Coste del asma en pediatría en España: un modelo de evaluación de costes basado en la prevalencia / Cost of childhood asthma in Spain: a cost evaluation model based on the prevalence

Introducción: El asma es la enfermedad crónica más frecuente en la infancia, disminuye la calidad de vida de los niños y sus familiares, y produce elevados costes sociales y sanitarios que en España no se conocen. Objetivo: Estimar el coste del manejo del asma en pediatría en España y estudiar su variabilidad en función de la gravedad. Pacientes y métodos: Se estimó el coste del manejo del asma en menores de 16 años en 2008, construyendo un modelo de evaluación de costes considerando los factores de los que depende: prevalencia, distribución de la gravedad, edad, frecuencia de utilización de recursos según la gravedad, y coste de cada recurso. Se realizó un análisis de sensibilidad para evaluar la incertidumbre subyacente dependiente de la variabilidad en los estimadores de utilización de recursos, del coste unitario de cada recurso y de la prevalencia. Resultados: El coste total del asma en pediatría en España es de unos 532 millones de euros, pudiendo oscilar entre 392 y 693 millones de euros. Los costes directos (costes sanitarios) representan el 60% del coste total y los costes indirectos (tiempo de cuidador) el 40%. El coste medio anual por niño asmático es 1.149 euros, y oscila entre 403 euros para la categoría de gravedad más leve y 5.380 euros para la más grave. Conclusiones: El coste del asma en pediatría en España es muy elevado y depende de la gravedad de la enfermedad. Los costes más importantes son los del sistema sanitario, pero los costes indirectos no son despreciables (AU)

Introduction: Asthma is the most common chronic disease in childhood, reduces the quality of life of children and their families, and produces high social and health care costs. In Spain, the cost of managing paediatric asthma is unknown. Objective: To estimate the cost of managing paediatric asthma in Spain and to examine its variability depending on asthma severity. Patients and methods: The cost of asthma in children under 16 years in 2008 was estimated by building a costs assessment model including the factors that influence the cost of asthma in children: prevalence, distribution of disease severity, age, frequency of resources use depending on severity, and the cost of each resource. A sensitivity analysis was conducted to evaluate the underlying uncertainty depending on the variability of the estimators of resource use, the unit cost of each resource, and the prevalence. Results: According to the model, the total cost of paediatric asthma in Spain is around 532 million euros, with a range of 392 to 693 million euros. Direct costs (health care costs) represent 60% of the total costs, and indirect costs (carer time), 40%. The mean annual cost per child with asthma is 1,149 euros, ranging from 403 euros for the mildest category of the disease to 5,380 euros for the most severe. Conclusions: The cost of paediatric asthma in Spain is very high and depends on disease severity. Although the most important costs are for the health care system, indirect costs are not negligible (AU)

[Cost of childhood asthma in Spain: a cost evaluation model based on the prevalence]. / Coste del asma en pediatría en España: un modelo de evaluación de costes basado en la prevalencia.

INTRODUCTION: Asthma is the most common chronic disease in childhood, reduces the quality of life of children and their families, and produces high social and health care costs. In Spain, the cost of managing paediatric asthma is unknown. OBJECTIVE: To estimate the cost of managing paediatric asthma in Spain and to examine its variability depending on asthma severity. PATIENTS AND METHODS: The cost of asthma in children under 16 years in 2008 was estimated by building a costs assessment model including the factors that influence the cost of asthma in children: prevalence, distribution of disease severity, age, frequency of resources use depending on severity, and the cost of each resource. A sensitivity analysis was conducted to evaluate the underlying uncertainty depending on the variability of the estimators of resource use, the unit cost of each resource, and the prevalence. RESULTS: According to the model, the total cost of paediatric asthma in Spain is around 532 million euros, with a range of 392 to 693 million euros. Direct costs (health care costs) represent 60% of the total costs, and indirect costs (carer time), 40%. The mean annual cost per child with asthma is 1,149 euros, ranging from 403 euros for the mildest category of the disease to 5,380 euros for the most severe. CONCLUSIONS: The cost of paediatric asthma in Spain is very high and depends on disease severity. Although the most important costs are for the health care system, indirect costs are not negligible.

Non-cardiac arterial disease in Catalonia: patient profiles and quality of clinical records by characteristics of the Vascular Surgery Unit.

AIM: Non-cardiac arterial disease (NCAD) is a frequent cause of hospital admission. The aim of this study was to investigate differences in patient profiles and clinical records as a function of the size of the Vascular Surgery Unit (VSU). METHODS: Retrospective observational study. Stratified cluster sampling and selection of patients hospitalized for NCAD. ANALYSIS: 1) description of patient profiles, quality of clinical records, and VSU [availability of diagnostic (DR) and therapeutic (TR) resources, and of written protocols (WP)]; 2) association between these variables and size of VSU. RESULTS: The sample consisted of 14 hospitals, 6 with a VSU of 15 or fewer beds (VSU < or = 15B) and 8 with >15 beds (VSU >15B). The mean number of DRs, TRs and WPs was 9, 2.8 and 2 in VSUs < or = 15B, and 11.5, 6.5 and 3.3 in VSUs >15B. The proportion of patients older than 70, female, with ischemic disease, or with coexisting diabetes was significantly higher in VSUs < or = 15B (67%, 31%, 95% and 57%, respectively) than in VSUs >15B (58%, 22%, 69% and 48%). Comorbid conditions and treatment during admission and at discharge were documented significantly less frequently in the clinical records in VSUs < or = 15B. Risk factors were under-reported in the clinical records of both types of VSU. CONCLUSION: Patient profiles and the quality of clinical records vary by size of VSU. Under-reporting of risk factors may hinder the implementation of prevention and treatment measures.

[The efficiency (cost-effectiveness) of palivizumab as prophylaxis against respiratory syncytial virus infection in premature infants with a gestational age of 32-35 weeks in Spain]. / La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España.

OBJECTIVES: To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. DESIGN: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. PERSPECTIVES: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. RESULTS: Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 euro/QALY from the NHS perspective, and an ICER of 4,605 euro/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351 euro/QALY (most favorable scenario) to 23,276 euro/QALY (least favorable scenario). CONCLUSIONS: Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 Euro/QALY considered socially acceptable in Spain.

La eficiencia (coste-efectividad) de palivizumab como profilaxis para la infección por virus respiratorio sincitial en prematuros de 32-35 semanas en España / The efficiency (cost-effectiveness) of palivizumab as prophylaxis against respiratory syncytial virus infection in premature infants with a gestational age of 32-35 weeks in Spain

Objetivos Evaluar la eficiencia (coste-efectividad) de palivizumab para prevenir la infección grave por virus respiratorio sincitial (VRS) en prematuros de edad gestacional de 32 a 35 semanas (EG 32-35) y dos o más factores de riesgo (FR) en España. Métodos Diseño: modelo de decisión alimentado con datos de la literatura científica y de los estudios FLIP I y FLIP II (cohorte de 326 niños con EG 32-35 y dos o más FR que recibieron palivizumab) promovidos por la Sociedad Española de Neonatología. Medida de efectividad principal: años de vida ajustados por calidad (AVAC) ganados. Perspectivas: la del Sistema Nacional de Salud (SNS), que incluye los costes directos (administración de palivizumab e ingresos hospitalarios), y la perspectiva social, que incluye además los costes indirectos (futura productividad perdida del niño). Descuento: 3 % anual para la efectividad y costes indirectos. Análisis de sensibilidad: construcción de 37 escenarios modificando variables relacionadas con la efectividad y los costes. Resultados La profilaxis con palivizumab en prematuros de EG 32-35 y dos o más FR produce una relación de coste-efectividad incremental (CEI) de 13.849 euros/AVAC con la perspectiva del SNS, y de 4.605 euros/AVAC con la perspectiva social. En el análisis de sensibilidad, con la perspectiva del SNS, el CEI osciló de 5.351 euros/AVAC (escenario más favorable) a 23.276 euros/AVAC (escenario menos favorable). Conclusiones Palivizumab es una terapia coste-efectiva como profilaxis frente a VRS en niños de EG 32-35 y dos o más FR. Su uso es eficiente desde la perspectiva del SNS, al conseguir un AVAC, incluso en los escenarios menos favorables, por debajo del umbral de 30.000 euros/AVAC, considerado en España como socialmente aceptable

Objectives To evaluate the efficiency (cost-effectiveness) of palivizumab in preventing severe respiratory syncytial virus (RSV) infection in premature infants with a gestational age of 32-35 weeks (GA 32-35) and two or more risk factors (RF) in Spain. Methods Design: decision tree model using data from the scientific literature and the FLIP I and FLIP II studies (cohort of 326 infants with GA 32-35 and two or more RF who received palivizumab) sponsored by the Spanish Society of Neonatology. Main effectiveness measure: quality-adjusted life years (QALY) gained. Perspectives: the national health service (NHS), which includes direct costs (administration of palivizumab and hospital admissions), and the societal perspective, which also includes indirect costs (the child's future lost productivity). Discount: 3 % annually for effectiveness and indirect costs. Sensitivity analysis: construction of 37 scenarios modifying variables related to effectiveness and costs. Results Prophylaxis with palivizumab in premature infants with GA 32-35 and two or more RF produced an incremental cost-effectiveness ratio (ICER) of 13,849 euros/QALY from the NHS perspective, and an ICER of 4,605 euros/QALY from the societal perspective. In the sensitivity analysis, from the NHS perspective the ICER ranged from 5,351euros/QALY (most favorable scenario) to 23,276 euros/QALY (least favorable scenario). Conclusions Palivizumab is a cost-effective therapy as prophylaxis against RSV in infants with GA 32-35 and two or more RF. Its use is efficient from the NHS perspective, since the cost of a QALY, even in the least favorable scenarios, is lower than the threshold of 30,000 euros/QALY considered socially acceptable in Spain

[Prevalence of urinary incontinence and linked factors in men and women over 65]. / Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años.

OBJECTIVES: To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. DESIGN: Population survey. SETTING: Leganés (Madrid). PARTICIPANTS: Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). MAIN MEASUREMENTS: Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. RESULTS: The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. CONCLUSIONS: Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años / Prevalence of urinary incontinence and linked factors in men and women over 65

Objetivos. Estimar la prevalencia de la incontinencia urinaria e identificar los factores asociados en una población de personas mayores que viven en sus domicilios. Diseño. Encuesta poblacional. Emplazamiento. Leganés (Madrid).Participantes. Muestra representativa de las personas mayores de 65 años empadronadas en Leganés (n = 1.560). Se realizaron dos entrevistas en el domicilio, y durante la segunda se incluyó un examen médico. La tasa de respuesta fue del 75 por ciento (n = 1.150).Mediciones principales. Frecuencia de pérdidas involuntarias de orina y utilización de fármacos y absorbentes, estado de salud, uso de diuréticos y oxibutinina y variables demográficas y sociales. Resultados. La prevalencia de incontinencia urinaria fue del 14 por ciento (intervalo de confianza [IC] del 95 por ciento, 11-17) en varones y 30 por ciento (IC del 95 por ciento, 26-34) en mujeres. La edad avanzada está asociada a una mayor prevalencia en los varones pero no en las mujeres. En el análisis multivariado, los factores asociados a la incontinencia urinaria son la comorbilidad y el déficit cognitivo; en las mujeres se añaden, además, el índice de masa corporal elevado y las limitaciones graves de movilidad. El 20 por ciento de las mujeres y el 5 por ciento de los varones mayores de 65 años utilizan absorbentes. La utilización de diuréticos y el bajo número de pacientes con tratamiento específico en personas con incontinencia urinaria sugieren una baja detección de este problema. Conclusiones. La incontinencia urinaria es frecuente y podría ser mejor detectada y tratada en la atención primaria. La prevención de la incontinencia urinaria en las mujeres debería comenzar antes de la vejez (AU)

Distribución de los urólogos en España: situación actual y estimación de necesidades futuras mediante un modelo predictivo

No disponible

GUIPCAR: una guía de práctica clínica para el manejo de la artritis reumatoide en España / GUIPCAR, a practical clinical guide to the management of rheumatoid arthritis in Spain

No disponible

[The libraries of the public hospitals in Spain. An economic analysis. The Research Group on Libraries]. / Las bibliotecas de los hospitales públicos en España. Un análisis económico. Grupo de Investigación en Bibliotecas.

BACKGROUND: The continuous increase in scientific knowledge in the health field, the development of new technologies and the rising cost of publications means that libraries are essential for patient care, medical education and research. In Spain some deficiencies have been seen in hospital libraries, and their cost is unknown. OBJECTIVE: To analyze the cost of public hospital libraries in Spain and to estimate the cost of adapting them to international standards. METHODS: Cross-sectional survey of public hospitals larger than 100 beds, or smaller public hospitals with teaching accreditation. Information on the variables of interest was collected by questionnaire mailed to the libraries and followed up by telephone. Data collection was completed in 1996. The information on costs is for 1994. A sensitivity analysis was done to examine the effects of imprecise estimates and assumptions. RESULTS: Of the 314 hospitals identified, 211 (67.2%) had libraries. The 1994 cost of the of the 211 libraries was 3,060 million pesetas (mean cost: 14.5 million pesetas). Personnel costs were the most important item (38% of the total), followed by the cost of subscriptions (29%). The cost of hospital libraries represented 0.08% of national public expenditures on health. The cost of correcting inadequacies in accordance with international standards would increase spending by about 400 million pesetas the first year (0.01% of public spending on health). CONCLUSIONS: The cost of hospital libraries represents only a small fraction of public spending on health. Correction of the observed deficiencies and the importance of libraries in the health system would require increasing spending to about 0.1% of public spending on health.