Modelling efficiency in primary healthcare using the DEA methodology: an empirical analysis in a healthcare district.

BACKGROUND: Primary healthcare management efficiency conditions the functioning of specialized care and has a direct impact on the outcomes of the health system and its sustainability. The objective of this research is to develop models to evaluate the efficiency, including health outcomes, of the primary healthcare centres (PHC) of the Clínico - La Malvarrosa Health District in Valencia. METHODS: To evaluate efficiency, Data Envelopment Analysis (DEA) was used with output orientation and variable returns to scale, with panel data from the years 2015 to 2019. In rates per 10,000 inhabitants, the inputs are: medical and nursing staff and pharmacy cost. The outputs are: number of consultations, hospital emergencies, referrals, avoidable hospitalisations, avoidable mortality and pharmaceutical prescription efficiency. As exogenous variables: the percentage of population over 65 years old, over 80 and case-mix. Three models were developed, all of them with the same inputs and different combinations of outputs related to: healthcare activity, outcomes, and both, in order to study the influence of the different approaches on efficiency. Each model is analysed both without exogenous variables and with each of them. RESULTS: The efficiency results vary depending on the model used, although certain PHCs are always on, or very close to, the efficient frontier, while others are always inefficient. When healthcare activity outputs are considered, efficiency scores improve and the number of efficient PHCs increases. However, in general, the PHC score decreases throughout the evaluated period. This decrease is more pronounced when only activity outputs are included. CONCLUSIONS: DEA allows the inefficiencies of PHCs to be analysed and the efficient ones are clearly distinguished from the inefficient, although different efficiency scores are obtained depending on the model used. Evaluation can be according to healthcare activity, health outcomes or both, making it necessary to identify the expected objectives of the PHCs, as the perspective of the analysis influences the results.

Telenursing: The view of care professionals in selected EU countries. A pilot study.

Background: With the growth of digital nursing, several studies have focused on recording patients' views on remote care, or specialised nurse staffing aspects. This is the first international survey on telenursing focused exclusively on clinical nurses that analyses the dimensions of usefulness, acceptability, and appropriateness of telenursing from the staff point of view. Methods: A previously validated structured questionnaire including demographic variables, 18 responses with a Likert-5 scale, three dichotomous questions, and one overall percentual estimation of holistic nursing care susceptible to being undertaken by telenursing, was administered (from 1 September to 30 November 2022) to 225 clinical and community nurses from three selected EU countries. Data analysis: descriptive data, classical and Rasch testing. Results: The results show adequacy of the model for measurement of the domains of usefulness, acceptability, and appropriateness of telenursing (overall Cronbach's alpha 0.945, Kaiser-Meyer-Olkin 0.952 and Bartlett's p < 0.001). Answers in favour of telenursing ranked 4 out of 5 in Likert scale, both globally and by the three domains. Rasch: reliability coefficient 0.94, Warm's main weighted likelihood estimate reliability 0.95. In the ANOVA analysis, the results for Portugal were significantly higher than those for Spain and Poland, both overall and for each of the dimensions. Respondents with bachelor's, master's and doctoral degrees score significantly higher than those with certificates or diplomas. Multiple regression did not yield additional data of interest. Conclusions: The tested model proved to be valid, but although the majority of nurses are in favour of telenursing, given the nature of the care, which is mainly face-to-face, according to the respondents, the chances of carrying out their activities by telenursing is only 35.3%. The survey provides useful information on what can be expected from the implementation of telenursing and the questionnaire proves to be a useful tool to be applied in other countries.

Cost-utility model of brivaracetam in the adjunctive treatment of patients with epilepsy in Spain.

OBJECTIVE: This study aims to assess the cost utility of Brivaracetam compared with the third-generation anti-epileptic drugs used as standard care. METHODS: A cost utility analysis of Brivaracetam was carried out with other third-generation comparators. The treatment pathway of a hypothetical cohort over a period of 2 years was simulated using the Markov model. Data for effectiveness and the QALYs of each health status for epilepsy, as well as for the disutilities of adverse events of treatments, were analyzed through a studies review. The cost of the anti-epileptics and the use of medical resources linked to the different health statuses were taken into consideration. A probabilistic sensitivity analysis was performed using a Monte Carlo simulation. RESULTS: Brivaracetam was shown to be the dominant alternative, with Incremental Cost Utility Ratio (ICUR) values from -11,318 for Lacosamide to -128,482 for Zonisamide. The probabilistic sensitivity analysis validates these results. The ICUR sensitivity is greater for increases in the price of Brivaracetam than for decreases, and for Eslicarbizapine over the other adjunctives considered in the analysis. CONCLUSIONS: Treatment with Brivaracetam resulted in cost effective and incremental quality adjusted life years come at an acceptable cost.

[Direct hospitalization costs associated with chronic Hepatitis C in the Valencian Community in 2013]. / Costes de hospitalización aso- ciados a la hepatitis crónica C en la Comunidad Valenciana en 2013.

OBJECTIVE: Hospital costs associated with Chronic Hepatitis C (HCC) arise in the final stages of the disease. Its quantification is very helpful in order to estimate and check the burden of the disease and to make financial decisions for new antivirals. The highest costs are due to the decompensation of cirrosis. METHODS: Cross-sectional observational study of hospital costs of HCC diagnoses in the Valencian Community in 2013 (n= 4,486 hospital discharges). Information source: Minimum basic set of data/ Basic Minimum Data Set. The costs were considered according to the rates established for the DRG (Diagnosis related group) associated with the episodes with diagnosis of hepatitis C. The average survival of patients since the onset of the decom- pensation of their cirrhosis was estimated by a Markov model, according to the probabilities of evolution of the disease existing in Literatura. RESULTS: There were 4,486 hospital episodes, 1,108 due to complications of HCC, which generated 6,713 stays, readmission rate of 28.2% and mortality of 10.2%. The hospital cost amounted to 8,788,593EUR: 3,306,333EUR corresponded to Cirrhosis (5,273EUR/patient); 1,060,521EUR to Carcinoma (6,350EUR/ patient) and 2,962,873EUR to transplantation (70,544EUR/paciente. Comorbidity was 1,458,866EUR. These costs are maintai- ned for an average of 4 years once the cirrhosis decompensation begins. CONCLUSIONS: Cirrhosis due to HCC generates a very high hospitalization's costs. The methodology used in the estimation of these costs from the DRG can be very useful to evaluate the trend and economic impact of this disease.

OBJETIVO: Los costes hospitalarios asociados a la Hepatitis Crónica C (HCC) surgen en los estadíos finales de la enfermedad. Su cuantificación es de gran utilidad para estimar la carga de la enfermedad y establecer decisiones de financiación de los nuevos antivirales. Los costes más elevados son motivados por la descompensación de la cirrosis. METODOS: Estudio observacional de corte transversal de los costes hospitalarios de episodios con diagnóstico de HCC en la Comunidad Valenciana en 2013. Fuente de información: Conjunto mínimo básico de datos. Se estimaron los costes según las tarifas establecidas para los GRD (Grupos relacionados por el diagnóstico) asociados a los episodios con diagnóstico de hepatitis C. La supervivencia media de los pacientes desde que se inició la descompensación de su cirrosis se estimó mediante un modelo de Markov, según las probabilidades de evolución de la enfermedad existentes en la literatura. RESULTADOS: Se registraron 4.486 episodios de hospitalización con diagnóstico de HCC, 1.108 fueron debidos a complicaciones de la HCC que generaron 6.713 estancias, tasa de reingresos del 28,2 % y mortalidad del 10,2%. El coste hospitalario ascendió a 8.788.593EUR: 3.306.333EUR correspondieron a Cirrosis (5.273EUR/paciente); 1.060.521EUR a Carcinoma (6.350EUR/ paciente) y 2.962.873EUR a trasplante (70.544EUR/paciente). La comorbilidad por Hepatitis C supuso 1.458.866EUR. Estos costes se mantienen durante una media de 4 años una vez comienza la descompensación de la cirrosis. CONCLUSIONES: La cirrosis por HCC genera un coste muy elevado por hospitalización, la metodología utilizada en la estimación de estos costes a partir de los GRD puede ser de gran utilidad para evaluar la tendencia e impacto económico de esta enfermedad.

Correction to: Budget Impact Analysis of Brivaracetam Adjunctive Therapy for Partial-Onset Epileptic Seizures in Valencia Community, Spain.

In the original publication, the abstract, conclusion was incorrectly published.

Budget Impact Analysis of Brivaracetam Adjunctive Therapy for Partial-Onset Epileptic Seizures in Valencia Community, Spain.

BACKGROUND AND OBJECTIVE: More than 30% of patients with epilepsy have inadequate control of seizures with drug therapy. The goal of this study is to determine the budget impact (BI) of the introduction of brivaracetam to the portfolio of approved drugs in Spain as adjunctive therapy for the treatment of partial-onset epilepsy in patients over 16 years old with a 5-year time horizon in the Valencia Community, a Spanish region with a population of 5 million. METHODS: The BI model compares the pharmaceutical expenditure on antiepileptics in two scenarios: with and without brivaracetam. It assumes that the introduction and increased use of brivaracetam will lead to a proportional decrease in consumption of coexisting adjunctive antiepileptics and calculates the evolution of the consumption of brivaracetam over 5 years (2016-2020). The model was designed from the perspective of the Spanish National Health System. Data on the candidate population, consumption of antiepileptics, market share and pharmaceutical expenditure were obtained from real-world data. Finally, a sensitivity analysis was carried out on the set of variables involved in the evolution of costs using a Monte-Carlo simulation. RESULTS: The model estimates that the target population eligible for adjunctive antiepileptics will hold at around 2352 between 2016 and 2020. Annual expenditure on antiepileptics is approximately €3.6 million. The number of patients eligible for treatment with brivaracetam would increase from 42 to 179 and annual savings of 0.09-0.37% would be created, representing €41,873 over 5 years (0.23% of the total budget). The sensitivity analysis corroborates that the probability of achieving savings with brivaracetam is around 84%. CONCLUSIONS: Brivaracetam is a therapeutic alternative that allows savings for the health system in patients with non-controlled epilepsy in monotherapy, having a fixed, predictable annual cost (independent of dose) from the first day of treatment as the lack of need for titration means the patient is within a range of therapeutic doses from the first dose.

Costes de hospitalización asociados a la hepatitis crónica C en la Comunidad Valenciana en 2013 / Direct hospitalization costs associated with chronic Hepatitis C in the Valencian Community in 2013

Fundamentos. Los costes hospitalarios asociados a la Hepatitis Crónica C (HCC) surgen en los estadios finales de la enfermedad. Su cuantificación es de gran utilidad para estimar la carga de la enfermedad y establecer decisiones de financiación de los nuevos antivirales. Los costes más elevados son motivados por la descompensación de la cirrosis. Métodos. Estudio observacional de corte transversal de los costes hospitalarios de episodios con diagnóstico de HCC en la Comunidad Valenciana en 2013. Fuente de información: Conjunto mínimo básico de datos. Se estimaron los costes según las tarifas establecidas para los GRD (Grupos relacionados por el diagnóstico) asociados a los episodios con diagnóstico de hepatitis C. La supervivencia media de los pacientes desde que se inició la descompensación de su cirrosis se estimó mediante un modelo de Markov, según las probabilidades de evolución de la enfermedad existentes en la literatura. Resultados. Se registraron 4.486 episodios de hospitalización con diagnóstico de HCC, 1.108 fueron debidos a complicaciones de la HCC que generaron 6.713 estancias, tasa de reingresos del 28,2 % y mortalidad del 10,2%. El coste hospitalario ascendió a 8.788.593EUR: 3.306.333EUR correspondieron a Cirrosis (5.273EUR/paciente); 1.060.521EUR a Carcinoma (6.350EUR/ paciente) y 2.962.873EUR a trasplante (70.544EUR/paciente). La comorbilidad por Hepatitis C supuso 1.458.866EUR. Estos costes se mantienen durante una media de 4 años una vez comienza la descompensación de la cirrosis. Conclusiones. La cirrosis por HCC genera un coste muy elevado por hospitalización, la metodología utilizada en la estimación de estos costes a partir de los GRD puede ser de gran utilidad para evaluar la tendencia e impacto económico de esta enfermedad

Background. Hospital costs associated with Chronic Hepatitis C (HCC) arise in the final stages of the disease. Its quantification is very helpful in order to estimate and check the burden of the disease and to make financial decisions for new antivirals. The highest costs are due to the decompensation of cirrosis. Methods. Cross-sectional observational study of hospital costs of HCC diagnoses in the Valencian Community in 2013 (n=4,486 hospital discharges). Information source: Minimum basic set of data/ Basic Minimum Data Set. The costs were considered according to the rates established for the DRG (Diagnosis related group) associated with the episodes with diagnosis of hepatitis C. The average survival of patients since the onset of the decompensation of their cirrhosis was estimated by a Markov model, according to the probabilities of evolution of the disease existing in Literatura. Results. There were 4,486 hospital episodes, 1,108 due to complications of HCC, which generated 6,713 stays, readmission rate of 28.2% and mortality of 10.2%. The hospital cost amounted to 8,788,593EUR: 3,306,333EUR corresponded to Cirrhosis (5,273EUR/patient); 1,060,521EUR to Carcinoma (6,350EUR/ patient) and 2,962,873EUR to transplantation (70,544EUR/paciente. Comorbidity was 1,458,866EUR. These costs are maintained for an average of 4 years once the cirrhosis decompensation begins. Conclusions. Cirrhosis due to HCC generates a very high hospitalization’s costs. The methodology used in the estimation of these costs from the DRG can be very useful to evaluate the trend and economic impact of this disease

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups.

BACKGROUND: Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines. OBJECTIVE: We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care. METHODS: A database of 261,054 population in one health district of an Eastern region of Spain was used. The predictive power of two models was compared. The first model (ATC-model) used nine dummy variables: sex and 8 groups from 1 to 8 or more chronic conditions while in the second model (CRG-model) we include sex and 8 dummy variables for health core statuses 2-9. RESULTS: The two models achieved similar levels of explanation. However, the CRG system offers higher clinical significance and higher operational utility in a real context, as it offers richer and more updated information on patients. CONCLUSIONS: The potential of the CRG model developed compared to ATC codes lies in its capacity to stratify the population according to specific chronic conditions of the patients, allowing us to know the degree of severity of a patient or group of patients, predict their pharmaceutical cost and establish specific programmes for their treatment.

[Incidence and variability of temporary disability due to anxiety disorders during 2009 in the Valencia Community, Spain].

BACKGROUND: Anxiety, dissociative and somatoform disorders (WHO-e 300) are the second cause of Temporary Disability (TD) in Spain. This is the main reason that justifies the analysis of the variability among primary health care centers (PHC) of the Valencian Community in the prescription processes of Temporary Disability for these disorders. METHODS: Epidemiological cross-sectional descriptive study of variability of TD processes initiated in 2009 corresponding to diagnosis e 300 in 739 PHC from 23 health districts in the Valencian Community, where 25,859 TD processes for the diagnosis e 300 were prescribed. Traditional indicators of variation developed for the analysis of small areas were used to determine variability in the incidence rate of TD processes. The analysis of variance was used to determine the percentage of explanation of the factors studied. RESULTS: The average incidence rate obtained was of 1.08 for 100 individuals. The variation range was between 0.01 and 1.97 for percentiles P(5) to P(95). In the variance components analysis, the factor of health district explains the highest percentage of variability (22.12), followed by the factor province (20.21%), coastal areas (4.65%), teaching accreditation (2.44%) and the size of population assigned to each PHC (2.40%). CONCLUSIONS: Significant differences were observed in the incidence rate of TD processes for the diagnosis e 300. The PHCs with greater population pressure and those that are accredited had the highest rates of incidence.

Incidencia y variabilidad de la incapacidad temporal por trastornos de ansiedad en la Comunidad Valenciana durante el 2009 / Incidence and variability of temporary disability due to anxiety disorders during 2009 in the Valencia Community, Spain

Fundamentos: Los trastornos de ansiedad, disociativos y somatomorfos (Cod300) constituyen la segunda causa de incapacidad temporal (IT) en España. Esta razón justifica que el presente trabajo se centre en analizar la variabilidad en la prescripción de procesos de IT por estas patologías en los centros de salud y consultorios (CS) de la Comunidad Valenciana (CV). Métodos: Se realizó un estudio epidemiológico poblacional transversal de variabilidad de los procesos de IT iniciados en 2009 correspondientes al Cod300 en los 739 CS, de los 23 departamentos de salud de la CV, donde se prescribieron un total de 25.859 procesos de IT por Cod300. Se utilizaron los estadísticos de variabilidad habituales en el análisis de áreas pequeñas para determinar la variabilidad observada en la tasa de incidencia (TI) de los procesos de IT. El análisis de la varianza se utilizó para determinar el porcentaje de explicación de cada factor estudiado. Resultados: La TI media por 100 individuos es de 1,08 con un rango de variación de 0,01 a 1,97 entre los percentiles P5 a P95. En el análisis de componentes de la varianza, el factor departamento de salud es el que explica mayor porcentaje de variabilidad (22,12%) seguido del factor provincia (20,21%), litoralidad (4,65%), acreditación para la docencia (2,44%) y tamaño poblacional asignado al CS (2,40%). Conclusiones: Se observa una variabilidad notable en las TI de las prescripciones de IT por Cod300. Los factores departamento y provincia son los que más explican esta variabilidad. Los CS con mayor presión poblacional y los acreditados tienen mayores tasas de incidencia(AU)

Background: Anxiety, dissociative and somatoform disorders (WHO-Code 300) are the second cause of Temporary Disability (TD) in Spain. This is the main reason that justifies the analysis of the variability among primary health care centers (PHC) of the Valencian Community in the prescription processes of Temporary Disability for these disorders. Methods: Epidemiological cross-sectional descriptive study of variability of TD processes initiated in 2009 corresponding to diagnosis code 300 in 739 PHC from 23 health districts in the Valencian Community, where 25,859 TD processes for the diagnosis code 300 were prescribed. Traditional indicators of variation developed for the analysis of small areas were used to determine variability in the incidence rate ofTD processes. The analysis of variance was used to determine the percentage of explanation of the factors studied. Results: The average incidence rate obtained was of 1.08 for 100 individuals. The variation range was between 0.01 and 1.97 for percentiles P5 to P95. In the variance components analysis, the factor of health district explains the highest percentage of variability (22.12), followed by the factor province (20.21%), coastal areas (4.65%), teaching accreditation (2.44%) and the size of population assigned to each PHC (2.40%). Conclusions: Significant differences were observed in the incidence rate of TD processes for the diagnosis code 300. The PHCs with greater population pressure and those that are accredited had the highest rates of incidence(AU)

[Hospital processes and costs in neurology. A study of a referral hospital]. / Costes y procesos hospitalarios en neurologia. Estudio en un hospital de referencia.

INTRODUCTION: The steady growth of spending on healthcare and the limited availability of resources make it necessary to include cost analysis among the tools used for hospital management. AIMS. To obtain the hospitalisation operating statement of a neurology service and to analyse the differences with regard to costs per process. PATIENTS AND METHODS: The study involved an analysis of costs per process in the neurology service of a referral hospital in the Valencian Community (400,000 inhabitants). The data used were those concerning health care activity in 2008 according to the information registered by the Economic Information System of the Valencian Regional Ministry of Health; ABC and top-down methods were applied to calculate the cost per process. The results thus obtained were compared with the fees established for hospital production in the Valencian Regional Government's Law on Fees. RESULTS: For a production of 1092 hospital discharges, with a case-mix index of 0.96 and a mean length of stay of 9.2 days with a case mix of 1.91, hospitalisation costs came to 4,411,643.45 euros, with a mean cost per process of 2,111.46 euros. Taking into account the fees that were applied, the difference between income and expenditure was -12,770.39 euros. The diagnosis-related groups with the greatest difference were numbers 14 (-246,392.49 euros), 533 (-90,292.49 euros) and 15 (-55,139.66 euros). CONCLUSIONS: The hospitalisation profit and loss account obtained is negative due to the fact that the mean length of stay in the service is longer than expected, above all in diagnosis-related groups 14, 533 and 15, which are the most inefficient.

Evaluación de los sistemas de salud: estudio multivariante del logro en salud en los países europeos / Evaluation of the health systems: multivariant study of the profit in health in the European countries

La mayoría de países del mundo dedica un alto porcentaje de su presupuesto al sistema sanitario, y este porcentaje crece año tras año. Cobrando así, cada vez más importancia la evaluación de los sistemas sanitarios y su desempeño. El objetivo de este estudio es determinar las principales variables socioeconómicas que influyen sobre la esperanza de vida ajustada por discapacidad (EVAD) en los países europeos. Se han tomado 16 variables de carácter social, económico, sanitario y medioambiental, para los periodos de 2003 y 2004 en 22 países europeos. La información de de las 15 variables explicativas ha sido trasformada mediante un análisis factorial. Con el análisis de regresión, se ha obtenido la relación entre la EVAD y el resto de variables explicativas. Por último se ha realizado una agrupación de los países mediante un análisis cluster.

The majority of the countries in the world dedicate a high percentage of their budget to their Health Care System. In addition, this percentage grows year by year. For that reason, theHealth Care evaluation and its repercussion in the improvement of the population health are very important. The aim of this paper is to determine the mean socioeconomic variables thatinfluence the healthy life expectancy in the european countries. Taking 16 variables of social, economic, sanitary and environmental character, for the periods 2003 and 2004 in 22 europeancontries. The information of the 15 variables is transformed by a factorial analysis. The relation between the variables and the healthy life expectancy by means of a regression analisys. And a classification of the countries is made using the analysis cluster.