Effectiveness of the low-density lipoprotein cholesterol goals in secondary cardiovascular prevention.

BACKGROUND: The effectiveness of statin treatment to reduce coronary events and mortality has been hardly examined considering goals of LDL-C. We aimed to analyse such association in secondary cardiovascular prevention. METHODS: Retrospective cohort analysis of electronic health records from the SIDIAP database, Catalonia-Spain. Recruitment period was from 2006 to 2017 and study period finished at the end of 2018. We included 54,175 people aged ≥35 years in cardiovascular secondary prevention starting statin treatment. We analysed the association of achieved LDL-C goals after statin initiation with coronary heart disease and all-cause mortality. RESULTS: Mean age was 69 years and 20,146 (37.2%) were women. Coronary heart disease occurred in 5687 (10.5%) participants, and 10,676 (19.7%) persons passed away. Median follow-up lasted 5.7 years (interquartile range, 3.4-8.1). The coronary heart disease HRs (95% CI) for the LDL-C goals of 70-100, <70-55 and <55 mg/dL were .86 (.81-.92), .83 (.76-.9) and .8 (.72-.88), respectively. They were .89 (.83-.96) in the group with 30%-40% reduction and .86 (.8-.93) in the groups with 40%-50% and ≥50% reduction. We observed no association with mortality. We observed no relevant differences by sex or age. CONCLUSIONS: This population-level retrospective analysis of real-world data observed that treatment with statins is effective to achieve certain LDL-C goals and CHD reduction. The lack of significant difference between LDL-C goals needs confirmation in additional studies with real-world data. The LDL-C target should consider the magnitude of the decrease in coronary events.

Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain).

OBJECTIVE: The aim of this study was to assess the efficacy of an electronic reminder in primary healthcare in patients diagnosed with an indicator condition (IC) to improve HIV screening. METHODS: We developed a prospective interventional study in 51 primary healthcare centres in Barcelona randomly assigned into one of two study groups: control and alert. Between June 2018 and May 2019, an electronic reminder appeared in the electronic medical record each time a diagnosis of an IC in patients aged 16-65 years was registered in the alert group. We assessed HIV testing rates within 4 months following the diagnosis of an IC. RESULTS: In all, 13 000 patients were diagnosed with at least one IC. HIV testing was more likely in the alert group than in the control group. The electronic reminder multiplied the odds of being tested in men by 1.26 [95% confidence interval (CI): 1.04-1.52, p = 0.019], by 1.77 (95% CI: 1.33-2.38, p < 0.001) among patients aged < 50 years , and by 1.51 (95% CI: 1.20-1.92, p < 0.001) in diagnoses of IC other than a sexually transmitted infection (STI) or an AIDS-defining illness. Five (0.08%) cases of HIV were detected in the control group and 10 (0.17%) in the alert group. CONCLUSIONS: Implementing an electronic reminder had a positive impact on HIV screening rates in patients diagnosed with an IC. The alert was more effective among older patients, those living in less socioeconomically deprived neighbourhoods, and those with an IC other than an STI or an AIDS-defining illness.

Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication.

OBJECTIVE: To study the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth. DESIGN: Retrospective observational study. LOCATION: Sexual and reproductive health units at the Institut Català de la Salut (ICS) in Catalonia, Spain. PARTICIPANTS: Pregnant women with a result of live-born child from 1/1/2012 to 30/10/2015. INTERVENTIONS: Data were obtained from the ICS Primary Care electronic medical record. MAIN MEASUREMENTS: Diagnosis of AD before and during pregnancy, months of pregnancy, and possible confusion factors were collected. Descriptive statistical analysis (median, interquartile range, and absolute and relative frequency), bivariate analysis (Wilcoxon test and Chi-square test), and multivariate analysis (logistic regression) were performed. RESULTS: 102,086 women presented valid information for the study. Prevalence of AD during pregnancy was 3.5% (4.29% in pre-term and 3.46% in term births; p<0.004). Pregnant women with pre-term births presented a higher age, smoking habit, lower inter-pregnancy interval, and a lower socio-economic status. Pre-term birth was significantly associated to previous history of stress and dissociative disorder (SDD), anxiety, obsessive-compulsive disorder (OCD) and eating disorders (ED), and use of antidepressants. It was also associated to abuse of alcohol, smoking, and use of psychoactive substances, as well as SDD, ED, use of antipsychotics, and divorce during pregnancy. Multivariate analysis confirmed the relationship between pre-term birth and history of AD, SDD, ED, and smoking, but not with AD during pregnancy. CONCLUSIONS: Examining the previous history of SDD and ED in pregnant women, and SDD, and ED during pregnancy is highly relevant to avoid pre-term birth.

Association between EBRT dose volume histograms and quality of life in prostate cancer patients.

AIM: To evaluate the association between dose-volume histogram (DVH) values in organs at risk (OAR) and patient-reported HRQoL outcomes. BACKGROUND: Data on the association between DVHs and health-related quality of life (HRQoL) in prostate cancer (PCa) patients are limited. MATERIALS AND METHODS: Five-year follow-up study of 154 patients with organ-confined (stage T1/T2) PCa treated with EBRT between January 2003 and November 2005. HRQoL was evaluated with the Expanded Prostate Cancer Index (EPIC). DVH for OARs (penile bulb, rectum and bladder) were created for all patients for whom data were available (119/154; 77%). The functional data analysis (FDA) statistical method was used. HRQoL data was collected prospectively and data analysis was performed retrospectively. RESULTS: Worsening of urinary incontinence and obstructive symptoms correlated with higher DVH dose distributions at 24 months. Increased rectal bleeding at months 24 and 60 correlated with higher DVH dose distributions in the 40-70 Gy range. Patients with deterioration in rectal incontinence presented a higher DVH distribution range than patients without rectal incontinence. Penile bulb DVH values and erectile dysfunction were not significantly associated. CONCLUSIONS: DVH parameters and post-radiotherapy HRQoL appear to be closely correlated, underscoring the importance of assessing DVH values prior to initiating EBRT to determine the risk of developing HRQoL related adverse effects. Advanced treatment modalities may be appropriate in high risk cases to minimize treatment-related toxicity and to improve treatment outcomes and HRQoL. Future studies are needed to better elucidate the association between pre-treatment DVH parameters in organs at risk and subsequent HRQoL.

Asthma inhaler adherence determinants in adults: systematic review of observational data.

Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults. We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990-2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition- and patient-related factors. The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis. A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further.

Predicting factors of health-related quality of life in octogenarians: a 3-year follow-up longitudinal study.

PURPOSE: The proportion of very old people is rising, and so, describing their health-related quality of life (HRQoL) is an important point of interest. The aim of this study was to analyse the predictive factors on HRQoL throughout a 3-year follow-up period, in a community-based cohort of octogenarian people. METHODS: From 290 subjects aged 85 and over, sociodemographic and geriatric data, including levels of frailty phenotype assessment, and HRQoL using the EuroQol 5D3L (EQ-5D) instrument were collected. A longitudinal analysis was performed by generalized estimating equations (jointly testing the bivariate effect of variables and its time dependence) and regression mixed models to evaluate the adjusted effect of variables on HRQoL after a 3-year follow-up. RESULTS: In the EQ-5D baseline assessment, the average visual analogue self-rating scale value was 63.82 (SD ± 19.45), the EQ-5D index was 0.67 (0.34) and the most significant issues were pain/discomfort (61.2 %), depression (45.3 %) and mobility (44.6 %). The third year index was 0.55 (0.38). Independent predictive factors of a lower HRQoL identified by the regression mixed models were female gender (marginal effect ME = -0.101; p = 0.003), being pre-frail (ME = -0.142; p = 0.011) or frail (ME = -0.071; p = 0.030), having heart failure (ME = -0.081; p = 0.037) and having a high social risk score (ME = -0.020; p = 0.015). In contrast, higher functional status (ME = 0.050; p < 0.001) and nutritional score (ME = 0.013; p = 0.011) appeared to be predictive factors of an enhanced HRQoL. The adjusted effect of "time of follow-up" had no statistical significance. CONCLUSION: Frail individuals at baseline have a significant lower HRQoL, whereas a higher functional status and nutritional status are independent predicting factors of an enhanced HRQoL after 3 years of follow-up. These findings may encourage clinicians in order to asses HRQoL.

Final Stage of Chronic Kidney Disease with Conservative Kidney Management or Renal Replacement Therapy: A Primary-Care Population Study.

BACKGROUND: Studies focus on the incidence and risk factors (RFs) associated with reaching the final stage of chronic kidney disease (CKD-G5) and receiving kidney replacement therapy (KRT). Analysis of those related to reaching CKD-G5 while receiving conservative kidney management (CKM) has been neglected. METHODS: Retrospective cohort study analysing electronic health records of individuals aged ≥ 50 with eGFR < 60 mL/min/m2. Cumulative incidence rates of CKD-G5, with and without KRT, were calculated. Multinomial regression models determined odds ratios (ORs) for CKD-G5 progression with KRT, CKM, or death. RESULTS: Among 332,164 patients, the cumulative incidence of CKD-G5 was 2.79 cases per 100 person-years. The rates were 1.92 for CKD-G5 with KRT and 0.87 for CKD-G5 with CKM. Low eGFR and albuminuria were the primary RFs. Male gender and uncontrolled blood pressure had a greater impact on KRT (OR = 2.63 CI, 1.63) than on CKD-G5 with CKM (OR = 1.45 CI, 1.31). Increasing age and rurality reduced the probability of KRT but increased the probability of CKD-G5 with CKM. Higher incomes decreased the likelihood of developing CKD-G5 with and without KRT (OR = 0.49 CI). CONCLUSION: One-third of CKD-G5 cases receive CKM. Those are typically older, female, rural residents with lower incomes and with lesser proteinuria or cardiovascular RF. The likelihood of receiving KRT is influenced by location and socioeconomic disparities.

Efficacy of low-frequency low-intensity electrotherapy in the treatment of breast cancer-related lymphoedema: a cross-over randomized trial.

OBJECTIVE: To compare the efficacy of low-frequency low-intensity electrotherapy and manual lymphatic drainage in the treatment of chronic upper limb breast cancer-related lymphoedema. DESIGN: Cross-over single-blind random clinical trial. SETTING: Rehabilitation service. PARTICIPANTS: Thirty-six women with chronic upper limb breast cancer-related lymphoedema. METHODS: Patients were randomized to undergo 10 sessions of manual lymphatic drainage followed by 10 sessions of low-frequency low-intensity electrotherapy or to undergo first low-frequency low-intensity electrotherapy followed by manual lymphatic drainage. There was a month of washout time between treatments. Each patient was examined just before and after each treatment. Researchers and outcome assessors were blinded for assigned treatment. MEASURES: Outcomes were lymphoedema volume, pain, heaviness and tightness, and health-related quality of life measured with the Functional Assessment of Cancer Therapy Questionnaire for Breast Cancer version 4 (FACT-B+4). Carry-over, period and treatment effects were analysed. Treatment effect was assessed using paired t-test. RESULTS: Thirty patients finalized treatment. Comparing the changes in low-frequency low-intensity electrotherapy with manual lymphatic drainage changes, there were no significant differences. Low-frequency low-intensity electrotherapy did not reduce lymphoedema volume (mean of change = 19.77 mL, P = 0.36), but significant reductions were observed in pain, heaviness and tightness (mean of change = 13.1, 16.2 and 6.4 mm, respectively), and FACT-B+4 summaries improved significantly (Trial Outcome Index mean of change = 5.4, P = 0.015). Manual lymphatic drainage showed no significant changes in any of the outcomes CONCLUSION: Although there are no significant differences between treatment changes, the observed trend towards a better health-related quality of life is remarkable in low-frequency low-intensity electrotherapy.

Trends in glycemic control, cardiovascular risk factors and chronic complications of type 2 diabetes, 2012-2016, in a healthcare area of Barcelona.

AIMS: This study aimed to analyse the evolution of the metabolic control, cardiovascular risk factors and chronic complications in a Type 2 Diabetes (T2D) population in a healthcare area of Barcelona. METHODS: We carried out a comparative study of T2D patients (20.457) between 2012 and 2016 (data recorded in the "Electronic Clinical-Station in Primary Care") concerning: age, gender, body mass index (BMI), arterial blood pressure (BP), HbA1c, LDL-Cholesterol, smoking, heart failure (HF), micro and macrovascular complications. RESULTS: Average HbA1c was 6.9 % in 2012 and 7 % in 2016 (Non significant differences)(NS). In 2012, 57.9 % of patients presented proper glycaemic control, 42.8 % LDL-Cholesterol < 100 mg/dL and 76.9 % BP < 140/90 while in 2016 it was 61.2 % (NS), 59.2 % (p = 0.001) and 82.9 % (p = 0.016) respectively. No changes were found in BMI or active smoking. Significant increases were found in the prevalence of microvascular complications, HF and peripheral vasculopathy (PV). Patients with vascular diseases (PVD) and adequate metabolic control increased from 57.5 % to 62.7 % (p = 0.006). Albuminuria > 30 mg/g were more frequent among PVD. CONCLUSIONS: Between 2012 and 2016 it was observed that, amongst our study population, glycaemic control was steady and cholesterol and BP levels were improved, while there was a significant increase of diabetic complications, HF and PV.

Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey.

PURPOSE: To compare the EQ-5D, SF-6D, and SF-12 in terms of their capacity to discriminate between groups defined by relevant socio-demographic and health characteristics in a general population survey. METHODS: Data were obtained from the 2006 Catalan Health Interview Survey, a representative sample (n = 4,319) of the general population of Catalonia (Spain). Effect sizes (ES) and Receiver Operating Characteristic (ROC) curves were calculated to evaluate the instruments' capacity to distinguish between groups based on socio-demographic variables, recent health problems, perceived health, psychological distress, and selected chronic conditions. RESULTS: All instruments showed a similar discriminative capacity between groups based on socio-demographic variables, recent medical visit (ES = 0.47-0.55), activity limitations (ES = 0.92-0.98), perceived health (ES = 0.97-1.33), and psychological well-being (ES = 1.17-1.57). Effect sizes between respondents with and without any of fourteen selected chronic conditions were large (0.76-1.04) for 4, moderate (0.55-0.74) for 8, and small (0.17-0.39) for two on the EQ-5D index. A similar pattern was observed for the SF-12 but ES were predominantly moderate (7 conditions) or small (6 conditions) on the SF-6D. CONCLUSIONS: The EQ-5D and SF-12 were largely comparable in estimating the health burden of chronic conditions, recent health problems, and social inequalities. The SF-6D was less sensitive than the EQ-5D index and SF-12, particularly for physical chronic conditions.

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.

BACKGROUND: Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce. AIM: To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care. DESIGN AND SETTING: Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015. METHOD: Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo). RESULTS: In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses. CONCLUSION: A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.

Effectiveness of Brief Systemic Therapy versus Cognitive Behavioral Therapy in routine clinical practice.

BACKGROUND: Combining strategies and techniques from different therapeutic approaches is a common procedure in routine mental health practice. It has been claimed that the integration of systemic brief therapies offers useful psychotherapeutic alternatives, especially in our overloaded public mental health services. However, this claim has rarely been put to the test, and comparison with well-established empirically-based treatments has been scarce. METHOD: Of 419 patients referred to an Adult Ambulatory Mental Health Service, 212 were allocated to Cognitive-Behavioral Therapy (CBT), and 207 to an integrative Brief Systemic Therapy (BST). Follow-up assessments of patients’ status took place between one and three years later. RESULTS: Both therapy models were found to be equivalent in their percentage of therapeutic discharges, drop-outs, relapses and in the use of other mental health services during the follow-up period. Although both treatments were cost-efficient, BST was not briefer than CBT. The between-group equivalence was also confirmed, analyzing the data by psychiatric diagnosis. CONCLUSIONS: This study provides some preliminary data that suggest that BST might be an effective and efficient treatment in public mental health practice, comparable to well-established treatments like CBT.

Estimating preferences for treatments in patients with localized prostate cancer.

PURPOSE: Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. METHODS AND MATERIALS: This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. RESULTS: Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. CONCLUSIONS: Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions.

Quality of life impact of treatments for localized prostate cancer: cohort study with a 5 year follow-up.

PURPOSE: To assess long-term quality of life (QoL) impact of treatments in localized prostate cancer patients treated with radical prostatectomy, external beam radiotherapy or brachytherapy. MATERIAL AND METHODS: Observational, prospective cohort study with pre-treatment QoL evaluation and follow-up until five years after treatment. 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited in 2003-2005. QoL was measured by the EPIC questionnaire, with urinary irritative-obstructive, incontinence, bowel, sexual, and hormonal scores (ranging 0-100). RESULTS: Brachytherapy's QoL impact was restricted to the urinary domain, Generalized Estimating Equation models showed score changes at five years of -12.0 (95% CI=-15.0, -9.0) in incontinence and -5.3 (95% CI=-7.5, -3.1) in irritative-obstructive scales. Compared to brachytherapy, radical prostatectomy fared +3.3 (95% CI=+0.0, +6.5) points better in irritative-obstructive but -17.1 (95% CI=-22.7, -11.5) worse in incontinence. Sexual deterioration was observed in radical prostatectomy (-19.1; 95% CI=-25.1, -13.1) and external radiotherapy groups (-7.5; 95% CI=-12.5, -2.5). CONCLUSIONS: Brachytherapy is the treatment causing the least impact on QoL except for moderate urinary irritative-obstructive symptoms. Our study provides novel long-term valuable information for clinical decision making, supporting brachytherapy as a possible alternative to radical prostatectomy for patients seeking an attempted curative treatment, while limiting the risk for urinary incontinence and sexual impact on QoL.

[Reference guidelines for the 12-Item Short-Form Health Survey version 2 based on the Catalan general population]. / Normas de referencia para el Cuestionario de Salud SF-12 versión 2 basadas en población general de Cataluña.

BACKGROUND AND OBJECTIVE: The SF-12 health survey is the short version of the SF-36. The main interpretation strategy for these health related quality of life (HRQL) questionnaires is the use of population based reference values. This study aims to obtain the population based norms for the Spanish version of SF-12 version 2 (SF-12v2), to evaluate its construct validity and to compare the scores obtained by the standard and the specific method of calculation. SUBJECTS AND METHODS: We analyzed a subsample of the Catalan Health Interview Survey (n=4,261), representative of the general non-institutionalized population. Median and percentiles were calculated for each of the 8 dimensions and for the component summaries, stratified by sex and age groups. The construct validity was evaluated by comparing known groups, applying ANOVA. RESULTS: The results for the known groups analysis supported the hypothesis established a priori (P<.001): worse physical health for persons with mobility problems (EQ-5D) (37.8 vs 52), with restriction in activities (41.8 vs 51.2), and with greater number of chronic disorders (from 43.2 to 53.9); and worse mental health with problems of anxiety/depression (EQ-5D) (42.2 vs 51.9). The scores obtained by the 2 different methods of calculation were similar, except for General Health and Vitality. CONCLUSIONS: The SF-12v2 is a valid instrument to measure HQRL in our environment. The obtained norms facilitate the interpretation of SF-12v2 scores in the clinical practice, research and health policy. We recommend the use of the specific method of calculation for national HRQL comparison and the standard one for international comparison.

[Cost comparison of three treatments for localized prostate cancer in Spain: radical prostatectomy, prostate brachytherapy and external 3D conformal radiotherapy]. / Comparación de costes de tres tratamientos del cáncer de próstata localizado en España: prostatectomía radical, braquiterapia prostática y radioterapia conformacional externa 3D.

OBJECTIVE: To compare the initial costs of the three most established treatments for clinically localized prostate cancer according to risk, age and comorbidity groups, from the healthcare provider's perspective. METHODS: We carried out a cost comparison study in a sample of patients consecutively recruited between 2003 and 2005 from a functional unit for prostate cancer treatment in Catalonia (Spain). The use of services up to 6 months after the treatment start date was obtained from hospital databases and direct costs were estimated by micro-cost calculation. Information on the clinical characteristics of patients and treatments was collected prospectively. Costs were compared by using nonparametric tests comparing medians (Kruskall-Wallis) and a semi-logarithmic multiple regression model. RESULTS: Among the 398 patients included, the cost difference among treatments was statistically significant: medians were € 3,229.10, € 5,369.00 and € 6,265.60, respectively, for the groups of patients treated with external 3D conformal radiotherapy, brachytherapy and radical retropublic prostatectomy, (p<0.001). In the multivariate analysis (adjusted R(2)=0.8), the average costs of brachytherapy and external radiotherapy were significantly lower than that of prostatectomy (coefficient -0.212 and -0.729, respectively). CONCLUSIONS: Radical prostatectomy proved to be the most expensive treatment option. Overall, the estimated costs in our study were lower than those published elsewhere. Most of the costs were explained by the therapeutic option and neither comorbidity nor risk groups showed an effect on total costs independent of treatment.