Till Örebro universitet

This paper compares the value per statistical life (VSL) in the context of suicide prevention to that of prevention of traffic fatalities. We conducted a contingent valuation survey with questions on willingness to pay (WTP) in both contexts by administering a web questionnaire to 1038 individuals aged 18 to 80. We conjectured that WTP for a given impact on the number of fatalities would be lower for suicide prevention because suicide, at least to some degree, is the result of individuals' own decisions. However, this hypothesis was not supported by the within- or between-sample estimates of WTP or by responses to direct questions. Hence, no support is provided for the use of a lower valuation of the impact of suicide prevention than for risk-reducing programs in other fields, such as traffic safety. This implies that the same VSL should be used for evaluating suicide prevention interventions and for risk-reducing programs in other policy areas and funds for the prevention of fatalities should be directed to the area with the lowest cost per life saved.

Det svenska e-infrastrukturlandskapet är fragmenterat och trots rekommendationer från beslutsfattare så ökar fragmenteringen. De nationella aktörer som har uppdrag och/eller mandat som rör forskningsdata är främst SNIC, SND, och Sunet. Dessa aktörer tillhandahåller tjänster och stöd till forskare under olika delar av forskningsdatalivscykeln. På grund av de oklara mandat och uppdrag som råder nationellt, så finns förväntningar på de olika aktörerna som inte går att uppfylla. Ett exempel är lagring av forskningsdata, såväl aktiva som inaktiva. Svenska forskare är del av ett globalt forskarsamhälle, och tar därigenom del av en mängd internationella infrastrukturer, verktyg, och sammanhang. I och med den implementeringsfas som EOSC gått in i, så behöver svensk e-infrastruktur vara interoperabel med de internationellt tillgängliga tjänster som svenska forskare använder.Exakt vilka behov som finns hos svenska forskare, och vem som har ansvar för att svara upp mot behoven, är oklart i många frågor. Det infrastrukturella stöd som forskare behöver för att hantera forskningsdata under hela datalivscykeln, med välfungerande gränssnitt mellan nationella och internationella aktörers e-infrastrukturlösningar finns i vissa fall och är i andra fall fragmenterat. För att komma vidare i utvecklingen av sammanhållet stöd för forskare, formerades under 2021 ett nationellt samarbete inom verksamhetsarkitektur för forskningsdataområdet, med syfte att ta fram ett gemensamt bildspråk, visualisera ett mycket komplext område, och att konkretisera krav, villkor, juridiska ramverk, styrdokument etc. som påverkar forskningsdatahantering.Projektet som rapporteras här fokuserade på vad forskare behöver ha för att forskningsdata ska hanteras på ett högkvalitativt sätt och vilket infrastrukturellt stöd forskarna i detta. Projektet fokuserade på helheten i datahanteringen, vad som finns på plats på nationell nivå och vad som behöver åtgärdas. Angreppsättet var verksamhetsarkitekturellt, som med Vintergatan som metod. En grundkarta för forskningsdataområdet, framtagen inom ett tidigare verksamhetsarkitekturellt projekt på Lunds universitet, låg till grund för projektet.

Denna rapport beskriver resultaten av ett projekt där ett verksamhetsarkitekturellt angreppssätt har använts för att förstå, utforska och beskriva forskares praktiker och behov av stöd i sitt arbete med forskningsdatahantering, och särskilt datalagring. Här beskriver vi rapporten för dig som läser, så att du kan välja de delar som du finner mest intressanta och relevanta för just dig, just nu. Vår ambition har varit att ta fram ett rikt material som kan leva vidare, byggas på, revideras, förkastas, byggas upp på nytt utifrån nya resultat, och så vidare.

Många utvärderingar om insatser tittar främst på direkta ekonomiska effekter. Men dessa kan leda till ekonomiska konsekvenser i andra delar av individens liv och för samhället.

Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the "value for money." The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to "status quo" (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts.

Objective: In 1997 the Swedish Parliament decided on a “vision zero” long-term target for reduction of fatalities and severe injuries caused by traffic accidents. In 2008 a similar zero vision was adopted for suicides. While the former decision has been very successful, resulted in a slimming of the number of traffic fatalities by close to a half percentages, the number of suicides has been more or less constant since the latter decision was made. A possible explanation could be that the general public, and therefore also the many people that need to be involved to accomplish a broad and ambitious target of this kind, give less priority to the reduction of death that is in some sense caused by voluntary action than death brought about by an accident. The objective of this study is to compare the valuation of statistical life (VSL) of a representative sample of Swedish adult residents in traffic accident and suicide prevention contexts.

Method: We make within-sample comparisons of responses to a pair of consecutive contingent-valuation WTP questions to a web panel of 800 individuals in the age of 18-80. The respondent are asked to state their WTP for interventions that are expected to save 100 (200) lives by prevention of traffic accidents or suicides, respectively. Respondents are also asked whether they think it is more important to reduce the number of deaths due to traffic accidents or due to suicides.

Results: 68 percent state that they think it is equally important to save lives by prevention of suicides as by traffic accidents. For 18 percent suicide prevention is more important and for 13 percent reduction of traffic safety is more important. The same picture emerges from the WTP responses. 35 percent state equal WTP values and the differences between the average VSL are not statistically significant (preliminary results).

Discussion: This finding indicates that the same VSL should be used in both areas, implying that funds for prevention of fatalities should be directed to the area with the lowest cost per saved life. To our knowledge the only previous studies on WTP for suicide prevention are Sueki (2015, 2016) that reported a lower average WTP to reduce mortality risk from suicide than from reducing mortality from other causes. However, these studies were framed within a private good context, which is problematic in the specific case of suicide since the respondent has to think of herself as a current “planner” restricting herself future “doer”. In our study, we therefore frame both kind of prevention measures as public goods, which avoids this cognitive task and also can be related to quite commonly made economic trade-offs in budget planning by state and local governments, traffic administrations, hospital boards, etc.

In this study, we investigate whether, or to what degree, a ‘business case’ could be made for implementation of a Supported-Employment (SE) inspired program for pupils with intellectual disabilities (IDs), starting during the final school years. For this aim, we do a quasi-experimental before-after intervention impact evaluation of such a project funded by the European Social Fund in the Swedish city of Örebro (135,000 inhabitants) during 2010–2013. From an estimate of the average treatment effect, we calculate the internal net present value and the payback period that would make this program break even from avoided expenditure for day-activity services, assuming that it had been funded entirely by the municipality.

The focus of this thesis is economic evaluations of programs and interventions regarding children and adolescents with mental health issues, victimization, and intellectual disabilities (ID). The first paper examines a potential link between mental health issues among adolescent and the class-size of the school class they are enrolled in. The class-size and schools’ financial resources is often at the center of policy debates. Our results suggest that there is no evidence that larger classes have negative impact on the mental health for adolescents in a Swedish context. The second paper investigate the societal willingness to pay (WTP) to reduce bullying in Swedish schools. The results suggest that the tax payers WTP is about 5 SEK and the societal is about 600 000 SEK per reduced bullying victim. This value of WTP could be used as a measure to evaluate different investments in anti-bullying programs and efforts to reduce the bullying in schools. The third paper estimates the cost-effectiveness of one recently introduced antibullying program, the Finnish KiVa program, one of the few evidence based programs in the world. Based on a decision-analytic model, the results indicate that the KiVa program is a cost-effective program that has a cost per reduced victim well below the WTP as estimated in the second paper as documented above. The fourth paper evaluates, from the municipality perspective, the effects of investing in a SE program compared to “business as usual” in order to increase the likelihood for gaining regular employment for the pupils with ID. The results indicate that it takes 9 years before breakeven is reached if investing in the SE program. The fifth paper conducts a decision-analytic economic evaluation of the SE program using simulations to assess the effects over the full life-course. The results suggest that from a societal perspective the program is cost-effective ten years after the investment and by then has generated a benefit of 17 000 SEK per individual.