ABSTRACT
OBJECTIVE: To provide a comprehensive and detailed overview of the burden of disease in Spain for 2008. Implications for public health policies are discussed. STUDY DESIGN: Cross-sectional population-based study. METHODS: Disability-adjusted life years (DALYs) were calculated at country level using the methodology developed in the Global Burden of Disease study. DALYs were divided into years of life lost and years of life lived with disability. Results were obtained using Spanish mortality data for 2008 and morbidity data estimated previously by the World Health Organization for Euro-A. RESULTS: In 2008, DALYs lost due to all diseases and injuries were estimated at 5.1 million. Non-communicable diseases accounted for 89.2% of the total DALYs. The leading causes of DALYs were neurological and mental disorders (29.9%), malignant neoplasms (15.8%) and cardiovascular diseases (12.5%). The main specific causes included depression (5.5%), ischaemic heart disease (5.5%), lung cancer (5.3%) and alcohol abuse (4.7%) among males; and depression (11.7%), dementias (10.0%), hearing loss (4.2%) and cerebrovascular disease (3.5%) among females. CONCLUSIONS: Measuring DALYs specifically for Spain represents a systematic analysis of population health losses, and also provides an important measure to track the outcomes of future health interventions.
Subject(s)
Cost of Illness , Disabled Persons/statistics & numerical data , Quality-Adjusted Life Years , Wounds and Injuries/epidemiology , Adolescent , Adult , Aged , Cause of Death , Child , Child, Preschool , Cross-Sectional Studies , Female , Health Policy , Humans , Infant , Male , Middle Aged , Spain/epidemiology , Wounds and Injuries/mortality , Young AdultABSTRACT
Objetivo Revisar los métodos utilizados para elaborar evaluaciones económicas de intervenciones en enfermedades oncológicas y comparar sus principales características con las de los estudios dirigidos a otras enfermedades. Métodos Revisión sistemática y análisis comparativo calculando odds ratios (OR). Se realizaron búsquedas bibliográficas para identificar las evaluaciones económicas sobre enfermedades oncológicas realizadas en España entre 1983 y 2008. Se revisaron y describieron sus características, incluyendo las siguientes variables: revista y año de publicación, intervención, tipo de estudio, diseño, perspectiva, tipo de costes, fuente de financiación, y si se presentaban (o no) recomendaciones. Resultados Se incluyeron 63 estudios. Principalmente, resultaron ser análisis coste-efectividad y evaluaban tratamientos (60,3%; n=38). Diecisiete estudios (27,0%) utilizaron un diseño observacional. Los trabajos sobre enfermedades oncológicas mostraron las siguientes asociaciones (respecto a los estudios en otras causas [n=411]) con: análisis de minimización de costes (OR=1,73; intervalo de confianza [IC] del 95%: 0,91-3,27), diagnóstico (OR=2,18; IC95%: 1,07-4,43), análisis de decisiones (OR=0,46; IC95%: 0,24-0,87), perspectiva social (OR=0,20; IC95%: 0,05-0,86) y fuente de financiación con ánimo de lucro (OR=0,52; IC95%: 0,30-0,93).Conclusiones El número de evaluaciones económicas es escaso a pesar del aumento progresivo producido en los últimos años. Los estudios identificados presentaron heterogeneidad en cuanto a los métodos y las fuentes de información utilizadas. Es necesario aumentar la evaluación de la eficiencia de intervenciones oncológicas y garantizar su calidad metodológica (AU)
Objective To review standard methods used to evaluate the efficiency of oncology interventions, comparing their main characteristics with those of the studies aimed for other conditions. Methods We performed a systematic review and comparative analysis calculating odds ratios (OR). We searched the biomedical literature to assess economic evaluation studies on malignant neoplasms in Spain published between 1983 and 2008. Their characteristics were reviewed and summarised, including the following variables: journal and year of publication, intervention, type and design of study, perspective, type of costs, financing source, and decision-making recommendations. Results Sixty-three studies were included. Main characteristics of the reports were: cost-effectiveness analysis and therapeutic interventions (60.3%; n=38). Seventeen studies (27.0%) used an observational design. Economic evaluations of malignant neoplasms showed the following associations (compared to those studies addressing other causes [n=411]): cost minimisation analysis (OR: 1.73; 95% confidence interval [CI]: 0.91-3.27), diagnostic interventions (OR: 2.18; 95% CI: 1.07-4.43), decision analysis design (OR: 0.46; 95% CI: 0.24-0.87), societal perspective (OR: 0.20; 95% CI: 0.05-0.86) and for-profit source of financing (OR: 0.52; 95% CI: 0.30-0.93). Conclusions Economic evaluations of interventions for malignant neoplasms are not common despite the gradual increase produced during recent years in Spain. Reports presented heterogeneity in the quality of the information regarding the methods and the data sources used. Further efficiency evaluations of oncology interventions are needed and methodological quality should be warranted (AU)
Subject(s)
Humans , Drug Costs/statistics & numerical data , Antineoplastic Agents/economics , Neoplasms/drug therapy , Evaluation of the Efficacy-Effectiveness of Interventions , Neoplasms/economicsABSTRACT
OBJECTIVE: To review standard methods used to evaluate the efficiency of oncology interventions, comparing their main characteristics with those of the studies aimed for other conditions. METHODS: We performed a systematic review and comparative analysis calculating odds ratios (OR). We searched the biomedical literature to assess economic evaluation studies on malignant neoplasms in Spain published between 1983 and 2008. Their characteristics were reviewed and summarised, including the following variables: journal and year of publication, intervention, type and design of study, perspective, type of costs, financing source, and decision-making recommendations. RESULTS: Sixty-three studies were included. Main characteristics of the reports were: cost-effectiveness analysis and therapeutic interventions (60.3%; n=38). Seventeen studies (27.0%) used an observational design. Economic evaluations of malignant neoplasms showed the following associations (compared to those studies addressing other causes [n=411]): cost minimisation analysis (OR: 1.73; 95% confidence interval [CI]: 0.91-3.27), diagnostic interventions (OR: 2.18; 95% CI: 1.07-4.43), decision analysis design (OR: 0.46; 95% CI: 0.24-0.87), societal perspective (OR: 0.20; 95% CI: 0.05-0.86) and for-profit source of financing (OR: 0.52; 95% CI: 0.30-0.93). CONCLUSIONS: Economic evaluations of interventions for malignant neoplasms are not common despite the gradual increase produced during recent years in Spain. Reports presented heterogeneity in the quality of the information regarding the methods and the data sources used. Further efficiency evaluations of oncology interventions are needed and methodological quality should be warranted.
Subject(s)
Cost-Benefit Analysis/statistics & numerical data , Neoplasms/economics , Bibliometrics , Clinical Trials as Topic/economics , Cost Savings , Cost-Benefit Analysis/methods , Decision Support Techniques , Financing, Organized , Health Expenditures/statistics & numerical data , Humans , Journal Impact Factor , Models, Theoretical , Neoplasms/diagnosis , Neoplasms/prevention & control , Neoplasms/rehabilitation , Neoplasms/therapy , Odds Ratio , Research Design , Spain , Treatment OutcomeSubject(s)
Cardiovascular Diseases/economics , Cost-Benefit Analysis/statistics & numerical data , Cardiac Rehabilitation , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/therapy , Clinical Trials as Topic/economics , Clinical Trials as Topic/statistics & numerical data , Cost-Benefit Analysis/methods , Decision Support Techniques , Health Facilities/economics , Health Facilities/statistics & numerical data , Humans , Models, Theoretical , Research Design , Spain , Treatment OutcomeABSTRACT
BACKGROUND: There exists the need to evaluate interventions addressed to prevent, control and reduce the burden of the infectious diseases; being economic evaluation an instrument can help to allocate healthcare resources efficiently. In this context, we assessed the evolution of economic evaluation of interventions for infectious diseases published in Spain, as well as we compared their main methodological characteristics with those of the studies directed to other diseases. METHODS: Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature beetwen 1983 and 2008 were conducted in PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME e IBECS, and manually in specialized journals and technical reports. The following variables were identified to analyze the characteristics of the reports: journal and year of publication, intervention, type of study, design, perspective, type of costs, financing source, and decision-making recommendations. RESULTS: One-hundred and one studies were included in the review. The main characteristics of the reports were: cost-effectiveness analysis (n=56; 55.4%), treatments evaluations (n=60; 59.4%) and the use of decision analysis and mathematical simulation models (n=63; 62.4%). Economic evaluation studies of infectious diseases showed the following associations (compared to a cohort of studies of other disease conditions [n=376]): cost-benefit analysis (OR, 3.55; 95% confidence interval [CI], 1.63 to 7.74), prevention (OR, 4.14; 95% CI, 2.49 to 6.90), and societal perspective (OR, 2.55; 95% CI, 1.43 to 4.56). CONCLUSION: Although there is an increase in the number of economic evaluations of infectious diseases published during last decades, the studies showed heterogeneity in the quality of the information regarding methods of analysis and data sources.
Subject(s)
Infections/drug therapy , Infections/economics , Cost-Benefit Analysis , Humans , Models, Statistical , Odds Ratio , SpainABSTRACT
AIM: We analyzed the trends over time and the characteristics of economic evaluation studies of neurological and mental disorders published in Spain between 1983 and 2008. MATERIALS AND METHODS: Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature were conducted in PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME and IBECS, and manually in specialized journals and technical reports. RESULTS: The 52 studies included in the review showed heterogeneity in the quality of the information regarding methods of analysis and data sources. Economic evaluation studies of neurological and mental disorders showed the following associations, compared to a cohort of studies of other disease conditions (n = 425): cost-utility analysis (OR = 1.57; 95% confidence interval, 95% CI = 0.77-3.22), treatments (OR = 3.02; 95% CI = 1.33-6.88), simulation mathematics models (OR = 2.51; 95% CI = 1.30-4.87), and healthcare system perspective (OR = 1.43; 95% CI = 0.80-2.54). CONCLUSIONS: Findings suggested that there is little research on economic evaluation research on neurological and mental disorders in Spain. In the future, more and better quality economic evaluation studies -according to their burden generated- are expected.
Subject(s)
Cost-Benefit Analysis/economics , Cost-Benefit Analysis/trends , Mental Disorders/economics , Cost of Illness , Databases, Factual , Evaluation Studies as Topic , Humans , Models, Theoretical , Quality-Adjusted Life Years , SpainABSTRACT
Objetivo. Analizar la evolución y las características metodológicas de los estudios de evaluación económica sobre enfermedades neurológicas y mentales publicados en España entre 1983 y 2008. Materiales y métodos. Revisión sistemática y análisis comparativo calculando odds ratios (OR). Se realizaron búsquedas de estudios publicados en PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME e IBECS, y además manualmente en revistas especializadas e informes técnicos. Resultados. Los 52 estudios incluidos en la revisión combinan heterogeneidad en la calidad de la información comunicada respecto a los métodos de análisis y las fuentes de datos. Los trabajos sobre enfermedades neurológicas y mentales mostraron las siguientes asociaciones, respecto a los estudios en otras causas (n = 425): con análisis coste-utilidad (OR = 1,57; intervalo de confianza del 95%, IC 95% = 0,77-3,22), tratamientos (OR = 3,02; IC 95% = 1,33-6,88), modelos matemáticos de simulación (OR = 2,51; IC 95% = 1,30-4,87) y perspectiva del sistema sanitario (OR = 1,43; IC 95% = 0,80-2,54). Conclusiones. Se observa que hay poca investigación en evaluación económica sobre enfermedades neurológicas y mentales en España. Sería de esperar que en el futuro aumentara el número de estudios en enfermedades neurológicas y mentales en relación con la carga de enfermedad que generan y su calidad metodológica (AU)
Aim. We analyzed the trends over time and the characteristics of economic evaluation studies of neurological and mental disorders published in Spain between 1983 and 2008. Materials and methods. Systematic review and comparative analysis calculating odds ratios (OR). Electronic searches for literature were conducted in PubMed/Medline, Scopus, ISI Web of Knowledge, CRD, IME and IBECS, and manually in specialized journals and technical reports. Results. The 52 studies included in the review showed heterogeneity in the quality of the information regarding methods of analysis and data sources. Economic evaluation studies of neurological and mental disorders showed the following associations, compared to a cohort of studies of other disease conditions (n = 425): cost-utility analysis (OR = 1.57; 95% confidence interval, 95% CI = 0.77-3.22), treatments (OR = 3.02; 95% CI = 1.33-6.88), simulation mathematics models (OR = 2.51; 95% CI = 1.30-4.87), and healthcare system perspective (OR = 1.43; 95% CI = 0.80-2.54). Conclusions. Findings suggested that there is little research on economic evaluation research on neurological and mental disorders in Spain. In the future, more and better quality economic evaluation studies according to their burden generated are expected (AU)
Subject(s)
Humans , Mental Disorders/economics , Nervous System Diseases/economics , Cost of Illness , 50303 , Economics, Pharmaceutical/trendsABSTRACT
El presente estudio trata de realizar una estimación del consumo de recursos sanitarios y costes monetarios medios generados por pacientes de la Comunidad de Madrid (CAM) atendidos en Centros de Salud Mental (CSM) e identificar factores que pueden estar asociados con el coste total, además de estudiar la comorbilidad física y psiquiátrica. Para ello se realizó un estudio descriptivo transversal, siendo la población de referencia 309 pacientes de ambos sexos, mayores de 17 años, con diagnóstico CIE-9 de depresión neurótica, reacción depresiva breve, reacción depresiva prolongada y trastorno depresivo no clasificado en otra parte. El coste medio total por paciente es de 442,15e, el coste medio del consumo de fármacos es 378,58e y el gasto medio por paciente de las asistencias es de 63,58e. Existe una elevada variabilidad entre los costes mínimos y máximos que ha llevado a dividir la muestra en grupos mediante cuartiles de gastos para su análisis y se concluye que el diagnóstico con mayor porcentaje de pacientes es el de depresión neurótica, siendo el que presenta los mayores costes (546,14e) (AU)
The present study tries to make an estimation of the consumption of health care resources and monetary costs means generated by patients of the Community of Madrid (CAM) seen in Mental Health Centers (CSM) and to identify factors that may be associated with the total cost, beside studying the phisical and psychiatric conmorbidity. We conducted a corss-sectional study, being the reference population of 309 male and female patients older than 17 years, with ICD-9 diagnosis of depression neurotic, depressive reaction shortly prolonged depressive reaction and depressive disorder not classified under another part. The average totalcost per patient is 442,15 e the average cost of the drugs is 378,58 e and the average expense per patient attendance is 63,58 e. There is a high variability between the minimum and maximum costs that led to divide the sample into groups by quartile expenses for analysis and concluded that the diagnosis of patients with the highest percentage is the neurotic depression, and the one that presents the greatest costs (546,14 e) (AU)
Subject(s)
Humans , Depressive Disorder/epidemiology , Antidepressive Agents/economics , Health Care Rationing/organization & administration , /statistics & numerical dataABSTRACT
BACKGROUND: In view of the highly limited amount of data on the prevalence of hypothyroidism in Spain, the decision was made to estimate this prevalence based on the consumption of its specific treatment, that is, thyroid hormones, employing the drug use study methodology. METHODS: Calculation of the Daily Inhabitants Doses (DID)' of thyroid hormones (ATC treatment group H03) by means of the Defined Daily Doses (DDD's) for 1996-1999 in the different provinces, autonomous communities and on a nationwide basis. The confidence intervals have been calculated at 95% for the estimated prevalence figures in the autonomous communities and nationwide, in addition to the percentage increases for 1999 as compared to 1996. The prescription-related data was furnished by the Spanish Ministry of Health and Consumer Affairs. RESULTS: Nationwide hypothyroidism prevalence is estimated at 3.19 cases per 1,000 inhabitants for 1996 and at 4.33 cases per 1000 inhabitants for 1999, totaling a percentage increase of 26.38%. The DID results revealed prevalence figures which vary from one province to another: Guadalajara having totaled the highest figures for the two years studied (5.02 and 7.01 cases per 1,000 inhabitants/day respectively in 1996 and 1999), Melilla having recorded the lowest (1.07 and 1.60 cases per 1,000 inhabitants/day). The DID revealed an increase in all of the provinces and autonomous communities in 1999 as compared to 1996. This lowest increase was in Asturias (9.62%), the highest having been in La Rioja (35.26%). CONCLUSIONS: The 3.19 and 4.33 DDD per 1,000 inhabitants/day respectively in 1996 and 1999 may be interpreted as the prevalence of diagnosed and treated hypothyroidism. These figures fall within the range found in other studies, although one must be highly cautious when drawing comparisons among studies in which different methodologies are employed. The reason for the increased consumption found could best be said to lie in this disease being diagnosed to a better degree more than its being due to any actual increase in prevalence per se.
