Diagnosis of hepatitis C virus infection in Spain: An opportunity to improve. / El diagnóstico de la infección por el virus de la hepatitis C en España: una oportunidad para mejorar.

BACKGROUND: Reflex testing of antibodies and viral load in the same sample for diagnosing hepatitis C virus infection speeds up access to treatment. However, how hepatitis C is diagnosed in Spanish hospitals is unknown. OBJECTIVE: To describe the available resources and procedures for the diagnosis of hepatitis C virus infection in Spain. METHODS: Survey sent to public and private Spanish hospitals with teaching accreditation with at least 200 beds. RESULTS: Of the 160 hospitals that met the inclusion criteria, 90 centres (response rate 56.3%) completed the survey. Two hospitals (2.2%) have no diagnostic resources, 15 (16.7%) can only test for anti-hepatitis C virus(Ab), 9 (10.0%) for Ab and viral load, 47 (52.2%) for Ab, viral load and genotype, 2 (2.2%) for Ab, viral load and core antigen, and 15 (16.7%) can perform Ab, core antigen, viral load and genotype tests. When an Ab test is positive, 28 (31.1%) hospitals perform reflex testing. When an active infection is diagnosed, some communication strategy is used in 62 (68.9%) hospitals. Approximately 44.2% of the respondents believe that all determinations needed to reach a definitive diagnosis should be done on a single blood sample. CONCLUSION: Although 81% of Spanish hospitals have the resources to perform reflex hepatitis C virus infection testing, it is only done in 31%, and less than a half of respondents believe that the definitive diagnosis should be performed on a single sample.

El diagnóstico de la infección por el virus de la hepatitis C en España: una oportunidad para mejorar / Diagnosis of hepatitis C virus infection in Spain: An opportunity to improve

ANTECEDENTES: El diagnóstico de la infección por el virus de la hepatitis C en un solo paso (anticuerpos y carga viral en una misma muestra) disminuiría el tiempo de acceso al tratamiento. Se desconoce el proceso del diagnóstico de la hepatitis C en los hospitales españoles. OBJETIVO: Describir los recursos diagnósticos disponibles y el proceso del diagnóstico de la infección por virus de la hepatitis C en España. MÉTODOS: Encuesta dirigida a hospitales españoles, públicos o privados con acreditación docente, de 200 camas o más. RESULTADOS: De los 160 hospitales con criterios de inclusión, respondieron 90 (tasa de respuesta del 56,3%). Dos centros (2,2%) no disponen de ningún recurso diagnóstico, 15 (16,7%) solo pueden realizar determinación de anticuerpos (Ac), 9 (10%) de Ac y carga viral (CV), 47 (52,2%) de Ac, CV y genotipo, 2 (2,2%) de Ac, CV y antígeno core, y 15 (16,7%) de Ac, antígeno core, CV y genotipo. Ante un resultado de Ac positivo, 28 (31,1%) hospitales hacen diagnóstico virológico en la misma muestra. Cuando hay una infección activa, se utiliza alguna estrategia de comunicación en 62 (68,9%) hospitales. El 44,2% de los respondedores cree que las determinaciones para llegar a un diagnóstico definitivo se deben hacer con una muestra única de sangre. CONCLUSIONES: Aunque el 81% de los hospitales dispone de medios para realizar el diagnóstico de la infección por virus de la hepatitis C en un solo paso, únicamente lo hace el 31%. Menos de la mitad de los encuestados cree que el diagnóstico definitivo se debe hacer con una única muestra

BACKGROUND: Reflex testing of antibodies and viral load in the same sample for diagnosing hepatitis C virus infection speeds up access to treatment. However, how hepatitis C is diagnosed in Spanish hospitals is unknown. OBJECTIVE: To describe the available resources and procedures for the diagnosis of hepatitis C virus infection in Spain. METHODS: Survey sent to public and private Spanish hospitals with teaching accreditation with at least 200 beds. RESULTS: Of the 160 hospitals that met the inclusion criteria, 90 centres (response rate 56.3%) completed the survey. Two hospitals (2.2%) have no diagnostic resources, 15 (16.7%) can only test for anti-hepatitis C virus(Ab), 9 (10.0%) for Ab and viral load, 47 (52.2%) for Ab, viral load and genotype, 2 (2.2%) for Ab, viral load and core antigen, and 15 (16.7%) can perform Ab, core antigen, viral load and genotype tests. When an Ab test is positive, 28 (31.1%) hospitals perform reflex testing. When an active infection is diagnosed, some communication strategy is used in 62 (68.9%) hospitals. Approximately 44.2% of the respondents believe that all determinations needed to reach a definitive diagnosis should be done on a single blood sample. CONCLUSION: Although 81% of Spanish hospitals have the resources to perform reflex hepatitis C virus infection testing, it is only done in 31%, and less than a half of respondents believe that the definitive diagnosis should be performed on a single sample

Eficiencia de diversas estrategias para el diagnóstico de la hepatitis C en un solo paso / The efficiency of several one-step testing strategies for the diagnosis of hepatitis C

Antecedentes: la implementación de estrategias de diagnóstico de la hepatitis C en un solo paso contribuiría a disminuir el tiempo de acceso al tratamiento, evitando el progreso de la enfermedad y sus complicaciones y facilitando la eliminación de la enfermedad. Objetivo: evaluar la validez y la seguridad de las posibles estrategias del diagnóstico de la infección por virus de la hepatitis C (VHC) en un solo paso, así como sus costes y eficiencia. Métodos: estudio de evaluación económica de la eficiencia (coste/eficacia) mediante la construcción de árboles de decisión con análisis de sensibilidad determinista. La perspectiva del análisis es la del financiador (Sistema Nacional de Salud), que solo considera los costes directos. Se han considerado únicamente los costes diferenciales (costes de los test analíticos realizados). El ámbito del estudio es España. Se define la eficacia de una estrategia diagnóstica como el porcentaje de pacientes con infección activa por VHC con diagnóstico positivo y la eficiencia, como el coste de diagnosticar correctamente un paciente con infección activa. Resultados: todas las estrategias para el diagnóstico de VHC en un solo paso evaluadas presentan validez y seguridad aceptables como consecuencia de la elevada sensibilidad y especificidad que tienen los test utilizados. La estrategia más eficiente es Ac-Ag, seguida de Ac-Ag-CV y Ac-CV. La estrategia más eficiente es Ac-Ag debido a su menor coste por paciente testado, pero es menos eficaz que Ac-CV. Conclusión: los hallazgos de este estudio pueden contribuir a establecer las estrategias de diagnóstico más adecuadas en un solo paso teniendo en cuenta su eficacia y eficiencia

Background: implementing one-step strategies for hepatitis C diagnosis would help shorten the time to treatment access. Thus avoiding disease progression and complications, while facilitating hepatitis C virus (HCV) elimination. Objective: to assess the validity and certainty of potential one-step strategies for the diagnosis of HCV infection and their associated cost and efficiency. Methods: the study design is an economic appraisal of efficiency (cost/efficacy) using decision trees and deterministic sensitivity analysis. The analysis was performed from the payer perspective (Spanish National Health System), which exclusively considers the direct costs. Only the differential costs (diagnostic testing costs) were taken into account and the study was set in Spain. The efficacy of a diagnostic strategy was defined as the percentage of patients with an active HCV infection who received a positive diagnosis and the efficiency was defined as the cost per patient with a correctly diagnosed and active infection. Results: the one-step strategies evaluated for the diagnosis of HCV had an acceptable validity and certainty due to the high sensitivity and specificity of the considered tests. The Ab-Ag strategy was the most efficient, followed by Ab-Ag-VL and Ab-VL. Ab-Ag was the most efficient due to the lower cost per patient tested, although the efficacy was lower than the Ab-VL efficacy. Conclusion: the study findings may help to establish more appropriate one-step diagnostic approaches whilst considering the efficacy and efficiency

The efficiency of several one-step testing strategies for the diagnosis of hepatitis C.

BACKGROUND: implementing one-step strategies for hepatitis C diagnosis would help shorten the time to treatment access. Thus avoiding disease progression and complications, while facilitating hepatitis C virus (HCV) elimination. OBJECTIVE: to assess the validity and certainty of potential one-step strategies for the diagnosis of HCV infection and their associated cost and efficiency. METHODS: the study design is an economic appraisal of efficiency (cost/efficacy) using decision trees and deterministic sensitivity analysis. The analysis was performed from the payer perspective (Spanish National Health System), which exclusively considers the direct costs. Only the differential costs (diagnostic testing costs) were taken into account and the study was set in Spain. The efficacy of a diagnostic strategy was defined as the percentage of patients with an active HCV infection who received a positive diagnosis and the efficiency was defined as the cost per patient with a correctly diagnosed and active infection. RESULTS: the one-step strategies evaluated for the diagnosis of HCV had an acceptable validity and certainty due to the high sensitivity and specificity of the considered tests. The Ab-Ag strategy was the most efficient, followed by Ab-Ag-VL and Ab-VL. Ab-Ag was the most efficient due to the lower cost per patient tested, although the efficacy was lower than the Ab-VL efficacy. CONCLUSION: the study findings may help to establish more appropriate one-step diagnostic approaches whilst considering the efficacy and efficiency.

Cost/efficacy analysis of preferred Spanish AIDS study group regimens and the dual therapy with lopinavir/ritonavir plus lamivudine for initial ART in HIV infected adults.

INTRODUCTION: The National AIDS Plan and the Spanish AIDS study group (GESIDA) proposes "preferred regimens" (PR) of antiretroviral treatment (ART) as initial therapy in HIV-infected patients. In 2013, the recommended regimens were all triple therapy regimens. The Gardel Study assessed the efficacy of a dual therapy (DT) combination of lopinavir/ritonavir (LPV/r) plus lamivudine (3TC). Our objective is to evaluate the GESIDA PR and the DT regimen LPV/r+3TC cost/efficacy ratios. METHODS: Decision tree models were built. EFFICACY: probability of having viral load <50 copies/mL at week 48. ART regime cost: costs of ART, adverse effects, and drug resistance tests during the first 48 weeks. RESULTS: Cost/efficacy ratios varied between 5,817 and 13,930 euros per responder at 48 weeks, for the DT of LPV/r+3TC and tenofovir DF/emtricitabine+raltegravir, respectively. CONCLUSIONS: Taking into account the official Spanish prices of ART, the most efficient regimen was DT of LPV/r+3TC, followed by the triple therapy with non-nucleoside containing regimens.

Rheumatology in the community of Madrid: current availability of rheumatologists and future needs using a predictive model.

OBJECTIVES: To: 1) describe the distribution of the public sector rheumatologists; 2) identify variables on which the workload in Rheumatology depends; and 3) build a predictive model on the need of rheumatologists for the next 10 years, in the Community of Madrid (CM). METHODOLOGY: The information was obtained through structured questionnaires sent to all services/units of Rheumatology of public hospitals in the CM. The population figures, current and forecasted, were obtained from the National Statistics Institute. A predictive model was built based on information about the current and foreseeable supply, current and foreseeable demand, and the assumptions and criteria used to match supply with demand. The underlying uncertainty in the model was assessed by sensitivity analysis. RESULTS: In the CM in 2011 there were 150 staff rheumatologists and 49 residents in 27 centers, which is equivalent to one rheumatologist for every 33,280 inhabitants in the general population, and one for every 4,996 inhabitants over 65 years. To keep the level of assistance of 2011 in 2021 in the general population, it would be necessary to train more residents or hire more rheumatologists in scenarios of demand higher than 15%. However, to keep the level of assistance in the population over 65 years of age it would be necessary to train more residents or hire more specialists even without increased demand. CONCLUSIONS: The model developed may be very useful for planning, with the CM policy makers, the needs of human resources in Rheumatology in the coming years.