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Gil-Nagel A, Falip M, Sánchez-Carpintero R, Abad-Sazatornil MR, Poveda JL, Aibar JÁ, Cardenal-Muñoz E, Aras LM, Sánchez R, Sancho-López A, Trillo-Mata JL, Torrejón M, Gil A. The contribution of fenfluramine to the treatment of Dravet syndrome in Spain through Multi-Criteria Decision Analysis. Epilepsy Behav 2022; 132:108711. [PMID: 35588562 DOI: 10.1016/j.yebeh.2022.108711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dravet Syndrome (DS) is a severe, developmental epileptic encephalopathy (DEE) that begins in infancy and is characterized by pharmaco-resistant epilepsy and neurodevelopmental delay. Despite available antiseizure medications (ASMs), there is a need for new therapeutic options with greater efficacy in reducing seizure frequency and with adequate safety and tolerability profiles. Fenfluramine is a new ASM for the treatment of seizures associated with DS as add-on therapy to other ASMs for patients aged 2 years and older. Fenfluramine decreases seizure frequency, prolongs periods of seizure freedom potentially helping to reduce risk of Sudden Unexpected Death in Epilepsy (SUDEP) and improves patient cognitive abilities positively impacting on patients' Quality of Life (QoL). Reflective Multi-Criteria Decision Analysis (MCDA) methodology allows to determine what represents value in a given indication considering all relevant criteria for healthcare decision-making in a transparent and systematic manner from the perspective of relevant stakeholders. The aim of this study was to determine the relative value contribution of fenfluramine for the treatment of DS in Spain using MCDA. METHOD A literature review was performed to populate an adapted a MCDA framework for orphan-drug evaluation in Spain. A panel of ten Spanish experts, including neurologists, hospital pharmacists, patient representatives and decision-makers, scored four comparative evidence matrices. Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. RESULTS Dravet syndrome is considered a severe, rare disease with significant unmet needs. Fenfluramine is perceived to have a higher efficacy profile than all available alternatives, with a better safety profile than stiripentol and topiramate and to provide improved QoL versus studied alternatives. Fenfluramine results in lower other medical costs in comparison with stiripentol and clobazam. Participants perceived that fenfluramine could lead to indirect costs savings compared to available alternatives due to its efficacy in controlling seizures. Overall, fenfluramine's therapeutic impact on patients with DS is considered high and supported by high-quality evidence. CONCLUSIONS Based on reflective MCDA, fenfluramine is considered to add greater benefit in terms of efficacy, safety and QoL when compared with available ASMs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Alicia Gil
- Omakase Consulting S.L., Barcelona, Spain.
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Peris-Campillo P, Trillo-Mata JL, Roca-Navarro MP, Usó-Talamantes R, Navarro-Pérez J. Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019). Rev Esp Geriatr Gerontol 2022; 57:90-94. [PMID: 35292158 DOI: 10.1016/j.regg.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/03/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). OBJECTIVE Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019. METHOD Descriptive population-based study. SETTING 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain. PERIOD 2015-2019. SUBJECTS Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. ANALYSES frequencies and time trends, both overall and by specific type. RESULTS Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). CONCLUSIONS IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.
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Affiliation(s)
- Paula Peris-Campillo
- Emergency Department, University Clinical Hospital, Health Department 'València - Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain.
| | - José Luis Trillo-Mata
- Direction of Pharmacy, Health Department 'València-Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain
| | - María Pilar Roca-Navarro
- Primary Care Physician, República Argentina Health Centre, Health Department 'València-Clinic-Malvarrosa', Valencia, C/ República Argentina n° 8, Valencia, Spain
| | - Ruth Usó-Talamantes
- Medical Direction, Valencia Quiron Hospital, Av. Blasco Ibáñez n° 14, 46010 Valencia, Spain
| | - Jorge Navarro-Pérez
- Medical Direction, Health Department 'València-Clinic-Malvarrosa', Valencia, Av. Blasco Ibáñez n° 17, 46010 Valencia, Spain; INCLIVA Health Research Institute, University Clinical Hospital, Health Department 'València - Clinic-Malvarrosa', Valencia, Spain; CIBERESP Consortium for Biomedical Research in Epidemiology & Public Health, Spain
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Usó-Talamantes R, González-de-Julián S, Díaz-Carnicero J, Saurí-Ferrer I, Trillo-Mata JL, Carrasco-Pérez M, Navarro-Pérez J, Górriz JL, Vivas-Consuelo D, Redón J. Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain. Int J Environ Res Public Health 2021; 18:ijerph18189853. [PMID: 34574782 PMCID: PMC8468968 DOI: 10.3390/ijerph18189853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clínico–La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years (13.9); 51.5% male). Up to 14.935 patients (52.6%) had data on kidney function. According to the KDIGO classification, 66.2% of the patients were at low risk of CKD, 20.6% at moderately increased risk, 7.9% at high risk, and 5.2% at very high risk. The average healthcare costs associated with these four risk groups were EUR 3437, EUR 4936, EUR 5899 and EUR 7389, respectively. The large number of T2D patients with CKD in the early stages of the disease generated a significant increase in direct healthcare costs. The economic impact could be mitigated by early and comprehensive therapeutic approaches.
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Affiliation(s)
- Ruth Usó-Talamantes
- Conselleria de Sanitat i Salut Pública, Generalitat Valenciana, 46010 Valencia, Spain
- School of Medicine and Health Sciences, Valencia Catholic University, 46001 Valencia, Spain
- Correspondence:
| | - Silvia González-de-Julián
- Research Unit for Health Economics and Management, Universitat Politècnica de València, 46022 Valencia, Spain; (S.G.-d.-J.); (J.D.-C.); (D.V.-C.)
| | - Javier Díaz-Carnicero
- Research Unit for Health Economics and Management, Universitat Politècnica de València, 46022 Valencia, Spain; (S.G.-d.-J.); (J.D.-C.); (D.V.-C.)
| | | | | | | | - Jorge Navarro-Pérez
- INCLIVA Research Institute, 46010 Valencia, Spain; (I.S.-F.); (J.N.-P.); (J.L.G.); (J.R.)
- Hospital Valencia Clínico–Malvarrosa, 46010 Valencia, Spain;
- School of Medicine, University of Valencia, 46010 Valencia, Spain
| | - José Luis Górriz
- INCLIVA Research Institute, 46010 Valencia, Spain; (I.S.-F.); (J.N.-P.); (J.L.G.); (J.R.)
- Hospital Valencia Clínico–Malvarrosa, 46010 Valencia, Spain;
- School of Medicine, University of Valencia, 46010 Valencia, Spain
| | - David Vivas-Consuelo
- Research Unit for Health Economics and Management, Universitat Politècnica de València, 46022 Valencia, Spain; (S.G.-d.-J.); (J.D.-C.); (D.V.-C.)
| | - Josep Redón
- INCLIVA Research Institute, 46010 Valencia, Spain; (I.S.-F.); (J.N.-P.); (J.L.G.); (J.R.)
- Hospital Valencia Clínico–Malvarrosa, 46010 Valencia, Spain;
- School of Medicine, University of Valencia, 46010 Valencia, Spain
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Díaz Planelles I, Saurí Ferrer I, Trillo-Mata JL, Navarro-Pérez J. [Analysis of potentially inappropriate prescriptions according to the START criteria in nursing homes]. Rev Esp Geriatr Gerontol 2021; 56:195-202. [PMID: 34116800 DOI: 10.1016/j.regg.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The potentially inappropriate prescription by omission of a drug is defined as the failure to prescribe drugs that are clinically indicated. The objective of this article is to describe and analyse the evolution of inappropriate prescriptions by omission in nursing homes of a health department. MATERIAL AND METHODS Retrospective observational descriptive study carried out in nursing homes of the Valencia-Clínico-Malvarrosa health department during the period 2016-2018. All institutionalized patients during this period were included. The prevalence of potentially inappropriate prescriptions by omission was assessed based on version 2 of the START criteria. The variables came from the electronic medical records of ambulatory care of the Conselleria de Sanitat (Abucasis). RESULTS 2251 different patients were selected, mean age of 79,53years, 69% women, and an average of 4,60 chronic drugs/resident. A total of 2647 inappropriate prescriptions by omission were identified during the study period, and the results were similar during these 3years. The most prevalent START criteria were those related to the musculoskeletal system and the cardiovascular system, and those related to analgesic consumption. The mean value of inappropriate prescriptions by omission prevalence for the period studied were 39.54%. CONCLUSION The results of our study confirm a high prevalence of potentially inappropriate prescriptions by omission in residents of nursing homes, and the maintenance of this prevalence during the 3years of the study.
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Affiliation(s)
| | - Inma Saurí Ferrer
- INCLIVA Instituto de Investigación Sanitaria. Hospital Clínico Universitario de Valencia, Valencia, España
| | - José Luis Trillo-Mata
- Servicio de Farmacia de Área de Salud, Departamento de Salud Clínico-Malvarrosa. Hospital Clínico Universitario de Valencia, Valencia, España
| | - Jorge Navarro-Pérez
- Universidad de Valencia, Valencia, España; INCLIVA Instituto de Investigación Sanitaria. Hospital Clínico Universitario de Valencia, Valencia, España; Dirección Médica Hospital Clínico Universitario de Valencia, Valencia, España; Centro de Investigación Biomédica en red Epidemiología y Salud Pública (CIBERESP), España
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Cabo-Meseguer A, Cerdá-Olmedo G, Trillo-Mata JL. [Epidemiology and sociodemographic characterization of the fibromyalgia in Comunidad Valenciana]. Rev Esp Salud Publica 2019; 93:e201912099. [PMID: 31831726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/26/2019] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The elevated prevalence of the fibromyalgia and its polypathologic clinic suppose an important Public Health problem in Spain. The purpose of this study was to carry out an approach of the syndrome's epidemiology, with the finality of collaborate in the scientific knowledge progress of the people who suffer fibromyalgia, in this case, through the sociodemographic analysis of Comunidad Valenciana patients, in Spain. METHODS It was done an epidemiologic descriptive transversal study, by extractions and analysis of epidemiological variables in official resources of health information of Comunidad Valenciana (Abucasis II, SIA, GAIA, SIP, SIE). The study presented two different analysis processes: the first one was the exam of the fibromyalgia prevalence evolution of the whole Comunidad Valenciana, considering the totality of diagnosed people between 2012 and 2016. The second one, supposed the sociodemographic characterization of people who are affected with fibromyalgia, using a sample of 9,267 people with active diagnostic of the disease in one of the 25 health department of the valencian public system, observing variables such as age, sex, origin, asistenciality, labour activity and economic level. The datum statistic treatment was descriptive univariable and it was made with percentage values of means, median and mode. The confidence interval for the average when required was set at 95 percent. RESULTS Fibromyalgia was an elevated prevalence disease in Comunidad Valenciana (3.7%) in the study's period, establishing itself above the world media prevalence studied, Europe or Spain. What is more, it presented a special gravity in the male prevalence. Its evolution reflected a growth year-to-year of the order of 28 percent, with an average incidence rate of 5.39 new cases per thousand inhabitants / year. It specially affected women (it had it the 63% of the sample) and the average age of 54 years. Besides, people with fibromyalgia presented low economic levels and laboural difficulties defined by low employment rate, the elevated unemployment rate and the frequency and length of their work leaves. CONCLUSIONS Fibromyalgia has a special epidemiological importance in Comunidad Valenciana, with a high prevalence and incidence. In its basic sociodemography we found an elevated percent of women with ages between 51 and 70 years, but also, we find a male prevalence of special consideration comparatively with other studies. We observe an important reduce of the socioeconomic and sociodemographic conditions between fibromyalgia diagnosed people.
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Affiliation(s)
- Asensi Cabo-Meseguer
- Grupo de Investigación de Fibromialgia. Universidad Católica de Valencia San Vicente Mártir. Valencia. España
| | - Germán Cerdá-Olmedo
- Facultad de Medicina. Universidad Católica de Valencia San Vicente Mártir. Valencia. España
| | - José Luis Trillo-Mata
- Departamento Clínico Malvarrosa. Conselleria de Sanidad. Generalitat Valenciana. Valencia. España
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Cabo-Meseguer A, Cerdá-Olmedo G, Trillo-Mata JL. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med Clin (Barc) 2017; 149:441-448. [PMID: 28734619 DOI: 10.1016/j.medcli.2017.06.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
Fibromyalgia is an idiopathic chronic condition that causes widespread musculoskeletal pain, hyperalgesia and allodynia. This review aims to approach the general epidemiology of fibromyalgia according to the most recent published studies, identifying the general worldwide prevalence of the disease, its basic epidemiological profiles and its economic costs, with specific interest in the Spanish and Comunidad Valenciana cases. Fibromyalgia affects, on average, 2.10% of the world's population; 2.31% of the European population; 2.40% of the Spanish population; and 3.69% of the population in the Comunidad Valenciana. It supposes a painful loss of the quality of life of the people who suffer it and the economic costs are enormous: in Spain is has been estimated at more than 12,993 million euros annually.
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Affiliation(s)
- Asensi Cabo-Meseguer
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España.
| | - Germán Cerdá-Olmedo
- Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, España
| | - José Luis Trillo-Mata
- Departamento Clínico Malvarrosa, Conselleria de Sanidad, Generalitat Valenciana, Valencia, España
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Vivas-Consuelo D, Usó-Talamantes R, Trillo-Mata JL, Mendez-Valera P. Methods to control the pharmaceutical cost impact of chronic conditions in the elderly. Expert Rev Pharmacoecon Outcomes Res 2015; 15:425-37. [DOI: 10.1586/14737167.2015.1017564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David Vivas-Consuelo
- 1Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio7J, Campus de Vera s/n 46022-Valencia, Spain
| | - Ruth Usó-Talamantes
- 2Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
| | - José Luis Trillo-Mata
- 2Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
| | - Pablo Mendez-Valera
- 2Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
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Vivas-Consuelo D, Usó-Talamantes R, Trillo-Mata JL, Caballer-Tarazona M, Barrachina-Martínez I, Buigues-Pastor L. Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups. Health Policy 2014; 116:188-95. [DOI: 10.1016/j.healthpol.2014.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 12/18/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
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