The Economic Burden of Localized Prostate Cancer and Insights Derived from Cost-Effectiveness Studies of the Different Treatments.

Prostate cancer has huge health and societal impacts, and there is no clear consensus on the most effective and efficient treatment strategy for this disease, particularly for localized prostate cancer. We have reviewed the scientific literature describing the economic burden and cost-effectiveness of different treatment strategies for localized prostate cancer in OECD countries. We initially identified 315 articles, studying 13 of them in depth (those that met the inclusion criteria), comparing the social perspectives of cost, time period, geographical area, and severity. The economic burden arising from prostate cancer due to losses in productivity and increased caregiver load is noticeable, but clinical decision-making is carried out with more subjective variability than would be advisable. The direct cost of the intervention was the main driver for the treatment of less severe cases of prostate cancer, whereas for more severe cases, the most important determinant was the loss in productivity. Newer, more affordable radiotherapy strategies may play a crucial role in the future treatment of early prostate cancer. The interpretation of our results depends on conducting thorough sensitivity analyses. This approach may help better understand parameter uncertainty and the methodological choices discussed in health economics studies. Future results of ongoing clinical trials that are considering genetic characteristics in assessing treatment response of patients with localized prostate cancer may shed new light on important clinical and pharmacoeconomic decisions.

Gender Inequalities in Diagnostic Inertia around the Three Most Prevalent Cardiovascular Risk Studies: Protocol for a Population-Based Cohort Study.

Evidence shows that objectives for detecting and controlling cardiovascular risk factors are not being effectively met, and moreover, outcomes differ between men and women. This study will assess the gender-related differences in diagnostic inertia around the three most prevalent cardiovascular risk factors: dyslipidemia, arterial hypertension, and diabetes mellitus, and to evaluate the consequences on cardiovascular disease incidence. This is an epidemiological and cohort study. Eligible patients will be adults who presented to public primary health care centers in a Spanish region from 2008 to 2011, with hypertension, dyslipidemia, or/and diabetes and without cardiovascular disease. Participants' electronic health records will be used to collect the study variables in a window of six months from inclusion. Diagnostic inertia of hypertension, dyslipidemia, and/or diabetes is defined as the registry of abnormal diagnostic parameters-but no diagnosis-on the person's health record. The cohort will be followed from the date of inclusion until the end of 2019. Outcomes will be cardiovascular events, defined as hospital admission due to ischemic cardiopathy, stroke, and death from any cause. The results of this study could inform actions to rectify the structure, organization and training of health care teams in order to correct the inequality.

Green recovery packages for a post-Covid-19 world: A lesson from the collapse of Spanish wind farms in the past financial crisis.

Governments are implementing massive stimulus fiscal packages to mitigate the economic crisis caused by the coronavirus disease. If policymakers want to stimulate the economy through renewable energy investments, policies must focus on financing as the key priority. This is the lesson we draw from the Spanish wind farms in the past financial crisis. Using an economic approach to the drivers of external finance within the backdrop of Spanish windfarms, this work employs a dataset of 318 projects commissioned throughout 2006-2013. The main conclusion from this study is that the financial crisis of 2008 changed the behaviour of Spanish financial institutions towards renewable projects. The pre-crisis period was a time when costly ventures were prone to a higher debt leverage. Post-crisis times, however, punished these types of projects by curbing their access to financial resources.

Behavioural and structural interventions in cancer prevention: towards the 2030 SDG horizon.

Traditionally, the prevention of cancer (and other chronic diseases) has been considered primarily linked to personal responsibility, for which interventions must be based on health education information enabling individuals to make knowledge-based decisions to improve their lifestyle. However, lifestyle is conditioned by environmental factors (including dimensions such as the context of economics, transport, urbanism, agriculture or education) that may render healthy behavioural choices either easier or, alternatively, impossible. This article reviews the conceptual underpinnings of the behavioural-structural dichotomy. We believe that it is advisable to opt for multilevel strategies that take into account all the determinants of health, using structural and behavioural approaches, rather than only the latter, as has been done until now.

Epidemiological Study and Cost Analysis of Suicide in Spain: Over 100 Years of Evolution.

OBJECTIVE: Society has changed during the last 100 years of evolution; however, some problems, such as suicide, remain. The objective here is to carry out a long-term epidemiological study in Spain, and to calculate the social and labor costs of 2016. METHOD: Epidemiological data were obtained from official data obtained between 1906 - 2016. The calculation of the costs of suicides included the social costs and the costs of production losses (labor costs). The latter were obtained by the human capital method, taking into account the unemployment rate. The economic growth rate stood at 2.6% per year. RESULTS: The suicide rate was between 4 and 8% per year. The evolution during these 100 years had three periods. Until 1940 it had slight increases, and then it decreased until 1980 and, subsequently, the rate increased until it reached almost 8% in 2016. The costs of the suicides were 2,167 million € of economic losses for society, or its equivalent of 607 € for suicide. CONCLUSIONS: Public health policies aimed at the prevention of suicide should be increased, and supported by the economic costs they mean for society.

Defining and Assessing Public Health Functions: A Global Analysis.

Given the broad scope and intersectoral nature of public health structures and practices, there are inherent difficulties in defining which services fall under the public health remit and in assessing their capacity and performance. The aim of this study is to analyze how public health functions and practice have been defined and operationalized in different countries and regions around the world, with a specific focus on assessment tools that have been developed to evaluate the performance of essential public health functions, services, and operations. Our review has identified nearly 100 countries that have carried out assessments, using diverse analytical and methodological approaches. The assessment processes have evolved quite differently according to administrative arrangements and resource availability, but some key contextual factors emerge that seem to favor policy-oriented follow-up. These include local ownership of the assessment process, policymakers' commitment to reform, and expert technical advice for implementation.

Аргументы в пользу инвестиций в общественное здоровье: Укрепление потенциала и служб общественного здравоохранения в Европе. Один из важнейших элементов новой Европейской региональной политики здравоохранения – Здоровье-2020

Экономический кризис привел к росту спроса и сокращению ресурсов для сектора здравоохранения. Наблюдается выраженная тенденция к росту затрат на медико-санитарное обслуживание для отдельных лиц, сектора здравоохранения и всего общества в целом. Меры общественного здравоохранения могут способствовать решению этой проблемы. Фактические данные показывают, что меры профилактики могут быть эффективными с точки зрения затрат, обеспечивая эффективное использование вложенных средств и окупаемость инвестиций как в краткосрочной, так и долгосрочной перспективе. Настоящий краткий доклад по вопросам общественного здравоохранения указывает на быструю окупаемость затрат сектора здравоохранения и других секторов на осуществление мер, которые способствуют росту физической активности и здоровой занятости; решению проблем в области жилищных условий и психического здоровья; и снижению уровня дорожно-транспортного травматизма и насилия. Программы вакцинации и скрининга в большинстве случаев являются затратоэффективными. Меры вмешательства на общепопуляционном уровне требуют, в среднем, в пять раз меньше затрат, чем меры, принимаемые на индивидуальном уровне. В настоящем докладе приводятся примеры мер вмешательства, обеспечивающие быструю окупаемость инвестиций, а также подходы, позволяющие добиться положительных результатов на более долгосрочную перспективу. Инвестиции в затратоэффективные меры вмешательства в целях снижения затрат в секторе здравоохранения и других секторах могут способствовать построению устойчивых систем здравоохранения и развитию экономики стран в будущем.

Cancer screening and health system resilience: keys to protecting and bolstering preventive services during a financial crisis.

The aim of this paper is to elucidate the rationale for sustaining and expanding cost-effective, population-based screening services for breast, cervical and colorectal cancers in the context of the current financial crisis. Our objective is not only to promote optimal delivery of high-quality secondary cancer prevention services, but also to underline the importance of strengthening comprehensive cancer control, and with it, health system response to the complex care challenges posed by all chronic diseases. We focus primarily on issues surrounding planning, organisation, implementation and resources, arguing that given the growing cancer burden, policymakers have ample justification for establishing and expanding population-based programmes that are well-organised, well-resourced and well-executed. In a broader economic context of rescue packages, deficits and cutbacks to government entitlements, health professionals must intensify their advocacy for the protection of vital preventive health services by fighting for quality services with clear benefits for population health outcomes.

Quo vadis SANEPID? A cross-country analysis of public health reforms in 10 post-Soviet states.

BACKGROUND: The public health systems of the post-Soviet states have evolved from the san-epid system, which dominated public health practice throughout the former Soviet Union. Since independence, reforms have taken different directions. This article provides a cross-country comparison of public health reform processes and contents in 10 post-Soviet states. METHODS: The study is descriptive and comparative, based on a literature review of the major health databases, the Health Systems in Transition (HiT) volumes and grey literature. Search terms included terms on public health, the san-epid services and organizational reforms in one or several post-Soviet states. RESULTS: Public health reforms have varied greatly: some countries have preserved the san-epid structure, some have built structures in addition to the san-epid system, and others have set up a new public health infrastructure. Traditional "functions" of the former san-epid system, such as vaccination, are still more advanced, while health promotion and intersectoral collaboration are less developed. CONCLUSION: Critical self-evaluation, implementation of performance measurement and rigorous external research will prove essential in identifying strengths and weaknesses of past reforms and learning for the future.

The effects of the financial crisis on primary prevention of cancer.

The present financial crisis will affect primary cancer prevention through several avenues: personal lifestyle choices, exposure to environmental risk factors, decisions made in the private sector and public policy on cancer prevention. Whilst it is clearly problematic to reach solid conclusions on a direct connection between economic crises and cancer mortality, we can identify trends that provide guidance for further action. For some lifestyle choices such as smoking or diet, we argue that public policy may channel existing tendencies during times of crisis for clear added value. In other areas, including research and health system investments, we will make the case that the resources not used now for cancer prevention efforts will lead to increased costs (both financial and human) down the road. Policy makers face a clear choice: they can follow a cost contention strategy, which may reduce expenditure in the short-term only to increase it in the long-term, or they can use the financial crisis as an opportunity to make difficult choices in terms of health service rationalisation, whilst at the same time strengthening evidence-based prevention policies. In short, we argue that despite the scarcity of funds and the governmental priorities on economic recovery, cancer prevention is more relevant now than ever.

[The Public Health Services Port-folio in the National Health System: the contribution of the Central Government of Spain]. / La cartera de Servicios de Salud Pública en el Sistema Nacional de Salud: la aportación de la Administración General del Estado.

This paper concentrates on the port folio of public health services in the National Health System, with an inventory of those provided by the central level of government in the currently decentralized context of Spain. There is an important activity in public health, with some dispersion among different bodies and organisations. Most of the current activities of the central level of government concentrate in monitoring health levels and their determinants, managing information systems and health alerts and warnings, but with an involvement in policy development, both as a counterpart of the European Union and as an active agent with both regional levels of government and other organisations influencing public health. Besides, this level of government assures some essential services with little visibility for the general population as they are mostly delivered to other public administrations or to professional groups.