Efecto de la edad y el género sobre las consecuencias clínicas y económicas del tratamiento con especialidad farmacéutica de marca o genérica en pacientes con dolor neuropático periférico en práctica clínica habitual / Clinical and economic consequences of treating patients with peripheral neuropathic pain with brand name or generic drugs in routine clinical practice: The effects of age and sex

OBJETIVO: Analizar el efecto de la edad y el género sobre el dolor y los costes en pacientes con dolor neuropático periférico (DNp) crónico que inician tratamiento con gabapentina (marca) frente a gabapentina genérica (EFG). MÉTODOS: Estudio multicéntrico-retrospectivo, realizado con registros médicos electrónicos (RME) de pacientes de ambos géneros, > 18años, que iniciaron nuevo tratamiento con gabapentina de marca o genérico. Durante un año se midió la adherencia (ratio posesión medicación [RPM]) y la persistencia, la utilización de recursos sanitarios, los costes y la reducción del dolor. RESULTADOS: Se analizaron 1.369 RME (61,1% mujeres; edad 64,6 [15,9] años, 52,4% ≥ 65 años); marca: 400, EFG: 969. La persistencia y la adherencia fueron mayores con marca: 7,3 vs. 6,3 meses (p < 0,001) y 86,5 vs. 81,3% de RPM (p < 0,001). Con marca, se observaron costes sanitarios menores, tanto en < 65 como en ≥ 65años (diferencias medias por paciente de 221 Euros [IC95%: 59-382] y de 217 Euros [51-382], respectivamente [p < 0,01]), como en hombres (diferencias medias de 197 Euros [63-328]) o mujeres (diferencias de 239 Euros [96-397]), p = 0,005 y p = 0,004, respectivamente. Comparado con EFG, el tratamiento con marca mostró una reducción mayor del dolor: 13,5% (10,9-16,2) y 10,8% (8,2-13,5) en < 65 y ≥ 65 años, respectivamente (p < 0,001), así como del 10,7% (8,2-13,2) y del 13,8% (11,0-16,5) en mujeres y hombres, respectivamente (p < 0,001). CONCLUSIONES: Con independencia del género o la edad, los pacientes que iniciaron tratamiento del DNp con gabapentina de marca vs. genérico mostraron un mayor grado de adherencia y persistencia al tratamiento, repercutiendo en unos menores costes sanitarios, a la vez que se observaron mayores reducciones del dolor

OBJECTIVE: We aimed to analyse the effects of age and sex on pain and cost for patients with chronic peripheral neuropathic pain (PNP) who have started treatment with brand name gabapentin versus generic gabapentin (EFG). METHODS: We conducted a retrospective multicentre study using electronic medical records (EMR) for patients of both sexes, older than 18, who began treatment with brand name or generic gabapentin. Adherence (medication possession ratio [MPR]), persistence, use of healthcare resources, cost, and pain reduction were measured for one year. RESULTS: We analysed 1369 EMRs [61.1% women; mean age 64.6 (15.9), 52.4% ≥ 65 years]; 400 used brand name drugs while 969 used generic gabapentin. Persistence and adherence were higher in patients using brand name gabapentin (7.3 vs 6.3 months, P < .001; 86.5% vs 81.3% MPR, P < .001). Lower healthcare costs were observed in patients using brand-name gabapentin in both age groups (< 65 and ≥ 65). Mean difference in cost per patient amounted to Euros221 (95%CI: 59-382) and Euros 217 (95%CI: 51-382) in the < 65 and ≥ 65 age groups, respectively (P < .01). Mean difference in cost among men amounted to Euros 197 (63-328), while mean difference in cost among women amounted to Euros 239 (96-397) (P = .005 and P = .004, respectively). Compared with EFG, brand treatment showed greater pain relief: 13.5% (10.9-16.2) and 10.8% (8.2-13.5) in < 65 and ≥ 65year patients, respectively (P < .001), and 10.7% (8.2-13.2) and 13.8% (11.0-16.5) in women and men respectively (P < .001). CONCLUSIONS: Regardless of sex and age, patients who started PNP treatment with brand name medication showed greater persistence and adherence to treatment than those taking generic drugs. Brand name treatment also involved lower healthcare costs, and greater pain relief

Clinical and economic consequences of treating patients with peripheral neuropathic pain with brand name or generic drugs in routine clinical practice: The effects of age and sex. / Efecto de la edad y el género sobre las consecuencias clínicas y económicas del tratamiento con especialidad farmacéutica de marca o genérica en pacientes con dolor neuropático periférico en práctica clínica habitual.

OBJECTIVE: We aimed to analyse the effects of age and sex on pain and cost for patients with chronic peripheral neuropathic pain (PNP) who have started treatment with brand name gabapentin versus generic gabapentin (EFG). METHODS: We conducted a retrospective multicentre study using electronic medical records (EMR) for patients of both sexes, older than 18, who began treatment with brand name or generic gabapentin. Adherence (medication possession ratio [MPR]), persistence, use of healthcare resources, cost, and pain reduction were measured for one year. RESULTS: We analysed 1369 EMRs [61.1% women; mean age 64.6 (15.9), 52.4%≥65 years]; 400 used brand name drugs while 969 used generic gabapentin. Persistence and adherence were higher in patients using brand name gabapentin (7.3 vs 6.3 months, P<.001; 86.5% vs 81.3% MPR, P<.001). Lower healthcare costs were observed in patients using brand-name gabapentin in both age groups (<65 and ≥65). Mean difference in cost per patient amounted to €221 (95%CI: 59-382) and €217 (95%CI: 51-382) in the <65 and ≥65 age groups, respectively (P<.01). Mean difference in cost among men amounted to €197 (63-328), while mean difference in cost among women amounted to €239 (96-397) (P=.005 and P=.004, respectively). Compared with EFG, brand treatment showed greater pain relief: 13.5% (10.9-16.2) and 10.8% (8.2-13.5) in <65 and ≥65year patients, respectively (P<.001), and 10.7% (8.2-13.2) and 13.8% (11.0-16.5) in women and men respectively (P<.001). CONCLUSIONS: Regardless of sex and age, patients who started PNP treatment with brand name medication showed greater persistence and adherence to treatment than those taking generic drugs. Brand name treatment also involved lower healthcare costs, and greater pain relief.

Modelling a budgetary impact analysis for funding drug-based smoking cessation therapies for patients with major depressive disorder in Spain.

BACKGROUND: Smoking is associated with high healthcare resource utilisation and cost to society. Patients with major depressive disorder (MDD) exhibit high susceptibility to nicotine dependence. Varenicline, bupropion and nicotine replacement therapy are all indicated for smoking cessation; however funding by the Spanish national health system (SNHS) is limited. We modelled a budgetary impact analysis (BIA) to estimate the impact of the SNHS funding drug-based therapies for smoking cessation in smokers with MDD. METHODS: The BIA compared the current unfunded scenario versus a funded scenario (varenicline, bupropion, nicotine replacement therapy combined with medical follow-up and counselling) using the Spanish SNHS and societal perspectives. The BIA design was a hybrid model using a decision tree algorithm (population size: smokers with MDD) and Markov chains (smoking cessation attempts) over a 5-year horizon. Smoking cessation drug efficacy was derived from clinical trials, and smoking cessation costs avoided were taken from an analysis of the Spanish National Health Survey. Results were shown as incremental cost savings. Scenarios and threshold univariate sensitivity analyses tested model robustness. RESULTS: The funded scenario resulted in an increase of 43,478 cessation attempts and 8930 fewer smokers after 5 years compared to the unfunded scenario. The cost of funding was €25.3 million and costs avoided were €26.5 million. There was a cumulative 5-year incremental cost saving of €1.2 million to Spanish society. Results were robust using alternative scenarios. CONCLUSIONS: Funding smoking cessation drugs in patients with MDD is of economic benefit to Spain and could produce net savings from the third year of implementation.

Uso de recursos sanitarios y costes asociados en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva tratados con antimuscarínicos en la práctica médica habitual / Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice

Objetivo: Evaluar el uso de recursos y costes sanitarios en pacientes ancianos vulnerables no institucionalizados con vejiga hiperactiva (VH) tratados con fesoterodina, solifenacina o tolterodina en la práctica médica habitual. Material y métodos: Estudio multicéntrico, retrospectivo, realizado a partir de los registros de pacientes atendidos durante 2008-2010 en 3 localidades geográficas y que iniciaron tratamiento con antimuscarínicos (fesoterodina, solifenacina y tolterodina) para la VH. El atributo de vulnerabilidad se basó en reunir, al menos, 3 de los criterios del Vulnerable-Elders Survey-13; edad > 75 años, salud pobre/normal para la edad y alguna dificultad en al menos una actividad física diaria. Principales medidas: comorbilidad, persistencia y uso de recursos y costes. El seguimiento de los pacientes se realizó durante 52 semanas. Se utilizó un modelo lineal general con covariables y remuestreo (1.000) aleatorio para construir el IC 95% de las diferencias de costes entre fármacos. Resultados: Se analizaron registros de 552 pacientes (50,8% mujeres, edad media: 80,2 años), tratados con fesoterodina (n = 58), solifenacina (n = 252) o tolterodina (n = 212). El uso de absorbentes fue del 20,7, 29,4 y 33,0% (p = 0,186), respectivamente. La persistencia al tratamiento fue ligeramente mayor con fesoterodina. Los costes sanitarios paciente/año fueron inferiores con fesoterodina, 1.775 euros (1.550-2.014) vs. solifenacina 2.062 euros (1.911-2.223) y tolterodina 2.149 euros (1.978-2.307), p = 0,042, como consecuencia de una menor utilización de visitas y medicación concomitante. Conclusiones: A pesar de las posibles limitaciones del estudio, los pacientes ancianos vulnerables no institucionalizados con VH tratados con fesoterodina, en comparación con solifenacina o tolterodina, se asociaron a una menor utilización de recursos y costes sanitarios

Objective: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. Material and methods: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age > 75 years, poor/average age for health and difficulty in at least one daily physical activity. Main measures: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. Results: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N = 58), solifenacin (N = 252) or tolterodine (N = 212). The use of absorbent was 20.7%, 29.4% and 33.0% (p = 0.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, euros 1775 (1550-2014) vs. solifenacin euros 2062 (1911-2223) and tolterodine euros 2149 (1978-2307), p = 0.042, as a result of lower utilization visits and concomitant medication. Conclusions: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs

Use of health care resources and associated costs in non-institutionalized vulnerable elders with overactive bladder treated with antimuscarinic agents in the usual medical practice.

OBJECTIVE: To evaluate the use of resources and health costs in vulnerable elderly institutionalized patients with overactive bladder (OAB) treated with fesoterodine, tolterodine or solifenacin in routine medical practice. MATERIAL AND METHODS: A multicenter retrospective study, from the records of patients treated during 2008-2010 in three geographical locations and starting treatment with antimuscarinic (fesoterodine, solifenacin and tolterodine) for OAB. The attribute of vulnerability was based on collecting at least 3 of the Vulnerable Elders Survey criteria-13, age>75 years, poor/average age for health and difficulty in at least one daily physical activity. MAIN MEASURES: morbidity, persistence and resource use and costs. Monitoring of patients was conducted over 52 weeks. A general linear model with covariates and bootstraping (1000) at random was used to construct the 95% CI of the cost differences between drugs. RESULTS: Records of 552 patients (50.8% women, mean age: 80.2 years) were analyzed. Treated with fesoterodine (N=58), solifenacin (N=252) or tolterodine (N=212). The use of absorbent was 20.7%, 29.4% and 33.0% (P=.186), respectively. Persistence to treatment was slightly greater with fesoterodine. The patient healthcare costs/year were lower with fesoterodine, €1,775 (1550-2014) vs. solifenacin €2,062 (1911-2223) and tolterodine €2,149 (1,978-2,307), P=.042, as a result of lower utilization visits and concomitant medication. CONCLUSIONS: Despite the potential limitations of the study, the vulnerable elderly non institutionalized patients with OAB treated with fesoterodine, compared to solifenacin or tolterodine were associated with lower resource utilization and healthcare costs.

C-reactive protein as a marker of cardiovascular disease in patients with a schizophrenia spectrum disorder treated in routine medical practice.

OBJECTIVE: Interest in cardiovascular diseases (CVD) in schizophrenia has grown recently due to documented incremental mortality. C-reactive protein (CRP) has been assessed as a marker in individuals with CVD and/or at high risk of developing it. However, its role in schizophrenia patients is unknown. The goal of this research was thus to explore the use of CRP as a marker of CVD risk in patients with schizophrenia. METHODS: A cross-sectional analysis of the Badalona Serveis Assistencials (BSA) administrative claims database was conducted including all subjects aged>18 years with a diagnosis of schizophrenia spectrum disorder. CRP measurement, sociodemographics, medical history, 10-year CVD risk (Framingham function) and clinical chemistry data were extracted for analysis. RESULTS: Seven hundred and five patients (53.0% men, 48.2 [15.8] years, 78.7% on atypicals) met criteria for analysis. Mean 10-year CVD risk was high; 11.9±5.7% and mean CRP levels were 2.6±2.5 mg/L with 30.4% showing above-normative levels (>3 mg/L). After adjusting for age, gender, smoking and presence of neoplasm or inflammatory diseases, CRP was linearly associated with 10-year CVD risk stratified by risk (low, moderate, high/very high): respectively, 2.3 (95% CI: 2.1-2.5), 3.1 (2.6-3.5) and 3.7 (3.2-4.1) mg/L; F=13.5, P<0.001. Patients with known CVD also showed higher CRP levels: 3.7 (2.9-4.5) vs. 2.5 (2.4-2.7) mg/L, P=0.008; and higher probability of above-normal values; odds ratio=4.71 (2.01-11.04), P<0.001. CONCLUSIONS: High CRP levels above normative were associated with both known CVD and high/very high 10-year risk of a CVD event in patients with schizophrenia, suggesting CRP could be a marker of CVD in this psychiatric disorder.

Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease.

WHAT IS KNOWN AND OBJECTIVE: The effect of a statin-based medical intervention on prevention of fatal and non-fatal stroke recurrence and the incidence of all-causes mortality have been explored previously in aging populations within the scope of clinical trials research. However, such evidence needs to be explored under conditions of routine clinical practice. The objective of this study was to determine whether statin therapy in patients with a first stroke episode reduces the incidence of 6-year recurrent fatal or non-fatal stroke and all-cause mortality in an aging Mediterranean population without known coronary heart disease followed in routine medical practice. METHODS: A retrospective study was carried out using records on death, hospitalizations owing to stroke and history of statin therapy included in the Badalona Serveis Assistencials (BSA) database. The cohort studied consisted of consecutive patients covered by the BSA health provider plan with a first-ever acute stroke episode during January 2003 until December 2008, for whom there was available information covering the 6-year follow-up period. Recurrence rate (RR) and incidence rate (IR) of fatal/non-fatal stroke and all-causes mortality were computed. Association with statin therapy was assessed by means of calculation of relative risk (RR) and hazard ratio (HR) using multivariate logistic regression and Cox proportional hazards models controlling for confounding covariates. RESULTS AND DISCUSSION: The cohort comprised a series of 601 consecutive patients [57% men, 75·9 (12·4) years old (88% >60 years)]. Of these, 32% received statins, which were associated with lower fatal/non-fatal recurrent stroke RR; 7% vs. 18% [adjusted RR=0·32 (CI: 0·16-0·61), P=0·001] and lower IR; 16·78 vs. 45·22 events/year-1000 subjects [adjusted HR=0·35 (0·19-0·64), P=0·001]. Similarly, observed all-causes mortality was lower in the cohort receiving statins; 11% vs. 16% [adjusted RR=0·29 (CI: 0·08-1·12), P=0·072], and also mortality rate; 26·09 vs. 36·25 deaths/year-1000 subjects [adjusted HR=0·23 (0·08-0·67), P=0·007]. WHAT IS NEW AND CONCLUSIONS: Statin therapy in patients with first-ever acute stroke lowers the risk of 6-year stroke recurrence and improves survival in an aging Mediterranean cohort. These results add additional evidence in routine clinical practice to the observed effects of statins in clinical trials.

[The effect of donepezil in comparison with conventional treatment on cognitive functioning and the performance of the patient in a prospective cohort of patients with Alzheimer's disease treated in routine clinical practice in Spain]. / Efecto del donepecilo comparado con el tratamiento convencional en la funcion cognitiva y el rendimiento del paciente en una cohorte prospectiva de pacientes con enfermedad de Alzheimer tratados en la practica clinica habitual en Espana.

AIMS: Our aim was to perform a secondary analysis of a 12-month-long, non-blind, multi-centre prospective cost-of-illness study. The analysis assessed the effect of donepezil on cognitive functioning and the performance of patients with possible or probable Alzheimer's disease, compared to that of other drugs for dementia. PATIENTS AND METHODS: A sample of 700 patients took part in the study (76.8 ± 6.6 years of age, 67.3% females): 600 (31.4% drug-naive) received donepezil and 100 (9% drug-naive) were given other drugs for dementia. RESULTS: The mean variations corrected by the baseline values and the centre of the total scores on the Folstein minimental test, the clinical dementia rating and Blessed dementia rating scales at 12 months were significantly lower in patients treated with donepezil: -1.23 ± 3.41 versus -2.26 ± 3.07 (p = 0.006), 0.20 ± 0.68 versus 0.39 ± 1.03 (p = 0.014) and 1.28 ± 3.31 versus 2.04 ± 2.84 (p = 0.027), respectively. CONCLUSIONS: This secondary analysis shows that the deterioration in the cognitive functioning and performance of patients with the passage of time is slower with donepezil than with other drugs for dementia in routine medical practice. Since these results were observed in a post hoc analysis, formal prospective clinical trials should be conducted to confirm these findings.

Morbilidad y costes asociados al síndrome depresivo en sujetos con ictus en un ámbito poblacional / Morbidity and costs associated with depressive syndrome in stroke sufferers in a population

Objetivo: Medir la morbilidad y los costes asociados al síndrome depresivo (SD) en sujetos con ictus en población atendida por equipos de atención primaria y en condiciones de práctica clínica habitual. Método: Estudio transversal de carácter retrospectivo. Se incluyeron pacientes adultos con presencia de ictus y de SD atendidos por 5 equipos de atención primaria durante el año 2006. Se formó una cohorte comparativa con el resto de pacientes sin SD. Las principales medidas fueron: edad, sexo, historial/comorbilidad, índice de Charlson, parámetros clínicos y costes totales (visitas, pruebas complementarias, derivaciones y medicamentos). Se efectuó un análisis de regresión logística y de ANCOVA para la corrección de los modelos. Resultados: El total de pacientes atendidos con ictus fue de 2.566. Un 17,7% (intervalo de confianza del 95%, 16,2-19,2%) se identificaron con SD; promedio de edad: 69,5 años (desviación estándar: 12,6); el 57,2% eran mujeres. En la corrección del modelo, el sexo femenino (odds ratio [OR]: 2,1), la obesidad (OR: 1,1) y las neuropatías (OR: 2,2) se asociaron significativamente al SD en sujetos con ictus. Los costes totales ajustados del SD fueron superiores en la mayoría de sus componentes, 2.037,55 frente a 1.498,24 ¿, p < 0,001. El 73,4% de los costes se derivó de los medicamentos. Conclusiones: La prevalencia del SD en sujetos con ictus es elevada, se asocia al sexo femenino y a la presencia de obesidad y neuropatías. Los costes de estos pacientes son altos y ocasionan un elevado consumo de recursos sanitarios (AU)

Objective: To measure morbidity and the associated costs of depressive disorders (DD) in subjects who have had a stroke in a population treated by primary care settings under usual clinical practice conditions. Method: Cross-sectional, retrospective studies. Adult stroke patients with DD were included in the study, and treated by five primary care settings (PCS) during 2006. A comparative group was formed with the rest of non-DD patients. The main measurements taken were: age, sex, history/co-morbidity, Charlson index, clinical parameters and corresponding outpatient costs; drugs, diagnostic tests, referrals and visits. Multiple logistic regression analysis and ANCOVA were used to correct the models. Results: A total of 2,566 stroke patients were assessed. 17.7% (95% CI, 16.2-19.2%) were identified as having DD; average age: 69.5 years (12.6); 57.2% of those were female. In the correction of the model, females (OR: 2.1), obesity (OR: 1.1) and neuropathy (OR: 2.2), were significantly associated with DD in stroke patients. The adjusted total costs of DD were higher in most components, ¿ 2,037.55 versus ¿ 1,498.24, p < 0.001. 73.4% of the total cost was drugs-derived. Conclusions: Prevalence of DD was higher in stroke patients, and was more associated with females, obesity and neuropathy. The patient cost is high and patients use more health resources (AU)

[Drug regimens in patients with medication-resistant epilepsy in neurology and epilepsy outpatient departments in Spain]. / Pautas terapéuticas en el paciente con epilepsia farmacorresistente en consultas ambulatorias de neurología y epilepsia en España.

INTRODUCTION: About 30% of epileptic patients suffer from drug-resistant epilepsy (DRE). Quality of life is worse and costs are higher than in controlled epilepsy. One of the aims of the LINCE study was to assess the prevalence of DRE in epilepsy-specialized and general neurology clinics in Spain and the clinical management of these patients in routine clinical practice. PATIENTS AND METHODS: Cross-sectional, retrospective study to evaluate clinical prevalence and cost of DRE in Spain. Every participant neurologist assessed the percentage of DRE among the first 40 patients with diagnosed epilepsy seen. Patients of both sexes, older than 18 years were recruited. Their treatment before and after DRE diagnosis was analyzed. RESULTS: DRE prevalence in Spain is 22.7% (36% in epilepsy-specialized and 18.5% in neurology clinics; p < 0.0001), with no differences between genders. More than 50% of these patients have hardly achieved a secondary education and only 44% are employed. The most frequent drugs used after DRE diagnosis are lamotrigine (33.5%), levetiracetam (32.4%), carbamazepine (31.9%) and topiramate (25.8%) in various combinations, but the highest efficacy (equal or more than 50% seizures reduction) is obtained with pregabaline (53.1%), oxcarbazepine (50.6%) and levetiracetam (49.5%) and topiramate (48%). CONCLUSIONS: 22.7% of epileptic outpatients in Spain are diagnosed with DRE in clinics of neurology. These will require certain social interventions and greater use of health resources, including treatment with more appropriate AEDs. Pregabaline, oxcarbazepine, levetiracetam and topiramate are among the most effective AEDs in this type of patients.

Asociación entre el uso de fármacos antipsicóticos y las alteraciones metabólicas en población adulta española / Association between the use of antipsychotic drugs and the metabolic disorders in a Spanish adult population setting

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[Impact of the obesity on the use of antipsychotic drugs in adult population attended in several primary care centers]. / Impacto de la obesidad en la utilizaciónde fármacos antipsicóticos en población adulta atendida en varios centros de atención primaria.

INTRODUCTION: We describe the association between the obesity and the use of antipsychotic drug (APD) in patients attended by five primary care teams. METHODS: Multicenter-retrospective design, carried out between July 2004 and June 2005, in patients who consumed APD treatment. A Body Mass Index (BMI) >29 kg/m2 was considered obesity. The main measurements were: consumption of APD, generals (gender and age), comorbidities and clinical parameters. Regression logistic analysis and ANCOVA (Bonferroni-adjustment) were applied to correct the model. RESULTS: From a total of 42,437 attended patients (mean age: 50.9 (SD: 17.8) years; women: 59.9 %; with obesity: 27.3% [confidence interval [CI] of 95 %: 26.9- 27.7]), the 1.3% received APD treatment (typical: 48.8%; atypical: 51.2%; p=not significant). In the logistic-model the obesity was related with the ADP use (odds ratio [OR]: 1.5; CI: 1.3-1.8), hypertension (OR: 2.4; CI:2.2-2.5), diabetes (OR: 1.4; CI: 1.3-1.5) and dyslipidemia (OR: 1.3; CI: 1.2-1.4); p=0,000. The adjusted BMI, in presence of APD, was 27.8 kg/m2 vs. 27.4 kg/m2; p=0,002. CONCLUSIONS: Obesity was associated with the use of APD and with the presence of hypertension, diabetes and dyslipidemia. Differences could not be observed between the use of typical or atypical APD.

Impacto de la obesidad en la utilización de fármacos antipsicóticos en población adulta atendida en varios centros de atención primaria / Impact of the obesity on the use of antipsychotic drugs in adult populationattended in several primary care centers

Introducción. Se describe la asociación de la obesidad con el uso de fármacos antipsicóticos (ATP) en pacientes atendidos por cinco equipos de atención primaria. Métodos. Diseño retrospectivo-multicéntrico realizado entre julio de 2004 y junio de 2005 en pacientes en tratamiento con ATP. Se consideró obesidad un índice de masa corporal (IMC) >29 kg/m2. Las principales mediciones fueron: consumo de ATP, generales (sexo y edad), comorbilidades y parámetros clínicos. Se efectuó un análisis de regresión logística y ANCOVA (ajuste-Bonferroni) para la corrección del modelo. Resultados. De 42.437 pacientes atendidos (promedioedad:50,9 años [DE: 17,8]; mujeres: 59,9 %; con presencia de obesidad el 27,3% [intervalo de confianza [IC] del 95%:26,9-27,7]); un 1,3 % recibían tratamiento ATP (típicos:48,8 %; atípicos: 51,2%; p=no significativo). En el modelo logístico la obesidad se relacionó con el uso de ATP (odds ratio [OR]: 1,5; IC: 1,3-1,8), hipertensión (OR: 2,4; IC: 2,2-2,5), diabetes (OR: 1,4; IC: 1,3-1,5) y dislipidemia (OR: 1,3; IC: 1,2-1,4); p=0,000. El IMC corregido en presencia de ATP fue de 27,8 frente a 27,4 kg/m2; p=0,002.Conclusiones. La obesidad se asoció con el uso de ATP y con la presencia de hipertensión, diabetes y dislipidemia. No se observaron diferencias entre el uso de ATP típicos o atípicos (AU)

Introduction. We describe the association between the obesity and the use of antipsychotic drug (APD) inpatients attended by five primary care teams. Methods. Multicenter-retrospective design, carried out between July 2004 and June 2005, in patients who consumed APD treatment. A Body Mass Index (BMI)>29 kg/m2 was considered obesity. The main measurements were: consumption of APD, generals (gender and age), comorbidities and clinical parameters. Regression logistic analysis and ANCOVA (Bonferroni-adjustment)were applied to correct the model. Results. From a total of 42,437 attended patients (mean age: 50.9 (SD: 17.8) years; women: 59.9 %; with obesity: 27.3% [confidence interval [CI] of 95 %: 26.9-27.7]), the 1.3% received APD treatment (typical: 48.8%;atypical: 51.2%; p=not significant). In the logistic-model the obesity was related with the ADP use (odds ratio [OR]: 1.5; CI: 1.3-1.8), hypertension (OR: 2.4; CI:2.2-2.5),diabetes (OR: 1.4; CI: 1.3-1.5) and dyslipidemia (OR: 1.3;CI: 1.2-1.4); p=0,000. The adjusted BMI, in presence of APD, was 27.8 kg/m2 vs. 27.4 kg/m2; p=0,002.Conclusions. Obesity was associated with the use of APD and with the presence of hypertension, diabetes and dyslipidemia. Differences could not be observed between the use of typical or atypical APD (AU)

[Morbidity and costs associated with depressive syndrome in stroke sufferers in a population]. / Morbilidad y costes asociados al síndrome depresivo en sujetos con ictus en un ámbito poblacional.

OBJECTIVE: To measure morbidity and the associated costs of depressive disorders (DD) in subjects who have had a stroke in a population treated by primary care settings under usual clinical practice conditions. METHOD: Cross-sectional, retrospective studies. Adult stroke patients with DD were included in the study, and treated by five primary care settings (PCS) during 2006. A comparative group was formed with the rest of non-DD patients. The main measurements taken were: age, sex, history/co-morbidity, Charlson index, clinical parameters and corresponding outpatient costs; drugs, diagnostic tests, referrals and visits. Multiple logistic regression analysis and ANCOVA were used to correct the models. RESULTS: A total of 2,566 stroke patients were assessed. 17.7% (95% CI, 16.2-19.2%) were identified as having DD; average age: 69.5 years (12.6); 57.2% of those were female. In the correction of the model, females (OR: 2.1), obesity (OR: 1.1) and neuropathy (OR: 2.2), were significantly associated with DD in stroke patients. The adjusted total costs of DD were higher in most components, euro 2,037.55 versus euro 1,498.24, p < 0.001. 73.4% of the total cost was drugs-derived. CONCLUSIONS: Prevalence of DD was higher in stroke patients, and was more associated with females, obesity and neuropathy. The patient cost is high and patients use more health resources.