Evaluación económica e impacto presupuestario de un procedimiento de telemedicina para el control de calidad de las espirometrías en atención primaria / Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting

OBJETIVO: Evaluar el impacto económico de un sistema de telemedicina en un sistema público de salud para la mejora de la calidad de las espirometrías (espirometrías forzadas [EF]) en atención primaria. MATERIAL Y MÉTODOS: Se ha evaluado el impacto económico de 9.039 EF realizadas en 51 centros de salud (2010-2013) mediante teleespirometría (TE) comparándose con el sistema habitual. RESULTADOS: El sistema de TE encarece el coste unitario de la EF (47,8 € vs. 39,7 €) (2013), pero logra una mejora en la calidad de las mismas (un 84% con buena calidad, frente a un 61% mediante el procedimiento habitual). El coste total de la TE ha sido de 431.974 € (358.306 € por sistema habitual), lo que supone un impacto económico de 73.668 € (2013). El aumento de gasto para EF de buena calidad realizadas con TE fue de 34.030 € (2010) y de 144.295 € (2013), mientras que para las pruebas con mala calidad fue de -15.525€ (2010) y de -70.627€ (2013). CONCLUSIÓN: Del análisis coste-efectividad se concluye que la TE es un 23% más costosa y un 46% más efectiva. Asimismo, el gasto sanitario es menor a medida que el número de EF realizadas mediante TE aumenta. La no realización de EF de mala calidad, no válidas, supone un ahorro que compensa el aumento del gasto por la realización mediante TE, siendo un sistema coste-efectivo

OBJECTIVE: To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. Materials and methods: The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. RESULTS: TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). CONCLUSION: The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method

Clinical features and survival of 338 multiple myeloma patients treated with hematopoietic stem cell transplantation or conventional chemotherapy.

Therapeutic approaches against multiple myeloma (MM) have largely changed during the past decade. Hematopoietic stem cell transplantation (HSCT) and licensing of immunomodulators and proteasome inhibitors have resulted in better response and increased overall survival rates compared to previous conventional therapies. To assess the impact that these new strategies have had on outcome of patients with symptomatic MM in Spain, we conducted an epidemiological retrospective analysis of 338 newly diagnosed patients with stage II-III MM who started first-line treatment over a 2-yr period (2003-2005) by collecting data from their medical records. Most patients had been diagnosed with secretory MM (94.4%), 41.7% stage II and 58.3% stage III. The presence of bone lesions (72.2%), as well as anemia (79.8%) and elevated beta2-microglobulin levels (62.3%), was a common finding; in contrast, hypercalcemia and elevated serum creatinine were less frequent (25% each). First-line treatment had consisted of either conventional chemotherapy (62%) or induction treatment plus autologous HSCT (38%), as per standard clinical practice. HSCT not only resulted in greater objective response rates (93% vs. 50%), but also contributed to a significant increase in 3-yr survival (85% vs. 49.7%; 95% CI, range 77-91 vs. 41-58; P < 0.001). Overall, 55% of patients presented treatment-related adverse events, mainly hematological. Toxicity rates were higher among patients treated with alkylating-based regimens and in those undergoing transplantation. In conclusion, data analysis shows an adequate balance between increased response rates and safety that supports the use of up-front high-dose HSCT therapy in younger patients. Most importantly, this study provides further confirmation that the introduction of HSCT has significantly prolonged survival of patients with MM.

Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting.

OBJECTIVE: To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. MATERIALS AND METHODS: The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. RESULTS: TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). CONCLUSION: The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method.

Telemedicine spirometry training and quality assurance program in primary care centers of a public health system.

BACKGROUND: Forced spirometry is essential for diagnosing respiratory diseases and is widely used across levels of care. However, several studies have shown that spirometry quality in primary care is not ideal, with risks of misdiagnosis. Our objective was to assess the feasibility and performance of a telemedicine-based training and quality assurance program for forced spirometry in primary care. MATERIALS AND METHODS: The two phases included (1) a 9-month pilot study involving 15 centers, in which spirometry tests were assessed by the Basque Office for Health Technology Assessment, and (2) the introduction of the program to all centers in the Public Basque Health Service. Technicians first received 4 h of training, and, subsequently, they sent all tests to the reference laboratory using the program. Quality assessment was performed in accordance with clinical guidelines (A and B, good; C-F, poor). RESULTS: In the first phase, 1,894 spirometry tests were assessed, showing an improvement in quality: acceptable quality tests increased from 57% at the beginning to 78% after 6 months and 83% after 9 months (p<0.001). In the second phase, 7,200 spirometry tests were assessed after the inclusion of 36 additional centers, maintaining the positive trend (61%, 87%, and 84% at the same time points; p<0.001). CONCLUSIONS: (1) The quality of spirometry tests improved in all centers. (2) The program provides a tool for transferring data that allows monitoring of its quality and training of technicians who perform the tests. (3) This approach is useful for improving spirometry quality in the routine practice of a public health system.

Paciente con poliposis adenomatosa familiar y metástasis hepáticas de tumor neuroendocrino / Familial adenomatous polyposis and liver metastases from a neuroendocrine tumor

La poliposis adenomatosa familiar (PAF) se caracteriza principalmente por el desarrollo de un gran número de pólipos en el tracto gastrointestinal y por un mayor riesgo de desarrollo de adenocarcinomas. A continuación presentamos el caso de una paciente diagnosticada de PAF y metástasis hepáticas, cuyo examen histológico reveló que eran secundarias a un tumor neuroendocrino. En la revisión bibliográfica sólo se han descrito hasta el momento 3 casos en los cuales ambas entidades coexisten. Actualmente no hay ninguna base genética que explique la coexistencia de estas 2 enfermedades cuyas prevalencias son muy bajas (AU)

Familial adenomatous polyposis (FAP) is mainly characterized by the development of a large number of polyps in the gastrointestinal tract and by the risk of developing adenocarcinomas. We present the case of a woman diagnosed with FAP and liver metastases. Histological analysis revealed both diseases to be secondary to a neuroendocrine tumor. To date, only three cases showing the simultaneous occurrence of these two entities have been published. Currently, there is no genetic basis to explain the coexistence of these two diseases, both of which have a very low prevalence (AU)

[Familial adenomatous polyposis and liver metastases from a neuroendocrine tumor]. / Paciente con poliposis adenomatosa familiar y metástasis hepáticas de tumor neuroendocrino.

Familial adenomatous polyposis (FAP) is mainly characterized by the development of a large number of polyps in the gastrointestinal tract and by the risk of developing adenocarcinomas. We present the case of a woman diagnosed with FAP and liver metastases. Histological analysis revealed both diseases to be secondary to a neuroendocrine tumor. To date, only three cases showing the simultaneous occurrence of these two entities have been published. Currently, there is no genetic basis to explain the coexistence of these two diseases, both of which have a very low prevalence.