[Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish population]. / Morbimortalidad y consumo de recursos asociados tras síndrome coronario agudo en una población española.

OBJECTIVES: To describe the management of patients suffering acute coronary syndrome (ACS) and to determine its clinical and economic consequences in a Spanish population. METHODS: A multicenter, retrospective claim database study including patient medical records from 6 primary care centers, two hospitals and two years of follow-up was carried out. Patients ≥30 years, suffering a first acute coronary syndrome (ACS), between 2003 and 2007, were included. Groups: acute coronary syndrome with and without ST segment elevation. VARIABLES: socio-demographic, co-morbidities, metabolic syndrome (MS), biochemical parameters, drugs, cumulative incidence (total mortality and cardiovascular events (CVE: including myocardial infarction, stroke and peripheral artery disease) and total costs. STATISTICAL ANALYSIS: logistic regression, Kaplan-Meier curves and ANCOVA; (P<.05). RESULTS: A total of 1020 patients were included. Mean age: 69 years; males: 65%. Groups: ST segment elevation ACS (N=632; 62%). Co-morbidities: hypertension (56%), dyslipidemia (46%) and diabetes (38%). Prevalence of MS: 59% (CI 95%: 56-62%). All biochemical parameters had improved after two years of follow-up. The average total cost per patient was €14,069 (87% direct costs; 13% productivity loss costs). Direct costs: primary care (20%), specialty care (67%); hospitalization costs represented 63% of total costs. The average total cost for patients presenting more than one CVE was 22,750€ vs 12,380€ for those patients who suffered only one (P<.001). Cumulative incidence: total mortality 14%; CVE: 16%. CONCLUSIONS: In the current clinical practice, and despite the clinical efforts carried out, patients with an ACS are still at a high risk of suffering further CVE, representing a high cost burden to the health care system.

[Analysis of cost-minimization treatment with paracetamol or COX-2 inhibitors (rofecoxib) for pain from arthrosis of the knee or hip]. / Análisis de minimización de costes del tratamiento del dolor en la artrosis de rodilla o cadera con paracetamol o inhibidores de la COX-2 (rofecoxib).

OBJECTIVE: To assess the efficiency of paracetamol, indicated in first instance for light-to-moderate pain from hip and knee arthrosis, against rofecoxib, the COX-2 inhibitor most commonly used in Spain. DESIGN: Pharmaco-economic model: cost-minimisation analysis based on the information provided by a systematic review of the literature. SETTING: Spain: statewide. PARTICIPANTS: Patients with a diagnosis of knee or hip arthrosis, who demand health-care for light-to-moderate pain in the primary care services and present no counter-indication to the treatments under evaluation. MAIN MEASUREMENTS: Given the supposition of the equivalent efficacy of paracetamol and rofecoxib, the cost-minimisation model focused on the cost arising from the adverse side effects caused by the 2 drugs. A correction factor allowed for the number of subjects in the studies reviewed and the number of adverse side effects found. RESULTS: Paracetamol was cheaper than rofecoxib at both 3 months and 1 year. The average cost of paracetamol per year was 307.95 Euros (301.57-315.12) versus 574.59 Euros (566.74-580.40) for rofecoxib treatment. The main cause of costs after the sensitivity analysis was the cost of acquiring the drugs, rather than the rate of incidence of adverse side effects. CONCLUSIONS: In terms of economic analysis based on cost minimisation, paracetamol was the first-preference treatment over rofecoxib for light-to-moderate arthrosis pain. This confirmed the recommendations which, under efficacy and safety criteria, are indicated in various clinical practice guidelines in force.