Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study.

INTRODUCTION: Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. METHODS: A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. RESULTS: During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. CONCLUSIONS: Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.

[Adherence, satisfaction and health-related quality of life in HIV-infected patients with antiretroviral therapy in Spain. The ARPAS study]. / Adherencia, satisfacción y calidad de vida relacionada con la salud en pacientes infectados por el VIH con tratamiento antirretroviral en España. Estudio ARPAS.

OBJECTIVE: To determine the relationship between satisfaction with antiretroviral therapy (ART), adherence and quality of life (QoL) in adult patients diagnosed with HIV infection and ART according to the posologic load. METHOD: Multicenter, observational and cross-sectional study. Socio-demographic, clinical and of posologic load (1, 2-4 or > 4 tablets/day), adherence (SMAQ, dispensation recordings (DR) and visual analogical scale), satisfaction (ESART questionnaire) and QoL (MOS-HIV) variables were gathered. An adherent patient was defined as the one presenting simultaneously adherence according to SMAQ and DR > 95%. RESULTS: 328 patients (76% men; 46.0 ± 9.2 years) were evaluated. The posology of 1 tablet/day, 2-4 tablets/day and > 4 tablets/day occurred in 29%, 37% and 34% of the patients, respectively. Although the evaluation performed through the SMAQ questionnaire and the VAS scale independently showed statistically significant differences in favor of the 1 tablet/day scheme, the percentage (49%) of adherent patients according to the combined variable did not differ between the groups based on the posologic load. The satisfaction with ART and QoL were high in the three groups, being the 1 tablet/day scheme the one related with higher satisfaction and lower rate of adverse effects on fat metabolism. There were no differences in patients' satisfaction by the adherence level. CONCLUSIONS: Adherence, satisfaction with ART and QoL of the patients with ART are high. Although higher in patients taking 1 tablet/day, the satisfaction did not differ according to the level of adherence and no correlation was observed between satisfaction with ART and quality of life.

OBJETIVO: Determinar la relación entre satisfacción con el tratamiento antirretroviral (TAR), adherencia y calidad de vida (CV) en pacientes adultos diagnosticados de infección por VIH con TAR según la carga posológica. MÉTODO: Estudio observacional, transversal, multicéntrico. Se recogieron variables sociodemográficas, clínicas, carga posológica (1, 2-4 o más de 4 comprimidos al día), adherencia (SMAQ, registros de dispensación (RD) y escala visual analógica), de satisfacción (cuestionario ESTAR) y de CV (MOS-HIV). Se definió paciente adherente cuando simultáneamente presentaba adherencia según SMAQ y un RD > 95%. RESULTADOS: Se evaluaron 328 pacientes (76% varones; 46,0 ± 9,2 años). El esquema de 1c/día, 2-4 c/día y > 4 c/día se dio en el 29%, 37% y 34% de los pacientes respectivamente. Pese que la evaluación realizada por el cuestionario SMAQ y la escala EVA de forma independiente muestra diferencias estadísticamente significativas a favor del esquema 1c/día, el porcentaje de pacientes adherentes según la variable combinada (49%) no difiere entre los grupos en función de la carga posológica. La satisfacción al TAR y fueron elevadas en los tres grupos, siendo los esquemas 1 c/día los relacionados con mayor satisfacción y menores efectos adversos del metabolismo de las grasas. No se observaron diferencias en la satisfacción de los pacientes según la adherencia. CONCLUSIONES: La adherencia, la satisfacción al TAR y de los pacientes con TAR es alta. La satisfacción, mayor en pacientes que toman 1 c/día, no difiere en función de la adherencia y no se observó correlación entre satisfacción con el TAR y calidad de vida.

Impacto presupuestario de la utilización de hormona de crecimiento de la edad pediátrica a la adulta / Budget impact of growth hormone treatment during the transition phase between childhood and adulthood

Objetivo: Estimar el impacto presupuestario de utilizar somatropina (Genotonorm®) en el tratamiento del déficit de hormona de crecimiento (DGH) durante la transición entre edad pediátrica y adulta.Material y métodosSe diseñó un modelo desde la perspectiva del sistema sanitario español, con un horizonte de 5 años. El cálculo de pacientes susceptibles de tratarse se estimó aplicando datos de prevalencia de la enfermedad (0,02%) a la población española. Del total de DGH se estima que un 60% es persistente, que serían los pacientes candidatos. Un panel de expertos asumió que un 20% de los candidatos rechazaría el tratamiento y un 8% de los que aceptaran abandonará anualmente la terapia. En los costes se incluyeron: costes farmacológicos, costes del diagnóstico (visitas médicas y tests) y costes del seguimiento incluyendo las visitas para ajuste de dosis.ResultadosLos pacientes en tratamiento serían 49, 93, 132, 186 y 199 para cada año (2010-2014). El impacto total de la utilización de Genotonorm® durante el periodo de transición sería de 367.691, 655.430, 1.044.874, 1.334.059 y 1.594.670 € en los años 1 a 5. El coste medio anual/paciente sería de 7.506, 7.059, 7.903, 7.960 y 7.995 €.Conclusión: El tratamiento con GH en fase de transición en España supondría un impacto promedio anual de 7.684 €/paciente (AU)

Objective: To estimate the budget impact of somatrophin (Genotonorm®) use in growth hormone deficiency (GHD) patients during the transition between childhood and adulthood.MethodA budget impact model was designed under the Spanish National Health System with a 5-year time horizon. Calculations of susceptible patients were based on disease prevalence (0.02%) applied to Spanish population. From total GHD cases, 60% was considered persistent and treatment candidates. An expert panel assumed that 20% of candidates would reject the treatment and 8% would withdraw therapy annually. Considered costs included: therapy costs, diagnosis (test and medical visit) and follow-up cost.ResultsThere would be 49, 93, 132, 186 and 199 patients undergoing treatment each year (2010-2014). The total impact of Genotonorm® use during the transition phase would be €367 691, €655 430, €1044 874, €1334 059, and €1594 670 for years 1 to 5. The average annual cost per patient would be €7506, €7059, €7903, €7960, €7995.ConclusionsGHD treatment during the transition phase in Spain poses an annual average layout of €7684/patient (AU)

[Budget impact of growth hormone treatment during the transition phase between childhood and adulthood]. / Impacto presupuestario de la utilización de hormona de crecimiento de la edad pediátrica a la adulta.

OBJECTIVE: To estimate the budget impact of somatrophin (Genotonorm) use in growth hormone deficiency (GHD) patients during the transition between childhood and adulthood. METHOD: A budget impact model was designed under the Spanish National Health System with a 5-year time horizon. Calculations of susceptible patients were based on disease prevalence (0.02%) applied to Spanish population. From total GHD cases, 60% was considered persistent and treatment candidates. An expert panel assumed that 20% of candidates would reject the treatment and 8% would withdraw therapy annually. Considered costs included: therapy costs, diagnosis (test and medical visit) and follow-up cost. RESULTS: There would be 49, 93, 132, 186 and 199 patients undergoing treatment each year (2010-2014). The total impact of Genotonorm use during the transition phase would be €367,691, €655,430, €1044,874, €1334,059, and €1594,670 for years 1 to 5. The average annual cost per patient would be €7506, €7059, €7903, €7960, €7995. CONCLUSIONS: GHD treatment during the transition phase in Spain poses an annual average layout of €7684/patient.

[Psychometric characteristics of the antiretroviral treatment satisfaction scale (ESTAR): ARPAS study (I)]. / Características psicométricas de la escala de satisfacción con el tratamiento antirretroviral (ESTAR): estudio ARPAS (I).

OBJECTIVE: To evaluate the psychometric characteristics, convergent validity and reliability of the antiretroviral treatment satisfaction scale (ESTAR, escala de satisfacción con el tratamiento antirretroviral). METHOD: Patient satisfaction with ART was determined using the ESTAR questionnaire, developed in Spanish based on the English language version of the HIV-Treatment-Satisfaction Questionnaire (HIVTSQ). In order to evaluate this, internal consistency and test-retest reliability were measured. The construct analysis was performed by studying the covariance and correlation of the questions, and the convergent validity was assessed by using the MOS-HIV (Medical Outcomes Study HIV Health Survey) questionnaire as the standard, as was the content validity by the correlation between the ESTAR and the clinical and therapeutic variables. RESULTS: The ESTAR is structured in two dimensions (clinical satisfaction and satisfaction with lifestyle) with slight modifications to the original version; question 4, discarded in the original version, has been reworded in the Spanish version, and question 9 was deleted because of low communality. As regards the test-retest reliability, all the questions show significant intraclass correlation coefficients (p<0.001). The internal consistency shows higher values than the original version in the lifestyle dimension (a=0.81 vs. a=0.74) and in the total score (a=0.84 vs. a=0.82). With regard to convergent validity, the ESTAR presents significant correlations with the MOS-HIV as a whole and with different dimensions of it, especially the association with mental health, health distress and cognitive functioning dimensions. CONCLUSIONS: The ESTAR turns out to be a suitable, reliable instrument for evaluating satisfaction with ART by HIV+ patients.

[Preferences, satisfaction and compliance with antiretroviral treatment: ARPAS study (II)]. / Preferencias, satisfacción y adherencia con el tratamiento antirretroviral: estudio ARPAS (II).

OBJECTIVE: To describe the ARPAS study and analyse the sociodemographic and clinical characteristics and patient preferences with regards the antiretroviral treatment (ART), as well as the relationship between compliance and satisfaction with the ART and quality of life. METHOD: The ARPAS study has looked at adult patients diagnosed with HIV and on ART, using a protocol including sociodemographic, clinical, therapeutic and quality of life variables. Compliance was estimated using the SMAQ questionnaire; satisfaction was measured using the ESTAR questionnaire, as was quality of life with the MOS-HIV Health Survey, and treatment preferences were determined using a questionnaire prepared based on the consensus of an expert team in the field of therapeutic monitoring of these patients. A stratified univariate analysis according to compliance and a logistic regression analysis were carried out to study the association of the independent variables with compliance. RESULTS: A total of 234 patients were evaluated (73.7% male; 43.2+/-7.8 years of age). The average time since diagnosis and from the initiation of ART was 10.1+/-5.7 and 7.4+/-4.4 years respectively. The therapeutic regime of twice-daily doses (bid) was applied to 71% of the patients, and once daily (qd) in 21%. A total of 43% of the patients fulfilled compliance criteria according to the SMAQ. The percentage of the patients with qd complying with the ART was greater than the remaining dosing schedules (55.3 vs. 45.1%), although not significantly (p=0.251). No differences were observed in the sociodemographic and clinical variables in terms of compliance. An elective preference was observed for the simplest of the therapeutic regimes which contrasts with the evaluation of the ART characteristics, where power is given preference over durability, tolerance and lastly, the convenience of taking the ART. The univariate analysis showed the highest score on the satisfaction scales (50.4+/-7.8 vs. 46.5+/-9.7, p=0.001) and quality of life (81.6+/-10.7 vs. 75.7+/-11.8, p<0.001) in compliant patients with respect to non-compliers. The multivariate models confirm the existence of a significant association between compliance and satisfaction, and between compliance and quality of life. CONCLUSIONS: Patients consider treatment with a powerful, long-lasting and well-tolerated ART a priority and among their preferences for different treatment regimes, once-daily dosing regimes are highlighted. The ARPAS study showed a direct relationship between compliance and satisfaction with ART, and between compliance and quality of life, in a manner that the strategies improving compliance must necessarily include aspects that allow them to improve patient satisfaction with treatment and quality of life.

[Budget impact analysis of the treatment of chronic hepatitis C in a hospital]. / Análisis de impacto presupuestario en el tratamiento de la hepatitis por virus C en un hospital.

OBJECTIVE: To perform a budget impact analysis (BIA) of the treatment with pegylated interferon (pegIFN), alfa-2a or alfa-2b, plus ribavirin in patients with chronic hepatitis C (CHC). METHOD: An interactive model has been designed from the inputs obtained from hospital databases. Prices for pegIFN and RIB have been taken from the hospitals considering their respective discounts. Only pharmacological costs (euros 2005 values) for the options have been considered. Both strategies have been considered as therapeutic equivalents. RESULTS: The number of patients with CHC evaluated in the model has been of 117, with an average age of 42 years and an average weight of 75 kg. The genotypes of the patients were: G1/4, 85% and; G2/3, 15%. Discontinuation of the treatment at week 12 took place in 26% of the patients. The average duration of treatment has been of 37 weeks. Total cost of the 117 evaluated patients ranged between 942,632-952,109 and 861,646-880,751 euros for the treatment with pegIFN alfa-2a + RIB and pegIFN alfa-2b + RIB, respectively. CONCLUSIONS: BIA models can be useful for the inclusion or reassessment of drugs in formularies. In this case, the treatment with pegIFN alfa-2b + RIB (in comparison with pegIFN alfa-2a + RIB) is an efficient strategy although it depends on acquisition prices, and so, it would be rarely useful in other centres. In our hospital it would produce a budgetary saving that would range from 71,358 to 80,986 euros, which would represent a 7.5-8.6% of the total cost of the pharmacological treatment of the CHC.

Análisis de impacto presupuestario en el tratamiento de la hepatitis por virus C en un hospital / No disponible

Objetivo: Realizar un análisis de impacto presupuestario (AIP)del tratamiento con interferón pegilado (pegIFN), alfa-2a o alfa-2b, más ribavirina (RIB) en pacientes naïve con hepatitis crónicaC (HCC).Método: Se ha diseñado un modelo interactivo a partir de lasvariables obtenidas de bases de datos hospitalarias. Los precios depegIFN y RIB han sido los abonados por el hospital con sus respectivosdescuentos. Sólo se han considerado los costes farmacológicosasociados a las opciones (en euros 2005). Ambas estrategiasse han considerado equivalentes terapéuticos.Resultados: El número de pacientes con HCC evaluados enel modelo ha sido de 117, con una edad media de 42 años y unpeso promedio de 75 kg. Los genotipos de los pacientes y su distribuciónfueron: G1/4, 85% y G2/3, 15%. Se produjo discontinuacióndel tratamiento a las 12 semanas en el 26% de lospacientes. El tiempo promedio del tratamiento ha sido de 37semanas. El coste total de los 117 pacientes evaluados oscilaentre 942.632-952.109 y 861.646-880.751 euros para el tratamientocon pegIFN alfa-2a + RIB y con pegIFN alfa-2b + RIB,respectivamente.Conclusiones: Los modelos de AIP pueden ser útiles para lainclusión o reevaluación de medicamentos en las guías farmacoterapéuticas.En este hospital, el tratamiento con pegIFN alfa-2b +RIB (en comparación con pegIFN alfa-2a + RIB) es una estrategiaeficiente aunque muy sensible a los precios de adquisición por loque es difícilmente extrapolable a otros entornos. En nuestro hospitalproduciría un ahorro presupuestario entre 71.358 a 80.986euros, lo que representaría un 7,5-8,6% del coste total del tratamientofarmacológico de la HCC

Objective: To perform a budget impact analysis (BIA) of thetreatment with pegylated interferon (pegIFN), alfa-2a or alfa-2b,plus ribavirin in patients with chronic hepatitis C (CHC).Method: An interactive model has been designed from theinputs obtained from hospital databases. Prices for pegIFN andRIB have been taken from the hospitals considering their respectivediscounts. Only pharmacological costs (euros 2005 values) forthe options have been considered. Both strategies have been consideredas therapeutic equivalents.Results: The number of patients with CHC evaluated in themodel has been of 117, with an average age of 42 years and anaverage weight of 75 kg. The genotypes of the patients were:G1/4, 85% and; G2/3, 15%. Discontinuation of the treatment atweek 12 took place in 26% of the patients. The average durationof treatment has been of 37 weeks. Total cost of the 117 evaluatedpatients ranged between 942,632-952,109 and 861,646-880,751 euros for the treatment with pegIFN alfa-2a + RIB andpegIFN alfa-2b + RIB, respectively.Conclusions: BIA models can be useful for the inclusion orreassessment of drugs in formularies. In this case, the treatmentwith pegIFN alfa-2b + RIB (in comparison with pegIFN alfa-2a +RIB) is an efficient strategy although it depends on acquisitionprices, and so, it would be rarely useful in other centres. In ourhospital it would produce a budgetary saving that would rangefrom 71,358 to 80,986 euros, which would represent a 7,5-8,6%of the total cost of the pharmacological treatment of the CHC

Coste-efectividad de interferón pegilado alfa en el tratamiento de la hepatitis crónica por virus C / Cost-effectiveness of pegylated interferon-alpha in the treatment of chronic hepatitis due to HCV

No disponible

No disponible