health care provision, using the case of colorectal cancer. Methods All colorectal cancer decedents between 2009 and 2013 in Norway (n = 7695) were linked to six national registers. The registers included information on decedents’ living situation (days at home, in short- or long-term institution or in the hospital), their total health care utilization and costs in the secondary, primary and home- and community-based care setting. The effect of informal care was assessed through marital status (never married, currently married, or previously married) using regression analyses (negative binominal, two-part models and generalized linear models), controlling for age, gender, comorbidities, education, income, time since diagnosis and year of death. Results The average patient spent four months at home, while he or she spent 27 days in long-term institutions, 16 days in short-term institutions, and 21 days in the hospital. Of the total costs (~NOK 400,000), 58, 3 and 39% were from secondary carers (hospitals), primary carers (general practitioners and emergency rooms) and home- and community-based carers (home care and nursing homes), respectively. Compared to the never married, married patients spent 30 more days at home and utilized less home- and community-based care, but more health care services at the secondary and primary health care level. Their total healthcare costs were significantly lower (−NOK 65,621) than the never married. We found similar, but weaker, patterns for those who had been married previously. Conclusion End-of-life care is primarily provided in the secondary and home-and community-based care level, and informal caregivers have a substantial influence on formal end-of-life care provision. Excluding aspects of care such as home and community-based care or informal care in economic analyses of end-of-life care provides a biased picture of the total resources required, and might lead to inefficient resource allocations.

• Hammer, Ola-Lars; Jakobsen, Rune Bruhn; Clementsen, Ståle; Fuglesang, Hendrik Frølich; Bjørnelv, Gudrun Maria Waaler & Randsborg, Per-Henrik (2020). Cost-Effectiveness of Volar Locking Plate Compared with Augmented External Fixation for Displaced Intra-Articular Wrist Fractures. Journal of Bone and Joint Surgery. American volume. ISSN 0021-9355. 102(23), s. 2049–2059. doi: 10.2106/JBJS.19.01288. Fulltekst i vitenarkiv
• Fretland, Åsmund Avdem; Dagenborg, Vegar Johansen; Bjørnelv, Gudrun Maria Waaler; Aghayan, Davit; Kazaryan, Airazat M. & Barkhatov, Leonid [Vis alle 10 forfattere av denne artikkelen] (2019). Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. British Journal of Surgery. ISSN 0007-1323. 106(10), s. 1372–1380. doi: 10.1002/bjs.11227. Fulltekst i vitenarkiv Vis sammendrag

  Background Most treatments for cancer cause a decline in patients' health‐related quality of life (HRQoL). Limiting this decline is a universal goal for healthcare providers. Using minimally invasive instead of open surgical techniques might be one way to achieve this. The aim of this study was to compare postoperative HRQoL after open and laparoscopic liver resection. Methods This was a predefined substudy of an RCT comparing open with laparoscopic liver resection. Patients with colorectal liver metastases were assigned randomly to open or laparoscopic parenchyma‐sparing liver resection. HRQoL was assessed with the Short Form 36 questionnaire at baseline, and 1 and 4 months after surgery. Results A total of 280 patients were randomized, of whom 273 underwent surgery (129 laparoscopic, 144 open); 682 questionnaires (83.3 per cent) were available for analysis. One month after surgery, patients in the laparoscopic surgery group reported reduced scores in two HRQoL domains (physical functioning and role physical), whereas those in the open surgery group reported reduced scores in five domains (physical functioning, role physical, bodily pain, vitality and social functioning). Four months after surgery, HRQoL scores in the laparoscopic group had returned to preoperative levels, whereas patients in the open group reported reduced scores for two domains (role physical and general health). The between‐group difference was statistically significant in favour of laparoscopy for four domains after 1 month (role physical, bodily pain, vitality and social functioning) and for one domain after 4 months (role physical). Conclusion Patients assigned to laparoscopic liver surgery reported better postoperative HRQoL than those assigned to open liver surgery. For role limitations caused by physical health problems, patients in the laparoscopic group reported better scores up to 4 months after surgery. Registration number: NCT01516710 ( http://www.clinicaltrials.gov).

• Hausken, John; Fretland, Åsmund Avdem; Edwin, Bjørn; Andersen, Marit Helen; Dagenborg, Vegar Johansen & Bjørnelv, Gudrun Maria Waaler [Vis alle 10 forfattere av denne artikkelen] (2019). Intravenous patient-controlled analgesia versus thoracic epidural analgesia after open liver surgery: a prospective, randomized, controlled noninferiority trial. Annals of Surgery. ISSN 0003-4932. 270(2), s. 193–199. doi: 10.1097/SLA.0000000000003209. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Dueland, Svein; Line, Pål Dag; Joranger, Pål; Fretland, Åsmund Avdem & Edwin, Bjørn [Vis alle 8 forfattere av denne artikkelen] (2018). Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver. British Journal of Surgery. ISSN 0007-1323. doi: 10.1002/bjs.10962. Fulltekst i vitenarkiv
• Fretland, Åsmund Avdem; Dagenborg, Vegar Johansen; Bjørnelv, Gudrun Maria Waaler; Kazaryan, Airazat M.; Kristiansen, Ronny & Fagerland, Morten [Vis alle 17 forfattere av denne artikkelen] (2018). Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial. Annals of Surgery. ISSN 0003-4932. 267(2), s. 199–207. doi: 10.1097/SLA.0000000000002353. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To perform the first randomized controlled trial to compare laparoscopic and open liver resection. Summary Background Data: Laparoscopic liver resection is increasingly used for the surgical treatment of liver tumors.However, high-level evidence to conclude that laparoscopic liver resection is superior to open liver resection is lacking. Methods: Explanatory, assessor-blinded, single center, randomized superiority trial recruiting patients from Oslo University Hospital, Oslo, Norway from February 2012 to January 2016. A total of 280 patients with resectable liver metastases from colorectal cancer were randomly assigned to undergo laparoscopic (n ¼ 133) or open (n ¼ 147) parenchyma-sparing liver resection. The primary outcome was postoperative complications within 30 days (Accordion grade 2 or higher). Secondary outcomes included cost-effectiveness, postoperative hospital stay, blood loss, operation time, and resection margins. Results: The postoperative complication rate was 19% in the laparoscopicsurgery group and 31% in the open-surgery group (12 percentage points difference [95% confidence interval 1.67–21.8; P ¼ 0.021]). The postoperative hospital stay was shorter for laparoscopic surgery (53 vs 96 hours, P < 0.001), whereas there were no differences in blood loss, operation time, and resection margins. Mortality at 90 days did not differ significantly from the laparoscopic group (0 patients) to the open group (1 patient). In a 4-month perspective, the costs were equal, whereas patients in the laparoscopicsurgery group gained 0.011 quality-adjusted life years compared to patients in the open-surgery group (P ¼ 0.001). Conclusions: In patients undergoing parenchyma-sparing liver resection for colorectal metastases, laparoscopic surgery was associated with significantly less postoperative complications compared to open surgery. Laparoscopic resection was cost-effective compared to open resection with a 67% probability. The rate of free resection margins was the same in both groups. Our results support the continued implementation of laparoscopic liver resection. Keywords: colorectal liver metastases, cost and cost analysis, hepatectomy, laparoscopic, laparoscopy, liver resection, minimally invasive surgery, parenchyma-sparing liver surgery, randomized clinical trial, randomized controlled trial

• Andersen, Marit Helen; Lønning, Kjersti; Bjørnelv, Gudrun Maria Waaler & Fagerström, Lisbeth (2016). Nursing intensity and costs of nurse staffing demonstrated by the RAFAELA system: liver versus kidney transplant recipients. Journal of Nursing Management. ISSN 0966-0429. 24(6), s. 798–805. doi: 10.1111/jonm.12384. Fulltekst i vitenarkiv Vis sammendrag

  Aim To compare nursing intensity and nurse staffing costs for liver transplant (LTx) vs. kidney transplant (KTx) patients through the use of the RAFAELA system (the OPCq instrument). Background High-quality patient care correlates with the correct allocation of nursing staff. Valid systems for obtaining data on nursing intensity, in relation to actual patient care needs, are needed to ensure correct staffing. Methods A prospective, comparative study of 85 liver and 85 kidney transplant patients. Nursing intensity was calculated using the Oulu Patient Classification (OPCq) instrument. The cost per nursing intensity point was calculated by dividing annual total nursing wage costs with annual total nursing intensity points. Results The results showed significantly higher nursing intensity per day for liver transplant patients compared to kidney transplant patients. The length of stay was the most important variable in relation to nursing intensity points per day. Conclusions The study demonstrated differences in nursing intensity and nurse staffing costs between the two patient groups. Implications for Nursing Management When defending nurse staffing decisions, it is essential that nurse managers have evidence-based knowledge of nursing intensity and nurse staffing costs.

• Moger, Tron Anders; Bjørnelv, Gudrun Maria Waaler & Aas, Eline (2016). Expected 10-year treatment cost of breast cancer detected within and outside a public screening program in Norway. European Journal of Health Economics. ISSN 1618-7598. 17(6), s. 745–754. doi: 10.1007/s10198-015-0719-4. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Schepers, Robin; Bennett, Schyler Marie; Anthun, Kjartan Sarheim; Asheim, Andreas; Bjerkeset, Ottar & Bjørnelv, Gudrun Maria Waaler [Vis alle 8 forfattere av denne artikkelen] (2026). Mental Health Diagnostic Practice Variation as an Instrument: Methodological Insights and Limitations. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Edwards, Christina Hansen; Michel, Yvonne Anne & Bjørnelv, Gudrun Maria Waaler (2026). Enabling Cost-Effectiveness Analyses in Municipal Long-Term Care Services: Mapping the Norwegian Register-Based Disability Measure to EQ-5D-3L. Fulltekst i vitenarkiv
• Schepers, Robin; Bennett, Schyler Marie; Anthun, Kjartan Sarheim; Asheim, Andreas; Bjerkeset, Ottar & Bjørnelv, Gudrun Maria Waaler [Vis alle 8 forfattere av denne artikkelen] (2026). Variation in general practitioners' mental health diagnostic practices and their association with patient care: A Norwegian registry study. Fulltekst i vitenarkiv
• Aas, Eline; Kinge, Jonas Minet; Burger, Emily Annika; Pedersen, Kine; Iversen, Tor & Godager, Geir [Vis alle 14 forfattere av denne artikkelen] (2025). Feil tallgrunnlag kan koste liv i helsetjenesten. Fulltekst i vitenarkiv
• Burrell, Lisa Victoria; Edwards, Christina Hansen; Michel, Yvonne Anne & Bjørnelv, Gudrun Maria Waaler (2025). Enabling cost-effectiveness analyses in municipal long-term care services: Mapping the Norwegian register-based disability measures to EQ-5D-3L. Fulltekst i vitenarkiv
• Aas, Eline; Bjørnelv, Gudrun Maria Waaler; Edwards, Christina Hansen & Hjort, Ingrid (2025). Perspektiver på prioritering. 145(12), s. 1–8. doi: 10.4045/tidsskr.25.0419. Fulltekst i vitenarkiv Vis sammendrag

  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?

• Schepers, Robin; Bennett, Schyler Marie; Anthun, Kjartan Sarheim; Asheim, Andreas; Bjerkeset, Ottar & Bjørnelv, Gudrun Maria Waaler [Vis alle 8 forfattere av denne artikkelen] (2025). General practitioners’ diagnostic preference as a potential instrument for the diagnosis of mental health. Fulltekst i vitenarkiv
• Hjort, Ingrid; Aas, Eline; Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2025). Skal samfunnsgevinster telle? Fulltekst i vitenarkiv
• Asheim, Andreas; Næss, Lars Eide; Dale, Jostein; Uleberg, Oddvar; Ulvin, Ole Erik Eide & Krüger, Andreas Jørstad [Vis alle 11 forfattere av denne artikkelen] (2024). Opptatte ambulanser fører til forsinket respons. Har dette konsekvenser for risiko for død og helsetjenestebruk? Fulltekst i vitenarkiv
• Asheim, Andreas; Næss, Lars Eide; Dale, Jostein; Uleberg, Oddvar; Ulvin, Ole Erik Eide & Krüger, Andreas Jørstad [Vis alle 11 forfattere av denne artikkelen] (2024). Does delayed response due to busy ambulances impact the risk of death and hospital service utilisation? Fulltekst i vitenarkiv
• Vie, Gunnhild Åberge; Brandkvist, Maria; Brumpton, Ben Michael; Bjørnelv, Gudrun Maria Waaler; Åsvold, Bjørn Olav & Davies, Neil Martin [Vis alle 8 forfattere av denne artikkelen] (2024). Education and body mass index before and after the obesity epidemic – the HUNT Study. Fulltekst i vitenarkiv
• Aasdahl, Lene; Gismervik, Sigmund Østgård; Johnsen, Roar; Vasseljen, Ottar; Bjørnelv, Gudrun Maria Waaler & Bjørngaard, Johan Håkon [Vis alle 7 forfattere av denne artikkelen] (2024). 7 års oppfølging av effekter etter arbeidsrettet rehabilitering på Hysnes. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Asheim, Andreas; Næss, Lars Eide; Krüger, Andreas Jørstad; Uleberg, Oddvar; Dale, Jostein & Haugland, Helge [Vis alle 11 forfattere av denne artikkelen] (2024). Forsvarlig responstid i ambulansetjenesten. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Bjørngaard, Johan Håkon (2024). Økonomiske overraskelser – nye perspektiver på sammenhengen mellom BMI og kostnader. Fulltekst i vitenarkiv
• Røislien, Jo; Uleberg, Oddvar; Jagtenberg, Caroline J. & Bjørnelv, Gudrun Maria Waaler (2024). Cost-effective life saving: Air ambulance base locations in Norway. Fulltekst i vitenarkiv
• Edwards, Christina Hansen; Bjørngaard, Johan Håkon; Kinge, Jonas Minet; Vie, Gunnhild Åberge; Halsteinli, Vidar & Ødegård, Rønnaug Astri [Vis alle 8 forfattere av denne artikkelen] (2023). The healthcare costs of increased BMI - compiling the evidence from multiple methodological approaches. Fulltekst i vitenarkiv
• Edwards, Christina Hansen; Mignon, Doriane Marie; Bjørngaard, Johan Håkon; Bjørnelv, Gudrun Maria Waaler; Vie, Gunnhild Åberge & Kinge, Jonas Minet (2023). KMI og sykefravær. Fulltekst i vitenarkiv
• Vie, Gunnhild Åberge; Brandkvist, Maria Charlotta; Brumpton, Ben Michael; Bjørnelv, Gudrun Maria Waaler; Åsvold, Bjørn Olav & Davies, Neil [Vis alle 8 forfattere av denne artikkelen] (2023). Education and body mass index before and after the obesity epidemic – the HUNT Study. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Melberg, Hans Olav (2023). Penger, prinsipper og prioritering. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(9). doi: 10.4045/tidsskr.23.0210. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Aas, Eline (2023). Kostnadseffektivitetsanalyse: et rammeverk for prioriteringskriteriene. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(16), s. 1424–1425. doi: 10.4045/tidsskr.23.0474. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme, viser norsk studie. [Internet]. Psykologisk.no. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Teknisk Ukeblad. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Trondheim by (adressa). Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Klar tale. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Gemini. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Gauldalsposten. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Moss Avis. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Forskning.no. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. MSN. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt verre enn fedme. [Journal]. Nordlys. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Finnmark arbeiderblad. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Radio]. Radio Haugaland. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Adresseavisen. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Prioritering – den gylne regel. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.23.0689. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Fjordenes tidene. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Aftenposten. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler (2023). Vanlig overvekt koster samfunnet mer enn fedme. [Radio]. P4 Nyhetene. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Dagens Medisin. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Smaalenenes Avis. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Tønsberg blad. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Dagsavisen. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. ABC nyheter. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Avisa Møre. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Journal]. Folkebladet pluss. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2023). Overvekt tynger samfunnet mer enn fedme. [Internet]. Norsk rikskringkasting. Fulltekst i vitenarkiv
• Aasdahl, Lene; Fimland, Marius Steiro; Bjørnelv, Gudrun Maria Waaler; Gismervik, Sigmund Østgård; Johnsen, Roar & Vasseljen, Ottar [Vis alle 7 forfattere av denne artikkelen] (2023). Helseøkonomiske effekter av arbeidsrettet rehabilitering-Hysnes prosjektet. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Burger, Emily Annika & Aas, Eline (2023). Hvor ble det av prioriteringskriteriene for ABC-klinikken? Fulltekst i vitenarkiv Vis sammendrag

  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?

• Bjørnelv, Gudrun Maria Waaler; Asheim, Andreas; Nilsen, Sara Marie; Anthun, Kjartan Sarheim; Carlsen, Fredrik & Aam, Stina [Vis alle 8 forfattere av denne artikkelen] (2023). Betydningen av en presset eldreomsorg. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler (2023). Vanlig overvekt koster samfunnet mer enn fedme. [Radio]. Nyhetsmorgen NRK. Fulltekst i vitenarkiv
• Andvig, Jørgen Garberg; Johnsen, Lars Gunnar; Bjørnelv, Gudrun Maria Waaler; Bjørngaard, Johan Håkon; Nilsen, Sara Marie & Asheim, Andreas (2022). Frakturepidemiologi i Norge 2009-2016. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Edwards, Christina Hansen; Øvretveit, Karsten; Hveem, Kristian & Bjørngaard, Johan Håkon (2022). ‘Obese individuals and obese populations’. Hvordan perspektiver påvirker assosiasjonen mellom BMI og helsetjenestekostnader. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Uleberg, Oddvar; Jagtenberg, Caroline J. & Røislien, Jo (2022). Utopia for Norwegian Helicopter Emergency Medical Services: is leaving no man behind worth the effort? Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler (2022). Prioritering og helseøkonomi – hvordan vi kan gjennomføre økonomiske evalueringer, eller kostnadseffektivitets-analyser, av folkehelsetiltak. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Asheim, Andreas; Nilsen, Sara Marie; Anthun, Kjartan Sarheim; Carlsen, Fredrik & Aam, Stina [Vis alle 8 forfattere av denne artikkelen] (2022). Municipal capacity and patient mortality: exploring causal inference on municipal level. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler (2022). Prioritering i helsetjenesten før, nå og i framtiden - med fokus på økonomisk evaluering. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Edwards, Christina Hansen; Øvretveit, Karsten; Hveem, Kristian & Bjørngaard, Johan Håkon (2022). Obese individuals and obese populations. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler & Edwards, Christina Hansen (2022). Fedmedebatten: − Samfunnet har skylden. [Journal]. Verdens Gang (VG). Fulltekst i vitenarkiv
• Vinjerui, Kristin Hestmann; Svedahl, Ellen Rabben; Nilsen, Sara Marie; Kaspersen, Silje Lill; Hosar, Rannei & Vie, Gunnhild Åberge [Vis alle 9 forfattere av denne artikkelen] (2022). Forskning viser at ...., men er det sant? Fulltekst i vitenarkiv
• Edwards, Christina Hansen; Bjørnelv, Gudrun Maria Waaler; Øvretveit, Karsten; Hveem, Kristian & Bjørngaard, Johan Håkon (2022). Individual and societal perspectives on obesity. Fulltekst i vitenarkiv
• Edwards, Christina Hansen; Bjørngaard, Johan Håkon; Kinge, Jonas Minet; Vie, Gunnhild Åberge; Halsteinli, Vidar & Ødegård, Rønnaug [Vis alle 8 forfattere av denne artikkelen] (2022). The healthcare costs of increased BMI – compiling the evidence from multiple methodological approaches. Fulltekst i vitenarkiv
• Mignon, Doriane; Bjørnelv, Gudrun Maria Waaler; Bjørngaard, Johan Håkon; Carlsen, Fredrik & Vie, Gunnhild Åberge (2022). BMI Effect on Multimorbidity: A Mendelian Randomization Analysis with the HUNT Study. Fulltekst i vitenarkiv
• 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. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Hagen, Terje P.; Forma, Leena & Aas, Eline (2021). Living situation, healthcare utilization and costs at end-of-life for cancer patients in Norway. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Aas, Eline; Aaltonen, Mari; Hagen, Terje P. & Forma, Leena (2021). Place of living during end-of-life according to cause of death: a comparative analysis from Finland and Norway. Fulltekst i vitenarkiv
• Bjørnelv, Gudrun Maria Waaler; Forma, Leena; Hagen, Terje P. & Aas, Eline (2021). En komparativ analyse av sammensetningen av helsetjenester, bosituasjon og totale helsetjenestekostnader for personer med kreft ved livets slutt. Fulltekst i vitenarkiv
• Vervaart, Mathyn Adrianus Marinus; Aas, Eline; Asphaug, Lars; Bjørnelv, Gudrun Maria Waaler; Burger, Emily Annika & Wisløff, Torbjørn (2021). I strid med etablert kunnskap. Dagens medisin. ISSN 1501-4290. Fulltekst i vitenarkiv
• Melberg, Hans Olav; Aas, Eline; Hjort, Ingrid; Vorland, lars; Barra, Mathias & Husbyn, Hallstein [Vis alle 10 forfattere av denne artikkelen] (2024). Perspektiv og prioriteringer: Rapport fra ekspertgruppen perspektiv i prioritering nedsatt av Helse- og omsorgdepartementet. Helse- og omsorgdepartementet. Fulltekst i vitenarkiv

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