Cost-benefit analysis of funding smoking cessation before surgery.

BACKGROUND: Smoking at the time of surgery is associated with postoperative complications. Quitting smoking before surgery is linked to fewer complications during the hospital stay. This work analysed whether a smoking cessation intervention before surgery is economically worthwhile when funded by the National Health System (NHS) in Spain. METHODS: The economic analysis considered costs and benefits of the intervention to the NHS for the year 2016. The population who would benefit comprised adult smokers who were ready to quit and for whom surgery requiring admission to hospital was planned. The intervention, a combination of medical counselling and use of a smoking cessation drug which should occur 12 weeks before surgery, considered one attempt only to quit smoking. Benefits were costs avoided by averting postoperative complications if cessation was successful. The analysis compared the net economic outcome (benefit minus cost of intervention) and the return on investment, for intervention funded by the NHS versus the current situation without funding. RESULTS: Smoking cessation increased by 21·7 per cent with funding; the rate was 32·5 per cent when funded versus 10·7 per cent without funding, producing 9611 extra quitters. The cost per averted smoker was €1753 with a benefit of €503, achieving a net economic benefit of €4·8 million per year. Given the annual cost of the intervention (€17·4 million, of which €5·6 million (32·5 per cent) represents drugs), the return on investment was 28·7 per cent annually, equivalent to €1·29 per €1 of investment. CONCLUSION: From the perspective of the Spanish NHS, the benefit of funding smoking cessation before surgery, in terms of healthcare cost savings, appears to greatly outweigh the costs.

ANTECEDENTES: Ser fumador activo hasta el momento de la cirugía se asocia con complicaciones postoperatorias. Se ha descrito una disminución de las complicaciones durante la hospitalización al abandonar el hábito de fumar antes de la cirugía. Este trabajo analizó si una intervención preoperatoria para dejar de fumar es económicamente beneficiosa cuando se financia por el Sistema Nacional de Salud (SNS) en España. MÉTODOS: En el análisis económico se consideraron tantos los costes como los beneficios de la intervención para el SNS, en euros, correspondientes al año 2016. La población que se beneficiaría eran fumadores adultos dispuestos a dejar de fumar, en los que se programase una intervención quirúrgica con hospitalización. La intervención, una combinación de asesoramiento médico y tratamiento farmacológico para dejar de fumar, se llevó a cabo a las 12 semanas antes de la cirugía, considerando únicamente un intento para dejar de fumar. Los beneficios fueron los costes evitados por una reducción en la tasa de complicaciones postoperatorias en los casos en los que se hubiese conseguido la eliminación del hábito. El análisis comparó el resultado económico neto (beneficio menos coste de la intervención) y el retorno de la inversión (return on investment, ROI), cuando la intervención era financiada por el SNS en comparación con la situación actual sin financiamiento público. RESULTADOS: La tasa de abandono del hábito tabáquico aumentó en un 21,8%; 32,5% cuando se financiaba frente al 10,7% sin financiación, consiguiendo un extra de 9.611 personas que dejaron de fumar. El coste por fumador rescatado fue de €1753 con un beneficio de €503, por lo que el beneficio económico neto conseguido fue de €4,8 millones por año. Dado que el coste anual de la intervención (€17,4 millones, de los cuales €5,6 millones corresponden a fármacos (32%)), el ROI anual fue del 28,7% con un beneficio de €1,29 por cada €1 de inversión. CONCLUSIÓN: Desde la perspectiva del SNS español, los beneficios de financiar el abandono del hábito de fumar en el preoperatorio de los pacientes, en términos de ahorro de costes parecen ser muy superiores a los costes de la intervención.

Adaptación cultural al español (España) del cuestionario Overactive Bladder Family Impact Measure (OAB-FIM) / Cultural adaptation to Spanish (Spain) of the questionnaire

Objetivo: El OAB-FIM se desarrolló como una medida del impacto de la vejiga hiperactiva en los familiares que conviven con el paciente. El objetivo fue realizar la adaptación cultural al español (España) del cuestionario OAB-FIM. Métodos: La adaptación incluyó una fase de validación conceptual y lingüística, y otra de medición de las propiedades psicométricas en 25 familiares (edad media 63,0 años [DE: 14,3], siendo el 44% mujeres) con convivencia habitual con pacientes con vejiga hiperactiva, de ambos géneros y ≥18 años. Se midieron equivalencia conceptual y lingüística, fiabilidad interna, validez de constructo y validez de contenido. Se valoró la aplicabilidad y carga de administración. Resultados: El OAB-FIM fue equivalente conceptual y lingüísticamente al original, manteniendo sus 6 dominios: social, viajes, preocupación, irritabilidad, sueño y sexual. El acuerdo interjueces ubicó correctamente a todos los ítems en su dominio, excepto el 10, que se ubicó más en preocupación que en irritabilidad, motivando su reformulación. Un 2,95% de ítems estuvieron ausentes. Los efectos suelo y techo de los ítems variaron, respectivamente, entre 20-28% y 0-16%. El tiempo medio para cumplimentar el cuestionario fue de 5,2 minutos (DE: 2,8) y un 24% necesitó algún tipo de ayuda. El coeficiente α-Cronbach varió entre 0,948-0,839. Las correlaciones con escalas similares en el familiar fueron moderadas-altas (0,407-0,753) o pequeñas-moderadas con las administradas al paciente (0,004-0,423). Conclusión: Se ha obtenido una versión española (España) del OAB-FIM conceptual y lingüísticamente equivalente al original. El cuestionario ha mostrado buena consistencia interna y validez de contenido y constructo, además de ser aplicable

Objective: The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. Methods: The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. Results: The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). Conclusion: We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability

Cultural adaptation to Spanish (Spain) of the "Overactive Bladder - Family Impact Measure (OAB-FIM)" questionnaire. / Adaptación cultural al español (España) del cuestionario Overactive Bladder Family Impact Measure (OAB-FIM).

OBJECTIVE: The OAB-FIM was developed as a measure of the impact of an overactive bladder (OAB) on relatives who live with the patient. The objective of this study was conduct a cultural adaptation to Spanish (Spain) of the OAB-FIM questionnaire. METHODS: The adaptation included a conceptual and linguistic validation phase, as well as a phase for measuring the psychometric properties in 25 relatives [mean age, 63.0 years (SD, 14.3); 44% women] who regularly live with patients with OAB, who are of either sex and 18 years of age or older. We measured conceptual and linguistic equivalence, internal reliability, construct validity and content validity. We assessed the applicability and administration load. RESULTS: The OAB-FIM was conceptually and linguistically equivalent to the original, maintaining its 6 domains: social, travel, worry, irritability, sleep and sex. The interagreement correctly placed all items in their domain, except for number 10, which was placed more in worry than in irritability, motivates its reformulation. Some 2.95% of the items were missing. The floor and ceiling effects of the items varied, respectively, between 20-28%, and 0-16%. The mean time for completing the questionnaire was 5.2minutes (SD, 2.8), and 24% of the participants required some type of assistance. The α-Cronbach coefficient varied between 0.948-0.839. The correlations with similar scales in the family were moderate-high (0.407-0.753) or small-moderate with those administered to the patient (0.004-0.423). CONCLUSION: We obtained a Spanish (Spain) version of the OAB-FIM that was conceptually and linguistically equivalent to the original. The questionnaire showed good internal consistency, content and construct validity and applicability.

Análisis de coste efectividad de fesoterodina comparado con mirabegron en el marco de tratamiento de primera línea para vejiga hiperactiva con incontinencia urinaria de urgencia, desde la perspectiva del Sistema Nacional de Salud español / Cost effectiveness analysis of fesoterodine compared to mirabegron in first-line therapy setting for overactive bladder with urge urinary incontinence, from the Spanish National Health System perspective

Objetivos: Evaluar el coste-efectividad del tratamiento de primera línea de la vejiga hiperactiva (VH) con fesoterodina en relación con mirabegron, desde la perspectiva del Sistema Nacional de Salud (SNS) español. Métodos: Se desarrolló un modelo de árbol de decisión para representar un proceso clínico típico de tratamiento de 52 semanas para un paciente con VH con incontinencia urinaria de urgencia (IUU) iniciando el tratamiento de primera línea con fesoterodina 4 mg, incluyendo valoración opcional a 8 mg frente a mirabegron 50 mg. Los datos de eficacia se obtuvieron de un metaanálisis de tratamiento indirecto bayesiano. Los pacientes con IUU de menos de un episodio/día fueron definidos como respondedor al tratamiento, y la persistencia se evaluó en las semanas 4, 12 y 24. En la semana 12 los no respondedores interrumpieron el tratamiento de forma permanente. Los años de vida ajustados por calidad (AVAC) se calcularon sobre la base de tiempo de permanencia en estados de respondedores y no respondedores. Los costes de la medicina relacionada con la VH y atención médica, incluyendo visitas médicas, pruebas de laboratorio, compresas para la incontinencia y comorbilidades (fractura, infección de la piel, infecciones del tracto urinario y depresión) se modelaron y expresaron en 2015 Euros. Resultados: En la semana 52 el porcentaje de respondedores fue de 20,8% para los pacientes que comienzan con 4mg de fesoterodina, que opcionalmente valoró a 8 mg, y de 19,4% para los pacientes tratados con mirabegron. Los AVAC fueron ligeramente superiores con fesoterodina que con mirabegron (0,7703 vs. 0,7668, diferencia = 0,0035). El tratamiento con fesoterodina también tenía costes totales ligeramente mayores que mirabegron (3.296€ vs. 3.217, diferencia = 79€), lo que resulta en un coste de 22.523/AVAC€ ganado para la fesoterodina frente al mirabegron. El análisis de sensibilidad probabilístico confirmó la ligera ventaja de la fesoterodina, con un 61,1% de probabilidad de ser rentable en la disposición a pagar de 30.000€ para un umbral de AVAC. Conclusiones: Dada la relativamente pequeña diferencia de coste de un año entre los 2 tratamientos, la fesoterodina puede considerarse una opción rentable en relación con mirabegron para el manejo de primera línea de la VH con IUU en España

Objectives: To evaluate the cost-effectiveness of first-line treatment of Overactive Bladder (OAB) with fesoterodine relative to mirabegron, from the Spanish National Health System (NHS) perspective. Methods: A decision tree model was developed to represent a typical clinical process of 52-week of treatment for an OAB patient with urge urinary incontinence (UUI) initiating first-line therapy with fesoterodine 4 mg, including optional titration to 8mg, vs.mirabegron 50 mg. Efficacy data were obtained from a Bayesian indirect treatment meta-analysis. Patients with UUI of less than one episode/day were defined as treatment responder and persistence was assessed at weeks 4, 12 and 24. At week 12, non-responders discontinued treatment permanently. Quality-adjusted life years (QALYs) were calculated based on time spent in responder and non-responder states. OAB-related drug and medical care costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections and depression) were modeled and expressed in Euros 2015. Results: At week 52, the percentage of responders was 20.8% for patients starting on fesoterodine 4 mg who optionally titrated to 8 mg and 19.4% for patients treated with mirabegron. QALYs were slightly higher with fesoterodine than mirabegron (0.7703 vs. 0.7668, difference = 0.0035). Fesoterodine treatment also had slightly higher total costs than mirabegron (3,296 € vs. 3,217, difference = 79 €), resulting in a cost of 22,523/QALYEuros gained for fesoterodine versus mirabegron. Probabilistic sensitivity analysis confirmed the slight advantage of fesoterodine with a 61.1% probability of being cost-effective at the 30,000€ willingness-to-pay for 1QALY threshold. Conclusions: Given the relatively small 1-year cost difference between the two treatments, fesoterodine can be considered a cost-effective option relative to mirabegron for the first-line management of OAB with UUI in Spain

Calidad de vida relacionada con la salud en la población general española fumadora: una aproximación desde la Encuesta Nacional de Salud / Health-related quality-of-life in the smoking general population of Spain: an approach from the National Health Survey

Introducción. El consumo de tabaco lleva asociado un importante riesgo para la salud. El objetivo fue determinar la relación entre el estado de la calidad de vida relacionada con la salud (CVRS) y la condición de fumador de la población general adulta en España. Métodos. Se emplearon datos de la Encuesta Nacional de Salud 2011-2012 que recogen información de CVRS en población general mayor de 15 años. Adultos, mayores de 18 años, se clasificaron en 3 grupos excluyentes, de acuerdo con el consumo actual de tabaco: fumadores (fumadores diarios de, al menos, un año), exfumadores de uno o más años desde la cesación tabáquica y sujetos que nunca habían fumado (no fumadores). La CVRS se evaluó con la versión española del cuestionario EQ-5D-5L incluida en la Encuesta Nacional de Salud. Resultados. Se analizaron 19.604 registros: 4.723 (24,09%) fumadores, 3.797 (19,37%) exfumadores y 11.084 (56,54%) no fumadores, de ambos sexos, con 18 o más años, extraídos de la Encuesta Nacional de Salud. Los fumadores mostraron puntuaciones medias ajustadas (IC del 95%) de utilidad de 0,903 (0,899-0,908) y de 75,36 (74,06-76,69) en la escala visual analógica de valoración del estado actual de salud, 0,924 (0,919-0,929) y 76,85 (76,67-78,07) en los exfumadores, y 0,902 (0,899-0,905) y 76,25 (75,02-77,51) en los no fumadores, p<0,01 entre grupos, ambas variables. Conclusiones. En la población general española, los exfumadores mostraron mejores valores de utilidad y valoración del estado de salud, apoyando la hipótesis de que dejar de fumar podría estar asociado con una mejora, aunque discreta, de la CVRS (AU)

Introduction. Smoking has been associated with an important health risk. The aim was to analyze the health-related quality of life (HRQoL) status of the adult Spanish general population included in the National Health Survey according to its smoking status. Methods. Data were included from National Health Survey for the year 2011-2012 with information of HRQoL status in general population over 15 years of age. Adult male and female, 18 years of age or above, were categorized into 3 exclusive groups according to their current smoking status: smokers (daily smokers of any form of tobacco, at least the previous 12 months), ex-smokers of one or more years since quitting smoking and people who have never smoked (non smokers). HRQoL was assessed with the Spanish version of the EQ-5D-5L questionnaire included into the National Health Survey. Results. A total of 19,604 records were analyzed: 4,723 (24.09%) smokers, 3,797 (19.37%) ex-smokers, and 11,084 (56.54%) non smokers, male and female with 18 years of age or above. Smokers showed significantly adjusted mean scores (95% CI) in utility of 0.903 (0.899-0.908) and 75.36 (74.06-76.69) in the visual analogue scale of current state of health, ex-smokers 0.924 (0.919-0.929) and 76.85 (76.67-78.07), and non smokers 0.902 (0.899-0.905) and 76.25 (75.02-77.51), P<.01 between groups in both variables. Conclusions. In the Spanish general population, subjects who are ex-smokers showed better utility values and state health scores, supporting the hypothesis that quitting smoking could be associated with a discreet improvement of HRQoL (AU)

Self-perceived Sleep Quality and Quantity in Adults With Asthma: Findings From the CosteAsma Study.

BACKGROUND AND OBJECTIVE: Nocturnal asthma symptoms are associated with poor sleep quality, excessive daytime sleepiness, and poor daytime functioning. The aim of this study was to describe self-perceived sleep quality and quantity in asthmatic adults in a real-world setting according to different determinants of patient health status. METHODS: A cross-sectional, observational, seasonal, multiwave survey was designed. Allergists nationwide were asked to consecutively survey adult asthmatics aged 18 to 65 years, evenly distributed by seasons and asthma severity (Global Initiative for Asthma criteria). Sleep quality and quantity were assessed using the self-administered Medical Outcomes Study (MOS) Sleep Scale. The Asthma Control Test was applied to ascertain the degree of asthma symptom control. RESULTS: A total of 1098 individuals (58.7% females, 41.2 [13.6] years) were analyzed. Asthma severity was associated with poor sleep quality and quantity; patients with more severe disease scored higher on the MOS Sleep Scale (P<.001) and also reported significantly fewer daily average hours of sleep (0.3-0.5 hours, P<.001). Level of symptom control and asthma severity were both associated with poor sleep quality and quantity, with the following mean MOS sleep problem index scores: 25.3 (fully controlled asthma), 26.4 (controlled), 32.6 (partly controlled), and 44.6 (uncontrolled) (P<.001), and 48.4 (severe asthma), 39.0 (moderate), 32.6 (mild), and 26.5 (intermittent) (P<.001). Sex was significantly associated with the summary MOS sleep problem index. CONCLUSIONS: Sleep quality and quantity was significantly associated with poor health status in asthmatic patients. Guidelines should recommend asking about nocturnal asthma symptoms and encourage clinicians to take a global sleep history. Better control of nocturnal asthma symptoms could lead to improved sleep quality and a decrease in daytime sleep-related symptoms.

Análisis coste-efectividad de celecoxib frente a antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España: una perspectiva actual / Cost-effectiveness analysis of celecoxib versus non-selective non-steroidal anti-inflammatory drug therapy for the treatment of osteoarthritis in Spain: a current perspective

OBJETIVO: Realizar un análisis coste-efectividad de celecoxib y antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis según práctica habitual en España. MÉTODOS: El análisis coste-efectividad se realizó mediante un modelo analítico tipo árbol de decisión utilizando la distribución, dosis y duración de los tratamientos y la incidencia de eventos gastrointestinales (GI) y cardiovasculares observados en el estudio pragmático «GI-Reasons». La efectividad se expresó en eventos evitados y años de vida ajustados por calidad (AVAC) ganados. Los AVAC ganados se calcularon a partir del coeficiente de utilidad asociado a cada tipo de evento GI o cardiovascular observados en el estudio GI-Reasons. La perspectiva fue la del Sistema Nacional de Salud para el cálculo de los costes de tratamiento usando precios actuales (€, noviembre de 2014) de los fármacos y eventos GI y cardiovascular. El análisis coste-efectividad se expresó como coste incremental por AVAC ganado y por evento evitado. Se llevaron a cabo análisis de sensibilidad probabilísticos y univariantes. RESULTADOS: En comparación con antiinflamatorios no esteroideos no selectivos, celecoxib, a su precio actual, mostró mayores costes sanitarios por paciente: 157 € versus 201 €. Sin embargo, se asoció con un aumento de la ganancia de AVAC y una incidencia significativamente menor de eventos GI (p < 0,001), mostrando un coste incremental de 13.286 € por AVAC ganado y 4.471 € por evento evitado. Los análisis de sensibilidad confirmaron los resultados. CONCLUSIÓN: Celecoxib a su precio actual puede ser considerado una alternativa coste-efectiva frente a los antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España

OBJECTIVE: To assess the cost-effectiveness of celecoxib and non-selective non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis in clinical practice in Spain. METHODS: A decision-tree model using distribution, doses, treatment duration and incidence of GI and CV events observed in the pragmatic PROBE-designed «GI-Reasons» trial was used for cost-effectiveness. Effectiveness was expressed in terms of event averted and quality-adjusted life-years (QALY) gained. QALY were calculated based on utility decrement in case of any adverse events reported in GI-Reasons trial. The National Health System perspective in Spain was applied; cost calculations included current prices of drugs plus cost of adverse events occurred. The analysis was expressed as an incremental cost-effectiveness ratio per QALY gained and per event averted. One-way and probabilistic analyses were performed. RESULTS: Compared with non-selective non-steroidal anti-inflammatory drugs, at current prices, celecoxib treatment had higher overall treatment costs € 201 and € 157, respectively. However, celecoxib was associated with a slight increase in QALY gain and significantly lower incidence of gastrointestinal events (p<.001), with mean incremental cost-effectiveness ratio of € 13,286 per QALY gained and € 4,471 per event averted. Sensitivity analyses were robust, and confirmed the results of the base case. CONCLUSION: Celecoxib at current price may be considered as a cost-effective alternative vs. non-selective non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis in daily practice in the Spanish NHS

Impacto del número de episodios diarios de incontinencia de urgencia en los resultados descritos por el paciente con vejiga hiperactiva / Impact of daily number of urgency urinary incontinence episodes on overactive bladder patient reported outcomes

Objetivo: Explorar el impacto de la incontinencia urinaria de urgencia (IUU) en el bienestar de los pacientes no institucionalizados con vejiga hiperactiva (VH) en una muestra de la comunidad. Métodos: Se llevó a cabo un estudio transversal basado en Internet en la población general, incluyendo hombres y mujeres, >18 años de edad. Los pacientes con probable VH se identificaron utilizando un algoritmo validado junto con una puntuación ≥8 en la escala OAB-V8. La presencia de comportamiento de adaptación se consideró determinante para el diagnóstico clínico de la VH. Se determinó bienestar individual a través de una batería de mediciones de resultados comunicados por el paciente (PRO) incluida la evaluación de la calidad de vida relacionada con la salud (EQ-5D), alteraciones del sueño (sueño MOS) y satisfacción con la vida (LISAT-8). Los pacientes fueron agrupados de acuerdo con el número de episodios diarios de IUU (gravedad IUU): 0 (VH seca), 1, 2-3 o ≥4. Se realizó un análisis multivariado para evaluar los factores que afectan de forma independiente la calidad de vida. Resultados: Un total de 396 pacientes (52,5% mujeres, media de edad: 55,3 [11,1] años, OAB-V8 puntuación media: 14,5 [7,9]) de 2.035 sujetos participantes de la población general cumplieron los criterios de VH: 203 (51,3%) con 0 episodios; 119 (30,1%) con 1; 52 (13,1%) con 2 o 3 y 22 (5,6%) con >4 episodios. Se encontró una asociación ajustada lineal estadísticamente significativa entre el número de episodios de IUU y las puntuaciones de PRO. Los participantes con más episodios tenían peores perfiles de salud y calidad de autoevaluación de la vida, peor satisfacción con la vida, más trastornos del sueño y menos horas de sueño por noche. El número de episodios de incontinencia fue factor independiente para afectar a la calidad de vida utilizando los cuestionarios LISAT-8 y MOS. Conclusión: La gravedad de la IUU se asoció significativamente con peor bienestar individual en los sujetos con VH en una muestra comunitaria en España

Objective: To explore the impact of urgency urinary incontinence (UUI) on well-being in non-institutionalized patients with overactive bladder (OAB) in a community sample. Methods: A cross-sectional web-based study was conducted in the general population, including males and females, >18 years of age. Patients with probable OAB were identified using a validated algorithm together with a score ≥8 on the OAB-V8 scale. Presence of coping behavior was considered determinant for the clinical diagnosis of OAB. Individual well-being was determined through a battery of patient-reported outcomes (PRO) measurements including assessment of health-related quality of life (EQ-5D), sleep disturbances (MOS Sleep), and life satisfaction (LISAT-8). Patients were grouped according to the number of daily UUI episodes (UUI severity): 0 (dry OAB),1, 2-3, or ≥4. Multivariate analysis to evaluate factors independently affecting quality of life was undertaken. Results: A total of 396 patients (52.5% women, mean age: 55.3 [11.1] years, OAB-V8 mean score: 14.5 [7.9]) out of 2035 subjects participating from the general population met the criteria for OAB: 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with ≥4 episodes. A statistically significant linear adjusted association was found between number of UUI episodes and PRO scores. Participants with more episodes had poorer health profiles and self-evaluated quality of life, worse life satisfaction, and more sleep disturbances and fewer hours of sleep per night. Number of incontinence episodes was independent factor to affect quality of life using both LISAT-8 and MOS questionnaires. Conclusion: Severity of UUI was significantly associated with poorer individual well-being in subjects with OAB in a community sample in Spain

Cost effectiveness analysis of fesoterodine compared to mirabegron in first-line therapy setting for overactive bladder with urge urinary incontinence, from the Spanish National Health System perspective. / Análisis de coste efectividad de fesoterodina comparado con mirabegron en el marco de tratamiento de primera línea para vejiga hiperactiva con incontinencia urinaria de urgencia, desde la perspectiva del Sistema Nacional de Salud español.

OBJECTIVES: To evaluate the cost-effectiveness of first-line treatment of Overactive Bladder (OAB) with fesoterodine relative to mirabegron, from the Spanish National Health System (NHS) perspective. METHODS: A decision tree model was developed to represent a typical clinical process of 52-week of treatment for an OAB patient with urge urinary incontinence (UUI) initiating first-line therapy with fesoterodine 4mg, including optional titration to 8mg, vs.mirabegron 50mg. Efficacy data were obtained from a Bayesian indirect treatment meta-analysis. Patients with UUI of less than one episode/day were defined as treatment responder and persistence was assessed at weeks 4, 12 and 24. At week 12, non-responders discontinued treatment permanently. Quality-adjusted life years (QALYs) were calculated based on time spent in responder and non-responder states. OAB-related drug and medical care costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections and depression) were modeled and expressed in €2015. RESULTS: At week 52, the percentage of responders was 20.8% for patients starting on fesoterodine 4mg who optionally titrated to 8mg and 19.4% for patients treated with mirabegron. QALYs were slightly higher with fesoterodine than mirabegron (0.7703vs. 0.7668, difference=0.0035). Fesoterodine treatment also had slightly higher total costs than mirabegron (3,296€vs. 3,217, difference=79€), resulting in a cost of 22,523/QALY€ gained for fesoterodine versus mirabegron. Probabilistic sensitivity analysis confirmed the slight advantage of fesoterodine with a 61.1% probability of being cost-effective at the 30,000€ willingness-to-pay for 1QALY threshold. CONCLUSIONS: Given the relatively small 1-year cost difference between the two treatments, fesoterodine can be considered a cost-effective option relative to mirabegron for the first-line management of OAB with UUI in Spain.

[Health-related quality-of-life in the smoking general population of Spain: An approach from the National Health Survey]. / Calidad de vida relacionada con la salud en la población general española fumadora: una aproximación desde la Encuesta Nacional de Salud.

INTRODUCTION: Smoking has been associated with an important health risk. The aim was to analyze the health-related quality of life (HRQoL) status of the adult Spanish general population included in the National Health Survey according to its smoking status. METHODS: Data were included from National Health Survey for the year 2011-2012 with information of HRQoL status in general population over 15 years of age. Adult male and female, 18 years of age or above, were categorized into 3 exclusive groups according to their current smoking status: smokers (daily smokers of any form of tobacco, at least the previous 12 months), ex-smokers of one or more years since quitting smoking and people who have never smoked (non smokers). HRQoL was assessed with the Spanish version of the EQ-5D-5L questionnaire included into the National Health Survey. RESULTS: A total of 19,604 records were analyzed: 4,723 (24.09%) smokers, 3,797 (19.37%) ex-smokers, and 11,084 (56.54%) non smokers, male and female with 18 years of age or above. Smokers showed significantly adjusted mean scores (95% CI) in utility of 0.903 (0.899-0.908) and 75.36 (74.06-76.69) in the visual analogue scale of current state of health, ex-smokers 0.924 (0.919-0.929) and 76.85 (76.67-78.07), and non smokers 0.902 (0.899-0.905) and 76.25 (75.02-77.51), P<.01 between groups in both variables. CONCLUSIONS: In the Spanish general population, subjects who are ex-smokers showed better utility values and state health scores, supporting the hypothesis that quitting smoking could be associated with a discreet improvement of HRQoL.

Impact of daily number of urgency urinary incontinence episodes on overactive bladder patient reported outcomes.

OBJECTIVE: To explore the impact of urgency urinary incontinence (UUI) on well-being in non-institutionalized patients with overactive bladder (OAB) in a community sample. METHODS: A cross-sectional web-based study was conducted in the general population, including males and females, >18 years of age. Patients with probable OAB were identified using a validated algorithm together with a score ≥8 on the OAB-V8 scale. Presence of coping behavior was considered determinant for the clinical diagnosis of OAB. Individual well-being was determined through a battery of patient-reported outcomes (PRO) measurements including assessment of health-related quality of life (EQ-5D), sleep disturbances (MOS Sleep), and life satisfaction (LISAT-8). Patients were grouped according to the number of daily UUI episodes (UUI severity): 0 (dry OAB),1, 2-3, or ≥4. Multivariate analysis to evaluate factors independently affecting quality of life was undertaken. RESULTS: A total of 396 patients (52.5% women, mean age: 55.3 [11.1] years, OAB-V8 mean score: 14.5 [7.9]) out of 2035 subjects participating from the general population met the criteria for OAB: 203 (51.3%) with 0episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with ≥4 episodes. A statistically significant linear adjusted association was found between number of UUI episodes and PRO scores. Participants with more episodes had poorer health profiles and self-evaluated quality of life, worse life satisfaction, and more sleep disturbances and fewer hours of sleep per night. Number of incontinence episodes was independent factor to affect quality of life using both LISAT-8 and MOS questionnaires. CONCLUSION: Severity of UUI was significantly associated with poorer individual well-being in subjects with OAB in a community sample in Spain.

[Cost-effectiveness analysis of celecoxib versus non-selective non-steroidal anti-inflammatory drug therapy for the treatment of osteoarthritis in Spain: A current perspective]. / Análisis coste-efectividad de celecoxib frente a antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España: una perspectiva actual.

OBJECTIVE: To assess the cost-effectiveness of celecoxib and non-selective non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis in clinical practice in Spain. METHODS: A decision-tree model using distribution, doses, treatment duration and incidence of GI and CV events observed in the pragmatic PROBE-designed «GI-Reasons¼ trial was used for cost-effectiveness. Effectiveness was expressed in terms of event averted and quality-adjusted life-years (QALY) gained. QALY were calculated based on utility decrement in case of any adverse events reported in GI-Reasons trial. The National Health System perspective in Spain was applied; cost calculations included current prices of drugs plus cost of adverse events occurred. The analysis was expressed as an incremental cost-effectiveness ratio per QALY gained and per event averted. One-way and probabilistic analyses were performed. RESULTS: Compared with non-selective non-steroidal anti-inflammatory drugs, at current prices, celecoxib treatment had higher overall treatment costs €201 and €157, respectively. However, celecoxib was associated with a slight increase in QALY gain and significantly lower incidence of gastrointestinal events (p<.001), with mean incremental cost-effectiveness ratio of €13,286 per QALY gained and €4,471 per event averted. Sensitivity analyses were robust, and confirmed the results of the base case. CONCLUSION: Celecoxib at current price may be considered as a cost-effective alternative vs. non-selective non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis in daily practice in the Spanish NHS.

Self-perceived sleep quality and quantity in adults with asthma: findings from the costeAsma study

Background and Objective: Nocturnal asthma symptoms are associated with poor sleep quality, excessive daytime sleepiness, and poor daytime functioning. The aim of this study was to describe self-perceived sleep quality and quantity in asthmatic adults in a real-world setting according to different determinants of patient health status. Methods: A cross-sectional, observational, seasonal, multiwave survey was designed. Allergists nationwide were asked to consecutively survey adult asthmatics aged 18 to 65 years, evenly distributed by seasons and asthma severity (Global Initiative for Asthma criteria). Sleep quality and quantity were assessed using the self-administered Medical Outcomes Study (MOS) Sleep Scale. The Asthma Control Test was applied to ascertain the degree of asthma symptom control. Results: A total of 1098 individuals (58.7% females, 41.2 [13.6] years) were analyzed. Asthma severity was associated with poor sleep quality and quantity; patients with more severe disease scored higher on the MOS Sleep Scale (P<.001) and also reported significantly fewer daily average hours of sleep (0.3-0.5 hours, P<.001). Level of symptom control and asthma severity were both associated with poor sleep quality and quantity, with the following mean MOS sleep problem index scores: 25.3 (fully controlled asthma), 26.4 (controlled), 32.6 (partly controlled), and 44.6 (uncontrolled) (P<.001), and 48.4 (severe asthma), 39.0 (moderate), 32.6 (mild), and 26.5 (intermittent) (P<.001). Sex was significantly associated with the summary MOS sleep problem index. Conclusions: Sleep quality and quantity was significantly associated with poor health status in asthmatic patients. Guidelines should recommend asking about nocturnal asthma symptoms and encourage clinicians to take a global sleep history. Better control of nocturnal asthma symptoms could lead to improved sleep quality and a decrease in daytime sleep-related symptoms (AU)

Introducción y Objetivo: Los síntomas nocturnos de asma, están asociados con la calidad de la falta de sueño, somnolencia diurna excesiva y mal funcionamiento durante el día. El objetivo de este estudio fue describir la calidad y cantidad del sueño percibida por el paciente asmático en un emplazamiento de vida real según diferentes determinantes del estado de salud del paciente. Métodos: Se diseñó una encuesta de corte transversal, observacional, en olas estacionales. Se les pidió a alergólogos de todo el país que realizaran una encuesta de forma consecutiva a asmáticos de 18-65 años, distribuido por estaciones y gravedad (criterios GINA). Cantidad y calidad del sueño se evaluaron utilizando la escala autoadministrada de sueño MOS-sleep scale. La escala ACT se aplicó para determinar el grado de control de síntomas asmáticos. Resultados: Un total de 1.098 sujetos [58,7% mujeres, 41,2 (13,6) años] se incluyeron en el análisis. La gravedad del asma se relacionó con calidad/cantidad de falta de sueño, con puntuaciones más altas en los pacientes más graves (p<0,001), que tenían significativamente menos horas promedio diarias de sueño: 0,3-0,5 horas (p< 0,001). El grado de control de síntomas y nivel de severidad se asociaron con problemas de sueño: 25,3 (control total), 26,4 (controlada), 32,6 (parcialmente controlada) y 44,6 (no controlada); p<0,001 y 48,4 (grave), 39,0 (moderado), 32,6 (leve) y 26,5 (intermitente), p<0,001. En nuestro estudio, el género se asoció significativamente con la puntuación resumen del índice de sueño. Conclusión: La cantidad y calidad del sueño se asoció significativamente con el estado de salud de los pacientes asmáticos. Las guías deberían recomendar preguntar tanto por los síntomas de asma nocturno como asesorar a los clínicos acerca de hacer una historia global de sueño Un mejor control de la sintomatología nocturna del asma podría conllevar a una mejor calidad del sueño y una disminución en los síntomas relacionados con el sueño durante el día (AU)

La severidad de la vejiga hiperactiva modifica la carga asistencial y la productividad laboral / The Effect of Hyperactive Bladder Severity on Healthcare Utilization and Labor Productivity

Objetivo: Explorar la relación entre la severidad de la incontinencia urinaria de urgencia (IUU) y la utilización de recursos sanitarios o la pérdida de productividad laboral en pacientes con vejiga hiperactiva (VH) en la población general española. Métodos: Análisis secundario de un estudio transversal realizado por vía telemática (Internet) en la población general, > 18 años, mediante una batería de preguntas relacionadas con el uso de recursos sanitarios y la productividad laboral. Los sujetos con probable VH fueron identificados mediante un algoritmo previamente validado. Las preguntas sobre el uso de recursos sanitarios abarcaron la medicación concomitante, el empleo de absorbentes y las visitas médicas. Los pacientes se agruparon según el número de episodios de IUU en: 0, 1, 2-3 o 4 +. Resultados: De un total de 2.035 sujetos participantes de la población general se identificaron 396 pacientes (52,5% mujeres, edad media [DE] 55,3 [11,1] años, puntuación media en OAB-V8: 14,5 [7,9]), con probable VH: 203 (51,3%) con 0 episodios, 119 (30,1%) con uno, 52 (13,1%) con 2-3 y 22 (5,6%) con 4 +. Se observó una relación lineal significativa, de manera que a mayor número de episodios de IUU mayor uso de recursos sanitarios. Los sujetos con más episodios realizaron con mayor frecuencia visitas médicas, tanto de asistencia primaria (p < 0,001) como al especialista (p = 0,009) y emplearon mayor cantidad de absorbentes tanto en horario diurno (p < 0,001) como nocturno (p < 0,001) de ansiolíticos (p = 0,021) y de antibióticos (p = 0,05). Conclusión: La severidad de la incontinencia urinaria de urgencia, según el número diario de episodios de incontinencia de urgencia, mostró una relación lineal significativa con un uso más frecuente de recursos sanitarios y una disminución en la productividad laboral en pacientes con probable VH en España

Objective: To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. Methods: Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score > 8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4 + episodes. Results: Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = 0.001) and specialist (P = 0.009) level as well. Consumption of day (P < 0.001) and night (P < 0.001) urinary absorbents, anxiolytic medicines (P = 0.021) and antibiotics (P = 0.05) was higher in patients with more UUI episodes. Conclusion: The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain

Beneficio terapéutico tras cambiar tolterodina por otros nuevos antimuscarínicos / Therapeutic benefit in patients switching tolterodine to other novel antimuscarinic agents

Objetivos: Explorar en la práctica clínica diaria el beneficio clínico y del paciente conseguido tras cambiar su primer tratamiento para la vejiga hiperactiva (VH) con tolterodina de liberación prolongada (LP), por otro antimuscaríninico de última generación. Materiales y métodos: Análisis post hoc de un estudio observacional, multicéntrico retrospectivo y transversal. Se incluyeron pacientes adultos de ambos sexos, con VH y puntuación OAB-V8 ≥ 8, con respuesta insuficiente al tratamiento previo con tolterodina LP sustituido por fesoterodina o solifenacina en los 3-4 meses previos. Se seleccionaron 92 pacientes para cada grupo de tratamiento, emparejados (1:1) según probabilidad condicionada utilizando el propensity score. Se valoraron el beneficio del cambio percibido por el médico y el paciente mediante las escalas de Impresión clínica global de mejoría (ICG-M) y del Beneficio del tratamiento (TBS) respectivamente. También se analizaron el grado de preocupación, la molestia y el impacto en la vida diaria de la VH, el grado de satisfacción y la preferencia por la medicación actual. Resultados: Fesoterodina proporcionó una mejora significativamente mayor que solifenacina en cuanto a beneficio terapéutico percibido por el médico según la ICG-M. El 96,7% de los pacientes tratados con fesoterodina vs. 81,6% con solifenacina mostraron una puntuación de mejoría en la TBS (p < 0,05). La fesoterodina también resultó mejor valorada que la solifenacina en cuanto a la satisfacción y preferencia por el nuevo tratamiento (93,4 vs. 78,2%, p < 0,05). Conclusiones: En la práctica clínica diaria el cambio de tolterodina LP a fesoterodina parece proporcionar mayores beneficios tanto desde el punto de vista del médico como del paciente, comparado con el que aporta solifenacina

Objectives: To explore in the daily clinical practice setting that antimuscarinic, Fesoterodine or Solifenacin, provides a greater clinical benefit after changing their prior Overactive Bladder (OAB) therapy with tolterodine extended-release (ER) to other novel antimuscarinic agents. Material and methods: A post-hoc analysis of data from an observational multicenter, cross sectional, retrospective study. Adult patients of both sexes, with OAB and OAB-V8 score≥8, who switched to fesoterodine or solifenacin within the 3-4 months before study visit from their priortolterodine-ER-based therapy due to poor response were included. 92 patients were selected for each treatment group, matched (1:1) according to conditioned probability using the propensity score. Benefit of treatment change perceived by the physician and patient was evaluated by means of the Clinical Global Impression of Improvement subscale (CGI-I) and Treatment Benefit Scale (TBS), respectively. Degree of worry, bother and interference with daily living activities due to urinary symptoms, level of satisfaction, and preference for current treatment were also assessed. Results: Fesoterodine provided a significantly greater improvement than solifenacina in terms of therapeutic benefit perceived by the physician according to ICG-I. 96.7% of the patients on fesoterodine treatment vs. 81.6% of the solifenac in group showed a score of improvementin TBS (P < 0.05). Fesoterodine was also better rated than solifenacin with regard to satisfaction and preference for the new treatment (93.4 vs. 78.2% P < 0.05). Conclusions: In daily clinical practice the switch from tolterodine LP to fesoterodine seems to provide greater benefits both from the physician’s and the patient’s point of view compared with those provided by solifenacin

The effect of hyperactive bladder severity on healthcare utilization and labor productivity.

OBJECTIVE: To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. METHODS: Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score >8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4+ episodes. RESULTS: Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = .001) and specialist (P = .009) level as well. Consumption of day (P < .001) and night (P < .001) urinary absorbents, anxiolytic medicines (P = .021) and antibiotics (P = .05) was higher in patients with more UUI episodes. CONCLUSION: The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain.

Impact of osteoporosis and bone fracture on health-related quality of life in postmenopausal women.

BACKGROUND: Osteoporosis is responsible for fragility fractures, which are associated with decreased physical and social function. The GINERISK study was a cross-sectional epidemiological study conducted in 4157 Spanish postmenopausal women initially diagnosed with osteoporosis according to WHO criteria within the last 2 years. AIM: The aim of the study was to explore the impact of osteoporosis on health-related quality of life (HRQoL). METHOD: Menopause-specific and generic HRQoL were assessed, respectively, with the specific Cervantes Scale and the generic SF-12v2 Health Survey. The impact of osteoporosis on HRQoL was ultimately evaluated in 3328 (80.1%) women who had measurements for both bone mineral densitometry (BMD) and HRQoL. RESULTS: Menopause-specific or generic HRQoL, respectively, were worse in women with current osteoporosis and prior osteoporotic bone fracture (BF) in comparison with current osteoporosis without BF or whose T-score had increased above -2.5 on the BMD after receiving osteoporosis drug therapy. Impaired HRQoL was found both in Spanish postmenopausal female populations and the Spanish general female population. Women with osteoporosis with BF had physical and mental summary component scores in the 20th and 30th percentiles, respectively, of the Spanish general population. Higher risk for cardiovascular death was also associated with greater HRQoL impairment. The use of selective estrogen receptor modulators in women with a BMD T-score ≤ -2.5 was associated with lower impact of osteoporosis on HRQoL, particularly in the domains of physical health and sexuality. CONCLUSION: The HRQoL analysis results in this study demonstrated a loss of quality of life in postmenopausal women with osteoporosis and confirmed that this loss is greater in women with prior osteoporotic fracture.

Therapeutic benefit in patients switching tolterodine to other novel antimuscarinic agents.

OBJECTIVES: To explore in the daily clinical practice setting that antimuscarinic, Fesoterodine or Solifenacin, provides a greater clinical benefit after changing their prior Overactive Bladder (OAB) therapy with tolterodine extended-release (ER) to other novel antimuscarinic agents. MATERIAL AND METHODS: A post-hoc analysis of data from an observational multicenter, cross-sectional, retrospective study. Adult patients of both sexes, with OAB and OAB-V8 score≥8, who switched to fesoterodine or solifenacin within the 3-4 months before study visit from their prior tolterodine-ER-based therapy due to poor response were included. 92 patients were selected for each treatment group, matched (1:1) according to conditioned probability using the propensity score. Benefit of treatment change perceived by the physician and patient was evaluated by means of the Clinical Global Impression of Improvement subscale (CGI-I) and Treatment Benefit Scale (TBS), respectively. Degree of worry, bother and interference with daily living activities due to urinary symptoms, level of satisfaction, and preference for current treatment were also assessed. RESULTS: Fesoterodine provided a significantly greater improvement than solifenacina in terms of therapeutic benefit perceived by the physician according to ICG-I. 96.7% of the patients on fesoterodine treatment vs. 81.6% of the solifenacin group showed a score of improvement in TBS (P<.05). Fesoterodine was also better rated than solifenacin with regard to satisfaction and preference for the new treatment (93.4 vs. 78.2% P<.05). CONCLUSIONS: In daily clinical practice the switch from tolterodine LP to fesoterodine seems to provide greater benefits both from the physician's and the patient's point of view compared with those provided by solifenacin.

Cardiovascular and metabolic risk in outpatients with schizoaffective disorder treated with antipsychotics: results from the CLAMORS study.

AIM: To assess the coronary heart disease (CHD) risk and prevalence of the metabolic syndrome (MS) in patients with schizoaffective disorder (SD) receiving antipsychotics. METHODS: Patients meeting DSM-IV criteria for SD and receiving antipsychotic treatment were recruited in a retrospective, cross-sectional, multicenter study (the CLAMORS study). MS was defined as at least three of the following components: waist circumference greater than 102 cm (men)/greater than 88 cm (women); serum triglycerides greater or equal to 150 mg/dl; HDL cholesterol less than 40 mg/dl (men)/less than 50 mg/dl (women); blood pressure greater or equal to 130/85 mmHg; fasting blood glucose greater or equal to 110 mg/dl. The 10-year CHD risk was assessed by the Systematic coronary risk evaluation (SCORE) (cardiovascular mortality) and Framingham (any cardiovascular event) functions. Clinical severity was assessed using the PANSS and CGI-S scales. RESULTS: A total of 268 valuable patients with SD (127 men, 48.1%), 41.9±12.3 years (mean±S.D.), were analyzed. The 10-year overall cardiovascular mortality and CV-event risk were 0.8±1.6 (SCORE) and 6.5±6.8 (Framingham), respectively. A high/very high risk of any CV event (Framingham≥10%) was associated with severity [CGI-S=3-4; OR: 4.32 (1.15-16.26), P=0.03)]. MS was present in 26.5% (95%CI: 21.2-31.8) of subjects, without gender differences, but significantly associated with patient's impression of severity: CGI=3-4; OR=1.90 (0.83-4.36), and CGI=5-7; OR=3.13 (1.06-9.24), P=0<0.001, and age [OR=1.91 (1.09-3.34), P<0.024)]. CONCLUSIONS: CHD risk and MS prevalence were high among patients with SD, being MS prevalence associated with age and severity of disease.

Factors associated with temporary work disability in patients with fibromyalgia.

Temporary work disability (TWD) is more common in patients with fibromyalgia (FM) than among the rest of the workers. To describe the differences between patients who take sick leave (TWD group) and those who continue to work regularly (control group). To determine what factors are associated with TWD. Multicentre, cross-sectional study with a cohort of patients with FM seen in rheumatology clinics throughout Spain. The following information was recorded: demographic data, clinical manifestations, comorbidities, health self-perception, emotional issues, functional capacity, physical function tests, utilization of healthcare resources, TWD during the past 12 months, and quitting paid employment due to the disease. Descriptive statistics was used to compare variables between the TWD group and the control group. A logistic regression analysis was done to determine which factors are associated with TWD. The study cohort was composed of 301 patients with FM (women: 96.7%) with a mean age of 48.7 ± 8.5 years and a disease duration of 11.5 ± 9.1 years. There were 56.8% active workers, of whom 67.8% had had some TWD. The mean TWD length was 44 ± 69.6 days/year. TWD correlated significantly with sedentary work, clinical manifestations, comorbidities, self-perceived health, poor functional capacity, physical function, and healthcare resource utilization. The factors independently associated with TWD are sedentary work, more clinical manifestations, fatigue, and poor flexibility. Of the cases of people who quit their jobs, 66.9% were associated with FM. TWD in patients with FM is associated with sedentary work, a worse clinical situation, and worse functional capacity.