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Perea-Bello AH, Trapero-Bertran M, Dürsteler C. Palliative Care Costs in Different Ambulatory-Based Settings: A Systematic Review. Pharmacoeconomics 2024; 42:301-318. [PMID: 38151673 PMCID: PMC10861396 DOI: 10.1007/s40273-023-01336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Cost-of-illness studies in palliative care are of growing interest in health economics. There is no standard methodology to capture direct and non-direct healthcare and non-healthcare expenses incurred by health services, patients and their caregivers in the course of the ambulatory palliative care process. OBJECTIVE We aimed to describe the type of healthcare and non-healthcare expenses incurred by patients with cancer and non-cancer patients and their caregivers for palliative care in ambulatory-based settings and the methodology used to capture the data. METHODS We conducted a systematic review of studies on the costs of ambulatory-based palliative care in patients with cancer (breast, lung, colorectal) and non-cancer conditions (chronic heart failure, chronic obstructive pulmonary disease, dementia) found in six bibliographic databases (PubMed, EMBASE [via Ovid], Cochrane Database of Systematic Reviews, EconLit, the National Institute for Health Research Health Technology Assessment Database and the National Health Service Economic Evaluation Database at the University of York, and Google Scholar). The studies were published between January 2000 and December 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology for study selection and assessed study quality using the Quality of Health Economic Studies instrument. The study was registered in PROSPERO (CRD42021250086). RESULTS Of 1434 identified references, 43 articles met the inclusion criteria. The primary data source was databases. More than half of the articles presented data from public healthcare systems (65.12%) were retrospective (60.47%), and entailed a bottom-up costing analysis (93.2%) made from a healthcare system perspective (53.49%). The sociodemographic characteristics of patients and families/caregivers were similar across the studies. Cost outcomes reports were heterogeneous; almost all of the studies collected data on direct healthcare costs (97.67%). The main driver of costs was inpatient care (55.81%), which increased during the end-of-life period. Nine studies (20.97%) recorded costs due to productivity losses for caregivers and three recorded such costs for patients. Caregiving costs were explored through an opportunity cost analysis in all cases, based on interviews conducted with and questionnaires administered to patients and caregivers, mainly via telephone calls (23.23%). CONCLUSIONS This systematic review reveals that studies on the costs of ambulatory-based palliative care are increasing. These studies are mostly conducted from a healthcare system perspective, which leaves out costs related to patients'/caregivers' economic burden. There is a need for prospective studies to assess this financial burden and evaluate, with strong evidence, the interventions and actions designed to improve the quality of life of palliative care patients. Future studies should propose cost calculation approaches using a societal perspective to better estimate the economic burden imposed on patients in ambulatory-based palliative care.
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Affiliation(s)
| | - Marta Trapero-Bertran
- Department of Economics and Business, Faculty of Law, Economics and Tourism, Universitat de Lleida, Lleida, Spain
| | - Christian Dürsteler
- Pain Medicine Section, Department of Anaesthesiology, Hospital Clínic de Barcelona, Barcelona, Spain
- Department of Surgery. Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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Trapero-Bertran M, Gil-Doménech D, Vargas-Martínez AM. Economic evaluations of interventions aimed at the prevention, treatment and/or rehabilitation of alcohol-related disorders: A systematic review. Adicciones 2023; 35:325-348. [PMID: 34171112 DOI: 10.20882/adicciones.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this systematic literature review is to identify economic evaluations of programmes or interventions aimed at the prevention, treatment and rehabilitation of alcohol use disorders, as well as to determine those types of programmes, treatments or interventions that are efficient. The systematic literature review was conducted by searching the following databases: National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA), MEDLINE Ovid and PubMed. The search terms used were in English. No time restriction was applied. A data extraction form was used to draw information. The systematic review follows the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) on reporting systematic reviews. The interventions were classified into three categories: "A" treatments for people with alcohol use disorders (tertiary prevention); "B" treatments for people at risk for alcohol-related problems (secondary prevention); "C" policy legislation and enforcement interventions (primary prevention). Furthermore, the "A" interventions were subclassified into psychological, pharmacological and combined interventions. The review included 63 papers. In terms of treatments for people with alcohol use disorders, any psychosocial intervention compared to no intervention appeared to be a dominant strategy. In terms of treatments for people at risk of alcohol-related problems, brief intervention appears to be dominant or cost-effective when compared to no intervention. Advertising controls, tax increases, licensing, legal drinking age, and mass media campaigns seem to be dominant or cost-effective strategies compared to no intervention or random breath testing. Previous reviews have been extended by depicting alcohol programmes according to their efficiency. Despite this, the available studies in this regard have heterogeneous approaches and most do not adequately define the costs included in their analyses. Therefore, it is necessary to encourage the evaluation of the efficiency of these types of interventions to aid decision-making in public health.
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Affiliation(s)
- Marta Trapero-Bertran
- Departamento de Ciencias Básicas. Instituto Universitario de Pacientes. Universitat Internacional de Catalunya (UIC Barcelona)..
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Zozaya N, Villaseca J, Abdalla F, Ancochea A, Málaga I, Trapero-Bertran M, Martín-Sobrino N, Delgado O, Ferré P, Hidalgo-Vega A. Strategic discussion on funding and access to therapies targeting rare diseases in Spain: an expert consensus paper. Orphanet J Rare Dis 2023; 18:41. [PMID: 36823598 PMCID: PMC9950008 DOI: 10.1186/s13023-023-02635-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In recent years, significant advances have been made in the field of rare diseases (RDs). However, there is a large number of RDs without specific treatment and half of these treatments have public funding in Spain. The aim of the FINEERR project was to carry out a multidisciplinary strategic discussion on the challenge of funding and access to RD-targeted drugs in Spain, in order to agree on specific proposals for medium-term improvement and hence support decision-making in the Spanish National Healthcare System (SNHS). RESULTS The FINEERR Project was organized around a CORE Advisory Committee, which provided an overview, agreed on the design and scope of the project, and selected the members within each of four working groups (WG). Overall, 40 experts discussed and reached a consensus on different relevant aspects, such as conditioning factors for initial funding and access, evaluation and access to RD-targeted therapies, funding of these therapies, and implementation of a new funding and access model. From these meetings, 50 proposals were defined and classified by their level of relevance according to the experts. A descriptive analysis of responses was performed for each proposal. Thereafter, experts completed another questionnaire where they ranked the 25 most relevant proposals according to their level of feasibility of being implemented in the SNHS. The most relevant and feasible proposals were to improve: process of referral of patients with RDs, control over monitoring mechanisms, and communication between healthcare professionals and patients. CONCLUSIONS The FINEERR project may provide a starting point for stakeholders involved in the process of funding and access to RD-targeted therapies in Spain to provide the necessary resources and implement measures to improve both the quality of life and life expectancy of patients with RDs.
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Affiliation(s)
- N. Zozaya
- grid.510782.9Health Economics Department, Weber, C/ Moreto 17, 5D, 28014 Madrid, Spain
| | - J. Villaseca
- grid.510782.9Health Economics Department, Weber, C/ Moreto 17, 5D, 28014 Madrid, Spain
| | - F. Abdalla
- grid.510782.9Health Economics Department, Weber, C/ Moreto 17, 5D, 28014 Madrid, Spain
| | - A. Ancochea
- grid.452965.9Federación Española de Enfermedades Raras (FEDER), Madrid, Spain
| | - I. Málaga
- grid.411052.30000 0001 2176 9028Head of the Neuropediatrics Unit, Asturias Central University Hospital, Asturias, Spain
| | - M. Trapero-Bertran
- grid.410675.10000 0001 2325 3084Department of Basic Sciences, Universitat Internacional de Catalunya (UIC Barcelona), Barcelona, Spain
| | - N. Martín-Sobrino
- Castilla y León Health Management Department, Technical Director of Pharmacy, Valladolid, Spain
| | - O. Delgado
- grid.411164.70000 0004 1796 5984Pharmacy Service, Son Espases University Hospital, Palma, Balearic Spain
| | - P. Ferré
- grid.436087.eTechnical Advisor On Temporal Leave, Ministry of Health, Madrid, Spain
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Vargas-Martínez AM, Lima-Serrano M, Trapero-Bertran M. Cost-effectiveness and cost-utility analyses of a web-based computer-tailored intervention for prevention of binge drinking among Spanish adolescents. Alcohol Clin Exp Res 2023; 47:319-335. [PMID: 36811462 DOI: 10.1111/acer.14990] [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: 04/20/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Binge drinking (BD) among adolescents is a public health concern worldwide. This study assessed the cost-effectiveness and cost-utility of a web-based computer-tailored intervention to prevent BD in adolescence. METHODS The sample was drawn from a study evaluating the Alerta Alcohol program. The population consisted of adolescents 15 to 19 years of age. Data were recorded at baseline (January to February 2016) and after 4 months (May to June 2017) and were used to estimate costs and health outcomes, as measured by the number of BD occasions and quality-adjusted life years (QALYs). Incremental cost-effectiveness and cost-utility ratios were calculated from National Health Service (NHS) and societal perspectives and for a time horizon of 4 months. A multivariate deterministic sensitivity analysis of best/worst scenarios by subgroups was used to account for uncertainty. RESULTS The cost of reducing BD occasions by one per month was €16.63 from the NHS perspective, which from the societal perspective resulted in savings of €7986.37. From the societal perspective, the intervention resulted in an incremental cost of €71.05 per QALY gained from the NHS perspective and this was dominant, resulting in savings of €34,126.64 per QALY gained in comparison with the control group. Subgroup analyses showed that the intervention was dominant for girls from both the perspectives and for individuals 17 years or older from the NHS perspective. CONCLUSIONS Computer-tailored feedback is a cost-effective way to reduce BD and increase QALYs among adolescents. However, long-term follow-up is needed to evaluate more fully changes in both BD and health-related quality of life.
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Affiliation(s)
| | - Marta Lima-Serrano
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Marta Trapero-Bertran
- Department of Basic Sciences, University Institute for Patient Care, Universitat Internacional de Catalunya (UIC Barcelona), Barcelona, Spain
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Font-Ribera L, Rico M, Marí-Dell'Olmo M, Oliveras L, Trapero-Bertran M, Pérez G, Valero N, Bartoll X, Realp E, Gómez-Gutiérrez A. Estimating ambient air pollution mortality and disease burden and its economic cost in Barcelona. Environ Res 2023; 216:114485. [PMID: 36206924 DOI: 10.1016/j.envres.2022.114485] [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] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The new WHO air quality guidelines indicate that the air pollution disease burden is greater than previously reported. We aimed to estimate the air pollution disease burden and its economic cost in Barcelona to inform local action. METHODS We used a quantitative health impact assessment to estimate the non-accidental mortality and incidence of childhood asthma and lung cancer attributable to long-term air pollution exposure in the city of Barcelona (Spain) in 2018-2019. We used the population weighted mean of PM2.5 and NO2 assigned at the geocoded address during the study period and the 2021 WHO air quality guidelines as counterfactual scenario to estimate new annual cases attributable to each pollutant separately and combined. We estimated the social cost of attributable deaths and the health care cost of childhood asthma and lung cancer attributable cases. We also estimated attributable mortality by city district and the mortality avoidable by achieving the WHO air quality interim targets. RESULTS Mean exposure was 17 μg/m3 for PM2.5 and 39 μg/m3 for NO2. Total combined air pollution attributable mortality was 13% (95%CI = 9%-17%), corresponding to 1,886 deaths (95%CI = 1,296-2,571) and a social cost of €1,292 million (95%CI = 888-1,762) annually. Fifty-one percent (95%CI = 21%-71%) and 17% (95%CI = 7%-29%) of new cases of childhood asthma and lung cancer were attributable to air pollution with a health care cost of €4.3 and €2.7 million, respectively. Achieving the first unmet WHO air quality interim targets for PM2.5 and for NO2 would avoid 410 deaths and €281 million annually. CONCLUSION Air pollution in Barcelona represents a huge disease and economic burden, which is greater than previous estimates. Much stronger measures to reduce PM2.5 and NO2 levels are urgently needed. Until the WHO air quality guidelines are met in the city, achieving each WHO air quality interim targets would avoid hundreds of deaths each year.
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Affiliation(s)
- Laia Font-Ribera
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain.
| | - Marc Rico
- Agència de Salut Pública de Barcelona (ASPB), Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Laura Oliveras
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department. University Institute for Patient Care. Universitat Internacional de Catalunya (UIC), Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra (UPF), Spain
| | | | - Xavier Bartoll
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain
| | | | - Anna Gómez-Gutiérrez
- Agència de Salut Pública de Barcelona (ASPB), Spain; Institut de Recerca de Sant Pau (IIB Sant Pau), Spain
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Merino M, Martín Lorenzo T, Maravilla-Herrera P, Ancochea J, Gómez Sáenz JT, Hass N, Molina J, Peces-Barba G, Trapero-Bertran M, Trigueros Carrero JA, Hidalgo-Vega Á. A Social Return on Investment Analysis of Improving the Management of Chronic Obstructive Pulmonary Disease Within the Spanish National Healthcare System. Int J Chron Obstruct Pulmon Dis 2022; 17:1431-1442. [PMID: 35761956 PMCID: PMC9233487 DOI: 10.2147/copd.s361700] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To define a set of proposals that would improve the current management of chronic obstructive pulmonary disease (COPD) within the Spanish National Healthcare System (SNHS) from a comprehensive multidisciplinary perspective and to assess the impact of its implementation from clinical, healthcare, economic, and social perspectives. Patients and Methods A group of 20 stakeholders related to COPD (healthcare professionals, patients, and informal caregivers, among others) participated in an online Delphi process to agree on a set of 15 proposals that would improve the current management of COPD within the SNHS in four areas: diagnosis, risk stratification, management of exacerbations, and management of stable COPD. A one-year forecast-type social return on investment (SROI) analysis was used to estimate the impact that implementing the set of proposals would have in relation to the investment required. A sensitivity analysis was used to test the strength of the model when varying assumption-based data-points. Results The hypothetical implementation of the complete set of 15 proposals would require a €668 million investment and would generate a €2079 million social impact concerning savings for the SNHS and quality of life improvements for patients and their informal caregivers, among others. Accordingly, for every euro invested in the set of proposals, a social return of €3.11 would be generated (€2.71 in the worst-case scenario and €3.62 in the best-case scenario) of both tangible (32.56%) and intangible nature (67.44%). Conclusion Altogether, implementing this set of 15 proposals would generate a positive social impact, threefold the required investment. The results may inform decisions relative to healthcare policy and practice regarding COPD management within the SNHS, further contributing to reduce the large burden of COPD.
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Affiliation(s)
| | | | | | - Julio Ancochea
- Pulmonology Service, La Princesa University Hospital - IIS-Princesa, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Respiratory Diseases Networking Biomedical Research Centre - CIBERES, Carlos III Institute of Health - ISCIII, Madrid, Spain
| | | | - Nicole Hass
- Chronic Obstructive Pulmonary Disease Patient and Family Association - APEPOC, Pontevedra, Spain
| | - Jesús Molina
- Francia Health Centre, Fuenlabrada, Madrid, Spain
| | - Germán Peces-Barba
- Pulmonology Service, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Álvaro Hidalgo-Vega
- Department of Economic Analysis and Finances, Universidad de Castilla-La Mancha, Toledo, Spain
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Trapero-Bertran M, Pokhrel S, Hanney S. Research can be integrated into public health policy-making: global lessons for and from Spanish economic evaluations. Health Res Policy Syst 2022; 20:67. [PMID: 35717247 PMCID: PMC9206096 DOI: 10.1186/s12961-022-00875-6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
WHO promotes the use of research in policy-making to drive improvements in health, including in achieving Sustainable Development Goals such as tobacco control. The European Union’s new €95 billion Horizon Europe research framework programme parallels these aims, and also includes commitments to fund economic evaluations. However, researchers often express frustration at the perceived lack of attention to scientific evidence during policy-making. For example, some researchers claim that evidence regarding the return on investment from optimal implementation of evidence-based policies is frequently overlooked. An increasingly large body of literature acknowledges inevitable barriers to research use, but also analyses facilitators encouraging such use. This opinion piece describes how some research is integrated into policy-making. It highlights two recent reviews. One examines impact assessments of 36 multi-project research programmes and identifies three characteristics of projects more likely to influence policy-making. These include a focus on healthcare system needs, engagement of stakeholders, and research conducted for organizations supported by structures to receive and use evidence. The second review suggests that such characteristics are likely to occur as part of a comprehensive national health research system strategy, especially one integrated into the healthcare system. We also describe two policy-informing economic evaluations conducted in Spain. These examined the most cost-effective package of evidence-based tobacco control interventions and the cost-effectiveness of different strategies to increase screening coverage for cervical cancer. Both projects focused on issues of healthcare concern and involved considerable stakeholder engagement. The Spanish examples reinforce some lessons from the global literature and, therefore, could help demonstrate to authorities in Spain the value of developing comprehensive health research systems, possibly following the interfaces and receptor model. The aim of this would be to integrate needs assessment and stakeholder engagement with structures spanning the research and health systems. In such structures, economic evaluation evidence could be collated, analysed by experts in relation to healthcare needs, and fed into both policy-making as appropriate, and future research calls. The increasingly large local and global evidence base on research utilization could inform detailed implementation of this approach once accepted as politically desirable. Given the COVID-19 pandemic, increasing the cost-effectiveness of healthcare systems and return on investment of public health interventions becomes even more important.
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Affiliation(s)
- Marta Trapero-Bertran
- Basic Sciences Department, Patients Institute, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Subhash Pokhrel
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, UK.
| | - Stephen Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, UK
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Diaz M, Garcia M, Vidal C, Santiago A, Gnutti G, Gómez D, Trapero-Bertran M, Fu M. Health and economic impact at a population level of both primary and secondary preventive lung cancer interventions: A model-based cost-effectiveness analysis. Lung Cancer 2021; 159:153-161. [PMID: 34352591 DOI: 10.1016/j.lungcan.2021.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/16/2021] [Revised: 05/21/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Robust economic evaluations are needed to identify efficient strategies for lung cancer prevention that combine brief and intensive smoking cessation intervention programmes with screening using low-dose computed tomography (LDCT) at different ages, frequencies, and coverages. We aimed to assess the cost-effectiveness of smoking cessation approaches combined with lung cancer screening in the European context at a population level from a societal perspective. MATERIALS AND METHODS A microsimulation model that describes the natural history of lung cancer and incorporates several prevention strategies was developed. Discounted lifetime QALYs and costs at a rate of 3% were used to calculate incremental cost-effectiveness ratios, defined as additional costs in 2017 Euros per QALY gained. RESULTS Smoking cessation interventions reduce the incidence of lung cancer by 8%-46% and are consistently more effective and cost-effective when starting at younger ages. Screening reduces lung cancer mortality by 1%-24% and is generally less effective and more costly than smoking cessation interventions. The most cost-effective strategy would be to implement intensive smoking cessation interventions at ages 35, 40 and 45, combined with screening every three years between the ages of 55 and 65. CONCLUSIONS Combining smoking cessation interventions with LDCT screening is a very attractive prevention strategy that substantially diminishes the burden of lung cancer. These combined prevention strategies, especially when providing several intensive interventions for smoking cessation at early ages, are more cost-effective than both approaches separately and allow for a more intensified LDCT without losing efficiency.
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Affiliation(s)
- Mireia Diaz
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.
| | - Montse Garcia
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain
| | - Carmen Vidal
- Cancer Screening Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Santiago
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain; Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain
| | - Gerard Gnutti
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain
| | - David Gómez
- Unit of Infections and Cancer (UNIC-I&I), Cancer Epidemiology Research Programme (CERP), Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain
| | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona 08017, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat 08908, Barcelona, Spain
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Carreras G, Lachi A, Cortini B, Gallus S, López MJ, López-Nicolás Á, Lugo A, Pastor MT, Soriano JB, Fernandez E, Gorini G, Castellano Y, Fu M, Ballbè M, Amalia B, Tigova O, López MJ, Continente X, Arechavala T, Henderson E, Gallus S, Lugo A, Liu X, Borroni E, Colombo P, Semple S, O’Donnell R, Dobson R, Clancy L, Keogan S, Byrne H, Behrakis P, Tzortzi A, Vardavas C, Vyzikidou VK, Bakelas G, Mattiampa G, Boffi R, Ruprecht A, De Marco C, Borgini A, Veronese C, Bertoldi M, Tittarelli A, Gorini G, Carreras G, Cortini B, Verdi S, Lachi A, Chellini E, López-Nicolás Á, Trapero-Bertran M, Guerrero DC, Radu-Loghin C, Nguyen D, Starchenko P, Soriano JB, Ancochea J, Alonso T, Pastor MT, Erro M, Roca A, Pérez P, García-Castillo E. Burden of disease from exposure to secondhand smoke in children in Europe. Pediatr Res 2021; 90:216-222. [PMID: 33149260 DOI: 10.1038/s41390-020-01223-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. METHODS Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study. RESULTS Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight. CONCLUSIONS Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant. IMPACT Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.
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Affiliation(s)
- Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy.
| | - Alessio Lachi
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Barbara Cortini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | - Maria José López
- Public Health Agency of Barcelona (ASPB), Barcelona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.,IIB Sant Pau, Barcelona, Spain
| | | | - Alessandra Lugo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Milan, Italy
| | | | - Joan B Soriano
- Hospital Universitario La Princesa (IISP), Madrid, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Esteve Fernandez
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Catalan Institute of Oncology (ICO), L'Hopitalet de Llobregat, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), L'Hopitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
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10
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Hessheimer AJ, Trapero-Bertran M, Borin A, Butori E, Curell A, Espinoza AS, Jensen J, Turrado V, Morales X, de Lacy AM, Fondevila C. Resource utilization and outcomes in emergency general surgery during the COVID19 pandemic: An observational cost analysis. PLoS One 2021; 16:e0252919. [PMID: 34143802 PMCID: PMC8213049 DOI: 10.1371/journal.pone.0252919] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over the course of the COVID19 pandemic, global healthcare delivery has declined. Surgery is one of the most resource-intensive area of medicine; loss of surgical care has had untold health and economic consequences. Herein, we evaluate resource utilization, outcomes, and healthcare costs associated with unplanned surgery admissions during the height of the pandemic in 2020 versus the same period in 2019. METHODS Retrospective analysis on patients ≥18 years admitted from the emergency department to General & Digestive and Gastrointestinal Surgery Services between February and May 2019 and 2020 at our center; clinical outcomes and unadjusted and adjusted per-person healthcare costs were analyzed. RESULTS Consults and admissions to surgery declined between February and May 2020 by 37% and 19%, respectively, relative to the same period in 2019, with even greater relative decline during late March and early April. Time between onset of symptoms to diagnosis increased from 2±3 days 2019 to 5±22 days 2020 (P = 0.01). Overall hospital stay was two days less in 2020 (P = 0.19). Complications (Comprehensive Complication Index 10.3±23.7 2019 vs. 13.9±25.5 2020, P = 0.10) and mortality rates (3% vs. 4%, respectively, P = 0.58) did not vary. Mean unadjusted per-person costs for patients in the 2019 and 2020 cohorts were 5,886.72€±12,576.33€ and 5,287.62±7,220.16€, respectively (P = 0.43). Following multivariate analysis, costs remained similar (4,656.89€±390.53€ 2019 vs. 4,938.54±406.55€ 2020, P = 0.28). CONCLUSIONS Healthcare delivery and spending for unplanned general surgery admissions declined considerably due to COVID19. These results provide a small yet relevant illustration of clinical and economic ramifications of this healthcare crisis.
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Affiliation(s)
- Amelia J. Hessheimer
- General & Digestive Surgery, Institut de Malaties Digestives i Metabòliques (ICMDM), Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya Barcelona, Barcelona, Spain
| | - Alex Borin
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Eugenia Butori
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Anna Curell
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Arlena Sofía Espinoza
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Joaquín Jensen
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Víctor Turrado
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Xavier Morales
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Constantino Fondevila
- General & Digestive Surgery, Institut de Malaties Digestives i Metabòliques (ICMDM), Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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11
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Blanco B, Mora T, Trapero-Bertran M. Direct health care costs associated to neurological diseases and different degrees of malnutrition. Clin Nutr ESPEN 2021; 44:297-305. [PMID: 34330482 DOI: 10.1016/j.clnesp.2021.05.028] [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: 11/24/2020] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Home-based care and oral supplemental nutrition may be an efficient way of managing health resources, freeing up hospital resources and improving patient care and quality of life. For some conditions, such as neurodegenerative diseases and acute neurological conditions, adequate nutritional control of patients at the time of discharge, with home monitoring by a home hospitalization unit (HHU), coupled with the introduction of necessary and appropriate oral nutritional supplements for each patient, is a good strategy for ensuring the efficiency of health resources. The aim of this paper is to analyse the direct health costs, considering home care and oral nutritional supplement, of patients with newly diagnosed neurological diseases and at risk of nutritional problems. METHODS A study was designed to measure direct health care costs of patients with neurological related diseases according to their different nutritional needs. The sample for this study consisted of all patients (n = 100) of the Elda University Hospital in Elda, Spain, with newly diagnosed neurological pathology and suspected malnutrition at hospital discharge during a six months period. These patients were included in a home base care program and given oral nutritional supplements afterwards. The nutritional intervention consisted in giving nutritional supplements according to nutritional patients' needs through a home-based care unit. Nutritional needs could comprise from protein-calorie malnutrition to at risk of malnutrition. Descriptive health care costs analysis was carried out accounting for the nutritional status. Costs are expressed in 2018 euros and for a total time horizon of one year, six months of classical inpatient care and six months of home care monitoring with a nutritional intervention. RESULTS Mean direct health care cost for neurological patients in the six months of classical inpatient care was €8309.30 and, the direct healthcare cost of treating these patients according to their nutritional needs from a home care unit was €2970.18. The subgroup of patients that most benefited from the nutritional intervention and monitoring from the home care unit were those who were in a state of protein-calorie malnutrition or at risk of malnutrition. Under the log transformation of the variables, the Shapiro-Wilk test showed significant differences in mean costs at the 5% level for the two time periods for those suffering from protein-calorie malnutrition or at risk of malnutrition. CONCLUSIONS It is important to measure and economically quantify the direct health care costs of patients with neurological diseases in order to be able to evaluate different hospital and home-care interventions according to different nutritional needs. Oral nutritional supplements and monitoring by the hospital home care unit could be associated with saving money when patients have protein-calorie malnutrition or at risk of malnutrition. Therefore, direct health costs information is needed to future evaluate these different management interventions.
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Affiliation(s)
- Benjamin Blanco
- Head of Section, Home Hospitalization and Palliative Care Unit, Elda University General Hospital, Spain
| | - Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, Patients Institute, Universitat Internacional de Catalunya, Barcelona, Spain.
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12
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Gallus S, Lugo A, Liu X, Behrakis P, Boffi R, Bosetti C, Carreras G, Chatenoud L, Clancy L, Continente X, Dobson R, Effertz T, Filippidis FT, Fu M, Geshanova G, Gorini G, Keogan S, Ivanov H, Lopez MJ, Lopez-Nicolas A, Precioso J, Przewozniak K, Radu-Loghin C, Ruprecht A, Semple S, Soriano JB, Starchenko P, Trapero-Bertran M, Tigova O, Tzortzi AS, Vardavas C, Vyzikidou VK, Colombo P, Fernandez E. Who Smokes in Europe? Data From 12 European Countries in the TackSHS Survey (2017-2018). J Epidemiol 2021; 31:145-151. [PMID: 32249267 PMCID: PMC7813769 DOI: 10.2188/jea.je20190344] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Population data on tobacco use and its determinants require continuous monitoring and careful inter-country comparison. We aimed to provide the most up-to-date estimates on tobacco smoking from a large cross-sectional survey, conducted in selected European countries. METHODS Within the TackSHS Project, a face-to-face survey on smoking was conducted in 2017-2018 in 12 countries: Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain, representing around 80% of the 432 million European Union (EU) adult population. In each country, a representative sample of around 1,000 subjects aged 15 years and older was interviewed, for a total of 11,902 participants. RESULTS Overall, 25.9% of participants were current smokers (31.0% of men and 21.2% of women, P < 0.001), while 16.5% were former smokers. Smoking prevalence ranged from 18.9% in Italy to 37.0% in Bulgaria. It decreased with increasing age (compared to <45, multivariable odds ratio [OR] for ≥65 year, 0.31; 95% confidence interval [CI], 0.27-0.36), level of education (OR for low vs high, 1.32; 95% CI, 1.17-1.48) and self-rated household economic level (OR for low vs high, 2.05; 95% CI, 1.74-2.42). The same patterns were found in both sexes. CONCLUSIONS These smoking prevalence estimates represent the most up-to-date evidence in Europe. From them, it can be derived that there are more than 112 million current smokers in the EU-28. Lower socio-economic status is a major determinant of smoking habit in both sexes.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Xiaoqiu Liu
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Panagiotis Behrakis
- Institute of Public Health of the American College of Greece, Athens, Greece
| | - Roberto Boffi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giulia Carreras
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Liliane Chatenoud
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Xavier Continente
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Madrid, Spain
- Institut d’investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | | | - Tobias Effertz
- University of Hamburg, Hamburg Business School, Institute for Law & Economics, Hamburg, Germany
| | | | - Marcela Fu
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | | | - Giuseppe Gorini
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Sheila Keogan
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | | | - María J. Lopez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Madrid, Spain
- Institut d’investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
| | | | - José Precioso
- Instituto de Educação, Universidade do Minho, Braga, Portugal
| | - Krzysztof Przewozniak
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Foundation “Smart Health - Health in 3D”, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | | | - Ario Ruprecht
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Joan B. Soriano
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Hospital Universitario La Princesa, Madrid, Spain
| | | | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Olena Tigova
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Anna S. Tzortzi
- Institute of Public Health of the American College of Greece, Athens, Greece
| | | | | | | | - Esteve Fernandez
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - the TackSHS Project Investigators
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Institute of Public Health of the American College of Greece, Athens, Greece
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
- Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) (Biomedical Research Centre Network for Epidemiology and Public Health), Madrid, Spain
- Institut d’investigació Biomèdica Sant Pau (IIB St. Pau), Barcelona, Spain
- University of Stirling, Stirling, Scotland
- University of Hamburg, Hamburg Business School, Institute for Law & Economics, Hamburg, Germany
- Department of Primary Care and Public Health, Imperial College, London, UK
- Tobacco Control Unit, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
- Tobacco Control Research Unit, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
- Smoke Free Life Coalition, Sofia, Bulgaria
- Universidad Politécnica de Cartagena, Cartagena, Spain
- Instituto de Educação, Universidade do Minho, Braga, Portugal
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Foundation “Smart Health - Health in 3D”, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
- European Network for Smoking Prevention, Bruxelles, Belgium
- Hospital Universitario La Princesa, Madrid, Spain
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- DOXA Institute, Milan, Italy
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García-Lorenzo B, Trapero-Bertran M. [Evaluation of programs to reduce alcohol consumption in Spain: a pending issue.]. Rev Esp Salud Publica 2020; 94:e202006048. [PMID: 32555140] [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: 10/21/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To evaluate preventive interventions on alcohol consumption has been long recommended in Spain. The impact evaluation of structured programs and specific actions for the prevention and treatment of alcohol consumption (PAPTCA) would allow making better informed decisions on public health financing based on the efficiency criteria. To the best of our knowledge, there is no scientific document that illustrates the situation of the PAPTCAs' evaluation in Spain. This paper aims to classify and describe PAPTCAs in Spain, focused on their impact evaluation and information on financing for accountability to society. METHODS A systematic literature review of the PAPTCAs implemented in Spain, from 2000 till 2017, at regional (autonomous communities) and local level was carried out, and a descriptive analysis of the PAPTCA database obtained from the literature review was carried out. RESULTS 145 structured programs and 45 specific actions were identified. Only 25% of structured programs provided an impact evaluation, besides, only 15% presented some information about their financing. Regarding the specific actions, the numbers were less encouraging where 10% provided an impact evaluation while a similar figure of PAPTCAs showed financing information. CONCLUSIONS There is a need to systematize the information of the PAPTCA that serves as an instrument to conduct impact evaluations in Spain. This should ease the scarce presence of evaluative culture in this area and promote the accountability of resources spent on public health to society.
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Affiliation(s)
- Borja García-Lorenzo
- Facultat de Ciències Econòmiques i Socials. Universitat Internacional de Catalunya (UIC). Barcelona. España
- Unitat d'Avaluació d'Innovacions i Noves Tecnologies. Hospital Clínic Barcelona. Universitat de Barcelona. Barcelona. España
| | - Marta Trapero-Bertran
- Facultat de Ciències Econòmiques i Socials. Universitat Internacional de Catalunya (UIC). Barcelona. España
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Peña-Longobardo LM, Oliva-Moreno J, Zozaya N, Aranda-Reneo I, Trapero-Bertran M, Laosa O, Sinclair A, Rodríguez-Mañas L. Economic evaluation of a multimodal intervention in pre-frail and frail older people with diabetes mellitus: the MID-FRAIL project. Expert Rev Pharmacoecon Outcomes Res 2020; 21:111-118. [PMID: 32394757 DOI: 10.1080/14737167.2020.1766970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The aim of this study was to estimate the incremental cost-utility ratio (ICUR) of a multi-modal intervention in frail and pre-frail subjects aged ≥70 years with type-2 diabetes versus usual care group focused on quality adjusted life years (QALYs) in different European countries. Methods: The MID-FRAIL study was a cluster randomized multicentre trial conducted in seven European countries. A cost-utility analysis was carried out based on this study, conducted from the perspective of the health care system with a time horizon of one year. Univariate and probabilistic analysis were carried out to test the robustness of the results. Results: The cost estimation showed the offsetting health effect of the intervention program on total health care costs. The mean annual health care costs were 25% higher among patients in usual care. The mean incremental QALY gained per patient by the intervention group were 0.053 QALY compared with usual care practice. Conclusions: The MID-FRAIL intervention program showed to be the dominant option in comparison with usual care practice. It saved costs to the health care system and achieved worthwhile health gains. This finding should encourage its implementation, at least, in the trial participant countries.
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Affiliation(s)
| | - Juan Oliva-Moreno
- Department of Economic Analysis and Finance, University of Castilla-La Mancha , Toledo, Spain
| | - Neboa Zozaya
- Department of Health Economics, Weber, Madrid Spain, University of Las Palmas de Gran Canaria , Las Palmas De Gran Canaria, Spain
| | - Isaac Aranda-Reneo
- Department of Economic Analysis and Finance, University of Castilla-La Mancha , Toledo, Spain
| | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC) , Barcelona, Spain
| | - Olga Laosa
- Servicio de Geriatría, Hospital Universitario de Getafe , Madrid, Spain
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd , Luton, UK
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15
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Vargas-Martínez AM, Trapero-Bertran M, Mora T, Lima-Serrano M. Social, economic and family factors associated with binge drinking in Spanish adolescents. BMC Public Health 2020; 20:519. [PMID: 32303203 PMCID: PMC7165377 DOI: 10.1186/s12889-020-08605-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background The main aim of this study was to determine the socioeconomic and family factors associated with binge drinking (BD) in Spanish adolescents who participated in a web-based computer intervention for the prevention of binge drinking known as Alerta Alcohol. Methods Longitudinal analyses were carried out in a sample of Andalusian adolescents aged 15 to 19 enrolled in public schools, which was part of a two-arm cluster randomized controlled trial with an intervention group (IG) who received the Alerta Alcohol programme and a control group (CG) who did not receive any active intervention. Panel count data and the following econometric procedures were used: negative binomial, a two-part model and a finite mixture model. The endogenous variable in all models was the number of BD occasions in the last 30 days. A total of 1247 subjects in the pre-intervention period, with an average age of 16.8 years, plus 612 adolescents in the follow-up period (4 months later), were included in the analysis. Results In relation to findings, being older (≥ 17 years old), having more pocket money and higher family alcohol consumption were associated with greater BD. By contrast, subjects who completed the questionnaire on Wednesday, Thursday or Friday, further from the previous weekend, indicated a lower number of BD occasions. Conclusions Our results suggest the need to include families, especially parents and siblings, in interventions aimed at preventing alcohol use among adolescents, given the association shown between BD and both family alcohol consumption and weekly pocket money or availability of money to adolescents. Given the findings with regard to age, future research aimed at intervening in early adolescence to prevent BD would be justified. Trial registration (ClinicalTrials.gov): NCT03288896. Registration date: September 20, 2017. “Retrospectively registered”.
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Affiliation(s)
| | - Marta Trapero-Bertran
- Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Lima-Serrano
- Department of Nursing. Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Seville, Spain
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16
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Campillo-Artero C, Puig-Junoy J, Segú-Tolsa JL, Trapero-Bertran M. Price Models for Multi-indication Drugs: A Systematic Review. Appl Health Econ Health Policy 2020; 18:47-56. [PMID: 31523756 DOI: 10.1007/s40258-019-00517-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Marketing of new and existing drugs with new indications used alone or in combination is increasing. OBJECTIVE To identify the advantages and disadvantages of indication-based pricing (IBP) systems for such drugs from the standpoint of economic theory, practical applications and international experiences. METHODS We conducted a systematic review of published articles and reports using six bibliographic databases: PubMed, ASCO, Scopus, DARE, HTA and NHS EED. We also conducted a search of gray literature in Google Scholar. The same search terms were used as in Towse et al. (The debate on indication-based pricing in the U.S. and five major European countries. OHE Consulting Report, London, 2018). Articles and reports published from 1 January 2000 to 30 September 2018 were included. RESULTS A total of 26 studies met the inclusion criteria. There are three main types of IBP: different brands with different prices for each indication, an averaged single price for all indications and a single price with differential discounts. The studies indicate that IBP systems are premised on the idea that charging a different price for different indications reflects the differences in their value and in social willingness to pay for each one and for the investment in R&D based on the indication's incremental clinical benefit. Some argue that a uniform price reduces access and increases the price for lower-value indications, while others contend that if IBP sets prices at the maximum threshold of social willingness to pay for each indication, all surplus is transferred to the producer and consumer surplus is reduced to zero. No practical applications of pure IBP were found. Single pricing for drugs is the most prevalent approach. The system that most closely approximates an IBP model consists of agreements that are generally confidential and linked to risk-sharing agreements. CONCLUSIONS There are no applications of pure IBP systems and their practical consequences are therefore unknown. More economic theory-based assessments of the pros and cons of IBP and studies different from reviews are needed to capture their intricacies and specificities.
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Affiliation(s)
- Carlos Campillo-Artero
- Center for Research in Health and Economics, Barcelona School of Management, Universitat Pompeu Fabra, Barcelona, Spain.
- Balearic Health Service, Palma de Mallorca, Spain.
| | - Jaume Puig-Junoy
- Department of Economics and Business, Barcelona School of Management, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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17
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Oliva-Moreno J, Puig-Junoy J, Trapero-Bertran M, Epstein D, Pinyol C, Sacristán JA. Economic Evaluation for Pricing and Reimbursement of New Drugs in Spain: Fable or Desideratum? Value Health 2020; 23:25-31. [PMID: 31952669 DOI: 10.1016/j.jval.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/23/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The economic evaluation of healthcare technologies has become in many countries a basic tool for reimbursement, pricing and purchasing decisions. OBJECTIVE The objective of this article is to examine the institutional, legal, and political factors that have impeded the application of economic evaluation and the criterion of efficiency in the process of pricing and reimbursement of new medicines in Spain. METHODS Narrative description of the current institutional framework for the use of economic evaluation in pricing and reimbursement in Spain, legal and policy framework in the field of evaluation of new medicines, and stakeholder initiatives and policies related to the use of economic evaluation outside of the pricing and reimbursement process. RESULTS Spain has an institutional framework created and established over the last years that could have facilitated a formal use of economic evaluation in the process of pricing and reimbursement. Nevertheless, the real use of economic evaluation at the central or regional level is still unknown, although application of the efficiency criterion, linking to cost-effectiveness, has been clearly required by Spanish laws and regulations at the national level. We highlight a certain degree of moral hazard from the central government that is not directly responsible for the budget impact of reimbursement and pricing decisions. There are currently a number of ongoing initiatives in the field of economic evaluation by various agents, but they remain uncoordinated. CONCLUSIONS Poor governance at the highest level of decision making is the main reason for the lack of interest in economic evaluation. A profound political change, supported by transparency and accountability, is required before the criterion of efficiency can be fully considered in the process of pricing and reimbursement of new medicines in Spain.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Universidad de Castilla La-Mancha, Toledo, Spain.
| | - Jaume Puig-Junoy
- Barcelona School of Management, Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Trapero-Bertran
- Institut de Recerca en Avaluació i Polítiques Públiques, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
| | - Carme Pinyol
- Market Access Department, Pierre Fabre Ibérica, Barcelona, Spain; ISPOR Spain Chapter, Barcelona, Spain
| | - José Antonio Sacristán
- Department of Epidemiology and Public Health, Universidad Autonoma de Madrid, Madrid, Spain; Medical Department, Lilly, Madrid, Spain
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Ruiz R, Moragas A, Trapero-Bertran M, Sisó A, Berenguera A, Oliva G, Borràs-Santos A, García-Sangenís A, Puig-Junoy J, Cots JM, Morros R, Mora T, Lanau-Roig A, Monfà R, Troncoso A, Abellana RM, Gálvez P, Medina-Perucha L, Bjerrum L, Amo I, Barragán N, Llor C. Effectiveness and cost-effectiveness of Improving clinicians' diagnostic and communication Skills on Antibiotic prescribing Appropriateness in patients with acute Cough in primary care in CATalonia (the ISAAC-CAT study): study protocol for a cluster randomised controlled trial. Trials 2019; 20:740. [PMID: 31847912 PMCID: PMC6918568 DOI: 10.1186/s13063-019-3727-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/13/2019] [Indexed: 12/02/2022] Open
Abstract
Background Despite their marginal benefit, about 60% of acute lower respiratory tract infections (ALRTIs) are currently treated with antibiotics in Catalonia. This study aims to evaluate the effectiveness and efficiency of a continuous disease-focused intervention (C-reactive protein [CRP]) and an illness-focused intervention (enhancement of communication skills to optimise doctor-patient consultations) on antibiotic prescribing in patients with ALRTIs in Catalan primary care centres. Methods/design A cluster randomised, factorial, controlled trial aimed at including 20 primary care centres (N = 2940 patients) with patients older than 18 years of age presenting for a first consultation with an ALRTI will be included in the study. Primary care centres will be identified on the basis of socioeconomic data and antibiotic consumption. Centres will be randomly assigned according to hierarchical clustering to any of four trial arms: usual care, CRP testing, enhanced communication skills backed up with patient leaflets, or combined interventions. A cost-effectiveness and cost-utility analysis will be performed from the societal and national healthcare system perspectives, and the time horizon of the analysis will be 1 year. Two qualitative studies (pre- and post-clinical trial) aimed to identify the expectations and concerns of patients with ALRTIs and the barriers and facilitators of each intervention arm will be run. Family doctors and nurses assigned to the interventions will participate in a 2-h training workshop before the inception of the trial and will receive a monthly intervention-tailored training module during the year of the trial period. Primary outcomes will be antibiotic use within the first 6 weeks, duration of moderate to severe cough, and the quality-adjusted life-years. Secondary outcomes will be duration of illness and severity of cough measured using a symptom diary, healthcare re-consultations, hospital admissions, and complications. Healthcare costs will be considered and expressed in 2021 euros (year foreseen to finalise the study) of the current year of the analysis. Univariate and multivariate sensitivity analyses will be carried out. Discussion The ISAAC-CAT project will contribute to evaluate the effectiveness and efficiency of different strategies for more appropriate antibiotic prescribing that are currently out of the scope of the actual clinical guidelines. Trial registration ClinicalTrials.gov, NCT03931577.
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Affiliation(s)
- Rafa Ruiz
- Institut Català de la Salut, Barcelona, Spain
| | - Ana Moragas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Rovira i Virgili, Jaume I Health Centre, Institut Català de la Salut, Tarragona, Spain
| | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Glòria Oliva
- Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Alícia Borràs-Santos
- Institut Universitari de Pacients (Patients' University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jaume Puig-Junoy
- Pompeu Fabra University (UPF)-Barcelona School of Management, Barcelona, Spain of Economics and Business, Barcelona, Spain
| | - Josep M Cots
- Universitat de Barcelona, La Marina Health Centre, Institut Català de la Salut, Barcelona, Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anna Lanau-Roig
- La Marina Health Centre, Institut Català de la Salut, Associació d'Infermeria Familiar i Comunitària de Catalunya, Barcelona, Spain
| | - Ramon Monfà
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), UICEC de IDIAP Jordi Gol - Plataforma SCReN, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Amelia Troncoso
- Àrea de Suport al Medicament i Servei de Farmàcia Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Rosa M Abellana
- Biostatistics, Department of Basic Clinical Practice, Universitat de Barcelona, Barcelona, Spain
| | - Pau Gálvez
- Institut Universitari de Pacients (Patients' University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Lars Bjerrum
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Isabel Amo
- Institut Universitari de Pacients (Patients' University Institut), Universitat Internacional de Catalunya, Barcelona, Spain
| | - Nieves Barragán
- Catalan Society of Family Medicine, Group on Communication, Health Centre Vallcarca, Barcelona, Spain
| | - Carl Llor
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Manso Health Centre, Institut Català de la Salut, Barcelona, Spain.
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Vargas-Martínez AM, Trapero-Bertran M, Lima-Serrano M, Anokye N, Pokhrel S, Mora T. Measuring the effects on quality of life and alcohol consumption of a program to reduce binge drinking in Spanish adolescents. Drug Alcohol Depend 2019; 205:107597. [PMID: 31590139 DOI: 10.1016/j.drugalcdep.2019.107597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/06/2019] [Accepted: 07/22/2019] [Indexed: 10/25/2022]
Abstract
AIM To present a comparison between the effects on health due to a reduction in binge drinking (BD) and health-related quality of life (HRQoL), as a result of ALERTA ALCOHOL, an intervention aimed at reducing BD in Spanish adolescents. METHODS A two-arm cluster randomized controlled trial was conducted with an intervention and a control group, randomized at the school level, following individuals over four months. The study population consisted of Andalusian adolescents aged 15 to 19 years who were enrolled in urban public high schools (n = 1247). Participants were assigned randomly to receive the intervention. The main outcomes studied were the number of occasions of BD in the last 30 days, which was directly obtained from the answers given by the adolescents, and HRQoL measured with the EQ-5D-5 L questionnaire. The model of estimation was the generalized estimating equations (GEE) approach. RESULTS The program showed a BD reduction at the 4-month follow-up, although it was not shown to significantly increase the HRQoL in adolescents who reduced the number of occasions of BD and had received the intervention. However, it was shown that those who would predictably reduce the number of occasions of BD controlled by several sociodemographic variables perceived a higher HRQoL, as did those who had a greater adherence to the program. CONCLUSIONS Higher adherence to a web-based computer-tailored intervention to prevent BD in adolescents has a positive effect on decreasing the number of occasions of BD in adolescents as well as on increasing participants' HRQoL, although this second effect is very small, which could be due to the short follow-up time. This fact is quite important and should be assessed extensively to corroborate the results and translate into health policy.
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Affiliation(s)
- Ana Magdalena Vargas-Martínez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain; Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Marta Lima-Serrano
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
| | - Nana Anokye
- Health Economics Research Group (HERG), Brunel University, Uxbridge, London, UK.
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Brunel University, Uxbridge, London, UK.
| | - Toni Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya, Barcelona, Spain.
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Serra C, Valiño-Carrete M, Cots F, Trapero-Bertran M, Benavides FG. Costes sanitarios de las enfermedades profesionales: análisis de una serie de pacientes de un hospital público. Arch Prev Riesgos Labor 2019. [DOI: 10.12961/aprl.2019.22.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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21
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Serra C, Valiño-Carrete M, Cots F, Trapero-Bertran M, Benavides FG. [Health care costs of occupational disease: analysis of a patient series at a public hospital]. Arch Prev Riesgos Labor 2019; 22:171-175. [PMID: 31633890 DOI: 10.12961/aprl.2019.22.04.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/16/2019] [Indexed: 06/10/2023] Open
Abstract
The consistent under-recognition of occupational diseases (OD) in Spain leads to an exchange of patients and resources between the country's National Health System and the Social Security System. We examined the direct healthcare costs of a series of patients diagnosed with OD by the Clinical Occupational Diseases Unit in a Barcelona hospital. Information on all care associated with the diagnosis of PD was systematically reviewed. The economic value of each episode of care was obtained from the hospital cost accounting and billing system. Overall, we computed costs for 524 episodes in 33 patients. The average cost was 345.5€, being highest for hospital admissions (4,032.5€). The average cost per patient was € 5,486.2, and for cancer € 15,223.3. These results highlight the need for coordination between the National Health System and the Social Security System so that OD can be appropriately recognized.
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Affiliation(s)
- Consol Serra
- CiSAL-Centro de Investigación en Salud Laboral, Universidad Pompeu Fabra/IMIM-PSMAR, Barcelona, Sapain.
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Blanco B, Mora T, Trapero-Bertran M. SUN-PO129: The Effect of Nutrition Complements on Health Care Costs Before and After the Incorporation of Patients to a Home Hospital Unit. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Trapero-Bertran M, Rodríguez-Martín B, López-Bastida J. What attributes should be included in a discrete choice experiment related to health technologies? A systematic literature review. PLoS One 2019; 14:e0219905. [PMID: 31318926 PMCID: PMC6639002 DOI: 10.1371/journal.pone.0219905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/04/2019] [Indexed: 01/12/2023] Open
Abstract
Discrete choice experiments (DCEs) are a way to assess priority-setting in health care provision. This approach allows for the evaluation of individuals’ preferences as a means of adding criteria to traditional quality-adjusted life year analysis. The aim of this systematic literature review was to identify attributes for designing a DCE in order to then develop and validate a framework that supports decision-making on health technologies. Our systematic literature review replicated the methods and search terms used by de Bekker-Grob et al. 2012 and Clark et al. 2014. The Medline database was searched for articles dated between 2008 and 2015. The search was limited to studies in English that reflected general preferences and were choice-based, published as full-text articles and related to health technologies. This study included 72 papers, 52% of which focused on DCEs on drug treatments. The average number of attributes used in all included DCE studies was 5.74 (SD 1.98). The most frequently used attributes in these DCEs were improvements in health (78%), side effects (57%) and cost of treatment (53%). Other, less frequently used attributes included waiting time for treatment or duration of treatment (25%), severity of disease (7%) and value for money (4%). The attributes identified might inform future DCE surveys designed to study societal preferences regarding health technologies in order to better inform decisions in health technology assessment.
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Affiliation(s)
- Marta Trapero-Bertran
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Beatriz Rodríguez-Martín
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Faculty of Health Sciences, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Julio López-Bastida
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
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Abstract
The main data on HIV in high-income countries from the standpoint of health economics are updated and discussed. Specifically, issues surrounding the economic impact of HIV are addressed for health care and occupational perspectives. We review the main epidemiological data on the prevalence of disease and foreseeable changes in patterns within the coming years. Recent research on health care costs of HIV/AIDS and the occupational situation of HIV+ people are discussed. In high-income countries, there is an incipient change in trends that indicate that an increasing percentage of the intermediate-age HIV+ population will age prematurely, presenting more frequently comorbidities and becoming more exposed to frailty situations. Accordingly, health-care systems should have to plan their resources to accommodate new determinants of healthcare costs in the HIV+ population. On the occupational side, the decreased life expectancy of HIV+ persons, coupled with more severe health issues, on average may prompt early -retirement of this population from the labor market.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Universidad Castilla La-Mancha, Toledo, Spain
| | - Marta Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP); Universitat Internacional de Catalunya, Barcelona, Spain
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25
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Mestre-Ferrándiz J, Iniesta M, Trapero-Bertran M, Espín J, Brosa M. [Analysis of the evolution in the access to orphan medicines in Spain]. Gac Sanit 2019; 34:141-149. [PMID: 31014554 DOI: 10.1016/j.gaceta.2019.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/14/2019] [Accepted: 02/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the access to orphan medicines in Spain, focusing on those with an active "orphan" designation, as of 31st December 2017; and for those orphan medicines in the Spanish market, estimate the time between being assigned a National Code (NC) by the Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) and being approved for launch. METHOD We used the European Commission's Public Register of orphan medicines to identify the orphan medicines authorised by the European Medicines Agency (EMA), as of 31 December 2017, while we sourced expired orphan indications from the EMA's website. Dates when NCs were assigned were sourced from the AEMPS, and commercialisation dates from Bot PLUS. A descriptive analysis of the study variables was done. The quantitative variables were described using means and medians, as well as standard deviations and ranges. The qualitative variables were described according to absolute and relative frequencies. The comparison of results was performed by parametric and non-parametric contrasts according to the applicability, at a 5% significance level. RESULTS The EMA has approved 100 orphan medicines (with designation as of 31/12/2017) between 2002-2017. Eighty-six have a NC assigned by the AEMPS. Fifty-four have been launched in Spain (representing 54% of the full sample; 63% with NC). For the 53 orphan drugs with launch date in Spain, the median time between receiving its NC and its launch is 13.4 months (standard deviation: 17.0; minimum: 2.1; maximum: 91,7). The median time is 12.4 months and 14.0 months for those medicines launched in Spain between 2002-2013 and 2014-2017 respectively (p = 0.46). This difference is not statistically significant, which is what could be expected given the low numbers of orphan medicines in the "population". CONCLUSION Complex factors determine the access to orphan drugs in Europe. The centralised procedure to obtain marketing authorisation at European level is a success. However, access is more limited, given the complexities of the evaluation of the available evidence for pricing and reimbursement decisions. It is therefore necessary to implement new policies that reduce inequalities in access and help achieve sustainable healthcare systems. To achieve this, they will need to offer the possibility of allowing earlier access, and using payment by results when there is high uncertainty.
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Affiliation(s)
| | - Margarita Iniesta
- Asociación Española de Laboratorios de Medicamentos Huérfanos y Ultrahuérfanos, Madrid, España
| | - Marta Trapero-Bertran
- Institut de Recerca en Avaluació i Polítiques Publiques, Universitat Internacional de Catalunya, Barcelona, España
| | - Jaime Espín
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria (IBS), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Max Brosa
- Oblikue Consulting, S.L., Barcelona, España
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Grande E, Díaz Á, López C, Munarriz J, Reina JJ, Vera R, Bernárdez B, Aller J, Capdevila J, Garcia-Carbonero R, Jimenez Fonseca P, Trapero-Bertran M. Economics of gastroenteropancreatic neuroendocrine tumors: a systematic review. Ther Adv Endocrinol Metab 2019; 10:2042018819828217. [PMID: 30815246 PMCID: PMC6381439 DOI: 10.1177/2042018819828217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/13/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite current interest, enthusiasm and progress in the development of therapies for gastroenteropancreatic (GEP) neuroendocrine tumors (NETs), there are substantial gaps in the published literature regarding cost-of-illness analyses, economic evaluation and budget impact analyses. Compounding the issue is that data on resource utilization and cost-effectiveness of different diagnostic and therapeutic modalities for GEP-NETs are scarce. METHODS A systematic review on the economic impact of GEP-NETs was carried out using four databases: EMBASE, PubMed, the National Health Service Economic Evaluation Database and Cochrane review. Fully published articles from January 2000 to May 2017, in English and Spanish, were included. All articles that satisfied the inclusion criteria were included in the systematic review; summary descriptive statistics were used to describe the methodological characteristics. RESULTS The 14 studies selected included cost-of-illness analyses (n = 4), economic evaluations (n = 7) and budget impact analyses (n = 3). Almost all studies were performed in the United States. Healthcare costs for patients with NETs included medication, outpatient visits, hospitalizations, and check-ups/tests. Reducing adverse events is an area where cost savings could be achieved; however, there was not enough evidence on the cost impact of adverse events. CONCLUSION There is a lack of data related to resource utilization in the field of GEP-NETs. Therefore, cost-effectiveness and budget impact studies of existing and emerging treatments are urgently needed to help the decision-making process for patients with NETs.
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Affiliation(s)
- Enrique Grande
- Department of Medical Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ángel Díaz
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos López
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Munarriz
- Department of Medical Oncology, Hospital Provincial de Castellón, Castellón, Spain
| | - Juan-José Reina
- Department of Medical Oncology, Hospital Virgen Macarena, Sevilla, Spain
| | - Ruth Vera
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Beatriz Bernárdez
- Department of Pharmacy, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Aller
- Department of Endocrinology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Jaume Capdevila
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rocio Garcia-Carbonero
- Oncology Department, Hospital Universitario 12 de Octubre, IIS imas12, UCM, CNIO, CIBERONC, Madrid, Spain
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López-Bastida J, Ramos-Goñi JM, Aranda-Reneo I, Trapero-Bertran M, Kanavos P, Rodriguez Martin B. Using a stated preference discrete choice experiment to assess societal value from the perspective of decision-makers in Europe. Does it work for rare diseases? Health Policy 2018; 123:152-158. [PMID: 30528244 DOI: 10.1016/j.healthpol.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 03/23/2016] [Revised: 11/25/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To pilot the feasibility of using a discrete choice experiment (DCE) design to investigate individual preferences from the decision-maker perspective regarding the use of public funding for orphan drugs and generate prior information for future experimental designs. METHODS A DCE was used on a convenience sample of participants from five European countries (England, France, Germany, Italy and Spain), exploring their preferences in distinct healthcare scenarios involving orphan drugs. A preliminary review of the empirical literature on distributive preferences informed the selection of attributes and their levels in the design. An online questionnaire was used to conduct the DCE survey. RESULTS A total of 199 questionnaires were completed. The five country model showed relative preference for some attributes over others: cost of treatment, improvement in health, value for money and availability of treatment alternatives received the greatest attention. However, disease severity, beginning of life, waiting times and side effects were also shown to be important social values that should not be ignored. CONCLUSIONS The findings presented in this study provide insight about the preferences that can influence decisions on orphan drugs in different countries. This study also provides valuable prior information that could inform future DCE designs in this area.
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Affiliation(s)
- J López-Bastida
- University of Castilla-La Mancha, Faculty of Occupational Therapy, Speech Therapy and Nursing, Talavera de la Reina, Toledo, Spain.
| | | | - I Aranda-Reneo
- University of Castilla-La Mancha, Faculty of Social Science, Talavera de la Reina, Toledo, Spain
| | - M Trapero-Bertran
- Universitat Internacional de Catalunya (UIC), Faculty of Economics and Social Sciences, Barcelona, Spain
| | - P Kanavos
- London School of Economics and Political Science, London, UK
| | - B Rodriguez Martin
- University of Castilla-La Mancha, Faculty of Occupational Therapy, Speech Therapy and Nursing, Talavera de la Reina, Toledo, Spain
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Cainzos-Achirica M, Trapero-Bertran M, Bilal U, Corbella X, Comin-Colet J. Chronic Heart Failure Care and Costs: What Is the Efficiency of Investing in Quality? JACC Heart Fail 2018; 6:723-724. [PMID: 30071956 DOI: 10.1016/j.jchf.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
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Abstract
BACKGROUND In order to enhance childhood vaccination uptake and the health consequences for the whole society, there is a need to study predictors that might help in understanding parents' behaviour in relation to childhood vaccination schemes. The aim of this paper is to assess whether parental education has an influence on their children's public health-care use in terms of visits for vaccinations, and thus evaluate whether more educated parents use public health resources more frequently in childhood immunization schedules. METHODS The setting was the region of Catalonia in the north-east of Spain. Three different databases, containing information about 11,415 individuals corresponding to 79,905 observations, were merged and linked: 1) observational and longitudinal administrative data for adults and children in Catalonia; 2) a database containing information on the vaccination of children in relation to the public health programme called the "Healthy Child Programme"; and 3) the governmental vaccination registration. The presence of an education gradient was explored using a logistic regression. Children's health-care use was modelled using a logistic procedure. RESULTS The greater the mothers' educational attainment level, the higher the probability of being vaccinated in this immunization programme. The presence of an age profile for vaccinations showed that less educated parents visit their GPs more frequently for immunizations when their children are below the age of six, but that pattern is completely the opposite after that age. Hence, for children aged between six and 16, more educated parents are more likely to ensure their children are immunized. Likewise, systematic vaccinations are more likely for those parents with a lower educational attainment level. CONCLUSIONS This paper evidenced the presence of an education gradient for specific preventive care through the public health system and visits to the GP without any particular disease or advice for specific vaccinations.
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Affiliation(s)
- T. Mora
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Immaculada 22, 08017 Barcelona, Spain
| | - M. Trapero-Bertran
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Immaculada 22, 08017 Barcelona, Spain
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Gómez-Lumbreras A, Trapero-Bertran M. [The role of the economic evaluation in the Pharmacoterapeutic Committees of the two hospital of third level]. Farm Hosp 2018; 42:184-185. [PMID: 29959845 DOI: 10.7399/fh.11003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
| | - Marta Trapero-Bertran
- Facultad de Ciencias Económicas y Sociales, Universitat Internacional de Catalunya (UIC)..
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Trapero-Bertran M, Muñoz C, Coyle K, Coyle D, Lester-George A, Leidl R, Bertalan N, Cheung KL, Pokhrel S, Lopez-Nicolás A. Cost-effectiveness of alternative smoking cessation scenarios in Spain: results from the EQUIPTMOD. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trapero-Bertran M, Leidl R, Muñoz C, Kulchaitanaroaj P, Coyle K, Präger M, Józwiak-Hagymásy J, Cheung KL, Hiligsmann M, Pokhrel S, EQUIPT Study Group OBOT. Estimating costs for modelling return on investment from smoking cessation interventions. Tob Prev Cessat 2018. [DOI: 10.18332/tpc/90429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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López-Nicolás Á, Trapero-Bertran M, Muñoz C. Smoking, health-related quality of life and economic evaluation. Eur J Health Econ 2018; 19:747-756. [PMID: 28748308 DOI: 10.1007/s10198-017-0919-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIMS The economic evaluation of tobacco control policies requires the adoption of assumptions about the impact of changes in smoking status on health-related quality of life (HRQoL). Estimates for such impacts are necessary for different populations. This paper aims to test whether smoking status has an independent effect on HRQoL over and above the effect derived from the increased likelihood of suffering a tobacco related disease, and to calculate utility values for the Spanish population. METHODS Using data from the Spanish Encuesta Nacional de Salud of 2011-12, we estimate statistical models for HRQoL as measured by the EQ-5D-5L instrument as a function of smoking status. We include a comprehensive set of controls for biological, clinical, lifestyle and socioeconomic characteristics. RESULTS Smoking status has an independent, statistically significant effect on HRQoL. However, the size of the effect is small. The typical smoking related diseases, such as lung cancer, are associated with a reduction in HRQoL about 5 times larger than the difference between current smokers and never smokers. CONCLUSION Attributing substantive HRQoL gains to quitting smoking as well as accounting for the concomitant HRQoL gain derived from a smaller likelihood of contracting tobacco related diseases might lead to an overestimation of the benefits of tobacco control policies. Nonetheless, the relatively large drops in HRQoL associated with being diagnosed with diseases that might be causally linked to tobacco suggest that such diseases should not be omitted from the economic evaluations of tobacco control policies.
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Affiliation(s)
- Ángel López-Nicolás
- Economics Department, Faculty of Business Science, Universidad Politécnica de Cartagena (UPCT), C/Real, 3, 30201, Cartagena (Murcia), Spain.
| | - Marta Trapero-Bertran
- Faculty of Economic and Social Sciences, Universitat Internacional de Catalunya (UIC), C/Immaculada, 22, 08017, Barcelona, Spain
- Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Celia Muñoz
- Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Zozaya N, Martínez-Galdeano L, Alcalá B, Armario-Hita JC, Carmona C, Carrascosa JM, Herranz P, Lamas MJ, Trapero-Bertran M, Hidalgo-Vega Á. Determining the Value of Two Biologic Drugs for Chronic Inflammatory Skin Diseases: Results of a Multi-Criteria Decision Analysis. BioDrugs 2018; 32:281-291. [PMID: 29808418 PMCID: PMC5990558 DOI: 10.1007/s40259-018-0284-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Multi-criteria decision analysis (MCDA) is a tool that systematically considers multiple factors relevant to health decision-making. The aim of this study was to use an MCDA to assess the value of dupilumab for severe atopic dermatitis compared with secukinumab for moderate to severe plaque psoriasis in Spain. METHOD Following the EVIDEM (Evidence and Value: Impact on DEcision Making) methodology, the estimated value of both interventions was obtained by means of an additive linear model that combined the individual weighting (between 1 and 5) of each criterion with the individual scoring of each intervention in each criterion. Dupilumab was evaluated against placebo, while secukinumab was evaluated against placebo, etanercept and ustekinumab. A retest was performed to assess the reproducibility of weights, scores and value estimates. RESULTS The overall MCDA value estimate for dupilumab versus placebo was 0.51 ± 0.14. This value was higher than those obtained for secukinumab: 0.48 ± 0.15 versus placebo, 0.45 ± 0.15 versus etanercept and 0.39 ± 0.18 versus ustekinumab. The highest-value contribution was reported by the patients' group, followed by the clinical professionals and the decision makers. A fundamental element that explained the difference in the scoring between pathologies was the availability of therapeutic alternatives. The retest confirmed the consistency and replicability of the analysis. CONCLUSIONS Under this methodology, and assuming similar economic costs per patient for both treatments, the results indicated that the overall value estimated of dupilumab for severe atopic dermatitis was similar to, or slightly higher than, that of secukinumab for moderate to severe plaque psoriasis.
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Affiliation(s)
- Néboa Zozaya
- Department of Health Economics, Weber Economía y Salud, c/Norias 123, Majadahonda, 28221, Madrid, Spain.
| | - Lucía Martínez-Galdeano
- Department of Health Economics, Weber Economía y Salud, c/Norias 123, Majadahonda, 28221, Madrid, Spain
| | - Bleric Alcalá
- Department of Health Economics, Weber Economía y Salud, c/Norias 123, Majadahonda, 28221, Madrid, Spain
| | | | - Concepción Carmona
- Department of Healthcare, Servicio Extremeño de Salud, Mérida, Badajoz, Spain
| | - Jose Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pedro Herranz
- Department of Dermatology, La Paz Universitary Hospital-Carlos III, Madrid, Spain
| | - María Jesús Lamas
- Servicio de Farmacia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | - Marta Trapero-Bertran
- Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Álvaro Hidalgo-Vega
- Fundación Weber, Majadahonda, Madrid, Spain
- Universidad de Castilla-La Mancha, Campus de Toledo, Toledo, Spain
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Vargas-Martínez AM, Trapero-Bertran M, Gil-García E, Lima-Serrano M. Editorial. Impact of the Binge Drinking (BD) in Adolescence. Are we doing it right? Editorial. Impacto del consumo episódico excesivo de alcohol en la adolescencia. ¿Lo estamos haciendo bien? Adicciones 2018; 30:152-154. [PMID: 29353291 DOI: 10.20882/adicciones.1033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nowadays, one of the most prevalent patterns of alcohol consumption is called binge drinking (BD). In 2015, the European School Survey Project on Alcohol and Drugs (ESPAD) Group estimated that about 35% of adolescents of 15-16 years old have had at least one BD occasion in the past 30 days while at national level, the series of surveys on the use of drugs in adolescents of secondary education (ESTUDES, 2014-2015) determined that 32.2% of adolescents stated having performed BD in the last month. The aim of this editorial was to update the context of adolescence drinking and analysing the impact of BD by ages, including health and social costs derived. Once the magnitude of the problem was set, some research and action lines have been established in order to guide future work for the prevention of alcohol misuse and for establishing future preventive policies on alcohol. Finally, the need for evaluating these interventions from the efficiency point of view was discussed and assessed.
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Kulchaitanaroaj P, Kaló Z, West R, Cheung KL, Evers S, Vokó Z, Hiligsmann M, de Vries H, Owen L, Trapero-Bertran M, Leidl R, Pokhrel S. Understanding perceived availability and importance of tobacco control interventions to inform European adoption of a UK economic model: a cross-sectional study. BMC Health Serv Res 2018; 18:115. [PMID: 29444679 PMCID: PMC5813331 DOI: 10.1186/s12913-018-2923-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 02/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence on the extent to which stakeholders in different European countries agree with availability and importance of tobacco-control interventions is limited. This study assessed and compared stakeholders' views from five European countries and compared the perceived ranking of interventions with evidence-based ranking using cost-effectiveness data. METHODS An interview survey (face-to-face, by phone or Skype) was conducted between April and July 2014 with five categories of stakeholders - decision makers, service purchasers, service providers, evidence generators and health promotion advocates - from Germany, Hungary, the Netherlands, Spain, and the United Kingdom. A list of potential stakeholders drawn from the research team's contacts and snowballing served as the sampling frame. An email invitation was sent to all stakeholders in this list and recruitment was based on positive replies. Respondents were asked to rate availability and importance of 30 tobacco control interventions. Kappa coefficients assessed agreement of stakeholders' views. A mean importance score for each intervention was used to rank the interventions. This ranking was compared with the ranking based on cost-effectiveness data from a published review. RESULTS Ninety-three stakeholders (55.7% response rate) completed the survey: 18.3% were from Germany, 17.2% from Hungary, 30.1% from the Netherlands, 19.4% from Spain, and 15.1% from the UK. Of those, 31.2% were decision makers, 26.9% evidence generators, 19.4% service providers, 15.1% health-promotion advocates, and 7.5% purchasers of services/pharmaceutical products. Smoking restrictions in public areas were rated as the most important intervention (mean score = 1.89). The agreement on availability of interventions between the stakeholders was very low (kappa = 0.098; 95% CI = [0.085, 0.111] but the agreement on the importance of the interventions was fair (kappa = 0.239; 95% CI = [0.208, 0.253]). A correlation was found between availability and importance rankings for stage-based interventions. The importance ranking was not statistically concordant with the ranking based on published cost-effectiveness data (Kendall rank correlation coefficient = 0.40; p-value = 0.11; 95% CI = [- 0.09, 0.89]). CONCLUSIONS The intrinsic differences in stakeholder views must be addressed while transferring economic evidence Europe-wide. Strong engagement with stakeholders, focussing on better communication, has a potential to mitigate this challenge.
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Affiliation(s)
- Puttarin Kulchaitanaroaj
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Robert West
- Health Behaviour Research Centre, University College London, London, UK
- National Centre for Smoking Cessation and Training, Birmingham, UK
| | - Kei Long Cheung
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy & Health Economics, Faculty of Social Sciences, Eötvös Loránd University, Budapest, Hungary
| | - Mickael Hiligsmann
- Department of Health Services Research, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Caphri School of Public Health, Maastricht University, Maastricht, the Netherlands
| | - Lesley Owen
- National Institute for Health and Care Excellence, London, UK
| | - Marta Trapero-Bertran
- Centre for Research in Economics and Health, University Pompeu Fabra, Barcelona, Spain
| | - Reiner Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, Uxbridge, UK
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MacLennan SJ, MacLennan S, Bex A, Catto JW, De Santis M, Glaser AW, Ljungberg B, N’Dow J, Plass K, Trapero-Bertran M, Van Poppel H, Wright P, Giles RH. Changing Current Practice in Urology: Improving Guideline Development and Implementation Through Stakeholder Engagement. Eur Urol 2017; 72:161-163. [DOI: 10.1016/j.eururo.2017.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/04/2017] [Indexed: 11/28/2022]
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Oliva-Moreno J, Trapero-Bertran M, Peña-Longobardo LM, Del Pozo-Rubio R. The Valuation of Informal Care in Cost-of-Illness Studies: A Systematic Review. Pharmacoeconomics 2017; 35:331-345. [PMID: 27848219 DOI: 10.1007/s40273-016-0468-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND There is a growing interest in incorporating informal care in cost-of-illness studies as a relevant part of the economic impact of some diseases. OBJECTIVE The aim of this paper was to review the recent literature valuating the costs of informal care in a group of selected diseases from 2005 to 2015. METHODS We carried out a systematic review on the economic impact of informal care, focusing on six selected diseases: arthritis or osteoarthritis, cancer, dementia, mental diseases, multiple sclerosis and stroke. RESULTS We selected 91 cost-of-illness articles. The average weight attributed to the informal care cost over the total cost was highly relevant for dementia, stroke, mental diseases, cancer and multiple sclerosis. The most frequent valuation method applied was the opportunity cost method, followed by the proxy good method. The annual cost of informal care presented a high variability depending on the disease and geographic location. Distinguishing by type of illness, the disease with the highest annual value of informal caregiving was dementia, followed by mental illness and multiple sclerosis. The average hourly unit cost was €11.43 (2015 values), varying noticeably depending on the geographic location. CONCLUSION This paper identifies several aspects that should be enhanced to promote comparability between studies and countries, and it sends key messages for incorporating informal care costs to adequately measure the economic impact of diseases.
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Affiliation(s)
- Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, Universidad de Castilla La-Mancha, Toledo, Spain.
| | - Marta Trapero-Bertran
- Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Luz Maria Peña-Longobardo
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, Universidad de Castilla La-Mancha, Toledo, Spain
| | - Raúl Del Pozo-Rubio
- Department of Economic Analysis and Finance, Faculty of Social Sciences, Universidad de Castilla La-Mancha, Cuenca, Spain
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Trapero-Bertran M, Acera Pérez A, de Sanjosé S, Manresa Domínguez JM, Rodríguez Capriles D, Rodriguez Martinez A, Bonet Simó JM, Sanchez Sanchez N, Hidalgo Valls P, Díaz Sanchis M. Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study. BMC Public Health 2017; 17:194. [PMID: 28196467 PMCID: PMC5309977 DOI: 10.1186/s12889-017-4115-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 02/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. METHODS Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years - the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. RESULTS The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years. CONCLUSIONS In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01373723 .
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Affiliation(s)
- Marta Trapero-Bertran
- Economy and Business Organisation Department, Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Centre for Research in Economics and Health (CRES), University Pompeu Fabra, c/Immaculada 22, 08017 Barcelona, Spain
| | - Amelia Acera Pérez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain
- Grup de Recerca GRASSIR reconegut per la Generalitat de Catalunya SGR 2014-2016, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain
| | - Josep Maria Manresa Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol. Sabadell, Barcelona, Spain
- Departament de Infermeria, Universitat Autonoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Diego Rodríguez Capriles
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
| | - Ana Rodriguez Martinez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola-Ripollet, Institut Catala de la Salut, Ripollet, Barcelona, Spain
| | | | - Norman Sanchez Sanchez
- Sistemes d’Informació Sanitària, SAP Vallés Occidental, Institut Catala de la Salut, Sabadell, Barcelona, Spain
| | - Pablo Hidalgo Valls
- SAP Vallés Occidental, Institut Català de la Salut, Sabadell, Barcelona, Spain
| | - Mireia Díaz Sanchis
- Cancer Epidemiology Research Programme (CERP), Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBERESP), Barcelona, Spain
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Acera A, Manresa JM, Rodriguez D, Rodriguez A, Bonet JM, Trapero-Bertran M, Hidalgo P, Sànchez N, de Sanjosé S. Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial. PLoS One 2017; 12:e0170371. [PMID: 28118410 PMCID: PMC5261609 DOI: 10.1371/journal.pone.0170371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/30/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. METHODS The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation. RESULTS Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. CONCLUSIONS The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age. TRIAL REGISTRATION ClinicalTrials.gov NCT01373723.
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Affiliation(s)
- Amelia Acera
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola–Ripollet, Institut Català de la Salut, Ripollet, Spain
- Unitat de Suport a la Recerca Metropolitana Nord. Institut de Investigació en Atenció Primària (IDIAP) Jordi Gol. Sabadell, Spain
- Departament de Medicina, Universitat de Barcelona. Barcelona, Spain
- Grup de Recerca en Atenció Sexual i Reproductiva IDIAP Jordi Gol. Sabadell, Spain
| | - Josep Maria Manresa
- Unitat de Suport a la Recerca Metropolitana Nord. Institut de Investigació en Atenció Primària (IDIAP) Jordi Gol. Sabadell, Spain
- Departament de Infermeria. Universitat Autònoma de Barcelona. Bellaterra, Cerdanyola, Spain
| | - Diego Rodriguez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola–Ripollet, Institut Català de la Salut, Ripollet, Spain
| | - Ana Rodriguez
- Atenció a la Salut Sexual i Reproductiva (ASSIR) SAP Cerdanyola–Ripollet, Institut Català de la Salut, Ripollet, Spain
| | - Josep Maria Bonet
- Servei d’Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain
| | - Marta Trapero-Bertran
- Center for Research in Economics and Health (CRES). University Pompeu Fabra, Barcelona, Spain
- Universidad de Castilla La Mancha. Ciudad Real, Spain
| | - Pablo Hidalgo
- Servei d’Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain
| | - Norman Sànchez
- Servei d’Atenció Primària SAP Vallés Occidental. Institut Català de la Salut, Sabadell, Spain
| | - Silvia de Sanjosé
- Cancer Epidemiology Research Programme | IDIBELL | Catalan Institute of Oncology, L’Hospitalet de Llobregat, Spain
- Centro de Investigación Biomédica en Red en Epidemiologia y Salud Pública CIBERESP, Barcelona, Spain
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Muñoz C, Trapero-Bertran M, Cheung KL, Evers S, Hiligsmann M, de Vries H, López-Nicolás Á. [A return on investment tool in tobacco control: what do stakeholders think?]. Gac Sanit 2016; 30:121-5. [PMID: 26656947 DOI: 10.1016/j.gaceta.2015.10.012] [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] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/20/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The European EQUIPT study will co-create a return on investment tool in several countries, aiming to provide decision makers with information and justification on the returns that can be generated by investing in tobacco control. This study aimed to identify the needs of potential users in Spain in order to provide information on the transferability of the tool. METHODS Telephone interviews with stakeholders were conducted including questions about the implementation of the tool, intended use and tobacco control interventions. RESULTS Implementing the tool could provide added value to the information used in decision-making to advocate for cost-effective policies. The main drawback would be the training and time needed to learn how the tool works and for internal calculations. CONCLUSION Knowledge and ideas from potential users collected in this study could inform the EQUIPT Tool adaptation. Thus, stakeholders could have an instrument that assists them on making healthcare decisions.
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Affiliation(s)
- Celia Muñoz
- Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra, Barcelona, España.
| | - Marta Trapero-Bertran
- Centre de Recerca en Economia i Salut (CRES), Universitat Pompeu Fabra, Barcelona, España
| | - Kei Long Cheung
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
| | - Silvia Evers
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
| | - Mickaël Hiligsmann
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
| | - Hein de Vries
- Caphri School of Public Health and Primary Care, Health Services Research, Maastricht University, Maastricht, Países Bajos
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Espín Balbino J, Brosa Riestra M, Oliva Moreno J, Trapero-Bertran M. Cuestiones controvertidas en evaluación económica (III). Intervenciones sanitarias en tres situaciones especiales: enfermedades raras, tratamientos al final de la vida y externalidades en las evaluaciones. Rev Esp Salud Publica 2015; 89:237-47. [DOI: 10.4321/s1135-57272015000300002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Trapero-Bertran M, Brosa Riestra M, Espín Balbino J, Oliva J. Cuestiones controvertidas en evaluación económica (II): medidas de resultado en salud de las intervenciones sanitarias. Rev Esp Salud Publica 2015; 89:125-35. [DOI: 10.4321/s1135-57272015000200002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
The HIV/AIDS disease represent a priority for all health authorities in all countries and it also represents serious added socioeconomic problems for societies over the world. The aim of this paper is to analize the economic impact associated to the HIV/AIDS in an European context. We conducted a systematic literature review for five different countries (France, Germany, Italy, Spain and United Kingdom) and searched five databases. Three types of analyses were undertaken: descriptive statistics; quantitative analysis to calculate mean costs; and comparison across countries. 26 papers were included in this study containing seventy-six cost estimates. Most of the studies analyzed the health care cost of treatment of HIV/AIDS. Only 50% of the cost estimates provided mean lymphocyte count describing the patients' disease stage. Approximately thirty percent of cost estimates did not indicate the developmental stage of the illness in the patients included. There is a high degree of variability in the estimated annual cost per patient of the treatments across countries. There is also a great disparity in total healh care costs for patients with lymphocyte counts between 200CD4+/mm3 and 500 CD4/mm3, although the reason of variation is unclear. In spite of the potential economic impact in terms of productivity losses and cost of formal and informal care, few studies have set out to estimate the non-medical costs of HIV/AIDS in the countries selected. Another important result is that, despite the low HIV/AIDS prevalence, its economic burden is very relevant in terms of the total health care costs in this five countries. This study also shows that there are relatively few studies of HIV costs in European countries compared to other diseases. Finally, we conclude that the methodology used in many of the studies carried out leaves ample room for improvement and that there is a need for these studies to reflect the economic impact of HIV/AIDS beyond health care including other components of social burden.
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Affiliation(s)
- Marta Trapero-Bertran
- />University Pompeu Fabra, Department of Economics and Business, Centre for Research on Economics and Health, Ramon Trias Fargas 25-27, Barcelona, 08005 Spain
- />University Castilla La-Mancha, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Avda. Real Fábrica de Seda, s/n, Talavera de la Reina, Toledo, 45600 Spain
| | - Juan Oliva-Moreno
- />Facultad de Ciencias Jurídicas y Sociales, Análisis Económico y Finanzas, Cobertizo de San Pedro Mártir s/n, Toledo, 45071 Spain
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Pokhrel S, Evers S, Leidl R, Trapero-Bertran M, Kalo Z, de Vries H, Crossfield A, Andrews F, Rutter A, Coyle K, Lester-George A, West R, Owen L, Jones T, Vogl M, Radu-Loghin C, Voko Z, Huic M, Coyle D. EQUIPT: protocol of a comparative effectiveness research study evaluating cross-context transferability of economic evidence on tobacco control. BMJ Open 2014; 4:e006945. [PMID: 25421342 PMCID: PMC4244438 DOI: 10.1136/bmjopen-2014-006945] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Tobacco smoking claims 700,000 lives every year in Europe and the cost of tobacco smoking in the EU is estimated between €98 and €130 billion annually; direct medical care costs and indirect costs such as workday losses each represent half of this amount. Policymakers all across Europe are in need of bespoke information on the economic and wider returns of investing in evidence-based tobacco control, including smoking cessation agendas. EQUIPT is designed to test the transferability of one such economic evidence base-the English Tobacco Return on Investment (ROI) tool-to other EU member states. METHODS AND ANALYSIS EQUIPT is a multicentre, interdisciplinary comparative effectiveness research study in public health. The Tobacco ROI tool already developed in England by the National Institute for Health and Care Excellence (NICE) will be adapted to meet the needs of European decision-makers, following transferability criteria. Stakeholders' needs and intention to use ROI tools in sample countries (Germany, Hungary, Spain and the Netherlands) will be analysed through interviews and surveys and complemented by secondary analysis of the contextual and other factors. Informed by this contextual analysis, the next phase will develop country-specific ROI tools in sample countries using a mix of economic modelling and Visual Basic programming. The results from the country-specific ROI models will then be compared to derive policy proposals that are transferable to other EU states, from which a centralised web tool will be developed. This will then be made available to stakeholders to cater for different decision-making contexts across Europe. ETHICS AND DISSEMINATION The Brunel University Ethics Committee and relevant authorities in each of the participating countries approved the protocol. EQUIPT has a dedicated work package on dissemination, focusing on stakeholders' communication needs. Results will be disseminated via peer-reviewed publications, e-learning resources and policy briefs.
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Affiliation(s)
- Subhash Pokhrel
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Silvia Evers
- Maastricht University, Caphri School of Public Health and Primary Care, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | - Zoltan Kalo
- Faculty of Social Sciences, Department of Health Policy and Health Economics, Eötvös Loránd University, and Syreon Research Institute, Budapest, Hungary
| | - Hein de Vries
- Maastricht University, Caphri School of Public Health and Primary Care, Maastricht, The Netherlands
| | | | | | | | - Kathryn Coyle
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK
| | | | - Robert West
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
- National Centre for Smoking Cessation and Training, London, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, London, UK
| | - Teresa Jones
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Matthias Vogl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | - Zoltan Voko
- Faculty of Social Sciences, Department of Health Policy and Health Economics, Eötvös Loránd University, and Syreon Research Institute, Budapest, Hungary
| | - Mirjana Huic
- Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| | - Doug Coyle
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, London, UK
- Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Lord J, Willis S, Eatock J, Tappenden P, Trapero-Bertran M, Miners A, Crossan C, Westby M, Anagnostou A, Taylor S, Mavranezouli I, Wonderling D, Alderson P, Ruiz F. Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project. Health Technol Assess 2014; 17:v-vi, 1-192. [PMID: 24325843 DOI: 10.3310/hta17580] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND National Institute for Health and Care Excellence (NICE) clinical guidelines (CGs) make recommendations across large, complex care pathways for broad groups of patients. They rely on cost-effectiveness evidence from the literature and from new analyses for selected high-priority topics. An alternative approach would be to build a model of the full care pathway and to use this as a platform to evaluate the cost-effectiveness of multiple topics across the guideline recommendations. OBJECTIVES In this project we aimed to test the feasibility of building full guideline models for NICE guidelines and to assess if, and how, such models can be used as a basis for cost-effectiveness analysis (CEA). DATA SOURCES A 'best evidence' approach was used to inform the model parameters. Data were drawn from the guideline documentation, advice from clinical experts and rapid literature reviews on selected topics. Where possible we relied on good-quality, recent UK systematic reviews and meta-analyses. REVIEW METHODS Two published NICE guidelines were used as case studies: prostate cancer and atrial fibrillation (AF). Discrete event simulation (DES) was used to model the recommended care pathways and to estimate consequent costs and outcomes. For each guideline, researchers not involved in model development collated a shortlist of topics suggested for updating. The modelling teams then attempted to evaluate options related to these topics. Cost-effectiveness results were compared with opinions about the importance of the topics elicited in a survey of stakeholders. RESULTS The modelling teams developed simulations of the guideline pathways and disease processes. Development took longer and required more analytical time than anticipated. Estimates of cost-effectiveness were produced for six of the nine prostate cancer topics considered, and for five of eight AF topics. The other topics were not evaluated owing to lack of data or time constraints. The modelled results suggested 'economic priorities' for an update that differed from priorities expressed in the stakeholder survey. LIMITATIONS We did not conduct systematic reviews to inform the model parameters, and so the results might not reflect all current evidence. Data limitations and time constraints restricted the number of analyses that we could conduct. We were also unable to obtain feedback from guideline stakeholders about the usefulness of the models within project time scales. CONCLUSIONS Discrete event simulation can be used to model full guideline pathways for CEA, although this requires a substantial investment of clinical and analytic time and expertise. For some topics lack of data may limit the potential for modelling. There are also uncertainties over the accessibility and adaptability of full guideline models. However, full guideline modelling offers the potential to strengthen and extend the analytical basis of NICE's CGs. Further work is needed to extend the analysis of our case study models to estimate population-level budget and health impacts. The practical usefulness of our models to guideline developers and users should also be investigated, as should the feasibility and usefulness of whole guideline modelling alongside development of a new CG. FUNDING This project was funded by the Medical Research Council and the National Institute for Health Research through the Methodology Research Programme [grant number G0901504] and will be published in full in Health Technology Assessment; Vol. 17, No. 58. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- J Lord
- Health Economics Research Group, Brunel University, Uxbridge, UK
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Acera A, Manresa JM, Rodriguez D, Rodriguez A, Bonet JM, Sanchez N, Hidalgo P, Soteras P, Toran P, Trapero-Bertran M, Lozano I, De Sanjose S. Analysis of three strategies to increase screening coverage for cervical cancer in the general population of women aged 60 to 70 years: the CRICERVA study. BMC Womens Health 2014; 14:86. [PMID: 25026889 PMCID: PMC4106208 DOI: 10.1186/1472-6874-14-86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/09/2014] [Indexed: 11/23/2022]
Abstract
Background Cervical cancer is a frequently diagnosed cancer in women worldwide. Despite having easy preventive and therapeutic approaches, it is an important cause of mortality among women. Methods The CRICERVA study is a cluster clinical trial which assigned one of three interventions to the target population registered in Cerdanyola, Barcelona. Among the 5,707 resident women aged 60 to 70 years in the study area, women with no record of cervical cytology over the last three years were selected. The study included four arms: three interventions all including a pre-assigned date for screening visit and i) personalized invitation letter; ii) adding to i) an informative leaflet; and, iii) in addition to ii) a personalized appointment reminder phone call, and iv) no specific action taken (control group). Participants were offered a personal interview about social-demographic characteristics and about screening attitudes. Cervical cytology and HPV DNA test (HC2) were offered as screening tests. In the case of screening positive in any of these tests, the women were followed up until a full diagnosis could be obtained. The effect size of each study arm was estimated as the absolute gain in coverage between the original coverage and the final coverage. Results From the intervention groups (4,775 women), we identified 3,616 who were not appropriately screened, of which 2,560 women answered the trial call and 1,376 were amenable to screening. HPV was tested in 920 women and cervical cytology in all 1,376. Overall, there was an absolute gain in coverage of 28.8% in the intervention groups compared to 6% in the control group. Coverage increased from 51.2% to 76.0% in strategy i); from 47.4% to 79.0% in strategy ii) and from 44.5% to 74.6% in strategy iii). Lack of information about the relevance of screening was the most important factor for not attending the screening program. Conclusions The study confirms that actively contacting women and including a date for a screening visit, notably increased participation in the screening program. Efforts to improve health education in preventative activities are warranted. Trial registration Clinical Trials.gov Identifier NCT01373723. Registered 14 June 2011.
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Affiliation(s)
- Amelia Acera
- Atenció a la Salut Sexual i Reproductiva (ASSIR), SAP Cerdanyola -Ripollet, Institut Català de la Salut, Carretera N-150 s/n, Ripollet, Barcelona, Spain.
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Trapero-Bertran M, Mistry H, Shen J, Fox-Rushby J. A systematic review and meta-analysis of willingness-to-pay values: the case of malaria control interventions. Health Econ 2013; 22:428-450. [PMID: 22529037 DOI: 10.1002/hec.2810] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/08/2012] [Accepted: 02/15/2012] [Indexed: 05/31/2023]
Abstract
The increasing use of willingness to pay (WTP) to value the benefits of malaria control interventions offers a unique opportunity to explore the possibility of estimating a transferable indicator of mean WTP as well as studying differences across studies. As regression estimates from individual WTP studies are often assumed to transfer across populations it also provides an opportunity to question this practice. Using a qualitative review and meta analytic methods, this article determines what has been studied and how, provides a summary mean WTP by type of intervention, considers how and why WTP estimates vary and advises on future reporting of WTP studies. WTP has been elicited mostly for insecticide-treated nets, followed by drugs for treatment. Mean WTP, including zeros, is US$2.79 for insecticide-treated nets, US$6.65 for treatment and US$2.60 for other preventive services. Controlling for a limited number of sample and design effects, results can be transferred to different countries using the value function. The main concerns are the need to account for a broader range of explanators that are study specific and the ability to transfer results into malaria contexts beyond those represented by the data. Future studies need to improve the reporting of WTP.
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Acera A, Rodriguez A, Trapero-Bertran M, Soteras P, Sanchez N, Bonet JM, Manresa JM, Hidalgo P, Toran P, Prieto G. Economic evaluation of three populational screening strategies for cervical cancer in the county of Valles Occidental: CRICERVA clinical trial. BMC Health Serv Res 2011; 11:278. [PMID: 22011387 PMCID: PMC3215283 DOI: 10.1186/1472-6963-11-278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/19/2011] [Indexed: 05/26/2023] Open
Abstract
Background A high percentage of cervical cancer cases have not undergone cytological tests within 10 years prior to diagnosis. Different population interventions could improve coverage in the public system, although costs will also increase. The aim of this study was to compare the effectiveness and the costs of three types of population interventions to increase the number of female participants in the screening programmes for cancer of the cervix carried out by Primary Care in four basic health care areas. Methods/Design A cost-effectiveness analysis will be performed from the perspective of public health system including women from 30 to 70 years of age (n = 20,994) with incorrect screening criteria from four basic health care areas in the Valles Occidental, Barcelona, Spain. The patients will be randomly distributed into the control group and the three intervention groups (IG1: invitation letter to participate in the screening; IG2: invitation letter and informative leaflet; IG3: invitation letter, informative leaflet and a phone call reminder) and followed for three years. Clinical effectiveness will be measured by the number of HPV, epithelial lesions and cancer of cervix cases detected. The number of deaths avoided will be secondary measures of effectiveness. The temporal horizon of the analysis will be the life expectancy of the female population in the study. Costs and effectiveness will be discounted at 3%. In addition, univariate and multivariate sensitivity analysis will be carried out. Discussion IG3 is expected to be more cost-effective intervention than IG1 and IG2, with greater detection of HPV infections, epithelial lesions and cancer than other strategies, albeit at a greater cost. Trial Registration Clinical Trials.gov Identifier NCT01373723
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Affiliation(s)
- Amelia Acera
- Atenció a la Salut Sexual i Reproductiva SAP Cerdanyola -Ripollet, Institut Catala de la Salut, Barcelona, Spain.
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Berenguera A, Pujol-Ribera E, Rodriguez-Blanco T, Violan C, Casajuana M, de Kort N, Trapero-Bertran M. Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial. BMC Musculoskelet Disord 2011; 12:194. [PMID: 21859489 PMCID: PMC3170648 DOI: 10.1186/1471-2474-12-194] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 08/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. METHODS/DESIGN The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term).Assessment of outcomes will be blinded and will follow the intention-to-treat principle. DISCUSSION We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. TRIAL REGISTRATION ISRCTN: ISRCTN58719694.
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Affiliation(s)
- Anna Berenguera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, C/Gran Via de les Corts Catalanes 587 àtic, 08007 Barcelona, Spain
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