Public healthcare costs associated with long-term exposure to mixtures of persistent organic pollutants in two areas of Southern Spain: A longitudinal analysis.

BACKGROUND: Polychlorinated biphenyls and organochlorine pesticides are persistent organic pollutants (POPs) that had been banned or restricted in many countries, including Spain. However, their ubiquity still poses environmental and human health threats. OBJECTIVE: To longitudinally explore public healthcare costs associated with long-term exposure to a mixture of 8 POPs in a cohort of residents of two areas of Granada Province, Southern Spain. METHODS: Longitudinal study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was performed by analyzing adipose tissue POP concentrations at recruitment. Average primary care (APC) and average hospital care (AHC) expenditures of each participant over 14 years were estimated using the data from their medical records. Data analyses were performed by robust MM regression, weighted quantile sum regression (WQS) and G-computation analysis. RESULTS: In the adjusted robust MM models for APC, most POPs showed positive beta coefficients, being Hexachlorobenzene (HCB) significantly associated (ß: 1.87; 95% Confidence interval (95%CI): 0.17, 3.57). The magnitude of this association increased (ß: 3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semi-rural residents, where ß-HCH was also marginally-significantly associated to APC (ß: 3.40; 95%CI: -0.10, 6.90). WQS revealed a positive but non-significant mixture association with APC (ß: 0.14; 95%CI: -0.06, 0.34), mainly accounted for by ß-HCH (54%) and HCB (43%), that was borderline-significant in the semi-rural residents (ß: 0.23; 95%CI: -0.01, 0.48). No significant results were observed in G-Computation analyses. CONCLUSION: Long-term exposure to POP mixtures might represent a modifiable factor increasing healthcare costs, thus affecting the efficiency of the healthcare systems. However, and owing the complexity of the potential causal pathways and the limitations of the present study, further research is warranted to fully elucidate ascertain whether interventions to reduce human exposure should be considered in healthcare policies.

Historical exposure to persistent organic pollutants and cardiovascular disease: A 15-year longitudinal analysis focused on pharmaceutical consumption in primary care.

BACKGROUND: Despite restrictions on their production and use, most of the population is still exposed to Persistent Organic Pollutants (POPs), including organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs). These chemicals are thought to contribute to the aetiology of highly prevalent chronic conditions, such as cardiovascular diseases (CVDs), although current evidences are still controversial. OBJECTIVES: To explore the potential contribution of historical POP exposure to 15-year pharmaceutical consumption in relation to CVD. METHODS: This study is framed within GraMo adult cohort. Participants (n = 387) were recruited in two hospitals in Granada province, Southern Spain (2003-2004). Historical exposure to 5 OCPs and 3 non-dioxine-like PCBs was estimated by analysing adipose tissue concentrations at recruitment. Pharmaceutical consumption from recruitment until year 2017 was quantified by reviewing dispensation databases. Average consumption increase (ACI) in CVD medication was calculated by subtracting average consumption in 2002 to the average yearly consumption during follow-up. ACI was expressed as Defined Daily Dose (DDD)/year units. Data analyses were carried out using a multivariable multinomial logistic regression and weighted quantile sum regression (WQS), with ACI categorized in quartiles (Q) as the dependent variable. RESULTS: Concentrations of most pollutants showed a positive trend with the quartiles of ACI. Particularly, PCB-153 showed increasing and statistically significant odds ratios (ORs) for Q2 (OR: 1.27, 95% confidence interval (CI): 1.07-1.52), Q3 (OR: 1.49, 95 %CI: 1.17-1.88) and Q4 (OR: 1.42, 95 %CI: 1.13-1.78) vs Q1. Similarly, beta-hexachlorocyclohexane (ß-HCH) also showed increasing ORs, that reached statistical significance in Q4 (OR: 1.36, 95 %CI: 1.06-1.74) vs Q1. These findings were corroborated by WQS analyses, that revealed a significant mixture effect, predominantly accounted for by PCB-153 and ß-HCH. DISCUSSION: Our results suggest that long-term POP exposure might represent a modifiable risk factor for CVD. These findings are relevant for public health campaigns and management, since pharmaceutical consumption is considered an indicator of both morbidity and health expenditure.

Economic evaluation of elective single-embryo transfer with subsequent single frozen embryo transfer in an in vitro fertilization/intracytoplasmic sperm injection program.

OBJECTIVE: To analyze the cost-effectiveness of IVF-ICSI cycles with elective single-embryo transfer (eSET), plus elective single frozen embryo transfer (eSFET) if pregnancy is not achieved, compared with double-embryo transfer (DET). DESIGN: Cost-effectiveness analysis. SETTING: Public hospital. PATIENT(S): A population of 121 women (<38 years old), undergoing their first or second IVF cycles. INTERVENTION(S): We conducted a cost-effectiveness analysis using the results of a prospective clinical trial. The women in group 1 received eSET plus eSFET, and those in group 2 received DET. A probabilistic sensitivity analysis was performed. MAIN OUTCOME MEASURE(S): Live birth delivery rate. RESULT(S): The cumulative live birth delivery rate was 38.60% in the eSET+eSFET group versus 42.19% in the DET group. The mean costs per patient were €5,614.11 in the eSET+eSFET group and €5,562.29 in the DET group. These differences were not statistically significant. The rate of multiple gestation was significantly lower in the eSET group than in the DET group (0 vs. 25.9%). CONCLUSION(S): This study does not show that eSET is superior to DET in terms of effectiveness or of costs. The lack of superiority of the results for the eSET+eSFET and the DET groups corroborates that the choice of strategy to be adopted should be determined by the context of the health care system and the individual prognosis.

Effect of patient safety strategies on the incidence of adverse events.

OBJECTIVE: This study aims to estimate the incidence of adverse events (AEs) and avoidable AE in four hospital services before and after applying strategies for patient safety. DESIGN: Retrospective study of two cohorts (2006 and 2009). SETTING: General Surgery, Internal Medicine, Intensive Care Unit and Oncology services. PARTICIPANTS: A sample of 365 patients (2006) and 232 in 2009 randomly selected from the services previously cited. INTERVENTIONS: Strategies to improve patient safety (e.g. hand-hygiene campaign). MAIN OUTCOME MEASURES: Analyses were made of the change in the incidence and type of AE and avoidable AE, number of procedures and additional days of hospital stay, and the concordance between two recording systems. RESULTS: The incidence of patients with AE was 20.8% in 2006 compared with 28.9% in 2009 (P < 0.05). Oncology had twofold more AE than did General Surgery [odds ratio (OR) = 2.07, 95% confidence interval (CI): 1.12-3.86] for the same length of stay and number of extrinsic risk factors. In 2006, 84.6% were considered avoidable, compared with 57.1% of 2009 (P < 0.001). There was no difference in the average length of additional stay. In 2006, there were more additional procedures compared to 2009 (OR = 2.75, 95% CI: 1.28-6.06). A concordance of 61% was found for the detection of AE with the two recording systems. CONCLUSIONS: An increased incidence in AEs was found after the strategies, while avoidable AE decreased, as did additional treatments and procedures. The measures implemented constitute a further step in reducing avoidance and a greater awareness of recording AEs in the discharge report.

[Total knee and hip prosthesis: variables associated with costs]. / Prótesis total de rodilla y cadera: variables asociadas al costo.

BACKGROUND: The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. OBJECTIVE: To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. METHODS: A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. RESULTS: The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. CONCLUSIONS: There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

antecedentes: la alta prevalencia de artrosis en los países occidentales, el elevado costo de las intervenciones de artroplastia de cadera y rodilla y las amplias variaciones en la práctica médica generan gran interés por comparar los costos asociados antes y después de la cirugía. Objetivo: conocer el costo de las intervenciones de reemplazo total de cadera y rodilla durante la estancia hospitalaria y al año de seguimiento posterior al alta. material y métodos: estudio multicéntrico y prospectivo efectuado en 15 hospitales de tres comunidades autónomas. La relación entre las variables independientes con el costo de la estancia y costo post-alta, se analizó con modelos multinivel y para agrupar los casos se utilizó la variable "hospital." Las variables independientes fueron: edad, sexo, índice de masa corporal, calidad de vida prequirúrgica (cuestionarios ED-5D, SF-12 y Womac), intervención (cadera-rodilla), índice Charlson, complicaciones, número de camas y dependencia económico-institucional del hospital, comunidad autó-noma y presencia de cuidador. Resultados: el costo promedio por paciente, sin incluir el costo de la prótesis, fue de 4,734 Euros ± 2,136 y el costo del seguimiento post alta de 554 Euros ± 509. Si se incluye el costo de la prótesis, al final del año el costo total asciende a 7,645 Euros ± 2,248. Conclusiones: existe un margen considerable en la reducción de los costos de estancia; más de 44% de la variabilidad observada no está determinada por las condiciones clínicas de los pacientes sino por el comportamiento de los centros hospitalarios.

Body mass index as predictor of health-related quality-of-life changes after total hip arthroplasty: a cross-over study.

The objective of this study was to examine the contribution of patient weight and other preoperative variables to improvements in the general physical health of patients undergoing total hip arthroplasty (THA). Data were prospectively collected on 63 THA patients (28 males and 35 females). The primary outcome measure was the improvement in general health (Short Form-12 Health Survey questionnaire) at three months post-THA. Patients with body mass index >28kg/m(2) showed greater improvements in function and in the physical component of general health after THA. Stepwise regression analyses revealed that the BMI and WOMAC general index were independent and significant predictors of physical function and together explained 34.2% of the variance in physical function scores. These findings suggest that the body mass index before surgery and improvements in hip function are relevant contributors to post-THA improvements in general health.

Diagnostic accuracy, effectiveness and cost for cognitive impairment and dementia screening of three short cognitive tests applicable to illiterates.

BACKGROUND: Illiteracy, a universal problem, limits the utilization of the most widely used short cognitive tests. Our objective was to assess and compare the effectiveness and cost for cognitive impairment (CI) and dementia (DEM) screening of three short cognitive tests applicable to illiterates. METHODS: Phase III diagnostic test evaluation study was performed during one year in four Primary Care centers, prospectively including individuals with suspicion of CI or DEM. All underwent the Eurotest, Memory Alteration Test (M@T), and Phototest, applied in a balanced manner. Clinical, functional, and cognitive studies were independently performed in a blinded fashion in a Cognitive Behavioral Neurology Unit, and the gold standard diagnosis was established by consensus of expert neurologists on the basis of these results. Effectiveness of tests was assessed as the proportion of correct diagnoses (diagnostic accuracy [DA]) and the kappa index of concordance (k) with respect to gold standard diagnoses. Costs were based on public prices at the time and hospital accounts. RESULTS: The study included 139 individuals: 47 with DEM, 36 with CI, and 56 without CI. No significant differences in effectiveness were found among the tests. For DEM screening: Eurotest (k = 0.71 [0.59-0.83], DA = 0.87 [0.80-0.92]), M@T (k = 0.72 [0.60-0.84], DA = 0.87 [0.80-0.92]), Phototest (k = 0.70 [0.57-0.82], DA = 0.86 [0.79-0.91]). For CI screening: Eurotest (k = 0.67 [0.55-0.79]; DA = 0.83 [0.76-0.89]), M@T (k = 0.52 [0.37-0.67]; DA = 0.80 [0.72-0.86]), Phototest (k = 0.59 [0.46-0.72]; DA = 0.79 [0.71-0.86]). There were no differences in the cost of DEM screening, but the cost of CI screening was significantly higher with M@T (330.7 ± 177.1 €, mean ± sd) than with Eurotest (294.1 ± 195.0 €) or Phototest (296.0 ± 196. 5 €). Application time was shorter with Phototest (2.8 ± 0.8 min) than with Eurotest (7.1 ± 1.8 min) or M@T (6.8 ± 2.2 min). CONCLUSIONS: Eurotest, M@T, and Phototest are equally effective. Eurotest and Phototest are both less expensive options but Phototest is the most efficient, requiring the shortest application time.

Efecto de un programa de atención telefónica tras el alta hospitalaria de una unidad de cirugía traumatológica / Effect of a telephone care program after hospital discharge from a trauma surgery unit

Objetivo: Determinar el impacto, sobre la utilización de servicios sanitarios y la ansiedad del paciente,de un programa de atención telefónica durante el mes siguiente al alta hospitalaria de una unidad de cirugía traumatológica, junto con análisis presupuestario.Método: Estudio experimental en 604 pacientes, que constituyeron los grupos experimental y control.El grupo experimental dispuso de atención telefónica para solventar dudas durante el mes siguiente alalta. Al finalizar se registraron, en ambos grupos, si habían acudido a urgencias, al médico de familia o reingresado, y el resultado de un test de ansiedad, que constituyeron las variables resultado. El análisis dedatos incluyó análisis multivariados de regresión logística y lineal, y cálculo del impacto presupuestario del programa en tres escenarios (Hospital, Servicio Andaluz de Salud, Sistema Nacional de Salud).Resultados: Se atendieron 73 consultas telefónicas de 60 pacientes, casi la mitad de ellas por dudas respecto al régimen terapéutico. Para la variable resultado «asistencia a los servicios de urgencias», en el análisis multivariado los pacientes sin atención telefónica tenían una odds ratio de 1,8, ajustada por lasvariables «días de estancia hospitalaria», «ansiedad del paciente» y «comprensión de las indicaciones alalta». Para el resto de las variables resultado no hubo diferencias entre ambos grupos. El análisis de costes demostró la posibilidad de implantar el programa con un coste de 1,65 euros por paciente intervenido.Conclusiones: El programa fue eficaz para disminuir las visitas a urgencias, a un coste reducido (AU)

Objective: To determine the impact of a 1-month telephone care program after hospital discharge from a trauma surgery unit on health services utilization and patient anxiety and to perform a budgetaryanalysis. Methods: We carried out an experimental study in 604 patients who formed an experimental and a control group. The experimental group was offered telephone care to resolve doubts during the firstmonth after discharge. After this period, data were collected from both groups on the following outcomevariables: visits to the emergency department or family physician, hospital readmissions, and the resultsof an anxiety test. Data analyses included logistic and linear multivariate analyses and calculation of thebudgetary impact of the program on the hospital, the Andalusian Health Service, and the National Health System.Results: A total of 73 telephone consultations were conducted with 60 patients, almost half for doubts about the therapeutic regimen. For the outcome variable “visit to emergency department”, the groupwithout telephone care had an odds ratio of 1.8 in the multivariate analysis adjusted for the other independentvariables: days of hospital stay, patient anxiety and comprehension of discharge indications.No differences between groups were found in the remaining outcome variables. The budgetary analysis demonstrated the possibility of implementing the program at a cost of 1.65 D per patient.Conclusions: This program proved effective in reducing visits to the emergency department at a low cost (AU)

[Effect of a telephone care program after hospital discharge from a trauma surgery unit]. / Efecto de un programa de atención telefónica tras el alta hospitalaria de una unidad de cirugía traumatológica.

OBJECTIVE: To determine the impact of a 1-month telephone care program after hospital discharge from a trauma surgery unit on health services utilization and patient anxiety and to perform a budgetary analysis. METHODS: We carried out an experimental study in 604 patients who formed an experimental and a control group. The experimental group was offered telephone care to resolve doubts during the first month after discharge. After this period, data were collected from both groups on the following outcome variables: visits to the emergency department or family physician, hospital readmissions, and the results of an anxiety test. Data analyses included logistic and linear multivariate analyses and calculation of the budgetary impact of the program on the hospital, the Andalusian Health Service, and the National Health System. RESULTS: A total of 73 telephone consultations were conducted with 60 patients, almost half for doubts about the therapeutic regimen. For the outcome variable "visit to emergency department", the group without telephone care had an odds ratio of 1.8 in the multivariate analysis adjusted for the other independent variables: days of hospital stay, patient anxiety and comprehension of discharge indications. No differences between groups were found in the remaining outcome variables. The budgetary analysis demonstrated the possibility of implementing the program at a cost of 1.65 € per patient. CONCLUSIONS: This program proved effective in reducing visits to the emergency department at a low cost.

Cost-outcome analysis of joint replacement: evidence from a Spanish public hospital.

BACKGROUND AND OBJECTIVES: Efficiency-based healthcare decision-making has been widely accepted for some time, with cost per quality-adjusted life year (QALY) as the main outcome measure. Nevertheless, for numerous medical procedures, little data are available on the cost per QALY gained. The aim of the present study was to calculate the cost per QALY gained with primary hip and knee replacement and to compare the result with the cost per QALY for other medical procedures, as well as with the maximum threshold cost considered acceptable in Spain. METHODS: We performed a prospective cohort pre-test/post-test study of patients undergoing primary hip or knee arthroplasty. Age, sex, and clinical variables were recorded. Functional status and quality of life were measured by means of the WOMAC and EuroQol instruments, respectively, before the intervention and 6 months later. The direct costs of the intervention were calculated, with length of hospital stay and the prosthesis as the main cost drivers. RESULTS: A total of 80 patients, 40 from each intervention, were included in this study. Both functional and perceived health status improved after the intervention. The number of QALYs gained in the knee cohort was 4.64, while that in the hip cohort was 0.86. The total cost of knee replacement was lower (6,865.52 euro) than that of hip replacement (7,891.21 euro). The cost per QALY gained was 1,275.84 euro and 7,936.12 euro for knee and hip interventions, respectively. The calculations performed included a 6% discount rate for health outcomes, a 3% inflation rate for costs, and a success rate of 95% at 15 years. CONCLUSIONS: The costs of both knee and hip replacement were lower than the threshold of 30,000 euro per QALY considered acceptable in Spain, and compared favorably with other medical and surgical procedures.

Cost-outcome analysis of joint replacement: evidence from a Spanish public hospital / Análisis coste-resultado del remplazo de articulaciones. Evidencia de un hospital público español

Fundamento y objetivos: Está ampliamente aceptada la tomade decisiones sanitarias basada en la eficiencia, con el coste por año de vida ajustado por la calidad (AVAC) como medida de resultado. No obstante, aún es escasa la disponibilidad de datos de coste por AVAC de las intervenciones. El objetivo de este trabajo es calcular el coste por AVAC ganado en artroplastia de cadera y rodilla, y compararlo con los costes por AVAC de otras intervenciones, así como con el umbral máximo establecido.Métodos: Estudio de cohortes prospectivo pre-test post-test de pacientes intervenidos de prótesis primaria de cadera o rodilla. Se recogieron variables demográficas, clínicas, funcionales y del estado de salud percibida antes de la intervención y 6 meses después de ésta, mediante los cuestionarios WOMAC y EuroQol, respectivamente. Se calcularon los costesdirectos de la intervención, considerando la prótesis y la duración de la estancia como determinantes principales del gasto.Resultados: Se incluyeron 80 pacientes, 40 por cada articulación. El estado funcional y la salud autopercibida mejoraron tras la intervención. Se ganaron 4,64 y 0,86 AVAC en intervenciones de rodilla y cadera, respectivamente. El coste por proceso de prótesis de rodilla fue de 6.865,52 € y de cadera de 7.891,21 €. El coste por AVAC ganado es de 1.275,84 € y 7.936,12 € para las intervenciones de rodilla y cadera, respectivamente.Se ha tenido en cuenta una tasa de descuento para los resultados en salud del 6%, una inflación del 3%y una tasa de éxito de las intervenciones del 95% a 15 años.Conclusiones: El coste por AVAC ganado tras artroplastiade rodilla y cadera está dentro del límite considerado aceptable en España (30.000 € por AVAC) y resulta bien posicionado en comparación con otras intervenciones

Background and objectives: Efficiency-based healthcare decision-making has been widely accepted for some time, with cost per quality-adjusted life year (QALY) as the main outcome measure. Nevertheless, for numerous medical procedures, little data are available on the cost per QALY gained. The aim of the present study was to calculate the cost per QALY gained with primary hip and knee replacement and to compare the result with the cost per QALY for other medical procedures, as well as with the maximum threshold cost considered acceptable in Spain.Methods: We performed a prospective cohort pretest/posttest study of patients undergoing primary hip or knee arthroplasty. Age, sex, and clinical variables were recorded. Functional status and quality of life were measured by means of the WOMAC and EuroQol instruments, respectively, before the intervention and 6 months later. The direct costs of the interventionwere calculated, with length of hospital stay and theprosthesis as the main cost drivers.Results: A total of 80 patients, 40 from each intervention, were included in this study. Both functional and perceived health status improved after the intervention. The number of QALYs gainedin the knee cohort was 4.64, while that in the hip cohortwas 0.86. The total cost of knee replacement was lower(6,865.52 €) than that of hip replacement (7,891.21 €). The cost per QALY gained was 1,275.84 € and 7,936.12 € for knee and hip interventions, respectively. The calculations performed included a 6% discount rate for health outcomes, a 3% inflation rate for costs, and a success rate of 95% at 15 years.Conclusions: The costs of both knee and hip replacementwere lower than the threshold of 30,000 € per QALY considered acceptable in Spain, and compared favorably with other medical and surgical procedures

Evaluación económica del daño moral en el ámbito de losaccidentes de trabajo: Un método basado en indicadoresestadísticos normalizados / No disponible

Dos recientes pronunciamientos de la Sala 4ª de lo Social del Tribunal Supremo han puesto fin a la doctrina jurisprudencial por la que, para evitar el enriquecimiento injusto del trabajador accidentado, se exoneraba al empresario del deber de reparar los perjuicios causados en un accidente de trabajo o enfermedad profesional, por el incumplimiento de sus obligaciones en materia de seguridad. Este cambio jurisprudencial obliga a abordar la cuantificación económica de los distintos componentes indemnizatorios. En este trabajo ofrecemos un novedoso método para la evaluación económica directa del daño moral basado los años de vida ajustados por calidad perdidos por los trabajadores que sufren un accidente de trabajo. El método propuesto se ofrece como una alternativa ventajosa frente a la utilización del baremo de tráfico

Two recent Social Supreme Court rulings have put an end to the jurisprudential doctrine that prevented the "unfair enrichment" of an injured worker. This doctrine exempted the employer from the obligation of repairing the damage caused by work accidents or occupational diseases, stemming from breaches of the employers security obligations. The jurisprudential change requires addressing the economic quantification of the various components of workers compensation. Our study offers a novel method for assessing the economic value of moral damage based on Quality Adjusted Life Years lost by workers who suffer a work accident. The proposed method is presented as an alternative that is more appropriate than the use of the traffic scale

[Cost of assisted reproduction technology in a public hospital]. / Coste de las técnicas de reproducción asistida en un hospital público.

OBJECTIVES: Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. METHODS: Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. RESULTS: Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. CONCLUSIONS: Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a "learning effect," modified the structure of ART-related costs.

Coste de las técnicas de reproducción asistida en un hospital público / Cost of assisted reproduction technology in a public hospital

Objetivos: La mayoría de trabajos sobre costes de las técnicas de reproducción asistida (TRA) identifican el coste directo del procedimiento, sin considerar elementos como los costes estructurales o intermedios, de gran importancia. El objetivo de este trabajo es calcular el coste por proceso de las TRA realizadas en un hospital público en 2003 y compararlo con los resultados de 1998 en el mismo centro. Métodos: El estudio se realiza en la Unidad de Reproducción Humana (URH) del Hospital Universitario Virgen de las Nieves de Granada en 1998 y 2003. Partiendo de los costes totales de dicha unidad, y mediante una metodología de distribución de costes basada en la estructura de costes, calculamos el coste por proceso de las TRA realizadas en este centro, considerando los costes completos. Resultados: Entre 1998 y 2003, la actividad y los costes de la URH analizada evolucionan de forma distinta. El análisis de la actividad muestra la consolidación de técnicas, como la microinyección espermática (ICSI) y la desaparición de otras (ciclo sin reproducción asistida e inseminación artificial conyugal intracervical). En todos los procesos, los costes unitarios por ciclo y por embarazo disminuyen en el período analizado. Conclusiones: Se han producido importantes cambios en la estructura de costes de las TRA de la URH-HUVN entre 1998-2003. Mientras algunos procesos desaparecen, otros se consolidan con una elevada actividad. Los avances técnicos y las innovaciones organizativas, junto con un «efecto aprendizaje», han alterado la estructura de costes de las TRA

Objectives: Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. Methods: Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. Results: Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. Conclusions: Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a «learning effect», modified the structure of ART-related costs