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Forcada-Segarra JA, Cuesta-Esteve I, García Pérez A, Sancho Martínez R, Rey Biel P, Carrera-Barnet G, Cuadra-Grande ADL, Casado MÁ, Drago G, Gómez-Barrera M, López-Belmonte JL. Nurses' preferences regarding MenACWY conjugate vaccines attributes: a discrete choice experiment in Spain. Public Health 2024; 230:163-171. [PMID: 38555685 DOI: 10.1016/j.puhe.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Immunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. STUDY DESIGN A national-level discrete choice experiment (DCE) was conducted. METHODS A literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). RESULTS Thirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210-3.002), smaller volumes (OR = 1.494, 95%CI = 1.264-1.767), liquid formulations (OR = 1.283, 95%CI = 1.108-1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108-1.486). No statistical evidence was found for the remaining attributes. CONCLUSIONS Evidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses' preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.
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Affiliation(s)
- J A Forcada-Segarra
- Asociación Nacional de Enfermería y Vacunas (ANENVAC), Valencia, Spain; Public Health Nurse, Valencia, Spain
| | - I Cuesta-Esteve
- Asociación Nacional de Enfermería y Vacunas (ANENVAC), Valencia, Spain; Nurse and Matron, Zaragoza, Spain
| | - A García Pérez
- Asociación Nacional de Enfermería y Vacunas (ANENVAC), Valencia, Spain; Primary Care Nurse, Cáceres, Spain
| | - R Sancho Martínez
- Asociación Nacional de Enfermería y Vacunas (ANENVAC), Valencia, Spain; Vaccinology, Public Health, Basque Government, San Sebastian, Spain
| | - P Rey Biel
- ESADE Business School, Universitat Ramón Llull, Spain
| | | | - A de la Cuadra-Grande
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4 e Letter I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | - M Á Casado
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4 e Letter I, Pozuelo de Alarcón, 28224, Madrid, Spain
| | - G Drago
- Medical Advisor Vaccines, Sanofi, Barcelona, Spain
| | - M Gómez-Barrera
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4 e Letter I, Pozuelo de Alarcón, 28224, Madrid, Spain
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González-Flores E, Zambudio N, Pardo-Moreno P, Gonzalez-Astorga B, de la Rúa JR, Triviño-Ibáñez EM, Navarro P, Espinoza-Cámac N, Casado MÁ, Rodríguez-Fernández A. Recommendations for the management of yttrium-90 radioembolization in the treatment of patients with colorectal cancer liver metastases: a multidisciplinary review. Clin Transl Oncol 2024; 26:851-863. [PMID: 37747636 PMCID: PMC10981623 DOI: 10.1007/s12094-023-03299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Strategies for the treatment of liver metastases from colon cancer (lmCRC) are constantly evolving. Radioembolization with yttrium 90 (Y-90 TARE) has made significant advancements in treating liver tumors and is now considered a potential option allowing for future resection. This study reviewed the scientific evidence and developed recommendations for using Y-90 TARE as a treatment strategy for patients with unresectable lmCRC. METHODS A multidisciplinary scientific committee, consisting of experts in medical oncology, hepatobiliary surgery, radiology, and nuclear medicine, all with extensive experience in treating patients with ImCRC with Y-90 TARE, led this project. The committee established the criteria for conducting a comprehensive literature review on Y-90 TARE in the treatment of lmCRC. The data extraction process involved addressing initial preliminary inquiries, which were consolidated into a final set of questions. RESULTS This review offers recommendations for treating patients with lmCRC using Y-90 TARE, addressing four areas covering ten common questions: 1) General issues (multidisciplinary tumor committee, indications for treatment, contraindications); 2) Previous process (predictive biomarkers for patient selection, preintervention tests, published evidence); 3) Procedure (standard procedure); and 4) Post-intervention follow-up (potential toxicity and its management, parameters for evaluation, quality of life). CONCLUSIONS Based on the insights of the multidisciplinary committee, this document offers a comprehensive overview of the technical aspects involved in the management of Y-90 TARE. It synthesizes recommendations for applying Y-90 TARE across various phases of the treatment process.
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Affiliation(s)
- Encarna González-Flores
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Natalia Zambudio
- Surgery Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pedro Pardo-Moreno
- Radiodiagnostic Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - Eva M Triviño-Ibáñez
- Nuclear Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pablo Navarro
- Radiodiagnostic Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Nataly Espinoza-Cámac
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | - Miguel Ángel Casado
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain
| | - Antonio Rodríguez-Fernández
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
- Nuclear Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Villegas E, Arruñada M, Casado MÁ, González S, Moreno-Martínez ME, Peñuelas MÁ, Torres AM, Sierra Y, Seguí MA. National expert consensus on home-administered oncologic therapies in Spain. Front Oncol 2024; 14:1335344. [PMID: 38434688 PMCID: PMC10905380 DOI: 10.3389/fonc.2024.1335344] [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: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 03/05/2024] Open
Abstract
The diagnosis and treatment of cancer impose a significant emotional and psychological burden on patients, families, and caregivers. Patients undergo several interventions in a hospital setting, and the increasing number of patients requiring extended care and follow-up is driving the demand for additional clinical resources to address their needs. Hospital at Home (HaH) teams have introduced home-administered oncologic therapies that represent a new model of patient-centered cancer care. This approach can be integrated with traditional models and offers benefits to both patients and healthcare professionals (HCPs). Home-administered treatment programs have been successfully piloted globally, demonstrated as a preferred option for most patients and a safe alternative that could reduce costs and hospital burden. The document aims to establish the minimum recommendations for the home administration of oncologic therapies (ODAH) based on a national expert agreement. The expert panel comprised seven leading members from diverse Spanish societies and three working areas: clinical and healthcare issues, logistical and administrative issues, and economic, social, and legal issues. The recommendations outlined in this article were obtained after a comprehensive literature review and thorough discussions. This document may serve as a basis for the future development of home-administered oncologic therapy programs in Spain. .
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Affiliation(s)
| | - María Arruñada
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | - Sonia González
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
- University Hospital Complex of Vigo (SERGAS-UVIGO), Vigo, Spain
| | | | | | | | | | - Miguel Angel Seguí
- Parc Taulí Foundation, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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Buti M, Domínguez-Hernández R, Palom A, Esteban R, Casado MÁ. Impact of hepatitis D reflex testing on the future disease burden: A modelling analysis. Liver Int 2023; 43:2611-2614. [PMID: 37916574 DOI: 10.1111/liv.15776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/02/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Chronic hepatitis D (CHD) is a severe form of viral hepatitis that leads to liver cirrhosis and hepatocellular carcinoma. CHD is underdiagnosed, and this study aimed to assess the impact of hepatitis D reflex testing in HBsAg-positive individuals in Spain over the next 8 years. Two scenarios were compared: the current situation (7.6% of HBsAg-positive patients tested for anti-HDV) and reflex testing for all positive samples. A decision tree model was designed to simulate the CHD care cascade. Implementing reflex testing would increase anti-HDV detection to 5498 cases and HDV-RNA to 3225 cases. Additionally, 2128 more patients would receive treatment, with 213 achieving undetectable HDV-RNA levels. The cost per anti-HDV case detected would be €132. In the median time of the analysis, liver complications (decompensated cirrhosis, HCC and liver-related deaths) would be reduced by 35%-38%, implying an estimated cost savings of 36 million euros associated with the management of such complications. By 2030, implementing anti-HDV reflex testing would reduce the clinical and economic burden of CHD by 35%-38%.
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Affiliation(s)
- Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERHERD, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Adriana Palom
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERHERD, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Esteban
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBERHERD, Instituto de Salud Carlos III, Madrid, Spain
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Pascual Pastor F, Muñoz Á, Oraa R, Flórez G, Notario P, Seijo P, Gonzalvo B, Assaf C, Gómez M, Casado MÁ. Patients'satisfaction and experience in treatment with opioid substitution therapy in Spain. The PREDEPO study. Adicciones 2023; 35:433-444. [PMID: 34882243 DOI: 10.20882/adicciones.1684] [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 study was to compare patients' satisfaction, experience, objectives, and opinion based on their current opioid substitution therapy (OST) (buprenorphine/naloxone (B/N) or methadone). The PREDEPO study is an observational, cross-sectional, multicentric study performed in Spain. Adult patients diagnosed with opioid use disorder (OUD) receiving OST were included. They were asked to fill in a questionnaire regarding their current OST. A total of 98 patients were enrolled (B/N: 50%, methadone: 50%). Mean age was 47 ± 8 years old and 80% were male. Treatment satisfaction was similar between groups. The most frequently reported factor for being "very/quite satisfied" was "being able to distribute the dose at different times throughout the day" (44% B/N vs. 63% methadone; p = .122). A significantly lower proportion of patients in the B/N group versus the methadone group reported that having to collect the medication daily was "very/quite annoying" (19% vs. 52%, p = .032). Treatment objectives reported by the majority of patients were similar between groups ("not feeling in withdrawal anymore", "reduce/definitely stop drug use", "improve my health", and "stop thinking about using daily") except for "not having money problems anymore" (73% B/N vs. 92% methadone; p = .012). These results suggest there are several unmet expectations regarding current OST. There is a need for new treatments that reduce the burden of OUD, avoid the need for daily dosing, and are less stigmatizing which in turn could improve patient management, adherence and, quality of life.
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Crespo J, Cabezas J, Mateo Soler M, de la Cuadra-Grande A, Casado MÁ, Lazarus JV, Calleja JL. Current state of telemedicine in the field of Hepatology in Spain: challenges, threats and next steps to follow for an intelligent digital transformation. Rev Esp Enferm Dig 2023; 115:248-258. [PMID: 36043546 DOI: 10.17235/reed.2022.8918/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Medicine and technology are constantly evolving. The COVID-19 pandemic has accelerated the development of digitalization in the health sector and specifically of telemedicine. Through a structured bibliographic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, in this study, the concepts related to telemedicine, its application and the legal regulatory context are defined. With this information, some recommendations and codes of good practice are proposed for their effective implementation in the field of Hepatology.
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Affiliation(s)
- Javier Crespo
- Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, España
| | - Joaquín Cabezas
- Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, España
| | - Miguel Mateo Soler
- Dirección Gral. Ordenación, Farmacia e Inspección, Consejería de Sanidad de Cantabria, España
| | | | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, (ISGlobal, Hospital Clínic. Universidad de Barcelona, España
| | - José Luís Calleja
- Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, España
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7
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Flor-Lorente B, Noguera-Aguilar JF, Delgado-Rivilla S, García-González JM, Rodriguez-Martín M, Salinas-Ortega L, Casado MÁ, Álvarez M. The economic impact of anastomotic leak after colorectal cancer surgery. Health Econ Rev 2023; 13:12. [PMID: 36795234 PMCID: PMC9933261 DOI: 10.1186/s13561-023-00425-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To determine the economic impact of the incremental consumption of resources for the diagnosis and treatment of anastomotic leak (AL) in patients after resection with anastomosis for colorectal cancer compared to patients without AL on the Spanish health system. METHOD This study included a literature review with parameters validated by experts and the development of a cost analysis model to estimate the incremental resource consumption of patients with AL versus those without. The patients were divided into three groups: 1) colon cancer (CC) with resection, anastomosis and AL; 2) rectal cancer (RC) with resection, anastomosis without protective stoma and AL; and 3) RC with resection, anastomosis with protective stoma and AL. RESULTS The average total incremental cost per patient was €38,819 and €32,599 for CC and RC, respectively. The cost of AL diagnosis per patient was €1018 (CC) and €1030 (RC). The cost of AL treatment per patient in Group 1 ranged from €13,753 (type B) to €44,985 (type C + stoma), that in Group 2 ranged from €7348 (type A) to €44,398 (type C + stoma), and that in Group 3 ranged from €6197 (type A) to €34,414 (type C). Hospital stays represented the highest cost for all groups. In RC, protective stoma was found to minimize the economic consequences of AL. CONCLUSIONS The appearance of AL generates a considerable increase in the consumption of health resources, mainly due to an increase in hospital stays. The more complex the AL, the higher the cost associated with its treatment. INTEREST OF THE STUDY: it is the first cost-analysis study of AL after CR surgery based on prospective, observational and multicenter studies, with a clear, accepted and uniform definition of AL and estimated over a period of 30 days.
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Affiliation(s)
- Blas Flor-Lorente
- Colorectal Surgery Unit. Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | | | | | | | | | - María Álvarez
- Health Economics & Outcomes Research Unit (Medtronic Ibérica, S.A.), Madrid, Spain.
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Crespo J, Cabezas J, Aguilera A, Berenguer M, Buti M, Forns X, García F, García-Samaniego J, Hernández-Guerra M, Jorquera F, Lazarus JV, Lens S, Martró E, Pineda JA, Prieto M, Rodríguez-Frías F, Rodríguez M, Serra MÁ, Turnes J, Domínguez-Hernández R, Casado MÁ, Calleja JL. Recommendations for the integral diagnosis of chronic viral hepatitis in a single analytical extraction. Gastroenterol Hepatol 2023; 46:150-162. [PMID: 36257502 DOI: 10.1016/j.gastrohep.2022.09.009] [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: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
The Spanish Society of Digestive Pathology (SEPD), the Spanish Association for the Study of the Liver (AEEH), the Spanish Society of Infections and Clinical Microbiology (SEIMC) and its Viral Hepatitis Study Group (GEHEP), and with the endorsement of the Alliance for the Elimination of Viral Hepatitis in Spain (AEHVE), have agreed on a document to carry out a comprehensive diagnosis of viral hepatitis (B, C and D), from a single blood sample; that is, a comprehensive diagnosis, in the hospital and/or at the point of care of the patient. We propose an algorithm, so that the positive result in a viral hepatitis serology (B, C and D), as well as human immunodeficiency virus (HIV), would trigger the analysis of the rest of the virus, including the viral load when necessary, in the same blood draw. In addition, we make two additional recommendations. First, the need to rule out a previous hepatitis A virus (VHA) infection, to proceed with its vaccination in cases where IgG-type studies against this virus are negative and the vaccine is indicated. Second, the determination of the HIV serology. Finally, in case of a positive result for any of the viruses analyzed, there must be an automated alerts and initiate epidemiological monitoring.
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Affiliation(s)
- Javier Crespo
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Joaquín Cabezas
- Servicio de Gastroenterología y Hepatología, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Antonio Aguilera
- Servicio de Microbiología, Hospital Clínico Universitario de Santiago de Compostela, Departamento de Microbioloxía y Parasitoloxía, Universidade de Santiago de Compostela, A Coruña, España
| | - Marina Berenguer
- Unidad de Hepatología y Trasplante Hepático y CIBEREHD, Hospital Universitario y Politécnico La Fe; IIS La Fe y Universidad de Valencia, Valencia, España
| | - María Buti
- Servicio de Hepatología, Hospital Universitario Valle Hebrón y CIBEREHD del Instituto Carlos III, Barcelona, España
| | - Xavier Forns
- Servicio de Hepatología, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBEREHD, Barcelona, España
| | - Federico García
- Servicio de Microbiología, Hospital Universitario Clínico San Cecilio, Instituto de Investigación IBS, Ciber de Enfermedades Infecciosas (CIBERINFEC), Granada, España
| | | | - Manuel Hernández-Guerra
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, España
| | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBEREHD, León, España
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Sabela Lens
- Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, España
| | - Elisa Martró
- Servicio de Microbiología, Laboratori Clínic Metropolitana Nord (LCMN), Hospital Universitario Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona (Barcelona), España, Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Juan Antonio Pineda
- Departamento de Medicina, Universidad de Sevilla, Hospital Universitario de Valme, Ciber de Enfermedades Infecciosas (CIBERINFEC), Sevilla, España
| | - Martín Prieto
- Unidad de Hepatología y Trasplante Hepático, Hospital Universitario y Politécnico La Fe, Valencia, CIBEREHD, Instituto de Salud Carlos III, Madrid, España
| | - Francisco Rodríguez-Frías
- Servicios de Microbiología y Bioquímica, Laboratorios Clínicos Hospital Universitario Vall d'Hebron, CIBEREHD, Instituto de investigación Vall d'Hebron (VHIR), Barcelona, España
| | - Manuel Rodríguez
- Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Universidad de Oviedo, Oviedo, España
| | - Miguel Ángel Serra
- Catedrático Jubilado de Medicina, Universidad de Valencia, Valencia, España
| | - Juan Turnes
- Servicio de Digestivo, Hospital Universitario de Pontevedra, Pontevedra, España
| | | | | | - José Luis Calleja
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Instituto de Investigación Puerta de Hierro Majadahonda (IDIPHIM), Universidad Autónoma de Madrid, Madrid, España
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9
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Ramírez E, Romero-Jiménez R, Hernández-Muniesa B, Fernández-Pacheco M, Calvo A, Chamorro-de-Vega E, Herrero N, Úbeda B, Morell A, Ais-Larisgoitia A, Lobato-Matilla E, Muñoz Á, Casado A, Casado MÁ, Escudero-Vilaplana V. Evaluation of the hospital care quality perceived by patients with immune-mediated inflammatory diseases from the pharmacy service. SACVINFA study. J Clin Pharm Ther 2022; 47:2020-2029. [PMID: 35929568 DOI: 10.1111/jcpt.13742] [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: 04/07/2022] [Revised: 06/03/2022] [Accepted: 07/10/2022] [Indexed: 12/24/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Immune-mediated inflammatory diseases (IMIDs) are a group of chronic and highly disabling diseases. The objective is to evaluate the satisfaction with the health care received by patients with the most prevalent IMIDs in Spain: inflammatory bowel disease (IBD), psoriasis (Ps) psoriatic arthritis (PsA), rheumatoid arthritis (RA) and spondyloarthropathies (SpAs), and to determine the factors that influence patient satisfaction. METHODS This was an observational, cross-sectional, multicentre study in a real-world evidence context conducted in the Pharmacy Service in four hospital centres of the Community of Madrid that belong to the National Health System. The study included adult patients diagnosed with an IMID who had attended the Pharmacy Service at least three times. The patients were grouped according to the main IMID. Health care satisfaction was evaluated using the chronic patient experience assessment (IEXPAC) questionnaire. The responses to IEXPAC are grouped into three factors: productive interactions, new relational model and patient self-management, with a total score from 0 (worst) to 10 (best experience). Health-related quality of life (HRQoL) was also evaluated using the EQ-5D-5L questionnaire, and pharmacological adherence was evaluated through the Morisky-Green test. RESULTS AND DISCUSSION A total of 578 patients were analysed (IBD = 25.3%; Ps = 19.7%; SpAs = 18.7%; RA = 18.5%; PsA = 17.8%). The mean age (SD) was 49.8 (12.3) years and 50.7% were male. The average score (SD) for the total IEXPAC sample was 6.6 (1.9). RA was the IMID with the lowest score, at 5.83 (2.0), significantly lower than the scores of Ps (SD) [7.01 (1.7); p = 0.003], IBD [6.83 (1, 9); p = 0.012] and SpAs [6.80 (1.6); p = 0.001]. Productive interactions (SD) [8.5 (1.8)] and patient self-management (SD) [7.3 (2.3)] were the factors with the highest scores, and the new relational model had the lowest score (SD) [3.2 (2.7)]. Male gender, a longer time interval between medication administrations and a higher HRQoL were correlated with better patient satisfaction. Current biological therapy (according to the Anatomical Chemical classification system) also had a significant influence; patients treated with tumour necrosis factor inhibitors and interleukin inhibitors showed greater satisfaction than those treated with selective immunosuppressants. WHAT IS NEW AND CONCLUSION The IEXPAC results show high general satisfaction with care quality reported by patients with IMIDs treated in the Pharmacy Service. However, there are areas of improvement in care quality specially health professional-patient communication, such as increasing access to information, and promoting and facilitating relationships with patients in similar conditions.
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Affiliation(s)
- Esther Ramírez
- Department of Pharmacy, Hospital Universitario La Princesa, Madrid, Spain
| | - Rosa Romero-Jiménez
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Alberto Calvo
- Department of Pharmacy, Hospital Universitario La Princesa, Madrid, Spain
| | - Esther Chamorro-de-Vega
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón. Madrid, Spain
| | - Nuria Herrero
- Department of Pharmacy, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Bárbara Úbeda
- Department of Pharmacy, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Alberto Morell
- Department of Pharmacy, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Elena Lobato-Matilla
- Department of Pharmacy, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Álvaro Muñoz
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Araceli Casado
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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10
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Colom J, Torrens M, Rodríguez-Cejas Á, Aguilar I, Álvarez-Crespo R, Armenteros L, Ayala V, Cantero H, Casado MÁ, Crespo J, Estévez J, García-Samaniego J, Hernández-Guerra M, Mur C, Pérez-Bech E, Ricote M, Pineda JA. Certification program of Addiction Centres for hepatitis C virus elimination in Spain. HepCelentes Project. Adicciones 2022; 0:1743. [PMID: 36200230 DOI: 10.20882/adicciones.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Microelimination strategies for the hepatitis C virus (HCV) in vulnerable populations, such as users of Addiction Centres (AC), are key for the elimination of hepatitis C. The aim of the HepCelentes project was to design a certification program for AC from the generation of a guide with the criteria to favour the prevention, diagnosis, control, and treatment of HCV in Spain. The project was structured in 4 phases: normalisation, implementation, certification, and communication. In the first phase, developed between July and December 2020, a Steering Committee was created (formed by representatives of scientific societies, healthcare professionals from AC, primary care centres and hospital units, and patient associations) that, from of an exhaustive bibliographic review, generated by consensus an accreditation guide for AC. The guide consists of 22 criteria (15 mandatory and 7 recommended) structured based on the requirements to be met by AC, justification for the selection, level of action (management, prevention, diagnosis and treatment/follow-up), measurement of the indicator, objective level to be achieved, evidence of compliance, clarifications to improve understanding, and mandatory / recommendation (depending on their relevance to achieve HCV elimination and its feasibility for implementation in real practice). The development of a certification system for the AC, based on consensus and coordination of multidisciplinary teams, is intended to favour the management of hepatitis C and its elimination in AC users, supporting the international, national, and regional elimination strategies.
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Affiliation(s)
- Joan Colom
- Programa de Prevención, Control y Atención al VIH, las ITS y las Hepatitis Víricas (PCAVIHV) y Subdirección General de Drogodependencias. Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalitat de Catalunya, Barcelona.
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11
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Rubio AR, Mareque M, Soto J, Casado MÁ, Álvarez R, Andrade J, Esteban C, Chacón JI. Patient-reported experience in lung and breast cancer through a patient journey. Farm Hosp 2022; 46:215-223. [PMID: 36183219] [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] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To analyse a patient journey based on the experience reported by breast and lung cancer patients at Spanish hospital. Method: A mixed design was used, with interviews with 16 health professionals and 25 patients (qualitative method) and a Net Promoter Score questionnaire to 127 patients (quantitative method). INCLUSION CRITERIA oncology patients > 18 years treated in hospital between February- May 2019. EXCLUSION CRITERIA paediatric patients, in palliative care or who were hospitalised at the time of the study. RESULTS Six phases were identified from the data obtained in the qualitative method: my life before diagnosis; discovery; initiation; treatment; followup; and my current life. In the my life before diagnosis phase, a functional level of experience was established, as patients' lives met their expectations. In the discovery phase, patients' expectations were observed to be met, although several satellite experiences were found. In the initiation phase, the experience tended to be negative due to long waiting times and emotional and physical stress. The treatment phase was defined as a basic- poor experience, due to waiting times and lack of institutional support. The experience in the follow-up phase was positive in terms of tests and visits, but critical points were observed in waiting times. In the current phase, the effort made by health professionals to ensure the best possible treatment and care was mentioned. In terms of quantitative analysis, a positive score (46%) was obtained for the Net Promoter Score indicator, as 60% of patients were promoters, i.e. they were satisfied with the service offered by the hospital. CONCLUSIONS This study provides insight into the experience of cancer patients in the six main stages of the disease. The most positive phases were "my life before diagnosis" and "follow-up" while the phases with a negative trend were "initiation" and "treatment" due to the waiting times and the emotional burden on the patient.
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Affiliation(s)
- Ana Rosa Rubio
- Pharmacy Department, Complejo Hospitalario de Toledo, Toledo. Spain..
| | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid. Spain..
| | | | | | - Ruth Álvarez
- Department of Medical Oncology, Complejo Hospitalario de Toledo, Toledo. Spain..
| | - Jesús Andrade
- Department of Medical Oncology, Complejo Hospitalario de Toledo, Toledo. Spain..
| | - Carmen Esteban
- Department of Medical Oncology, Complejo Hospitalario de Toledo, Toledo. Spain..
| | - José Ignacio Chacón
- Department of Medical Oncology, Complejo Hospitalario de Toledo, Toledo. Spain..
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12
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Vargas‐Accarino E, Martínez‐Campreciós J, Domínguez‐Hernández R, Rando‐Segura A, Riveiro‐Barciela M, Rodríguez‐Frías F, Barreira A, Palom A, Casado MÁ, Esteban R, Buti M. Cost-effectiveness analysis of an active search to retrieve HCV patients lost to follow-up (RELINK-C strategy) and the impact of COVID-19. J Viral Hepat 2022; 29:579-583. [PMID: 35555847 PMCID: PMC9321878 DOI: 10.1111/jvh.13686] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Elena Vargas‐Accarino
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Joan Martínez‐Campreciós
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Ariadna Rando‐Segura
- Department of MicrobiologyHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MicrobiologyUniversitat Autònoma de BarcelonaBellaterraSpain
| | - Mar Riveiro‐Barciela
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- CIBERehdInstituto Carlos IIIBarcelonaSpain
| | - Francisco Rodríguez‐Frías
- CIBERehdInstituto Carlos IIIBarcelonaSpain
- Biochemistry and Microbiology DepartmentClinical Laboratories Hospital Universitari Vall d'HebronBarcelonaSpain
- Liver Pathology Unit, Biochemistry and Microbiology DepartmentsHospital Universitari Vall d'HebronBarcelonaSpain
| | - Ana Barreira
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Adriana Palom
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Rafael Esteban
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- CIBERehdInstituto Carlos IIIBarcelonaSpain
| | - María Buti
- Liver Unit, Internal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
- Department of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
- CIBERehdInstituto Carlos IIIBarcelonaSpain
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13
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Calvet X, Panés J, Gallardo-Escudero J, de la Cuadra-Grande A, Bartolomé E, Marín L, de la Portilla F, Navarro-Correal E, Gutiérrez A, Nos P, Serrano R, Casado MÁ, Barreiro-de Acosta M. Multicriteria Decision Analysis for Updating of Quality Indicators for Inflammatory Bowel Disease Comprehensive Care Units in Spain. J Crohns Colitis 2022; 16:1663-1675. [PMID: 35551380 PMCID: PMC9683078 DOI: 10.1093/ecco-jcc/jjac068] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Management of inflammatory bowel disease [IBD] is complex and IBD Comprehensive Care Units [ICCUs] facilitate the delivery of quality care to IBD patients. The objective of this study was to update the existing set of quality indicators [QIs] for ICCUs, based on a nationwide quality certification programme carried out in Spain, from a multi-stakeholder perspective and using multicriteria decision analysis [MCDA] methodology. METHODS An MCDA comprising three different phases was conducted. In phase 1, a systematic literature review was performed, and after validation by a scientific committee comprising 11 experts, a preliminary set of QIs was developed. In phase 2, a larger group of 49 experts determined the relevance and relative importance of each QI by prioritising and weighing the preliminary set. Finally in phase 3, the scientific committee reviewed the results and made a final selection via a deliberative process. RESULTS The final set comprised 67 QIs, classified as Structure [23 QIs], Process [35 QIs] and Outcome [9 QIs], which were ranked according to their relative importance. Multidisciplinary management was the most important requirement in ICCUs, followed by continuity of care, standardisation of clinical care and, especially, the incorporation of patients' reported outcomes. CONCLUSIONS This updated set of QIs comprises a weighted and prioritised set of items that represent the essential minimum of criteria for ensuring appropriate quality of care in the management of IBD patients.
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Affiliation(s)
- Xavier Calvet
- Corresponding author: Xavier Calvet, Servei d’Aparell Digestiu, Corporació Sanitària Universitària Parc Taulí, Sabadell, Barcelona, Spain.
| | - Julián Panés
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain,Gastroenterology Department, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Spain
| | - Javier Gallardo-Escudero
- Health Economics Department, Pharmacoeconomics & Outcomes Research Iberia [PORIB], Madrid, Spain
| | | | | | - Laura Marín
- Gastroenterology and Hepatology Department, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain
| | - Fernando de la Portilla
- General Surgery and Digestive System Clinical Management Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Ana Gutiérrez
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain,Gastroenterology Department, Hospital General de Alicante, Alicante, Spain,Instituto de Investigación Sanitaria y Biomédica de Alicante [ISABIAL], Alicante, Spain
| | - Pilar Nos
- Gastroenterology Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Ruth Serrano
- Confederación de Asociaciones de Crohn y Colitis Ulcerosa, Madrid, Spain
| | - Miguel Ángel Casado
- Health Economics Department, Pharmacoeconomics & Outcomes Research Iberia [PORIB], Madrid, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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14
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Alsina L, Montoro JB, Moral PM, Neth O, Pica MO, Sánchez-Ramón S, Presa M, Oyagüez I, Casado MÁ, González-Granado LI. Cost-minimization analysis of immunoglobulin treatment of primary immunodeficiency diseases in Spain. Eur J Health Econ 2022; 23:551-558. [PMID: 34546485 PMCID: PMC8964571 DOI: 10.1007/s10198-021-01378-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Primary immunodeficiency diseases (PID), which are comprised of over 400 genetic disorders, occur when a component of the immune system is diminished or dysfunctional. Patients with PID who require immunoglobulin (IG) replacement therapy receive intravenous IG (IVIG) or subcutaneous IG (SCIG), each of which provides equivalent efficacy. We developed a cost-minimization model to evaluate costs of IVIG versus SCIG from the Spanish National Healthcare System perspective. The base case modeled the annual cost per patient of IVIG and SCIG for the mean doses (per current expert clinical practice) over 1 year in terms of direct (drug and administration) and indirect (lost productivity for adults and parents/guardians of pediatric patients) costs. It was assumed that all IVIG infusions were administered in a day hospital, and 95% of SCIG infusions were administered at home. Drug costs were calculated from ex-factory prices obtained from local databases minus the mandatory deduction. Costs were valued on 2018 euros. The annual modeled costs were €4,266 lower for patients with PID who received SCIG (total €14,466) compared with those who received IVIG (total €18,732). The two largest contributors were differences in annual IG costs as a function of dosage (- €1,927) and hospital administration costs (- €2,688). However, SCIG incurred training costs for home administration (€695). Sensitivity analyses for two dose-rounding scenarios were consistent with the base case. Our model suggests that SCIG may be a cost-saving alternative to IVIG for patients with PID in Spain.
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Affiliation(s)
- Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - J Bruno Montoro
- Pharmacy Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pedro Moral Moral
- Sección de Inmunopatología Y Enfermedades Minoritarias, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Marta Ortiz Pica
- Hospital de Día Médico, Hospital Clínico San Carlos, Madrid, Spain
| | - Silvia Sánchez-Ramón
- Departamento de Inmunología Clínica, IML, Hospital Clínico San Carlos, Universidad Complutense of Madrid, Madrid, Spain
| | - María Presa
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Itziar Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | - Luis Ignacio González-Granado
- Primary Immunodeficiencies Unit, Pediatrics, University Hospital 12 Octubre/Research Institute Hospital, 12 octubre (i+12), Madrid, Spain.
- Pediatrics, School of Medicine, Complutense University, Madrid, Spain.
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15
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Forns X, Colom J, García‐Retortillo M, Quer JC, Lens S, Martró E, Domínguez‐Hernández R, Casado MÁ, Buti M. Point-of-care hepatitis C testing and treatment strategy for people attending harm reduction and addiction centres for hepatitis C elimination. J Viral Hepat 2022; 29:227-230. [PMID: 34806812 PMCID: PMC9299793 DOI: 10.1111/jvh.13634] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/05/2021] [Accepted: 11/02/2021] [Indexed: 12/09/2022]
Abstract
According to WHO goals, the elimination of Hepatitis C Virus (HCV) by 2030 requires enhancing and simplifying HCV testing. Our aim was to create a model to assess and compare different strategies for HCV testing, linkage to care and treatment among people who access harm reduction centres (HRC) and Addiction Centres in Catalonia. A decision tree model was designed to evaluate two strategies: Hepatitis C Point-of-care (POC) "test and treat", at the community versus standard-of-care (SOC), in which HCV testing was performed at community and therapy at the hospital. Both strategies were assessed separately in HRCs (6,878 users) and Addiction Centres (13,778 users). with a time horizon of 18 months. Healthcare outcomes were HCV testing, linkage to care, treatment outcomes and reinfection rate. HCV testing was performed in 3,178 (46%) of the HRC users. Compared with SOC, POC increased access to treatment by 57% (63% vs. 6%). SVR rates were 64% in POC vs. 23% in SOC. Reinfection rates were 21% with POC compared to 24% with SOC. With POC, losses to follow-up were reduced by 41%. In the Addiction Centres, 12,566 users (91%) were screened using the two strategies. Compared to the SOC, POC increased access to treatment and linkage to care by 19% along with SVR at the same rate. Reinfection rates decreased by 6%. Thus, the implementation of a POC "test and treat" strategy at HRCs and Addiction Centres has shown to be an effective public health strategy to help eliminating HCV in accordance with WHO goal.
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Affiliation(s)
- Xavier Forns
- Liver UnitHospital Clínic de BarcelonaIDIBAPSUniversity of BarcelonaBarcelonaSpain,CIBERehdInstituto Carlos IIIBarcelonaSpain
| | - Joan Colom
- Programme for Prevention, Control and Treatment of HIV, STIs and Viral HepatitisProgramme on Substance AbuseAgency of Public Health of CataloniaBarcelonaSpain
| | | | - Joan Carles Quer
- Gastroenterology DepartmentUniversity Hospital Joan XXIIITarragonaSpain
| | - Sabela Lens
- Liver UnitHospital Clínic de BarcelonaIDIBAPSUniversity of BarcelonaBarcelonaSpain,CIBERehdInstituto Carlos IIIBarcelonaSpain
| | - Elisa Martró
- Microbiology DepartmentLaboratori Clínic Metropolitana Nord. Hospital Universitari Germans Trias i Pujol. Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP)BadalonaSpain,Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP)Instituto de Salud Carlos III. MadridSpain
| | | | | | - María Buti
- CIBERehdInstituto Carlos IIIBarcelonaSpain,Liver UnitInternal Medicine DepartmentHospital Universitari Vall d'HebronBarcelonaSpain
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16
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Martínez N, Villar O, Armijo O, Castellanos M, Marin Huarte N, Mareque M, Casado MÁ, Martínez-Barrio J. Economic impact of obstetric events on women of reproductive age living with psoriatic arthritis, rheumatoid arthritis, axial spondyloarthritis and psoriasis in Spain. Reumatol Clin (Engl Ed) 2022; 18:105-113. [PMID: 35153033 DOI: 10.1016/j.reumae.2021.04.001] [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: 05/06/2020] [Accepted: 09/16/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. METHODS A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€,2019) were obtained from national, local databases. RESULTS During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3642 for a preconception consultation in patients with PsA, RA and axSpA and €4339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1214 for a miscarriage in the first trimester, €4419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. CONCLUSIONS This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
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Affiliation(s)
| | - Olga Villar
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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17
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Gómez-Peralta F, Mareque M, Muñoz Á, Maderuelo M, Casado MÁ. Patient Preferences for Pharmacological Diabetes Treatment Among People with Diabetes in Spain: A Discrete Choice Experiment. Diabetes Ther 2022; 13:75-87. [PMID: 34796456 PMCID: PMC8776952 DOI: 10.1007/s13300-021-01178-9] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/28/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The aim of the project was to describe the preferences related to the medication attributes of people with diabetes mellitus (DM) treated in Spain. METHODS The project was carried out in four different phases. In phase A, a Steering Committee defined and selected a total of 18 attributes for treating DM and grouped them into four categories: health outcomes, adverse events, treatment characteristics and cost of treatment. In phase B, a questionnaire according to a discrete choice experiment (DCE) methodology was developed. In phase C, the online DCE survey was sent to members of associations of people with DM from the Spanish Diabetes Federation (FEDE). Finally, in phase D, the results were discussed in a deliberative process. RESULTS Of the 238 participants who completed the questionnaire (May-September 2020), 231 were included (mean age, 58 years; males, 62%). The DCE results showed that the best-valued category was health outcomes (39.67%), followed by adverse events (26.85%), treatment characteristics (21.70%) and treatment costs (11.77%). Ten of 18 attributes had a significant effect on participants' choice (p < 0.05) and the highest relative importance value: blood pressure reduction (12.82%), hypoglycaemia (12.77%), HbA1c level reduction (8.54%), cost of the medication (8.13%), needle/tablet size (7.20%), weight change (6.72%), risk of genitourinary infections (6.36%), gastrointestinal problems (5.82%), improved kidney function (5.53%) and administration route (5.41%). CONCLUSIONS People with DM prefer a treatment that generates benefits in measurable health effects (reducing blood pressure and HbA1c level, while not risking hypoglycaemia) and a convenient route of administration. Considering the preferences of people with DM could generate better clinical results and therapeutic adherence, reducing morbidity, mortality and disease burden.
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Affiliation(s)
| | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain.
| | - Álvaro Muñoz
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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18
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Pascual FS, Muñoz A, Oraa R, Flórez G, Notario P, Seijo P, Gonzalvo B, Assaf C, Gómez M, Casado MÁ. Perception of a New Prolonged-Release Buprenorphine Formulation in Patients with Opioid Use Disorder: The PREDEPO Study. Eur Addict Res 2022; 28:143-154. [PMID: 34724674 PMCID: PMC8985036 DOI: 10.1159/000520091] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to assess the acceptance of patients with opioid use disorder (OUD) to switching their opioid dependence treatment (ODT) for a prolonged-release buprenorphine (PRB) injection according to their prior ODT (buprenorphine/naloxone [B/N] or methadone). METHODS This was an observational, retrospective/cross-sectional, multicentre study of adult patients diagnosed with OUD on ODT. Data collected from diaries were analysed to know their interest and opinion on PRB. Questions with fixed response options were included, and several Likert scales were used. RESULTS A total of 98 patients were enrolled (B/N: 50.0%, methadone: 50.0%). The mean age was 46.9 ± 8.43 years and 79.6% were males. PRB was similarly perceived by both groups in most variables analysed, receiving a mean score of 7.2/10 (B/N: 7.4, methadone: 7.0; p = 0.520), and approximately 65% of patients said they were willing to switch to PRB (B/N: 63.3%, methadone: 65.3%; p = 0.833). Of these, a higher percentage in the B/N group considered that switching would be easy/very easy (B/N: 90.3%, methadone: 46.9%; p < 0.001) and that they would start PRB when available (B/N: 64.5%, methadone: 34.3%; p = 0.005). More than 90% would prefer the monthly injection (B/N: 93.6%, methadone: 100%; p = 0.514). One-third of patients in both groups were unsure/would not switch their ODT to PRB (B/N: 36.7%, methadone: 34.7%; p = 0.833). The main reason was administration by injection. CONCLUSION Two-thirds of patients would switch their treatment for PRB, and most patients on B/N considered that switching would be easy. PRB could be a suitable alternative for OUD management.
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Affiliation(s)
| | - Alvaro Muñoz
- Outcomes Research, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain,*Alvaro Muñoz,
| | - Rodrigo Oraa
- Red de Salud Mental, Biocruces Bizkaia Health Research Institute, CSM Ajuriaguerra Adicciones, RSMB, Bilbao, Spain
| | - Gerardo Flórez
- Servizo Galego de Saúde, Unidad de Conductas Adictivas de Ourense, Ourense, Spain
| | - Pilar Notario
- Subdirección General de Adicciones, Centro de Atención a las Adicciones de Latina, Madrid, Spain
| | - Pedro Seijo
- Diputación de Cádiz, Centro de Tratamiento Ambulatorio de Adicciones de Villamartín, Cádiz, Spain
| | - Begoña Gonzalvo
- Red Adicciones, Institut Assistència Sanitària, Departament de Salut Centro de Atención y Seguimiento a las Drogodependencias, Girona, Spain
| | - Carla Assaf
- Medical Department, Camurus SL, Madrid, Spain
| | - Manuel Gómez
- Outcomes Research, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Miguel Ángel Casado
- Outcomes Research, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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19
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García-Herola A, Domínguez-Hernández R, Casado MÁ. Clinical and economic impact of an alert system in primary care for the detection of patients with chronic hepatitis C. PLoS One 2021; 16:e0260608. [PMID: 34928962 PMCID: PMC8687533 DOI: 10.1371/journal.pone.0260608] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/13/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Prevalence of chronic hepatitis C (CHC) is higher in patients born between 1955-1975. The aim was to perform an economic evaluation of an age-based electronic health record (EHR) alert in primary care to detect patients with undiagnosed CHC and its treatment in comparison with non-use of the alert system, in Valencian Community, Spain. MATERIALS AND METHODS Decision trees and Markov model were used to evaluate the diagnosis and progression of the disease, respectively. CHC was diagnosed by serology and viral load in seropositive subjects. Epidemiological data and diagnostic costs were extracted from public sources of the Valencian Community. Probabilities, utilities and costs of model states were obtained from the literature. The impact on mortality and hepatic complications avoided by the implementation of the alert were estimated, and efficiency was measured as an incremental cost-utility ratio (ICUR) based on quality-adjusted life years (QALYs) and the costs of both alternatives. RESULTS The EHR alert detected 269,548 patients, of whom 1,331 had CHC (vs. 23 patients with non-alert). Over the patients' lifetime, the alert would prevent 93% of decompensated cirrhosis cases, 87% of hepatocellular carcinomas, 90% of liver transplants, and 89% of liver related deaths compared to non-use of the alert system. In addition, it would obtain an additional 3.3 QALY per patient, with an incremental cost of €10,880 and an ICUR of €3,321. CONCLUSIONS The implementation of an age-based EHR alert in primary care to detect patients with CHC reduces hepatic complications and mortality and is an efficient strategy.
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Affiliation(s)
- Antonio García-Herola
- Digestive Medicine Section, Hospital Marina Baixa de la Vila Joiosa (Alicante), Marina Baixa de la Vila Hospital, Joiosa, Alicante, Spain
- * E-mail:
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Barrios V, Cinza-Sanjurjo S, Gavín O, Egocheaga I, Burgos-Pol R, Soto J, Polanco C, Suárez J, Casado MÁ. Carga y coste del mal control de la anticoagulación con antagonistas de la vitamina K en pacientes con fibrilación auricular no valvular en España. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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de Andrés-Nogales F, Cruz E, Calleja MÁ, Delgado O, Gorgas MQ, Espín J, Mestre-Ferrándiz J, Palau F, Ancochea A, Arce R, Domínguez-Hernández R, Casado MÁ. A multi-stakeholder multicriteria decision analysis for the reimbursement of orphan drugs (FinMHU-MCDA study). Orphanet J Rare Dis 2021; 16:186. [PMID: 33902672 PMCID: PMC8073956 DOI: 10.1186/s13023-021-01809-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/27/2020] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patient access to orphan medicinal products (OMPs) is limited and varies between countries, reimbursement decisions on OMPs are complex, and there is a need for more transparent processes to know which criteria should be considered to inform these decisions. This study aimed to determine the most relevant criteria for the reimbursement of OMPs in Spain, from a multi-stakeholder perspective, and using multicriteria decision analysis (MCDA). Methods An MCDA was developed in 3 phases and included 28 stakeholders closely related to the field of rare diseases (6 physicians, 5 hospital pharmacists, 7 health economists, 4 patient representatives and 6 members from national and regional health authorities). Initially [phase A], a bibliographic review was conducted to identify the potential reimbursement criteria. Then, a reduced advisory board (8 members) proposed, selected, and defined the final list of criteria that could be relevant for reimbursement. A discrete choice experiment (DCE) [phase B] was developed to determine the relevance and relative importance weight of such criteria according to the stakeholders’ preferences by choosing between pairs of hypothetical financing scenarios. A multinomial logit model was fitted to analyze the DCE responses. Finally [phase C], the advisory board review the results using a deliberative process. Results Thirteen criteria were selected, related to 4 dimensions: patient population, disease, treatment, and economic evaluation. Nine criteria were deemed relevant for decision-making and associated with a higher relative importance: Health-related quality of life (HRQL) (23.53%), treatment efficacy (14.64%), availability of treatment alternatives (13.51%), disease severity (12.62%), avoided costs (11.21%), age of target population (7.75%), safety (seriousness of adverse events) (4.72%), quality of evidence (3.82%) and size of target population (3.12%). The remaining criteria had a < 3% relative importance: economic burden of disease (2.50%), cost of treatment (1.73%), cost-effectiveness (0.83%) and safety (frequency of adverse events) (0.03%). Conclusion The reimbursement of OMPs in Spain should be determined by its effect on patient’s HRQL, the extent of its therapeutic benefit from efficacy and the availability of other therapeutic options. Furthermore, the severity of the rare disease should also influence the decision along with the potential of the treatment to avoid associated costs.
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Affiliation(s)
- Fernando de Andrés-Nogales
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Calle Paseo Joaquín Rodrigo, 4I. 28224, Pozuelo de Alarcón, Madrid, Spain.
| | | | | | - Olga Delgado
- Servicio de Farmacia, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Jaime Espín
- Escuela Andaluza de Salud Pública, Granada, Spain.,Instituto de Investigación Biosanitaria (IBS), Granada, Spain.,CIBER de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Francesc Palau
- Servicio de Medicina Genética y CIBERER, Hospital Universitari Sant Joan de Déu, Hospital Clínic y Universitat de Barcelona, Barcelona, Spain
| | - Alba Ancochea
- Federación Española de Enfermedades Raras (FEDER), Madrid, Spain
| | - Rosabel Arce
- Asociación Española de Laboratorios de Medicamentos Huérfanos y Ultrahuérfanos (AELMHU), Barcelona, Spain
| | - Raquel Domínguez-Hernández
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Calle Paseo Joaquín Rodrigo, 4I. 28224, Pozuelo de Alarcón, Madrid, Spain
| | - Miguel Ángel Casado
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Calle Paseo Joaquín Rodrigo, 4I. 28224, Pozuelo de Alarcón, Madrid, Spain
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Colom J, Szerman N, Cabrera ES, Ferre F, Pascual F, Gilabert-Perramon A, Casado MÁ, Bobes J, MCDA-OUD GDT. Study to determine relevant health outcome measures in opioid use disorder: Multicriteria decision analysis. Adicciones 2021; 33:109-120. [PMID: 33338240 DOI: 10.20882/adicciones.1263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
The aim of the current study was to establish the most relevant health outcomes to assess opioid substitution treatment programmes (OSP) in patients with opioid use disorder (OUD) in Spain. A multicriteria decision analysis was applied in 3 phases: 1) concepts and criteria definitions; 2) criteria screening and weighting by means of a discrete choice experiment; 3) deliberative process. Criteria established in phase 1 were: substance use (opioids, alcohol, tobacco, stimulants and cannabis), other mental disorders (affective/anxiety disorder, psychosis, attention deficit hyperactivity disorder, borderline personality disorder, antisocial personality disorder, gambling disorder and other impulse control disorders), level of disability, adherence, medical illnesses (medical comorbidities, risk behaviours, infectious and sexually transmitted diseases), psychosocial aspects (hostile and/or violent behaviour and work problems), functional disability (quality of life, treatment and service satisfaction, social functionality). In phase 2, the most relevant factors in OSP were determined, and subsequently assessed in the deliberative process: remission of substance use (opioids, alcohol and stimulants), improvement of other mental disorders (psychosis and borderline personality disorder), improvement in comorbidity management, and improvement in social functionality, with a weighting of 56.5%, 21.9%, 11.0%, and 10.7%, respectively. The current analysis defines the main health outcomes in OSP in patients with OUD in Spain, supporting decision making and socio-health management of existing resources.
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Taxonera C, de Andrés-Nogales F, García-López S, Sánchez-Guerrero A, Menchén B, Peral C, Cábez A, Gómez S, López-Ibáñez de Aldecoa A, Casado MÁ, Menchén L. Cost-effectiveness analysis of using innovative therapies for the management of moderate-to-severe ulcerative colitis in Spain. Expert Rev Pharmacoecon Outcomes Res 2021; 22:73-83. [PMID: 33615953 DOI: 10.1080/14737167.2021.1880324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND To evaluate the cost-effectiveness of tofacitinib in comparison to vedolizumab for the treatment of moderate-to-severe ulcerative colitis (UC) after failure or intolerance to conventional therapy (bio-naive) or first-line biologic treatment (bio-experienced), from the Spanish National Health System (NHS) perspective. METHODS A lifetime Markov model with eight-week cycles was developed including five health states: remission, response, active UC, remission after surgery, and death. Response and remission probabilities (for induction and maintenance periods) were obtained from a multinomial network meta-analysis. Drug acquisition - biosimilar prices included - (ex-factory price with mandatory deductions), administration, surgery, patient management, and adverse event management costs (€, year 2019) were considered. A 3% discount rate (cost/outcomes) was applied. Probabilistic and deterministic sensitivity analyses (PSA) were conducted. RESULTS Tofacitinib was dominant versus vedolizumab (both in bio-naive and bio-experienced patients) entailing total cost savings of €23,816 (bio-naïve) and €11,438 (bio-experienced). Differences in quality-adjusted life-year (QALY) were smaller than 0.1 for both populations. PSA results showed that tofacitinib has a high probability of being cost-effective (bio-naïve: 82.5%; bio-experienced: 90.6%) versus vedolizumab. CONCLUSIONS From the Spanish NHS perspective, tofacitinib could be a dominant treatment (less costly and more effective) in comparison to vedolizumab, with relevant cost savings and similar QALY gains.
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Affiliation(s)
- Carlos Taxonera
- Department of Gastroenterology. Hospital Clínico Universitario San Carlos, And Instituto De Investigación Del Hospital Clínico San Carlos [Idissc], Madrid, Spain
| | | | - Santiago García-López
- Department of Gastroenterology. Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Amelia Sánchez-Guerrero
- Hospital Pharmacy Department Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Spain
| | - Belén Menchén
- Hospital Pharmacy Department Hospital Universitario Puerta De Hierro-Majadahonda, Madrid, Spain
| | | | - Ana Cábez
- Pfizer S.L.U, Alcobendas, Madrid, Spain
| | | | | | - Miguel Ángel Casado
- Health Economics, Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Luis Menchén
- Department of Gastroenterology. Hospital General Universitario Gregorio Marañón, And Instituto De Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense De Madrid, Madrid, Spain
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de Andrés-Nogales F, Casado MÁ, Trillo JL, Ruiz-Moreno JM, Martínez-Sesmero JM, Peralta G, Poveda JL, Ortiz P, Ignacio E, Zarranz-Ventura J, Udaondo P, Mur C, Álvarez E, Cervera E, Martínez M, Llorente I, Zulueta J, Rodríguez-Maqueda M, García-Layana A, Martínez-Olmos J. A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study. Pharmacoecon Open 2020; 4:615-624. [PMID: 32100249 PMCID: PMC7688881 DOI: 10.1007/s41669-020-00201-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. OBJECTIVES A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. METHODS Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value < 0.05). Finally, the results were discussed in a deliberative process (phase C). RESULTS Thirty-one criteria were initially defined (phase A) and grouped into 5 categories: efficacy/effectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50- to 65-year-old DME patient: mean change in best corrected visual acuity (p value < 0.001), percentage of patients with an improvement of ≥ 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). CONCLUSIONS From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability.
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Affiliation(s)
| | | | | | - José María Ruiz-Moreno
- Universidad Castilla La Mancha, Albacete, Spain; Vissum Corporación, Spain; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- RETICS-OFTARED, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gemma Peralta
- Fundació Rossend Carrasco i Formiguera, MentBarcelona, Barcelona, Spain
| | | | - Pere Ortiz
- Consorci MAR Parc de Salut de Barcelona, Barcelona, Spain
| | | | - Javier Zarranz-Ventura
- RETICS-OFTARED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto Clinic de Oftalmología, Hospital Clinic, Barcelona, Spain
| | | | - Carlos Mur
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | | | - Iñaki Llorente
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | - Alfredo García-Layana
- RETICS-OFTARED, Instituto de Salud Carlos III, Madrid, Spain
- Clínica Universitaria de Navarra, Pamplona, Spain
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Martínez N, Villar O, Armijo O, Castellanos M, Marin Huarte N, Mareque M, Casado MÁ, Martínez-Barrio J. Economic Impact of Obstetric Events on Women of Reproductive Age Living With Psoriatic Arthritis, Rheumatoid Arthritis, Axial Spondyloarthritis and Psoriasis in Spain. Reumatol Clin (Engl Ed) 2020; 18:S1699-258X(20)30230-8. [PMID: 33257237 DOI: 10.1016/j.reuma.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/30/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. METHODS A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€, 2019) were obtained from national, local databases. RESULTS During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3,642 for a preconception consultation in patients with PsA, RA and axSpA and €4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1,214 for a miscarriage in the first trimester, €4,419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3,188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5,507 were estimated associated with admissions to neonatology of premature infants of <28, 28-32 and 33-37 weeks, respectively. CONCLUSIONS This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.
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Affiliation(s)
| | - Olga Villar
- Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | | | - María Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, España
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Barrios V, Cinza-Sanjurjo S, Gavín O, Egocheaga I, Burgos-Pol R, Soto J, Polanco C, Suárez J, Casado MÁ. Cost and burden of poor anticoagulation control with vitamin K antagonists in patients with nonvalvular atrial fibrillation in Spain. ACTA ACUST UNITED AC 2020; 74:773-780. [PMID: 32980294 DOI: 10.1016/j.rec.2020.06.033] [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: 11/20/2019] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this analysis was to evaluate the burden and cost of complications due to poor anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF) treated with vitamin K antagonists (VKA) in Spain. METHODS An analytical model was used to estimate annual differences in ischemic stroke, major bleeding, deaths, costs, and potential years of life lost between patients with poor anticoagulation control (time in therapeutic range <65%) and adequate control (time in therapeutic range ≥ 65%) with a 1-year time horizon. Information on the target population (patients ≥ 65 years), event rates, and costs were obtained from national sources. Direct costs in euros (2018) were included from the perspective of the national health system (NHS) and direct and indirect costs from the societal perspective. A sensitivity analysis was performed with post-hoc data from the SPORTIF III/V trials. RESULTS We analyzed a hypothetical cohort of 594 855 patients, 48.3% with poor anticoagulation control, with an increase of 2321 ischemic strokes, 2236 major bleeding events and 14 463 deaths, and an annual incremental cost between €29 578 306 from the NHS perspective and €75 737 451 from the societal perspective. The annual impact of mortality was 170 502 potential years of life lost. The results of the sensitivity analysis showed that the annual cost would reach €97 787 873 from the societal perspective. CONCLUSIONS Poor anticoagulation control with AVK has a strong impact on loss of health and on increased spending for the NHS.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
| | - Sergio Cinza-Sanjurjo
- Centro de Salud Porto do Son, Área Sanitaria de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Olga Gavín
- Servicio de Hematología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Ramón Burgos-Pol
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Javier Soto
- Farmacoeconomía e Investigación de Resultados, Pfizer S.L.U., Madrid, Spain
| | - Carlos Polanco
- Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain
| | - Jorge Suárez
- Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain
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García F, Domínguez-Hernández R, Casado M, Macías J, Téllez F, Pascasio JM, Casado MÁ, Alados JC. The simplification of the diagnosis process of chronic hepatitis C is cost-effective strategy. Enferm Infecc Microbiol Clin 2019; 37:634-641. [PMID: 30982677 DOI: 10.1016/j.eimc.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/05/2018] [Revised: 02/22/2019] [Accepted: 03/01/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND The cascade of care of the hepatitisC are complex. The diagnosis of active infection in the same serum sample would simplify the process establishing a rapid access for patients to treatment. Our objective was to estimate the impact on healthcare and economic outcomes of the diagnosis of chronic infection in one-step diagnosis compared to standard diagnosis in Andalusia (8.39 million people). METHODS A decision tree was developed to estimate the referral of patients with chronic infection, loss of follow-up, access to treatment and costs of the diagnosis of the infection, for both processes. The unit costs (€, 2018) of the health resources (medical visits, antibodies, viral load and genotype), without considering the pharmacological cost, were obtained form public sources in Andalusia. RESULTS Of the total estimated population (269,526 patients), 1,389 patients would be referred to the specialised care in the one-step diagnosis and 1,063 in de standard diagnosis, being treated 1,320 and 1,009, respectively. In one-step diagnosis, no negative viral loud patient would be referred to specialist versus 540 with standard diagnosis. One-step diagnosis would generate a cost saving of €184,928 versus standard diagnosis (€15,671,493 vs €15,856,421). When compared one-step diagnosis to standard diagnosis, the savings per patient with positive viral load referred to specialist would be €3,634 (€11,279 vs €14,923). CONCLUSION The one-step diagnosis will achieve an increase in diagnosed patients, will increase the access of chronic patient to treatment and will generate cost savings, demonstrating its efficiency in the system in Andalusia.
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Affiliation(s)
- Federico García
- Unidad de Gestión Clínica de Microbiología Clínica, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada, España.
| | | | - Marta Casado
- Departamento de Gastroenterología, Complejo Hospitalario Torrecárdenas, Almería, España
| | - Juan Macías
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, España
| | - Francisco Téllez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Puerto Real, Puerto Real, Cádiz, España
| | - Juan Manuel Pascasio
- Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, España
| | | | - Juan Carlos Alados
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
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Buti M, Domínguez-Hernández R, Casado MÁ, Sabater E, Esteban R. Healthcare value of implementing hepatitis C screening in the adult general population in Spain. PLoS One 2018; 13:e0208036. [PMID: 30485377 PMCID: PMC6261617 DOI: 10.1371/journal.pone.0208036] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 07/12/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elimination of hepatitis C virus (HCV) infection requires high diagnostic rates and universal access to treatment. Around 40% of infected individuals are unaware of their infection, which indicates that effective screening strategies are needed. We analyzed the efficiency (incremental cost-utility ratio, ICUR) of 3 HCV screening strategies: a) general population of adults, b) high-risk groups, and c) population with the highest anti-HCV prevalence plus high-risk groups. METHODS An analytical decision model, projecting progression of the disease over a lifetime, was used to establish the candidate population for HCV screening. HCV data were obtained from the literature: anti-HCV prevalence (0.56%-1.54%), viremic patients (31.5%), and percentage of undiagnosed persons among those with viremia (35%). It was assumed that most patients would be treated and have HCV therapy response (98% SVR); transition probabilities, utilities, and disease management annual costs were obtained from the literature. Efficiency over the life of patients under the National Health System perspective was measured as quality-adjusted life years (QALY) and total cost (screening, diagnosis, pharmacological and disease management). A discount rate of 3% was applied to costs and outcomes. RESULTS Screening of the adult population would identify a larger number of additional chronic hepatitis C cases (N = 52,694) than screening the highest anti-HCV prevalence population plus high-risk groups (N = 42,027) or screening high-risk groups (N = 26,128). ICUR for the general population vs. high-risk groups was €8914/QALY gained per patient (€18,157 incremental cost and 2.037 QALY). ICUR for the general population vs. population with highest anti-HCV prevalence plus high-risk groups was €7,448/QALY gained per patient (€7,733 incremental cost and 1.038 QALY). These ICUR values are below the accepted efficiency threshold (€22,000-€30,000). CONCLUSION HCV screening and treatment of the general adult population is cost-effective compared to screening of high-risk groups or the population with the highest anti-HCV prevalence plus high-risk groups.
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Affiliation(s)
- María Buti
- Hospital General Universitario Vall d'Hebron, CIBERehd, Barcelona, Spain
| | | | | | | | - Rafael Esteban
- Hospital General Universitario Vall d'Hebron, CIBERehd, Barcelona, Spain
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Turnes J, Domínguez-Hernández R, Casado MÁ. Value and innovation of direct-acting antivirals: long-term health outcomes of the strategic plan for the management of hepatitis C in Spain. Rev Esp Enferm Dig 2018; 109:809-817. [PMID: 29152988 DOI: 10.17235/reed.2017.5063/2017] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the long-term healthcare costs and health outcomes in association with the access to new direct-acting antivirals (DAAs), during the first year of the National Strategic Plan for Chronic Hepatitis C (SPCHC) in patients with chronic hepatitis C (CHC) in Spain. METHODS A decision tree and a lifetime Markov model were developed to simulate the natural history, morbidity, and mortality of a cohort of 51,900 patients with CHC before (pre-DAA strategy) and after (post-DAA strategy) access to DAAs, following SPCHC approval. The percentage of patients treated, transition probabilities, disease management costs, health state utility values, sustained virologic response rates and treatment costs were obtained from the literature and published data from Spain. The results were expressed in terms of costs (€, 2016), quality-adjusted life years (QALYs) and prevention of clinical events, with an annual discount rate of 3%. RESULTS The post-DAA strategy would prevent 8,667 cases of decompensated cirrhosis, 5,471 cases of hepatocellular carcinoma, 1,137 liver transplants and 9,608 liver-related deaths. The cohort of 51,900 patients would require investments of 1,606 and 1,230 million euros with the post-DAA and pre-DAA strategies, respectively. This would produce 819,674 and 665,703 QALYs. CONCLUSIONS The use of new DAA-based treatments in CHC patients during the first year after the implementation of the SPCHC significantly reduced long-term morbidity and mortality and increased quality of life; demonstrating that this plan is an efficient use of public health resources.
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Affiliation(s)
- Juan Turnes
- Department of Gastroenterology and Hepatology, Complejo Hospitalario Universitario de Pontevedra
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Bobes J, Pascual F, Sabater E, Colom J, Ferre F, Szerman N, Casado MÁ, MCDA-OUD GDT. Análisis de decisión multicriterio en programas de tratamiento de sustitución de opiáceos en trastornos por consumo de opiáceos. Adicciones 2018; 30:167-169. [PMID: 30059570 DOI: 10.20882/adicciones.1120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Editorial.
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Crespo J, Esteban R, Torres C, Oyagüez I, Casado MÁ, Buti M. Cost-effectiveness of a hepatitis B virus screening strategy to prevent reactivation in patients with hematologic neoplasms. Rev Esp Enferm Dig 2018. [PMID: 28648087 DOI: 10.17235/reed.2017.4693/2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The effectiveness of a screening strategy for the detection of a hepatitis B virus (HBV) infection followed by prophylaxis in order to prevent HBV reactivation was assessed in patients with hematologic neoplasms. MATERIAL AND METHODS A decision tree was developed to compare the cost and effectiveness (prevented reactivations) over an 18 month period of a screening strategy prior to chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) with a non-screening approach. HBsAg+ (hepatitis B surface antigen) and/or anti-HBc+ (antibodies to hepatitis B core antigen) and HBV-DNA+ patients received oral antiviral prophylaxis with tenofovir disoproxil (245 mg once daily) from chemotherapy baseline until one year after chemotherapy completion. Non-screened patients received tenofovir in case of a reactivation. Model probabilities were obtained from the literature. The total cost (€, 2015) included: antiviral prophylaxis, R-CHOP, screening tests (HBsAg, anti-HBc, HBV-DNA) and liver function tests. Drug therapy costs were estimated using ex-factory prices with mandatory deductions. The incremental cost-effectiveness ratio (ICER) was calculated in order to assess the cost-effectiveness of this intervention in terms of cost per reactivation averted versus no screening. RESULTS In a hypothetical cohort of 1,000 patients, screening prevented 7.36 reactivations when compared to the non-screening approach (14.9 versus 22.3). Total cost/patient (including €8,282 for R-CHOP) was €8,584 for the screening strategy and €8,449 for the non-screening approach. The ICER for screening versus non-screening was €18,376/prevented reactivation. CONCLUSION HBV screening followed by oral antiviral prophylaxis yielded more health benefits than non-screening, reducing HBV reactivation in patients with hematologic neoplasms on chemotherapy.
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Affiliation(s)
- Javier Crespo
- Clínica Mompía y Hospital Universitario Marqués de Valdecilla , España
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Oliva-Moreno J, Peña-Longobardo LM, Mar J, Masjuan J, Soulard S, Gonzalez-Rojas N, Becerra V, Casado MÁ, Torres C, Yebenes M, Quintana M, Alvarez-Sabín J. Determinants of Informal Care, Burden, and Risk of Burnout in Caregivers of Stroke Survivors. Stroke 2018; 49:140-146. [DOI: 10.1161/strokeaha.117.017575] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
The aim of this article was to analyze the likelihood of receiving informal care after a stroke and to study the burden and risk of burnout of primary caregivers in Spain.
Methods—
The CONOCES study is an epidemiological, observational, prospective, multicenter study of patients diagnosed with stroke and admitted to a Stroke Unit in the Spanish healthcare system. At 3 and 12 months post-event, we estimated the time spent caring for the patient and the burden borne by primary caregivers. Several multivariate models were applied to estimate the likelihood of receiving informal caregiving, the burden, and the likelihood of caregivers being at a high risk of burnout.
Results—
Eighty percent of those still alive at 3 and 12 months poststroke were receiving informal care. More than 40% of those receiving care needed a secondary caregiver at 3 months poststroke. The likelihood of receiving informal care was associated with stroke severity and the individual’s health-related quality of life. When informal care was provided, both the burden borne by caregivers and the likelihood of caregivers being at a high risk of burnout was associated with (1) caregiving hours; (2) the patient’s health-related quality of life; (3) the severity of the stroke measured at discharge; (4) the patient having atrial fibrillation; and (5) the degree of dependence.
Conclusions—
This study reveals the heavy burden borne by the caregivers of stroke survivors. Our analysis also identifies explanatory and predictive variables for the likelihood of receiving informal care, caregiver burden, and high risk of burnout.
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Affiliation(s)
- Juan Oliva-Moreno
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Luz María Peña-Longobardo
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Javier Mar
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Jaime Masjuan
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Stéphane Soulard
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Nuria Gonzalez-Rojas
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Virginia Becerra
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Miguel Ángel Casado
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Covadonga Torres
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - María Yebenes
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Manuel Quintana
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Jose Alvarez-Sabín
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
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Rodríguez M, Pascasio JM, Fraga E, Fuentes J, Prieto M, Sánchez-Antolín G, Calleja JL, Molina E, García-Buey ML, Blanco MÁ, Salmerón J, Bonet ML, Pons JA, González JM, Casado MÁ, Jorquera F. Tenofovir vs lamivudine plus adefovir in chronic hepatitis B: TENOSIMP-B study. World J Gastroenterol 2017; 23:7459-7469. [PMID: 29151700 PMCID: PMC5685852 DOI: 10.3748/wjg.v23.i41.7459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/22/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To demonstrate the non-inferiority (15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate (TDF) vs the combination of lamivudine (LAM) plus adefovir dipivoxil (ADV) in the maintenance of virologic response in patients with chronic hepatitis B (CHB) and prior failure with LAM.
METHODS This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups (TDF and LAM+ADV) of adult patients with hepatitis B e antigen (HBeAg)-negative CHB, prior failure with LAM, on treatment with LAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were analysed.
RESULTS Forty-six patients were evaluated [median age: 55.4 years (30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with LAM+ADV. During study development, hepatitis B virus DNA (HBV-DNA) remained undetectable, all patients remained HBeAg negative, and hepatitis B surface antigen (HBsAg) positive. Alanine aminotransferase (ALT) values at the end of the study were similar in the 2 groups (25.1 ± 7.65, TDF vs 24.22 ± 8.38, LAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects (AEs) (53.8%, TDF vs 37.5%, LAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the LAM+ADV groups, respectively (P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the LAM+ADV treatment (€4943 ± 1059 vs €5811 ± 1538, respectively, P < 0.001).
CONCLUSION TDF monotherapy proved to be safe and not inferior to the LAM+ADV combination therapy in maintaining virologic response in patients with CHB and previous LAM failure. In addition, the use of TDF generated a significant savings in hospital costs.
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Affiliation(s)
- Manuel Rodríguez
- Division of Gastroenterology and Hepatology. Hospital Universitario Central de Asturias, Oviedo 33011, Spain
| | - Juan Manuel Pascasio
- Unit for the Clinical Management of Digestive Diseases, IBIS, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain and CIBERehd
| | - Enrique Fraga
- Liver Transplantation and Hepatology Unit, Gastroenterology Service, Hospital Universitario Reina Sofía, Córdoba 14004, Spain
| | - Javier Fuentes
- Digestive Medicine Service, Hospital Universitario Miguel Servet, Zaragoza 50009, Spain
| | - Martín Prieto
- Hepatology Unit, Digestive Medicine Service, Hospital Universitari i Politècnic La Fe, Valencia 46026, Spain and CIBERehd
| | | | - José Luis Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro de Majadahonda, Universidad Autónoma de Madrid, Madrid 28049, Spain
| | - Esther Molina
- Digestive Medicine Service, Hospital Clínico de Santiago de Compostela, La Coruña 15706, Spain
| | | | - María Ángeles Blanco
- Digestive Medicine Service, Hospital General Universitario Gregorio Marañón, Madrid 28007, España
| | - Javier Salmerón
- Digestive Medicine Unit, Complejo Hospitalario de Granada, Granada 18014, Spain
| | - María Lucía Bonet
- Digestive Medicine Service, Hospital Universitario Son Espases, Palma de Mallorca 07120, Spain
| | - José Antonio Pons
- Hepatology Unit, IMIB Hospital Universitario Virgen de la Arrixaca, Murcia 30120, Spain
| | - José Manuel González
- Digestive Medicine Service, Hospital Clínico Universitario de Valladolid, Valladolid 47003, Spain
| | | | - Francisco Jorquera
- Division of Gastroenterology and Hepatology, Complejo Asistencial Universitario de León, León 24001, Spain CIBERehd and IBIOMED León
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de Andrés-Nogales F, Álvarez M, de Miquel MÁ, Segura T, Gil A, Cardona P, Casado MÁ, Nogueira RG, Dávalos A. Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain. Eur Stroke J 2017; 2:272-284. [PMID: 31008321 PMCID: PMC6454829 DOI: 10.1177/2396987317721865] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 06/29/2017] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION To assess the cost-effectiveness of stent-retriever mechanical thrombectomy and intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in patients with acute ischaemic stroke due to large vessel occlusions in Spain. MATERIALS AND METHODS Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). A Spanish National Health System perspective (direct medical costs) was considered. Resource utilisation and utilities were obtained from available published data and endorsed by an expert panel. Costs (€, 2016) were obtained from various Spanish sources. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Stent-retriever thrombectomy after intravenous tissue plasminogen activator was associated with better outcomes (1.17 life years gained and 2.51 quality adjusted life years) and savings of €44,378, resulting in a dominant therapy over intravenous tissue plasminogen activator alone. A net monetary benefit of €119,744 was obtained considering a willingness-to-pay threshold of €30,000/quality adjusted life year gained. The combined therapy was also dominant in all sensitivity analyses, deterministic and probabilistic. DISCUSSION The results were consistent with a previously published cost-effectiveness analysis and reinforce the likeliness of the selection of stent-retriever mechanical thrombectomy plus intravenous tissue plasminogen activator over intravenous tissue plasminogen activator alone. CONCLUSION Stent-retriever thrombectomy after intravenous tissue plasminogen activator is a dominant alternative over intravenous tissue plasminogen activator alone (more effective and less costly) for the treatment of acute ischaemic stroke patients with large vessel occlusions in the Spanish setting.
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Affiliation(s)
| | - María Álvarez
- Health Economics & Outcomes Research, Medtronic Ibérica, S.A., Madrid, Spain
| | | | - Tomás Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Alberto Gil
- Hospital Universitario de Cruces, Barakaldo, Spain
| | - Pere Cardona
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Catalunya, Spain
| | | | | | - Antoni Dávalos
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Turnes J, Domínguez-Hernández R, Casado MÁ. Análisis coste-efectividad de dos estrategias de tratamiento para la hepatitis C crónica: antes y después del acceso a los agentes antivirales de acción directa en España. Gastroenterología y Hepatología 2017. [DOI: 10.1016/j.gastrohep.2017.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Buti M, Domínguez-Hernández R, Oyagüez I, Casado MÁ. [Cost-effectiveness analysis of sofosbuvir, peginterferon and ribavirin in patients with chronic hepatitis C: Early treatment in the initial stage of fibrosis vs. delayed treatment in advanced fibrosis]. Gastroenterol Hepatol 2016; 39:449-57. [PMID: 27084669 DOI: 10.1016/j.gastrohep.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/26/2016] [Accepted: 03/07/2016] [Indexed: 01/16/2023]
Abstract
AIMS Cost-effectiveness analysis of sofosbuvir combined with peginterferon alpha-2a and ribavirin (SOF/Peg-IFN/RBV) in early versus advanced fibrosis in previously untreated patients with chronic hepatitis C genotype 1 (CHC-GT1), from the perspective of the Spanish National Health System (NHS). METHODS A Markov model was developed to compare lifetime costs and outcomes (life years gained [LYGs] and quality-adjusted life years [QALYs]) of 2 treatment strategies: SOF/Peg-IFN/RBV administered during early fibrosis (mild-moderate fibrosis; F2-F3) or advanced fibrosis (cirrhosis; F4). Efficacy (sustained virologic response), annual transition probabilities, disease management costs and utilities were obtained from the literature. Costs and outcomes were discounted annually at 3%. Direct costs were considered, expressed in Euros (€, 2014). Probabilistic sensitivity analysis (PSA) was also performed. RESULTS SOF/Peg-IFN/RBV therapy at F2-F3 was more effective (19.12 LYGs and 14.14 QALYs) compared to F4. In a cohort of 1,000 patients, SOF/Peg-IFN/RBV prevented 66 cases of decompensated cirrhosis, 60 hepatocellular carcinomas and 4 liver transplantations compared with therapy in advanced fibrosis. The total lifetime cost of early therapy (€43,263) was less than the cost of treatment in the advanced stage (€49,018). Early therapy was a dominant strategy, more effective and less costly in all simulations. In the PSA analysis, administration of SOF/PEG-IFN/RBV at F2-F3 was dominant in all simulations. CONCLUSIONS Starting SOF/Peg-IFN/RBV therapy at F2-F3, compared with therapy at F4, reduced the incidence of liver disease complications and was associated with cost savings for the Spanish NHS in CHC-GT1 patients.
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Affiliation(s)
- María Buti
- Unidad de Hepatología, Hospital Universitario Vall d'Hebron, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), España
| | | | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, España
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Mar J, Masjuan J, Oliva-Moreno J, Gonzalez-Rojas N, Becerra V, Casado MÁ, Torres C, Yebenes M, Quintana M, Alvarez-Sabín J. Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain. Health Qual Life Outcomes 2015; 13:36. [PMID: 25889480 PMCID: PMC4391532 DOI: 10.1186/s12955-015-0230-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 10/09/2014] [Accepted: 03/03/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction The primary objective of this sub analysis of the CONOCES study was to analyse outcomes in terms of mortality rates, quality of life and degree of autonomy over the first year in patients admitted to stroke units in Spain. The secondary objective was to identify the factors determining good prognosis. Methods We studied a sample of patients who had suffered a confirmed stroke and been admitted to a Stroke Unit in the Spanish healthcare system. Socio-demographic and clinical variables and variables related to the level of severity (NIHSS), the level of autonomy (Barthel, modified Rankin) and quality of life (EQ-5D) were recorded at the time of admission and then three months and one year after the event. Factors determining prognosis were analysed using logistic regression and ROC curves. Results A total of 321 patients were recruited, 33% of whom received thrombolytic treatment, which was associated with better results on the Barthel and the modified Rankin scales and in terms of the risk of death. Mean quality of life measured through EQ-5D improved from 0.57 at discharge to 0.65 one year later. Full autonomy level measured by Barthel index increased from 30.1% at discharge to 52.8% at one year and by the modified Rankin scale from 51% to 71%. The rates for in-hospital and 1-year mortality were 5.9% and 17.4% respectively. Low NIHSS scores were associated with a good prognosis with all the outcome variables. The three instruments applied (NIHSS, Barthel and modified Rankin scales) on admission showed good discriminative ability for patient prognosis in the ROC curves. Conclusions There has been a change in the prognosis for stroke in Spain in recent years as the quality of life at 1 year observed in our study is clearly higher than that obtained in other Spanish studies conducted previously. Moreover, survival and functional outcome have also improved following the introduction of a new model of care. These results clearly promote extension of the model based on stroke units and reinforced rehabilitation to the majority of the more than 100,000 strokes that occur annually in Spain.
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Affiliation(s)
- Javier Mar
- Clinical Management Service, Alto Deba Hospital, Mondragon, Spain. .,Unidad de Gestión Sanitaria, Hospital 'Alto Deba', Avenida Navarra 16, 20500, Mondragón, Spain.
| | - Jaime Masjuan
- Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Madrid, Spain.
| | - Juan Oliva-Moreno
- Department of Economic Analysis, Universidad de Castilla La Mancha and REDISSEC, Toledo, Spain.
| | - Nuria Gonzalez-Rojas
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain.
| | - Virginia Becerra
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain.
| | | | | | - María Yebenes
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain.
| | - Manuel Quintana
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain.
| | - Jose Alvarez-Sabín
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain.
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Gros B, Soto Álvarez J, Ángel Casado M. Incorporation of future costs in health economic analysis publications: current situation and recommendations for the future. Expert Rev Pharmacoecon Outcomes Res 2015; 15:465-9. [PMID: 25737028 DOI: 10.1586/14737167.2015.1021689] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Future costs are not usually included in economic evaluations. The aim of this study was to assess the extent of published economic analyses that incorporate future costs. A systematic review was conducted of economic analyses published from 2008 to 2013 in three general health economics journals: PharmacoEconomics, Value in Health and the European Journal of Health Economics. A total of 192 articles met the inclusion criteria, 94 of them (49.0%) incorporated future related medical costs, 9 (4.2%) also included future unrelated medical costs and none of them included future nonmedical costs. The percentage of articles including future costs increased from 2008 (30.8%) to 2013 (70.8%), and no differences were detected between the three journals. All relevant costs for the perspective considered should be included in economic evaluations, including related or unrelated, direct or indirect future costs. It is also advisable that pharmacoEconomic guidelines are adapted in this sense.
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Affiliation(s)
- Blanca Gros
- Market Access Department, Janssen-Cilag, Madrid, Spain
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Sole A, Poveda JL, Giron RM, Prados MC, De GJ, Casado MÁ. Economic Impact Linked To the Reduction of Exacerbations When A Treatment Regime With Inhaled Antibiotics Is Switched To Aztreonam Lysine In Patients With Cystic Fibrosis and Chronic Pulmonary Infection Caused By Pseudomonas Aeruginosa. Value Health 2014; 17:A526. [PMID: 27201659 DOI: 10.1016/j.jval.2014.08.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Sole
- Hospital Universitario La Fe, Valencia, Spain
| | - J L Poveda
- Hospital Universitario La Fe, Valencia, Spain
| | | | - M C Prados
- Hospital Universitario La Paz, Madrid, Spain
| | - Gracia J De
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Á Casado
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
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Gratacós J, Daudén E, Gómez-Reino J, Moreno JC, Casado MÁ, Rodríguez-Valverde V. Health-related quality of life in psoriatic arthritis patients in Spain. ACTA ACUST UNITED AC 2014; 10:25-31. [DOI: 10.1016/j.reuma.2013.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 03/22/2013] [Accepted: 05/01/2013] [Indexed: 11/16/2022]
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Oyagüez I, Frías C, Seguí MÁ, Gómez-Barrera M, Casado MÁ, Queralt Gorgas M. [Efficiency of oncologic treatments for solid tumours in Spain]. Farm Hosp 2013; 37:240-259. [PMID: 23789801 DOI: 10.7399/fh.2013.37.3.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To provide estimates of the efficiency for chemotherapy strategies used in Spain. METHODS Published reports of the phase-III clinical trials for chemotherapies used for the most prevalent solid tumours in Spain were retrieved. The incremental cost-effectiveness ratio (ICER) was calculated for each strategy compared to the control group in the clinical trial, with the National Health System perspective. The total cost (?, 2012) including only drug cost (exfactory price) was estimated based on the total units of each drug required for administration (no vial wastage), with the dosification and number of cycles specified in the publication for each treatment arm. Effectiveness was measured as month of overall survival (OS) and/or month of progression free survival (PFS). RESULTS A total of 40 chemotherapies for 13 different advanced or metastatic tumours were assessed. OS ranged from 5.3 to 33.3 months for the 34 therapies that included the information with hazard ratios (HR) values from 0.49 to 1.15 when compared with its control group. PFS ranged, from 39 therapies with these data, between 1.5 to 12.4 months, with HR from 0.33 to 1.52. ICERs were between ?2,142.57 and ?60,996.37 per each OS month gained, and from ?2,102.54 to ?661,845.27 per PFS month gained. CONCLUSION The variety and heterogenicity of survival and ICERs results, suggest disparity of criteria in the price and reimbursement process of drugs in Spain. The continuous advances in oncology seem to require economic revaluations of drugs.
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Cisneros C, Quiralte J, Capel M, Casado MÁ, Mellstrom C. Análisis coste-efectividad de budesonida/formoterol en el tratamiento de mantenimiento y a demanda (Symbicort SMART®) frente a salmeterol/fluticasona más terbutalina, en el tratamiento del asma persistente en España. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03321485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Homar F, Lozano V, Martínez-Gómez J, Oyagüez I, Pareja A, Payeras A, Serrano J, Carratalá C, Casado MÁ. Cost analysis of HIV treatment and drug-related adverse events when fixed-dose combinations of antiretrovirals (FDCs) were stopped, versus continuation with FDCs. Health Econ Rev 2012; 2:16. [PMID: 22943676 PMCID: PMC3484113 DOI: 10.1186/2191-1991-2-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/31/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The lower sales price of generic lamivudine has caused healthcare administrators to consider abolishing fixed-dose antiretroviral combinations (FDCs) that contain lamivudine and emtricitabine. The alternative is to administer the individual components of the FDCs separately, thus incorporating the new generic lamivudine medication. METHODS The Balearic Islands Health Service ordered the discontinuation of the treatment with FDCs in July 2010, but FDCs were reintroduced in August 2010. At that point, an independent, retrospective cost analysis was performed by Son Llàtzer Hospital. A total of 75 patients who were treated from July to August 2010 underwent replacement of their FDC treatment with the individual components. Additionally, 150 patients who continued using FDCs were randomly selected. For both patient groups, the antiretroviral therapy that was administered and the costs associated with management of adverse events were recorded. The study period used for the cost calculations was the average number of days that patients used separate components of FDCs (120 days). An alternative analysis was performed to consider the costs of the extra follow-up visit (consultation and clinical tests) that was required for patients who changed their antiretroviral therapy. RESULTS Considering antiretroviral therapies and adverse events, the administration of the separate components increased the total daily cost by 0.72 € per patient compared to treatment with FDCs. When the cost of an extra follow-up visit was considered, the daily cost increased by 3.61 € per patient. CONCLUSIONS Our study suggests that the discontinuation of FDC treatment and the replacement with the administration of separate antiretroviral agents could lead to an increase in healthcare costs due to the higher rate of adverse events that was observed with the discontinuation of FDCs.
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Affiliation(s)
- Francesc Homar
- Department of Internal Medicine, Son LLàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
| | - Virginia Lozano
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Calle de la Golondrina, 40A, Madrid, 28023, Spain
| | - Juan Martínez-Gómez
- Department of Internal Medicine, Son LLàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
| | - Itziar Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Calle de la Golondrina, 40A, Madrid, 28023, Spain
| | - Antonio Pareja
- Department of Epidemiology, Son Llàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
| | - Antoni Payeras
- Department of Internal Medicine, Son LLàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
| | - Joaquín Serrano
- Department of Internal Medicine, Son LLàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
| | - Carmen Carratalá
- Department of Internal Medicine, Son LLàtzer Hospital, Ctra. Manacor km 4, Palma de Mallorca, 07198, Spain
| | - Miguel Ángel Casado
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Calle de la Golondrina, 40A, Madrid, 28023, Spain
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García-Jurado L, Oyagüez I, Casado MÁ, Tural C, González-García J, Ortega E, Pineda JA. [Evaluation of the costs of transient elastography (FibroScan(®)) in the diagnosis of liver fibrosis in HIV patients with hepatitis C virus]. Enferm Infecc Microbiol Clin 2011; 30:294-9. [PMID: 22197275 DOI: 10.1016/j.eimc.2011.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 10/10/2011] [Accepted: 11/02/2011] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The assessment of liver fibrosis is crucial for taking therapeutic decisions in patients infected with HIV/AIDS coinfected with HCV, because it allows the prognosis of the disease and the prioritization of hepatitis C treatment in these patients. METHODS A discrete events model simulation (DEMS) and a Markov model have been developed to represent the evolution of liver fibrosis to cirrhosis in patients coinfected with HIV/HVC. The model evaluated two alternatives for the diagnosis and monitoring of these patients, transient elastography performed annually and liver biopsy performed every seven years. The models have been developed under Health Care System perspective and only considered direct medical costs (disease treatment and health state costs). One-way sensitivity analyses were carried out to assess the impact of parameters with higher uncertainty. A discount rate of 3% was applied. RESULTS Base case analysis shows that the diagnosis and monitoring of patients with transient elastography is a dominant strategy compared with to liver biopsy, resulting in greater life expectancy at lower cost. The sensitivity analysis performed confirmed the robustness of these results. CONCLUSION Transient elastography has proved to be a dominant strategy compared to liver biopsy in the diagnosis and monitoring of liver fibrosis in patients coinfected with HIV/HCV in Spain.
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Frías C, Cortés J, Seguí MÁ, Oyagüez I, Casado MÁ. Cost-effectiveness analyses of docetaxel versus paclitaxel once weekly in patients with metastatic breast cancer in progression following anthracycline chemotherapy, in Spain. Clin Transl Oncol 2010; 12:692-700. [DOI: 10.1007/s12094-010-0579-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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